lower back pain

Almost every modern person is probably familiar with low back pain. Employability can be affected for a number of reasons. Among them, there are low back pain, sciatica, osteochondrosis and other lumbosacral diseases. Don't take it lightly, because back pain can not only become unbearably intense and make life unbearable, but it can also become a symptom of the most dangerous diseases.

Low back pain can be of various types: acute or dull, painful or burning, localized (in one place), or spread throughout the back. Unpleasant feelings also appear in different ways: sometimes suddenly, suddenly, sometimes gradually, and intensifies every day.

Response to pain and the ability to tolerate it depend on many factors: age, psychological characteristics, accompanying symptoms, and other factors. But in any case, you can't leave disease to chance. Prompt treatment will help avoid dangerous consequences.

To diagnose the cause of back pain, it is necessary to examine the spine and some additional procedures: X-ray examination, computer or magnetic resonance imaging. About 80% of modern residents of European countries experience lumbosacral pain attacks in their lives.

Acute or chronic back pain in the lumbar region is the result of multiple neurological, degenerative and dystrophic diseases in both women and men. In some cases, low back pain is the result of visceral disease, obesity, stress, mental disorders.

Pain Syndromes - Primary and Secondary

Having understood the causes of low back pain, we must not forget that there are dozens of causes of this pain and a non-professional will never be able to pinpoint the real source of the problem. In general, the medical classification separates primary and secondary pain syndromes that may affect the lumbar region.

Primary low back pain syndromes result from musculoskeletal changes of a morphofunctional nature. It is he who is responsible for the vast majority of back pain cases in the lumbar region. The most important cause is the degenerative dystrophic changes that occur in various parts of the spine:

• Osteochondrosis is a disease of bone and cartilage tissue that is characterized by dystrophy. Along with it, the intervertebral disc and adjacent vertebrae are affected and spondylosis begins to develop.
• Spondyloarthropathy is a form of osteoarthritis in which the disease affects the intervertebral joints, which are responsible for the mobility of the spine or synovial joints.

Secondary pain syndromes have more different causes of pain:

• Scoliosis, which is a curvature of the spine, and some other growth disorders;
• Various non-infectious inflammations. Such as rheumatoid arthritis, Wright syndrome, etc. ;
• Tumors located in the vertebrae, the spinal cord itself, or the retroperitoneal space, whether primary or due to metastases;
• One or more back vertebrae fractures. This can be one of the worst causes of back pain;
• Various infectious diseases (TB, brucellosis, epidural abscesses, etc. ) that cause damage to the vertebrae and intervertebral discs;
• A stroke condition that severely disrupts the blood supply to the spinal cord. In this case, there may also be a feeling of low back pain;
• Gastrointestinal disease. For example, acute appendicitis, intestinal obstruction with atypical course;
• Often back pain is a reflection of nature. Similar problems can occur with diseases of certain organs located in the pelvic region. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, and stomatitis—all of which cause low back pain).

Acute and Chronic Low Back Pain

Low back pain is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. So-called lower back pain displacement is also frequently observed: in this case, pain sensations originate from deeper internal organs and body structures; in other words, lower back pain, as seen by the patient, is actually a complete part of the body. Different parts are affected.

Most often, back pain is felt in the lumbar region when pain projects from the pelvic organs, kidneys, pancreas, colon, or tumor behind the peritoneum to the area. Many patients with back pain do not know what to do. But there is one clear advice on what not to do: self-medicate. The causes of pain are varied and only a qualified specialist can make a correct diagnosis.

Possible causes of acute low back pain include:

• The pain is accompanied by an acute stretch of the muscle. In this case, the pain signal is located in the back, provided by the spasmodic long muscle. The pain does not transfer to the groin or leg area. Human mobility is limited.
• One of the most common and serious causes of severe back pain is spinal fractures (vertebral fractures, including compression fractures). Typically, this occurs with failed falls, back flexion, and other injuries; but if the patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, vertebral regionIn the presence of cancerous tumors and their metastases or other lesions of the skeletal system, vertebral fractures may occur "unexpectedly", even without feeling the patient's immobilization at the time of the fracture.
• An equally unpleasant condition for severe pain in the lower back is a displacement of the disc that occurs in the area of the vertebral body. Regions are distinguished based on the frequency of lesions: LV-SII - most common; LIV-LV - second in frequency; LIII-LIV and above are rare.

Symptoms include severe low back pain, forced posture, and limited mobility. Pathological processes involved in nerve roots show that:

1. radicular pain, usually unilateral;
2. sensitivity disorders (numbness, increased or decreased sensitivity levels);
3. Decreased or absent Achilles tendon reflex (if the S or S2 root is damaged);
4. Decreased or absent knee jerk strength (indicating damage to the L3-L4 region).

