Low back pain is probably familiar to almost every modern person. The ability to hire can be affected by a wide variety of reasons. These include back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be careless about this, because back pain can not only reach incredible strength, making a person's life unbearable, but also be a symptom of the most dangerous diseases.
Lower back pain can be varied: sharp or dull, painful or burning, local (occurs in one place) or spreading throughout the back. Unpleasant sensations also appear in different ways: sometimes abruptly, suddenly, and sometimes gradually, intensifying every day.
The response to pain and the ability to tolerate it depend on many factors: age, mental characteristics, accompanying symptoms and other factors. But in any case, you can't leave the disease to chance. Timely treatment will help avoid dangerous consequences.
To diagnose the cause of back pain, a study of the spine and some additional procedures are needed: X-ray examination, computer or magnetic resonance imaging. Attacks of pain, lumbosacral, occur during life in about 80% of modern people in European countries.
Acute or chronic back pain in the lumbar region is a consequence of various neurological, degenerative-dystrophic diseases in women and men. In some cases, low back pain is a consequence of diseases of the internal organs, obesity, stress, mental disorders.
Pain syndrome - primary and secondary
Understanding why the lower back hurts, we must not forget that the causes of such pain are dozens, and a non-professional will never be able to determine the true source of the problems. In general, the medical classification divides primary and secondary pain syndromes that can affect the lumbar region.
The syndrome of primary low back pain occurs as a result of musculoskeletal changes of a morphofunctional nature. It is the cause of most cases of back pain in the lumbar region. The most significant of the causes are degenerative-dystrophic changes occurring in different parts of the spine:
- osteochondrosis, which is a lesion of bone and cartilage tissue, this disease has a dystrophic nature. It affects the intervertebral disc and adjacent vertebrae, begins to develop spondylosis.
- spondyloarthritis 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 syndrome has many different causes of pain:
- scoliosis, which is a curvature of the spine, as well as some other diseases of growth;
- various inflammations that are non-infectious in nature. For example, rheumatoid arthritis, Reiter's syndrome and others. ;
- a tumor located on the vertebrae, in the spinal cord itself or in the retroperitoneal space, whether primary or caused by metastases;
- fracture of one or more vertebrae. This is probably one of the most serious causes of back pain;
- various infectious diseases that lead to damage to the vertebrae and intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
- stroke conditions in which there is a serious disturbance in the blood supply to the spinal cord. In this case, there may be a feeling that the lower back hurts;
- diseases of the gastrointestinal tract. For example, acute appendicitis with an atypical course, intestinal obstruction;
- often back pain is reflected. A similar problem can occur with some diseases of the organs located in the pelvic area. For example, renal colic, sexually transmitted diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, indexitis - all these diseases cause back pain).
Acute and chronic low back pain
Lumbar pain is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. The so-called displaced pain in the lower back is often observed: in this case there is a translation of pain sensations from deeper internal organs and structures of the body; in other words, the patient feels that the lower back hurts, but in fact a completely different part of the body is affected.
Most often, the back hurts in the lumbar region, when the pain is projected in this area by the pelvic organs, kidneys, pancreas, colon or tumors located behind the peritoneum. Many patients do not know what to do if their back hurts. But there is a clear recommendation of what exactly should not be done: to self-medicate. The causes of pain are so varied that only a qualified professional can make a correct diagnosis.
Possible causes of acute lower back pain include:
- The pain is accompanied by sharp stretching of the muscles. In this case, the pain signals are localized in the back, they are delivered by spasmodic long muscles. The pain does not tend to move to the groin or legs. Human mobility is limited.
- One of the most common and severe causes of severe back pain is a fracture of the spine (vertebral fracture, including compression). As a rule, this happens in case of unsuccessful fall, bending of the back and other injuries; but if the patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, has cancerous tumors and their metastases in the spinal region or other lesions of the skeletal system, vertebral fractures can occur literally "surprisingly", andeven without fixation on the patient's sensations at the time of the fracture.
- An equally unpleasant situation in which the lower back hurts sharply is the displacement of the intervertebral discs, which has occurred in the area of the vertebrae. According to the frequency of lesions, areas are distinguished: LV-SII - most often; LIV-LV - second in frequency; LIII-LIV and higher are rarer.
Symptoms include severe lower back pain, forced posture, and limited mobility. Participation in the pathological process of nerve roots is indicated by:
- radicular pain, usually unilateral;
- sensitivity disorders (tingling, increased or decreased sensitivity);
- reduction or disappearance of the Achilles' reflex (in case of damage to the roots of S or S2);
- decreased intensity or absence of the knee (indicates damage to the L3-L4 area).
The general tendency is for a protruding intervertebral disc to affect the main root (eg LIV-LV mismatch causes L5 root pathology). The defeat of the cauda equina (horsetail) impairs the functions of the bladder and rectum. Also, a similar condition can occur with a strong protrusion of the spinal disc.
