Almost all adults experience back pain at some point in their lives. This is a very common problem that can be based on various reasons that we will discuss in this article.
Causes of back pain
All causes of back pain can be divided into groups:
Muscular:
- osteochondrosis;
- disc herniation;
- compression radiculopathy;
- spondylolisthesis;
Inflammatory, including infectious:
- Osteomyelitis
- Tuberculosis
neurological;
injuries;
endocrinological;
vascular;
Tumor.
During the first visit to the doctor for back pain, the specialist should determine the cause and type of pain, paying special attention to "red flags" - possible manifestations of potentially dangerous diseases.
"White Flags":
- Age of the patient at the onset of pain: younger than 20 years or older than 50 years;
- a serious spinal injury in the past;
- the appearance of pain in patients with cancer, HIV infection or other chronic infectious processes (tuberculosis, syphilis, Lyme disease and others);
- Fever
- weight loss, loss of appetite;
- unusual localization of pain;
- increased pain in the horizontal position (especially at night), in the vertical position - weakening;
- no improvement for 1 month or more;
- Dysfunction of the pelvic organs, including urination and defecation disorders, numbness of the perineum, symmetrical weakness of the lower limbs;
- alcoholism;
- use of narcotic drugs, especially intravenous drugs;
- treatment with corticosteroids and/or cytostatics;
- With neck pain, pulsating nature of the pain.
The presence of one or more signs in itself does not mean the presence of a dangerous pathology, but it requires the attention and diagnosis of a doctor.
Back pain is divided into the following forms according to duration:
- acute- pain that lasts less than 4 weeks;
- Subacute- pain from 4 to 12 weeks;
- chronic- pain that lasts 12 weeks or more;
- Recurrence of pain- renewal of pain, if it has not occurred in the last 6 months or more;
- Exacerbation of chronic painRecurrence of pain less than 6 months after the previous episode.
Diseases
Let's talk about the most common musculoskeletal causes of back pain.
Osteochondrosis
It is a disease of the spine, which is based on the wear and tear of the vertebral discs and subsequently the spine itself.
Is osteochondrosis a pseudodiagnosis? - No. This diagnosis exists in the ICD-10 International Classification of Diseases. Currently, doctors are divided into two camps: some believe that such a diagnosis is incorrect, others, on the contrary, often diagnose osteochondrosis. This situation arose because foreign doctors understand osteochondrosis as a disease of the spine in children and adolescents associated with growth. However, this term specifically refers to degenerative spine disease in people of any age. Dorsopathy and dorsalgia are also frequently established diagnoses.
- Dorsopathy is a pathology of the spine;
- Dorsalgia is a benign non-specific back pain that spreads from the lower cervical vertebrae to the palate, which can also be caused by damage to other organs.
The spine has several sections: cervical, thoracic, lumbar, sacral and coccygeal. Pain can occur in any of these areas, described by the following medical terms:
- Cervicalgia is pain in the cervical spine. The intervertebral discs of the cervical region have anatomical features (there are no intervertebral discs in the upper part, and in other parts a weakly expressed nucleus pulposus with its regression, on average, by 30 years), which makes them more sensitive to stress. and damage that leads to stretching of ligaments and early development of degenerative changes;
- Thoracalgia - pain in the chest;
- Lumbodynia - pain in the lumbar region (in the lower part of the back);
- Lumboschialgia is pain in the lower back that radiates down the leg.
Factors causing the development of osteochondrosis:
- heavy physical work, lifting and moving heavy loads;
- low physical activity;
- long sitting work;
- being in an uncomfortable position for a long time;
- long work at the computer with a non-optimal location of the monitor, which creates a load on the neck;
- violation of posture;
- Congenital structural features and anomalies of the spinal column;
- weakness of back muscles;
- high growth;
- excess body weight;
- Diseases of the joints of the legs (gonarthrosis, coxarthrosis, etc. ), flat feet, flat feet, etc. ;
- natural wear and tear and age;
- smoke.
disc herniationThere is a protrusion of the nucleus of the intervertebral disc. It can be asymptomatic or cause compression of surrounding structures and manifest as radicular syndrome.
Symptoms:
- Violation of range of motion;
- feeling of stiffness;
- muscle tension;
- Pain radiating to other areas: arms, shoulder blade, legs, groin, rectum, etc. Sh.