The general trend is that a herniated disc affects the underlying root (eg, LIV-LV misalignment leading to L5 root lesions). With the failure of the cauda equina (cauda equina), the function of the bladder and rectum is disturbed. Also, a similar situation occurs in the case of a herniated disc.

Severe back pain in lumbar facet syndrome: In this case, the disc is not affected and the pain is due to compression of the root itself at the exit of the spinal canal. Unilateral facet joint syndrome most common in the root L5 region; narrowing of the intervertebral foramen due to increased facets of the intervertebral joints (superior and inferior).

In addition, severe low back pain is accompanied by an epidural abscess, a serious condition that requires urgent diagnosis and immediate treatment. In most cases, the inflammatory process occurs in the thoracic region of the spine. The pain becomes particularly intense, with a mechanical action (pressure, percussion) on the pathological area.

If there are signs of spinal cord compression, any effective medical measures, including surgery, are recommended. Another cause of lower back pain can be hip disease -- mostly hip disease. In this case, the pain is characteristic, radiating to the lower back, the buttocks, and also the legs to the knees.

Conditions characterized by chronic low back pain:

• Deformative spondylosis is a condition in which lumbar spine dystrophy, calcification of ligaments and further growth of bone; bone growth presses on the root and narrows the spinal canal. If lower back pain is accompanied by neurological symptoms such as leg weakness and numbness, the possibility of intermittent claudication syndrome due to spinal stenosis should be considered. Examination is necessary and its results determine the final diagnosis.
• Ankylosing spondyloarthropathy (or Bechterew disease). Early on, it is characterized by limited mobility, especially in the morning, and reduced chest movement during breathing. Pulling pain in lower back; spinal curvature that further develops and advances in the chest area. X-ray repairs abnormalities of the sacroiliac joint: destruction, structural changes, "bamboo" spine. A thorough examination and finding out the cause of lower back pain is necessary, as similar symptoms and limited mobility of the lower spine can also lead to other conditions - Wright syndrome, psoriatic arthritis, chronic colitis.
• Oncological diseases (tumors, metastases), metabolic disorders (including NBO). It is necessary to exclude these causes of back pain: metastatic cancer of the lung, breast, prostate and thyroid, kidney, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). X-ray examinations and myelography methods are excluded.
• Osteomyelitis can also cause prolonged pain in the lower back. If the disorder is suspected, x-rays of bone tissue, tuberculin skin tests, and ESR measurements to determine the presence of tuberculosis or purulent (purulent) bacteria in the body, usually of staphylococcal-osteomyelitispathogen.
• Various types of spinal cord tumors (intradural tumors). Conditions such as lipomas, neurofibromas, and meningiomas can cause persistent back pain without any accompanying neurological symptoms initially.

Causes of intermittent back pain. Disorders of many internal organs can cause periodic, sharp, or pulling pains in the lower back. At the same time, the patient has no feeling of stiffness in the back, no obvious pain localization, and pain does not increase with the maximum possible range of motion. The answer to the question of what to do if your lower back pain isn't frequent but occasional is simple: don't wait until it "should" be painful, but talk to your doctor.

The pathology of one or another organ has a marked effect on a certain part of the spine. Thus, from the pelvic organs, pain radiates to the sacrum, in diseases of the lower organs of the abdominal cavity it radiates to the lower back (L3-L5 segments), and in the upper - to the upper part of the segmental lumbar region or the lower part of the thoracic region.

Disorders - Causes of low back pain, and areas of pain distribution:

• Lower back pain can occur if the pelvic organs are affected, have endometriosis, ovarian cancer, or uterine cancer. In men, this intermittent pain may be caused by the development of chronic prostatitis or prostate cancer.
• Various kidney diseases can cause pain where the ribs and spine join.
• Stomach tumor, duodenal tumor, peptic ulcer, pancreatic tumor (especially if the disease has spread beyond the peritoneum) - the pain can spread to the T10-L2 spinal segment area;
• Lower back pain with ulcerative colitis, diverticulitis, or colon tumors;
• If the back is painful in the thoracic/lumbar region, aortic dissection (dissecting aneurysm) should be excluded.

Diagnosis of low back pain

For low back and low back pain, computed tomography (which shows the condition of the bony tissue in the spine) and magnetic resonance (which allows you to assess the condition of the soft tissue) tomography and ultrasound scans of internal organs are recommended.

One diagnostic method is radiography, which is relatively inexpensive and can be used to detect a range of conditions, from bone fractures to kidney stones. Many of the detected changes only indicate a correct diagnosis and may require additional research to confirm. In addition, some radiographic changes may be concomitant findings but not the cause of pain.

It all starts with a doctor's neurological and orthopedic exam. During this examination, the patient's neurological status is assessed and possible irregularities in the spinal biomechanics are identified through a mandatory assessment of the condition of the back and hip muscles. Already at this stage of research, patients with spinal osteochondrosis and back and lower back pain can be diagnosed and treated.

