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back pains

Back pain is a sign of diseases of the musculoskeletal system

Almost every adult has experienced back pain in their lifetime. This is a very common problem that can be based on various reasons that we will analyze in this article.

Causes of back pain

All causes of back pain can be divided into groups:

  1. Musculoskeletal:

    • Osteochondrosis;
    • disc herniation;
    • Compression radiculopathy;
    • spondylolisthesis;

  2. Inflammatory, including infectious:

    • Osteomyelitis
    • Tuberculosis

  3. neurological;

  4. Injuries;

  5. Endocrinological;

  6. vascular;

  7. Tumor.

At the first visit to a doctor with back pain, the specialist must determine the cause and type of pain, paying special attention to "red flags" - possible manifestations of potentially dangerous diseases. "Red flags" refers to a set of specific complaints and history that require a thorough examination of the patient.

"Red Flags":

  • age of the patient at the time of onset of pain: younger than 20 or over 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 a horizontal position (especially at night), in a vertical position - weakening;
  • no improvement for 1 month or more;
  • dysfunction of the pelvic organs, including disorders of urination and defecation, numbness of the perineum, symmetrical weakness of the lower limbs;
  • alcoholism;
  • the use of narcotic substances, especially intravenous;
  • treatment with corticosteroids and/or cytostatics;
  • with pain in the neck, pulsating nature of the pain.

The presence of one or more signs in itself does not mean the presence of a dangerous pathology, but requires the attention of a doctor and diagnostics.

Back pain is divided into the following forms by duration:

  • sharp- pain lasting less than 4 weeks;
  • subacute- pain lasting from 4 to 12 weeks;
  • chronic- pain lasting 12 weeks or more;
  • pain recurrence- renewal of pain, if it has not appeared 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 more about the most common musculoskeletal causes of back pain.

Osteochondrosis

This is a disease of the spine, the basis of which is the wear and tear of the spinal discs, and subsequently of the vertebrae themselves.

Is osteochondrosis a pseudodiagnosis? - No. This diagnosis exists in the International Classification of Diseases ICD-10. 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 due to the fact that foreign doctors understand osteochondrosis as a disease of the spine in children and adolescents, associated with growth. However, this term refers specifically to degenerative spinal disease in people of any age. Also, often established diagnoses are dorsopathy and dorsalgia.

  • Dorsopathy is a pathology of the spine;
  • Dorsalgia is a benign non-specific back pain that spreads from the lower cervical vertebrae to the sacrum, which can also be caused by damage to other organs.

The spine has several divisions: cervical, thoracic, lumbar, sacral and coccygeal. Pain can occur in any of these areas, which is described by the following medical terms:

  • Cervicalgia is pain in the cervical spine. The intervertebral discs of the cervical region have anatomical features (the intervertebral discs are absent in the upper part, and in other parts they have a weakly expressed nucleus pulposus with its regression on average up to 30 years), which makes them more susceptible to stress and injury, which leads to stretching ofconnections and early development of degenerative changes;
  • Thoracalgia - pain in the thoracic region of the spine;
  • Lumbodynia - pain in the lumbar spine (lower back);
  • Lumboschialgia is pain in the lower back that radiates to the leg.

Factors leading to the development of osteochondrosis:

  • heavy physical labor, lifting and moving heavy loads;
  • low physical activity;
  • long sedentary work;
  • long stay in an uncomfortable position;
  • prolonged work at the computer with a suboptimal location of the monitor, which creates a load on the neck;
  • posture disorder;
  • congenital structural features and anomalies of the spine;
  • weakness of the back muscles;
  • high growth;
  • overweight;
  • diseases of the joints of the feet (gonarthrosis, coxarthrosis, etc. ), flat feet, flat feet, etc. ;
  • natural wear and tear with age;
  • smoking.

disc herniationis a protrusion of the nucleus of the intervertebral disc. It can be asymptomatic or cause compression of surrounding structures and manifest as a radicular syndrome.

Symptoms:

  • range of motion violation;
  • feeling of stiffness;
  • muscle strain;
  • radiating pain in other areas: hands, shoulder blades, legs, groin, rectum, etc.
  • "shots" of pain;
  • numbness;
  • crawling sensation;
  • muscle weakness;
  • pelvic disorders.

