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Low back pain: causes, treatment

Low back pain Content:

Pain in the lumbar spine and surrounding areas may disturb the patient at any time of the day, while standing, sitting, lying, or on the move, during exercise or at rest. This symptom is so non-specific, that is, it can occur in such a huge number of cases that it requires special attention primarily from the patient: you should immediately consult a doctor.



Which doctor to contact?

According to statistics, up to 25% of patients seek medical help in connection with the occurrence of pain in the lumbar region. 8 out of 10 inhabitants of the globe experienced pain in the back at least 1 time in their lives. Moreover, people of working age most often suffer from these symptoms, slightly less often - people of retirement age and even less often - adolescents (according to various sources, from 8 to 40% in Russia).

Therapist, neurologist, traumatologist, rheumatologist

The first doctors to whom the majority of patients with lower back pain will turn will be a therapist and a neurologist. But young people with injuries in the recent (or long) past more often turn to a trauma specialist.

Both diagnostic and treatment tactics of these specialists differ. Often the therapist refers the patient to a neurologist, the neurologist determines “his” diagnosis and prescribes treatment. The traumatologist often works “individually”, and in addition to the use of nonsteroidal anti-inflammatory drugs, uses methods of manual therapy and physiotherapy. The main thing for the patient is not to become confused in this situation, not to get carried away with promises of instant healing when performing manual techniques, not to resort to them again in case of failure or, which is worse, the pain intensified against the background of such treatment.

When treating conservatively, that is, with medications, it should be understood that the failure of treatment for four weeks is a weighty argument for revising the diagnosis, referring to a rheumatologist, and not for repeated courses of therapy. There are frequent situations when a patient with complaints of pain in the lower back receives symptomatic (that is, just anesthetic) treatment according to a certain pattern, without clarifying the true cause of this pain.

Causes of lower back pain

The main causes of pain in the lumbar region are

  • changes in the structures of the spine, as a rule, age (they are degenerative), osteochondrosis of the spine (aka spondylosis), various hernias of intervertebral discs or inadequate work of the muscular-ligamentous complex. Such pains are called primary pains, that is, directly connected with the spine;
  • pathological changes of organs located near the painful area, but not directly related to the spine (for example, diseases of internal organs, skin). This category of causes includes joint inflammation, injuries, endocrine disorders (for example, diabetes) - in short, anything that does not fit the picture of the "natural age-related changes" of the spine. Such pains are called secondary.



Questioning and examination at the doctor

Pain, a feeling of stiffness or increased painful muscle tension in the area between the lower ribs and buttocks is usually denoted by the term "lumbodynia". If pain in the leg joins these symptoms, this condition is usually called lumboischialgia.

First of all, the severity of pain is important, that is, the duration of its occurrence. The pain of prescription up to 12 weeks (3 months) is called acute, more than 12 weeks - chronic. Chronic pain syndrome can occur with exacerbations and periods of improvement.

Of fundamental importance is how the pain is felt. This is either a sensation at a certain point, or a spread (“projection”, “irradiation”) of pain along the nerve to the thigh, buttock, knee joint, foot, or indistinct, “dull” pain. It is necessary to understand that movements in the spine are limited at the time of pain, or movements are unobstructed (this may indicate the mechanical nature of the damage, for example, during a vertebral fracture). At what moments does the pain appear? Does it occur under load, or at rest, during a night's sleep? The affirmative answer to the last question in general is a “red flag” for a rheumatologist and makes you think about the diagnosis of an inflammatory disease of the spine in a patient (we’ll stop on them a little later). If the pain increases with the movement of the head, walking, jumping, we are most likely talking about the so-called projection pain, the cause of which is damage to the nervous structures (most often radiculitis).

Spinal osteochondrosis, or spondylosis - a condition in which there is a seal and deformity of the vertebrae, with the appearance of small bony outgrowths, similar to spines, along the edges of the vertebrae. For a long time, it was considered to be spondylosis as a result of the natural course of degenerative processes, aging of the body. However, it has been convincingly proven that not only age can be the cause of osteochondrosis. A fixed lifestyle, increased load on the lumbar spine during prolonged work at the computer or during prolonged driving (for example, the profession of truck driver) contribute to the occurrence of osteochondrosis, even among young people. Under the influence of all these factors, the intervertebral disks-buffers flatten, and the nerve roots, branching off from the spinal cord, are compressed, and then injured by the growing regional bone spikes. Constant irritation and compression of these roots and causes pain. In Latin, the root is called radix, so this inflammation is usually called radiculitis.