Occasionally, the following additional diagnostic procedures may be prescribed based on the results of an orthopaedic surgeon's examination of a patient with painful symptoms in the context of spinal osteochondrosis:

• Lumbosacral spine X-rays and functional tests;
• CT scan of lumbosacral spine;
• MRI of the lumbosacral spine.

The center of the disc is occupied by a gelatinous nucleus pulposus. It is surrounded and supported by the annulus fibrosus, which consists of fibrocartilage and connective tissue. You can read more about this in our article on the anatomy of the human spine and spinal cord.

The thickness of the intervertebral disc decreases, the vertebral bodies move closer together, and the intervertebral foramen decreases and compromises the nerves and blood vessels that reside in it (osteochondrosis).

A herniated disc (herniated disc) that prolapses further into the spinal canal (herniated disc) most often causes compression of the nerve root, causing pain along the compressed nerve (pain radiating to the legs, arms, back of the head, neck, intercostal space (Depending on the degree of nerve compression), the muscle strength and sensitivity of its innervated areas are weakened and violated.

Often, a herniated or herniated disc is accompanied by muscle pain in which the nerves run (along the arms or legs). In this condition, one or both nerves are compressed at once (rarely).

In addition to nerve compression, the stability of spinal segments may also be compromised. When the spine is unstable, the vertebrae move forward (anterior slippage) or backwards (posterior slippage). To confirm the diagnosis, X-rays of the lumbosacral spine and functional testing may be required.

Most often, the nerve bundle that forms the sciatic nerve due to its anatomical location suffers from compression by a hernia or a herniated disc. The sciatic nerve consists of fibers L5, S1, S2, S3 - spinal nerves.

Foci of chronic inflammation in the spinal canal can lead to the formation of its narrowing (spinal stenosis) and compression of the nerves and spinal cord that pass through it. This is why, in the case of spinal stenosis, it is always necessary to carry out a complete course of treatment with the entire arsenal of different treatments and, in the case of ineffectiveness, surgery.

Which doctor should I contact?

For spinal pain, first, if the patient is stable, you should contact the neurologist at the regional clinic, or call an ambulance. Lower back pain can be one of the symptoms of gynecological, urological, surgical, gastrointestinal problems.

Low back pain is combined with various infections, limb injuries. Lower back pain with heart and lung disease is not excluded. This was determined by in-depth inspection. Once a patient is diagnosed, he is usually prescribed medications to relieve back pain, normalize blood circulation and help restore nerve tissue. These can be tablets, gels, ointments or injections to relieve inflammation and spasms.

Surgical intervention is often required when diagnosing a herniated disc, a complication of osteochondrosis. The hernia that compresses the nerve root is removed, healed, and the pain goes away over time.

If sleeping on a firm mattress, place a small pillow under your knees to relax your spine and paravertebral muscles. At the same time, bed rest should not be too long, as this will weaken the paravertebral muscles and only exacerbate the problem. Even with severe pain, you should try to maintain at least minimal physical activity.

How to Relieve Back Pain

Pain symptoms usually occur due to muscle spasms, which can be eliminated with the help of special means - muscle relaxants. These drugs are actively used to treat spinal disorders.

Therefore, in the event of strong unexpected pain in the lower back, it is advisable to take muscle relaxant tablets and rub the back with warm anesthetic gel. When using funds, their instructions should be strictly followed.

If the unpleasant symptoms are due to the presence of an inflammatory disease of the internal organs, it is advisable not to delay contacting the doctor, if at a certain moment it is not possible to see a specialist and the pain is too severe, you can take Pentalgin or No-shpu. A heating pad should not be used to heat the painful area, as the heat helps to spread the inflammatory process and therefore exacerbate the symptoms that accompany it.

back pain ointment

Preparations in the form of ointments are commonly used to treat lower spine disorders. These drugs include those with significant anti-inflammatory, mild analgesic and antipyretic effects.

The course of treatment is prescribed, taking into account the severity of the pain symptoms. Low back pain ointment as primary or adjunctive therapy. For obvious symptoms of osteochondrosis, it is recommended to rub the lower back with an ointment based on ketoprofen, a substance with powerful analgesic properties.

The main advantage of topical preparations is that their effect is not on the entire body, but on the specific area in need of treatment. Pain relievers and anti-inflammatory creams have fewer contraindications and side effects than similar drugs in tablet form.

exercises for back pain

Gymnastics is considered another way to treat lower spine disorders. The exercises shown to the patient are very simple and do not place a particular burden on the body. For example, usually hanging from the horizontal bar of the horizontal bar, it is good for the condition of the spine, helps to relax the muscles, and eliminates low back pain - the pain caused by pinching its nerve roots. Therapeutic exercises for back disorders, accompanied by lower pain, include exercises:

• Raise the leg (so that the knee touches the chin);
• "Bicycle", supine performance;
• Kneeling and walking.

Exercise no more than 10-15 minutes per day with significant pain - refusal to exercise.