- "shots" of pain;
- Numbness
- creeping sensation;
- muscle weakness;
- Pelvic disorders.
The localization of pain depends on the level at which the hernia is localized.
A herniated disc often resolves on its own within an average of 4-8 weeks.
Compression radiculopathy
Radicular (radicular) syndrome is a complex of manifestations that occurs due to the compression of the spinal roots at the points of their departure from the spinal cord.
Symptoms depend on the level of compression of the spinal cord. Possible manifestations:
- Pain in the limbs of a shooting nature with radiation of the fingers, aggravated movement or coughing;
- Numbness or the sensation of crawling flies in a certain area (dermatomas);
- muscle weakness;
- back muscle spasm;
- Violation of the strength of reflexes;
- Positive tension symptoms (appearance of pain with passive flexion of limbs)
- Limitation of spinal mobility.
Spondylolisthesis
Spondylolisthesis is displacement of the upper vertebra relative to the lower vertebra.
This condition can occur in both children and adults. Women suffer more often.
Spondylolisthesis may cause no symptoms with minor displacement and may be an incidental X-ray finding.
Possible symptoms:
- A feeling of discomfort
- pain in the back and lower limbs after physical work;
- Weakness in the legs
- radicular syndrome,
- Reduced pain and tactile sensitivity.
Progression of spinal displacement can lead to lumbar stenosis: the anatomical structures of the spine degenerate and grow, which gradually causes compression of the nerves and blood vessels in the spinal canal. Symptoms:
- Constant pain (both at rest and during movement)
- In some cases, the pain may decrease with lying down.
- The pain is not aggravated by coughing and sneezing.
- The nature of the pain ranges from pulling to very strong,
- Pelvic organ dysfunction.
With strong movements, arteries can be compressed, as a result of which the blood supply to the spinal cord is disturbed. This is manifested by a sharp weakness in the legs, a person may fall.
diagnosis
A collection of complaintsIt helps the doctor to suspect the possible causes of the disease, to determine the localization of the pain.
Assessment of pain intensity- a very important stage of diagnosis, which allows you to choose treatment and evaluate its effectiveness over time. In practice, a visual analog scale (VAS) is used, which is convenient for the patient and the doctor. In this case, the patient rates the severity of the pain on a scale of 0 to 10, where 0 points are no pain, and 10 points are the worst pain that a person can imagine.
InterviewAllows you to identify factors that provoke pain and destruction of the anatomical structures of the spine, identify movements and postures that cause, intensify and relieve pain.
Physical examination:Assessing the presence of back muscle spasm, determining the development of the muscular skeleton, excluding the presence of signs of infectious damage.
Assessment of neurological status:Muscle strength and symmetry, reflexes, sensitivity.
March Test:It is performed in suspected cases of lumbar stenosis.
Important!Patients with a classic clinical picture without "red flags" are not recommended to undergo additional studies.
X-ray:Performed functional tests on suspected instability of spinal structures. However, this diagnostic method is non-informative and is mainly carried out with limited financial resources.
Computed tomography (CT) and/or magnetic resonance imaging (MRI):The doctor prescribes based on clinical data, because these methods have different indications and benefits.
CT |
MRI |
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Important!In the majority of people, in the absence of complaints, degenerative changes in the spine will be detected by instrumental examination methods.
Bone densitometry:Performed to assess bone density (confirm or rule out osteoporosis). This study is recommended for postmenopausal women at high risk of fractures and always over 65 years of age, regardless of risk, men over 70 years of age, fracture patients with minimal history of trauma, long-term use of glucocorticosteroids. The 10-year risk of fracture is assessed using the FRAX scale.
Bone scintigraphy, PET-CT:It is carried out in the presence of suspicion of oncological disease according to other examination methods.
Treatment of back pain
For acute pain:
- Painkillers are prescribed in the course, mainly from the group of non-steroidal anti-inflammatory drugs (NSAIDs). The specific drug and dosage is selected according to the severity of the pain;
- maintaining moderate physical activity, special exercises to relieve pain;
Important!In back pain, physical inactivity increases pain, prolongs the duration of symptoms, and increases the likelihood of chronic pain.
- muscle relaxants for muscle spasms;
- Vitamins can be used, although their effectiveness remains unclear according to various studies;
- manual therapy;
- Analysis of lifestyle and elimination of risk factors.