The so-called inflammatory diseases of the spine - the area of ​​interest of rheumatologists. These mysterious diseases can "smolder" for several years, starting predominantly at a young age and affecting mostly men, and resulting in the result of immobility and disability of the patient. Patients in this group usually "tolerate to the last" and night pains, and morning stiffness in the back, and weakness, and an increasing decrease in efficiency. Unfortunately, from the first symptoms of the disease to a correct diagnosis, on average, it takes about seven years. During this time, changes in the spine can become irreversible, and functional (motor) activity - low. The spine becomes immobile, changes shape, a hump appears. This pathology is not as common as osteochondrosis, for example, but the costs of treatment and the total time of disability of such patients are disproportionately higher.

If, in addition to back pains, the patient, when questioned, speaks of inflammation of the joints (more often it concerns knee joints, joints of the hands or feet), pain in the buttocks, an unstable chair with unusual impurities, blurred vision or pain in the eyes, this is also a reason to urgently send it to a rheumatologist to conduct a specific additional examination and exclude the disease from the group of spondyloarthritis (for example, seronegative spondyloarthritis or Crohn's disease).

There are diseases that manifest as pain in the lower back and completely untouched by vertebral or neural structures. One of these diseases is myofascial pain syndrome. Patients (most often young patients) indicate a long stay in an uncomfortable position or physical overload that preceded the development of pain. During a medical examination, a sharp pain when pressing on certain points located near the spine attracts attention. This condition significantly reduces the patient's quality of life, but minor changes in muscle tissue (local overstrain) do not pose a danger to the nerve roots or internal organs. Usually, the therapeutic effect can be achieved by prescribing muscle relaxants (mydocalm), low doses of nonsteroidal anti-inflammatory drugs (meloxicam, diclofenac), local injection (injection) into the pain point of the steroid anti-inflammatory drug (diprospan).

Survey

It is considered that if a patient with complaints of pain in the lower back does not have “disturbing signs” (they are described below), then he does not need additional examination, and the treatment can be carried out by a therapist without tests and even X-rays. But, as practice shows, such “signs” can be detected in almost any patient, which means that there is a need to donate blood for at least a general (and even better for an immunological) analysis, and perform a X-ray of the lumbar spine in two projections ( ideally, with the “capture” of the pelvic bones).

могут выявить повышение скорости оседания эритроцитов (СОЭ), что свидетельствует о воспалении, возможно иммунного происхождения, или инфекции. - Blood tests can reveal an increase in erythrocyte sedimentation rate (ESR), indicating inflammation, possibly of immune origin, or infection. An increase in the level of leukocytes also indicates an infection or inflammation, and severe anemia indicates the possible presence of a neoplastic process.

сдается при подозрении на болезнь почек. - A urine test is taken if a kidney disease is suspected. The pain in the lumbar region in this case is aching in nature, often “spreading” upwards, to the lower ribs. If there are changes in the urine analysis, an ultrasound of the kidneys is performed, and further tactics are discussed in detail with the therapist or urologist.

– наиболее дешевое из инструментальных обследований, это метод выбора при диагностическом поиске в данном случае. - X - ray is the cheapest of instrumental examinations, it is the method of choice for diagnostic search in this case. On the radiograph, you can see a violation of the structures of the spine, signs of inflammation of the vertebral joints, by indirect signs to determine the place of compression of the nerves. "Transparency" of the vertebrae on the radiograph will suggest the idea of ​​osteoporosis (fragility) of the bone skeleton. As is well known, on the background of osteoporosis, such a complication as a vertebral fracture with subsequent compression of the adjacent nerves is most common. If the fracture, alas, took place, it will also be visible on the radiograph. The possibilities of this method of research are enormous, but if pathology is found, it is necessary to clarify how serious the damage is, whether the patient does not need surgical intervention on the spine. For this, a more precise study is already required - layered (tomography). There are two types of tomography - computer x-ray and magnetic resonance.