The back hurts sharply in the lumbar region with facet syndrome: in this case the disc remains intact, and the pain occurs as a result of pressing the root at the exit of the spinal canal. The most commonly observed unilateral facet syndrome in the L5 root area; occurs on the basis of increasing the veneers of the intervertebral joint (upper and lower) and as a result of this narrowing of the intervertebral foramen.
Also, severe lower back pain accompanies an epidural abscess, a serious illness that requires urgent diagnosis and immediate treatment. Most often the inflammatory process develops in the thoracic region of the spine; the pain becomes especially strong with a mechanical effect on the area of pathology (pressure, tapping).
If there are signs of spinal cord compression, all sorts of highly effective medical measures, including surgery, are recommended. Another reason that hurts the lower back can be diseases of the hip joint - especially coxarthrosis. In this case there is a characteristic pain radiating to the lower back, buttocks, and also in the legs to the knees.
Diseases characterized by chronic low back pain:
- Deforming spondylosis is a disease in which there is a dystrophic change in the lumbar vertebrae, calcification of their ligaments and further bone growth; bone growths compress the roots and narrow the spinal canal. In case of lower back pain accompanied by leg weakness, numbness and other neurological symptoms, the possibility of intermittent claudication syndrome, which may be caused by narrowing of the spinal canal, should be considered. An examination is needed, the results of which establish the final diagnosis.
- Ankylosing spondylitis (or Bechterew's disease). In the early stage it is characterized by limited mobility, especially in the morning, with a decrease in chest movements during breathing. There is pulling pain in the lower back; further the curvature of the spine in the thoracic region arises and progresses. X-ray examination reveals anomalies of the sacroiliac joints: destruction, change in structure, "bamboo" spine. It is necessary to thoroughly examine and determine the cause of low back pain, as such symptoms and limited mobility of the lower spine can cause other diseases - Reiter's syndrome, psoriatic arthritis, chronic colitis.
- Oncological diseases (tumors, metastases), metabolic disorders (including NBO). It is necessary to exclude such causes of back pain: metastatic cancer of the lungs, breast, prostate and thyroid gland, kidneys, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). Exceptions are the method of X-ray examination and myelography.
- Osteomyelitis also causes prolonged, painful pain in the lower back. If this disease is suspected, an X-ray of the bone tissue, a skin test with tuberculin and an ESR test are performed to determine the presence / absence of tuberculosis bacteria or pyogenic (pyogenic) bacteria in the body, usually staphylococci, the cause of osteomyelitis.
- Tumors of the spinal cord (intradural tumors) of various types. Diseases such as lipoma, neurofibroma, meningioma can provoke constant back pain, initially without concomitant neurological symptoms.
Causes of back pain of a periodic nature. Many diseases of the internal organs provoke periodic, sharp or pulling pain in the lower back. At the same time, patients do not have a feeling of stiffness in the back, there is no clear location of the pain and the pain does not increase with the maximum possible range of motion. To the question of what to do if the lower back hurts not constantly, but from time to time, the answer is simple: do not wait until it hurts "properly", and consult a doctor.
There is a clear influence of the pathology of one or another organ on a certain part of the spine. Thus, from the pelvic organs the pain is radiated to the sacrum, in diseases of the organs lying in the lower abdominal cavity, it is radiated to the lower back (segments L3-L5), and in the upper part - to the segments of the upper partof the lumbar region or the lower chest area.
Diseases - the causes of pain in the lower back and the area of pain:
- If the pelvic organs are affected, with endometriosis, ovarian or uterine cancer, the lower back hurts. In men, such recurrent pain can be caused by chronic prostatitis or the development of prostate cancer.
- Various kidney diseases provoke pain at the junction of the ribs and spine.
- Tumors of the stomach, duodenum, peptic ulcer, tumors of the pancreas (especially if the disease spreads outside the peritoneum) - the pain spreads to the spinal segments T10-L2;
- In ulcerative colitis, diverticulitis or tumors of the colon, the lower back hurts;
- If the back hurts in the thoracic / lumbar region, aortic dissection (dissecting aneurysm) should be ruled out.
Diagnosis of low back pain
For low back pain and lumbago, computed tomography (magnetic resonance imaging) and magnetic resonance imaging (allowing to assess the condition of soft tissues) tomography and ultrasound scanning of internal organs are recommended.
One method of diagnosis is radiography, which is relatively inexpensive and can be useful in detecting a number of diseases, from bone fractures to kidney stones. Many of the changes found only suggest a correct diagnosis, and further research may be needed to confirm. In addition, some radiological changes may be concomitant findings that are not a cause of pain.
It all starts with a neurological and orthopedic examination by a doctor. This examination assesses the patient's neurological status, as well as identifies possible disorders in the biomechanics of the spine with a mandatory assessment of the condition of the muscles of the back and gluteal region. At this stage of the study, a patient with osteochondrosis of the spine and back and lower back pain can be diagnosed and treated.