For subacute or chronic pain:
- use of painkillers on demand;
- special physical exercises;
- Assessment of the psychological state, because it can be an important factor in the development of chronic pain and psychotherapy;
- drugs from the group of antidepressants or antiepileptic drugs for the treatment of chronic pain;
- manual therapy;
- Analysis of lifestyle and elimination of risk factors.
In case of radicular syndrome, blockades (epidural injections) or intraosseous blockade are used.
Surgical treatment is indicated by the rapid increase of symptoms, the presence of compression of the spinal cord, significant stenosis of the spinal canal and ineffectiveness of conservative therapy. Urgent surgical treatment is performed: disorders of the pelvic cavity with numbness in the anogenital area and ascending weakness of the legs (cauda equina syndrome).
Rehabilitation
Rehabilitation should start as soon as possible and have the following goals:
- improving the quality of life;
- elimination of pain, and if its complete elimination is impossible - relief;
- restoration of functionality;
- rehabilitation;
- Self-service and safe driving training.
Basic rules of rehabilitation:
- The patient should feel responsible for his own health and compliance with recommendations, however, the doctor should choose treatment and rehabilitation methods that the patient can follow;
- systematic training and compliance with safety rules while performing exercises;
- Pain is not an obstacle to exercise;
- A relationship of trust must be established between the patient and the doctor;
- The patient should not focus and focus on the cause of pain in the form of structural changes in the spine;
- The patient should feel comfortable and safe while performing the movements;
- The patient should feel the positive impact of rehabilitation on his condition;
- The patient must develop the ability to respond to pain;
- The patient should associate movement with positive thoughts.
Rehabilitation methods:
- walk
- physical exercises, gymnastics, gymnastics programs at the workplace;
- individual orthopedic devices;
- cognitive behavioral therapy;
- Patient education:
- Avoid excessive physical activity;
- struggle with low physical activity;
- exclusion of prolonged static loads (standing, being in an uncomfortable position, etc. );
- Avoid hypothermia;
- Sleep organization.
Prevention
Optimal physical activity: strengthens the muscle frame, prevents bone resorption, improves mood and reduces the risk of cardiovascular accidents. The most optimal physical activity is walking more than 90 minutes a week (at least 30 minutes 3 days a week).
During long sitting work, it is necessary to take breaks for warming up every 15-20 minutes and observe the rules of sitting.
Life Hack:
how to sit
- Avoid too soft furniture;
- The feet should rest on the floor, which is achieved by the height of the chair equal to the length of the lower leg;
- It is necessary to sit at a depth of up to 2/3 of the hip length;
- sit straight, maintain a straight posture, the back should fit tightly to the back of the chair to avoid straining the back muscles;
- When reading a book or working at a computer, the head should have a physiological position (looking directly, not constantly down). For this, it is recommended to use special stands and set the computer monitor at the optimal height.
When standing for a long time, it is necessary to change the position every 10-15 minutes, alternately change the supporting leg and, if possible, walk and move on the ground.
Avoid lying down for long periods of time.
Life Hack:
how to sleep
- Sleep better on a semi-firm surface. If possible, you can choose an orthopedic mattress so that the spine maintains physiological curves;
- The pillow should be soft enough and of medium height to avoid stress on the neck;
- When sleeping in an inclined position, it is recommended to put a small pillow under the abdomen.
Stop smoking: If you are having trouble, talk to your doctor about a smoking cessation program.
Frequently asked questions
I use ointments together with glucocorticosteroids. Am I at risk for osteochondrosis or osteoporosis? No. External glucocorticosteroids (ointments, creams, gels) do not reach the systemic circulation in significant quantities and, therefore, do not increase the risk of developing these diseases.
Is surgery necessary in each case of disc herniation? No. Surgical treatment is performed only if indicated. On average, only 10-15% of patients require surgery.
Should you stop exercising if you have back pain? No. If, as a result of additional examination methods, the doctor does not find anything that significantly limits the degree of load on the spinal column, then it is possible to play sports, but after completing a course of treatment and adding certain exercises. Course of physiotherapeutic exercises and swimming.
Can my back pain go away forever if I have a herniated disc? They can be productive after a course of conservative therapy, following the recommendations of the attending neurologist, following the rules of prevention, regular exercise therapy and swimming.