. - Computed tomography (CT) . A method of examination that allows you to literally look inside the spine. All bone structures that escaped the attention of the radiologist with conventional radiography, on the tomogram will be perfectly visible. If necessary, using the obtained data and a special computer program, you can reconstruct the 3D model of any structure of interest.

. - Magnetic resonance imaging (MRI) . Non-X-ray method of research. It differs from computed tomography also in that it allows the doctor to more carefully assess the state of the “soft” structures of the spine (only bone elements are clearly visible on CT): the spinal cord, roots. In more detail, this examination shows vertebral hernia, changes in blood vessels and muscles. Usually, it is the MRI specialist who has the last word in the diagnostic search and the definition of further tactics.

Signs to look out for

Secondary back pain, that is, having no connection with osteochondrosis and “overworked” back is an alarming symptom, which forces you to start searching for the main pathological process causing pain as soon as possible. Let us briefly discuss the symptoms, which may indicate a possible secondary (that is, not directly related to the spine) nature of pain and require increased vigilance, both from the doctor and the patient:

  • rapid sudden loss of body weight (a tumor may be suspected);
  • infections of the kidneys and bladder (in this case, the pain may be a symptom of pyelonephritis);
  • increased pain at rest or after a night's sleep (this symptom is of particular interest to rheumatologists, as it may be a sign of developing Bechterew's disease);
  • fever;
  • changes in blood tests (increased blood clotting, detected during coagulation, increased white blood cell count or hemoglobin fall, as well as increased ESR (erythrocyte sedimentation rate) in the overall analysis, increased C-reactive protein in immunological analysis);
  • diagnosis of osteoporosis, or medication that reduces the amount of calcium in the bones;
  • age over 50 years (the risk of osteoporosis in women in menopause) or less than 20 years, especially for boys;
  • reference to injury, regardless of its age (for example, a fall from a height of more than 2 meters, and for older people a significant injury is already a fall from a height of your own body);
  • signs of serious neurological abnormalities (a violation of the sensitivity of the skin, urination or defecation usually indicates a deep lesion of the spinal cord);
  • the inefficiency of the "routine" treatment for 4 weeks.

Back pain treatment

As already mentioned, patients with lower back pain are primarily in the field of vision of the therapist and neurologist. According to the existing medical standards, the doctors of these specialties, especially therapists, are treating uncomplicated forms of pain in the absence of the “danger signs” mentioned earlier. Drug therapy is the appointment of nonsteroidal anti-inflammatory drugs (NSAIDs, for example, meloxicam) or simple analgesics. It is extremely important to convince the patient to reduce the load on the spine - get rid of excess weight, eliminate work associated with lifting and moving weights, reduce the time spent in a static vertical posture ("sedentary" lifestyle, work at the computer or, conversely, "work on the legs" ). The patient should be adjusted to regular physical education classes, and the most important thing is not to overdo it: jogging, jumping, and many team sports such as basketball, volleyball, and football are contraindicated for pain in the lower back.

Neurologists most often use complex therapy of pain in the lower back, including muscle relaxants (for example, mydocalm) and B vitamins in the scheme. The main effect of muscle relaxants is relaxation of spasm (squeezed) muscles, providing them with rest. B vitamins, as is commonly believed, improve nutrition and regeneration of nerve fibers. These drugs are more effective in cases of acute pain, but in chronic pain syndrome, their use does not harm, but does not have proven effectiveness.

Quite often, doctors (especially surgeons) recommend wearing a bandage on the lumbar region (supporting the lower back). This allows the patient to be relieved of unpleasant sensations in the event that physical exertion is to occur, a long road or performance, but has no actual therapeutic effect. As soon as the bandage is removed, the pain returns or increases. Physiotherapy procedures so popular in our country, “blockades”, massage or manipulations on the spine have a “distracting” effect, eliminate painful muscle spasm, but, like the use of a bandage, do not have a proven therapeutic effect. In the case of chronic pain, these appointments just need to be combined with physical therapy and swimming.