Sometimes, according to the results of an orthopedic examination of a patient with a symptom of pain on the background of osteochondrosis of the spine, the following additional diagnostic procedures may be prescribed:
- radiography of the lumbosacral spine with functional tests;
- CT scan of the lumbosacral spine;
- MRI of the lumbosacral spine.
The center of the intervertebral disc is occupied by the gelatinous pulpal nucleus. It is surrounded and supported by a fibrous ring consisting of fibrous cartilage and connective tissue. You can read more about this in the article on the anatomy of the human spine and spinal cord.
The thickness of the discs decreases, the vertebral bodies approach each other, reducing the intervertebral foramina and endangering the nerves and vessels located in them (osteochondrosis).
The protrusion of the discs (protrusion of the intervertebral disc) with their further prolapse in the lumen of the spinal canal (disc herniation) most often leads to compression of the nerve roots, causing pain along the compressed nerve (pain that radiates to the leg, arm, back, neck, intercostal spaces depending on the level of compression of the nerves) with a weakening of muscle strength in the areas of their innervation and impaired sensitivity.
Often the protrusion or hernia of the intervertebral disc is accompanied by muscle pain along the nerve (along the arm or leg). In this case, one or immediately (rarely) two nerves are compressed.
In addition to nerve compression, the stability of the spinal segment may also be impaired. In spinal instability, the vertebrae move forward (anterolysis) or backward (retrolysis). An X-ray of the lumbosacral spine with functional tests may be needed to clarify the diagnosis.
Most often, the nerve bundles that form the sciatic nerve due to their anatomical location suffer from compression of the hernia or protrusion of the intervertebral disc. The sciatic nerve consists of fibers L5, S1, S2, S3 - spinal nerves.
The focus of chronic inflammation in the lumen of the spinal canal can lead to the formation of its narrowing (stenosis of the spinal canal) and compression of the nerves and spinal cord passing through it. Therefore, in spinal stenosis it is always necessary to conduct a full course of treatment, using a whole arsenal of different treatment methods, and in case of ineffectiveness - surgical treatment.
Which doctor should I go to?
In case of back pain, in the first place, you should contact a neurologist at the district clinic if the patient's condition is stable, or call an ambulance. Low back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.
Low back pain is combined with various infections, injuries to the limbs. Low back pain is not ruled out in heart and lung diseases. This is established through an in-depth review. Once a patient is diagnosed, he or she is usually prescribed medications that reduce back pain, normalize blood circulation, and help repair nerve tissue. These can be tablets, gels, ointments or injections that relieve inflammation and cramps.
Surgery is usually required to diagnose a herniated disc, which is a complication of osteochondrosis. The hernia that presses on the nerve root is removed, restored, and the pain goes away over time.
It is best to relax your spine and paravertebral muscles if you sleep on a firm mattress with a small pillow under your knees. At the same time, bed rest should not last too long, as this is fraught with weakening of the paravertebral muscles, which will only worsen the problem. Even in severe pain, you should try to maintain at least low physical activity.
How to relieve back pain
The appearance of a symptom of pain is often due to muscle spasm, which can be eliminated with the help of special means - muscle relaxants. Such drugs are actively used in the treatment of diseases of the spine.
So, in case of severe, unexpected pain in the lower back, it is recommended to take a tablet for muscle relaxation, to rub the back with a warming anesthetic gel. When using funds, you must strictly follow his instructions.
In cases where an unpleasant symptom is due to the presence of inflammatory diseases of the internal organs, it is recommended not to delay contacting a doctor, if at some point it is impossible to visit a specialist and the pain is too intense, you can take Pentalgin or No-Shpu. The inflamed area should not be heated with a heating pad, as the heat contributes to the spread of the inflammatory process and therefore to the aggravation of the accompanying symptoms.
Ointment for back pain
Preparations in the form of ointments are often used in the treatment of diseases of the lower spine. These drugs include drugs that have pronounced anti-inflammatory, mild analgesic and antipyretic effects.
The course of treatment is prescribed taking into account the severity of the pain symptom. Ointment for back pain is used as a primary or secondary treatment. In severe symptoms of osteochondrosis, rubbing of the lower back with ointments based on ketoprofen, a substance with a powerful analgesic effect, has been shown.
The main advantage of topical preparations is due to their effect not on the whole body as a whole, but on a specific area that needs treatment. Painkillers and anti-inflammatory ointments have fewer contraindications and side effects than similar drugs in tablet form.
Exercises for back pain
Gymnastics is considered an additional method for the treatment of diseases of the lower spine. The exercises shown to the patients are quite simple and are not accompanied by a special load on the body. For example, the usual suspension of the crossbeam on the horizontal beam has a beneficial effect on the condition of the spine, helps to relax muscles and eliminate lumbago - pain caused by pinching its nerve roots. Therapeutic exercises for back diseases, accompanied by lower back pain, include exercises:
- lifting the legs (so that the knee touches the chin);
- "bicycle" performed lying on its back;
- walking on your knees.
Every day it is recommended to give exercises no more than 10-15 minutes, with severe pain - to refuse to perform them.