In cases of severe damage to the structures of the spinal cord, large disc herniation, compression fractures or tumors, surgical treatment is used. Spinal surgery is varied - from small, carried out under local anesthesia, to extensive interventions that are carried out by several teams of surgeons in several stages. Over the past twenty years, the technique of performing these operations has been constantly improved, and a great deal of experience has been gained; therefore, if there are indications for surgical treatment of the spine, it makes no sense to wait until the problem is solved by itself.

Maintain activity and mobility

A common mistake is keeping bed in case of acute back pain. Movement in this pathology of the musculoskeletal system is not just necessary, but necessary! In all cases, except for compression root syndrome (this diagnosis will be established by a neurologist), being in a horizontal position increases the cost of treatment and delays the recovery time. Even with radicular syndrome, the total bed rest period should not be more than two days.

In inflammatory (rheumatological) diseases of the spine and the sacroiliac joints, physical activity is the main means of dealing with the onset of disability. Recall that this group of diseases has a progressively progressive nature, and exercises aimed at maintaining flexibility and developing and strengthening the muscular “corset” of the spine can be considered as effective as the treatment of special anti-inflammatory drugs of different groups prescribed by rheumatologists.


| February 22, 2014 | | 7 961 | Uncategorized
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  • | National Medic | September 11, 2015

    Люди уже привыкли, что когда болит спина нужно сразу бежать в поликлинику, а потом за лекарствами. А ведь поясницу можно быстро вылечить, применяя народные средства. Помогут и редька, и хрен, и горчица. Но ведь не хочет никто заморачиваться с ними – проще отнести деньги в аптеку. Всем здоровья и всех благ!

  • | Tatiana | 28 Сентябрь 2015

    Начались боли в пояснице. Я растираю Финалгон. Не помогает, какие народные средства?

  • Мари | 19 Ноябрь 2015

    Tatiana, do you think the people will help you? Something to be honest, I doubt it. It is necessary to undergo a course of medication. I used the ointments and did the exercises, and Diclofenac retard-Akrikhin saw. Here such a complex treatment has helped and pain in the back is no longer a concern.

Leave your feedback


Jayseee Sayhaaa: im 14 and i was playing basketball when i tried to put up a shot and fell on the bleachers really hard (i think i fell on my lower back)

MediEvilFan 147: Are we just naturally meant to suffer and die? Why's it so hard to prevent our bodies from breaking down and dying, who does it come naturally to to just always sit up straight, I try when I'm aware of it but as soon as I start to get focused on something or forgetting I'm trying to keep my back straight I slowly start to slouch again. XD RIP Haha

Yeah: I just recently experienced back pain. My lower back I so sore I can’t even sit or stand still for a period of time before it really hurts. I can bend over without feeling pain. But I cannot sit or stand in one position over time. I don’t know what to do

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Jules Gaerlan: Wow avoid surgery surgeon put a steel iron in your lower lumbar spinal chord injury(hernia disc that ravages in time when you age) wow please god cure my back am in my early 50's birthday august this year 2020 i want to be healthy strong my back pray to god i want to survive healthy not struggling !

Joseph Astimbay: well i got some great news for most people. Unless you were lifting a extremely heavy object over 100 pounds your not going to get a raptured disk or some sort of disk injury or muscle tear. If you do injure you spine by tearing a disk you wont feel pain but get paralyzed. If you are feeling extreme pain in the back after lifting something under 50 pounds or for twisting the wrong way YOU HAVE PINCH NERVE. A pinch nerve occurs when the nerve moves out of its place in the spine which than is either squished or starts rubbing against bone or muscles. The trick to curing a pinched nerved is that you have to move it back into place. The easiest way to do this to simply bend back as far as possible laying down and than twist to the right or left which will cause the nerve to readjust back to its normal position. If you feel extreme pain you should do leg stretches by trying to lift you leg as far up as possible or by pulling your leg to your chest as far as possible. Than the pain will go down but you still must lay on your back as far as possible even if you feel pain and twist it to try to move the nerve back into its place.

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