The localization of the pain depends on the level at which the hernia is located.

Herniated discs often go away on their own within 4-8 weeks on average.

Compression radiculopathy

Radicular (radicular) syndrome is a complex of manifestations that occur due to compression of the spinal roots at the points of their exit from the spinal cord.

Symptoms depend on the level at which spinal cord compression occurs. Possible manifestations:

  • pain in the extremity of a shooting character with irradiation to the fingers, increasing with movement or coughing;
  • tingling or sensation of crawling flies in a certain area (dermatome);
  • muscle weakness;
  • back muscle spasm;
  • violation of the strength of reflexes;
  • positive tension symptoms (the appearance of pain when passively flexing the limbs)
  • limitation of spinal mobility.

Spondylolisthesis

Spondylolisthesis is a displacement of the upper vertebra relative to the lower one.

This condition can occur in both children and adults. Women are more often affected.

Spondylolisthesis may cause no symptoms with mild 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.

The progression of the displacement of the vertebrae can lead to lumbar stenosis: the anatomical structures of the spine degenerate and grow, which gradually leads to compression of the nerves and blood vessels in the spinal canal. Symptoms:

  • constant pain (both at rest and in motion),
  • in some cases, the pain may decrease when lying down,
  • the pain does not worsen with coughing and sneezing,
  • the nature of the pain from pulling to very strong,
  • pelvic organ dysfunction.

With a strong displacement, compression of the arteries can occur, as a result of which the blood supply to the spinal cord is disturbed. This is manifested by acute weakness in the legs, a person may fall.

Diagnosis

Collection of complaintshelps 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 diagnostics, which allows you to choose a treatment and evaluate its effectiveness over time. In practice, the visual analog scale (VAS) is used, which is convenient for the patient and the doctor. In this case, the patient evaluates the strength of the pain on a scale from 0 to 10, where 0 points means no pain, and 10 points is the worst pain that a person can imagine.

Interviewallows you to identify the factors that provoke pain and destruction of the anatomical structures of the spine, to identify movements and postures that cause, intensify and relieve pain.

Physical examination:assessment of the presence of spasm of the back muscles, determination of the development of the muscular skeleton, exclusion of the presence of signs of an infectious lesion.

Assessment of neurological status: muscle strength and its symmetry, reflexes, sensitivity.

Test in March:performed when lumbar stenosis is suspected.

important!For patients without "red flags" with a classic clinical picture, it is not recommended to conduct additional research.

X-ray:carried out with functional tests in case of suspected instability of the spinal structures. However, this diagnostic method is uninformative and is mostly carried out with limited financial resources.

Computed tomography (CT) and/or magnetic resonance imaging (MRI):the doctor will prescribe based on clinical data, since these methods have different indications and benefits.

CT

MRI
  • Assesses bony structures (vertebrae).

  • It allows you to see the later stages of osteochondrosis, in which bone structures are affected, compression fractures, destruction of the vertebrae in metastatic lesions, spondylolisthesis, abnormalities in the structure of the vertebrae, osteophytes.

  • It is also used in contraindications for MRI.
  • Evaluates soft tissue structures (intervertebral discs, ligaments, etc. ).
  • It allows you to see the first signs of osteochondrosis, intervertebral hernia, diseases of the spinal cord and roots, metastases.

important!In most people, in the absence of complaints, degenerative changes in the spine are detected by instrumental research methods.

Bone densitometry:performed to assess bone density (confirm or rule out osteoporosis). This study is recommended for postmenopausal women with a high risk of fractures and always aged 65 years, regardless of risk, men over 70 years, fracture patients with minimal history of trauma, long-term use of glucocorticosteroids. The 10-year fracture risk was assessed using the FRAX scale.

Bone scintigraphy, PET-CT:performed in case of suspicion of oncological disease according to other research methods.

back pain treatment

In acute pain:

  • Painkillers are usually prescribed, mainly from the group of non-steroidal anti-inflammatory drugs (NSAIDs). The specific drug and dosage are selected depending on the severity of the pain;
  • maintaining moderate physical activity, special exercises to relieve pain;

    important!Lack of physical activity with back pain increases pain, prolongs the duration of symptoms, and increases the likelihood of chronic pain.

  • muscle relaxants for muscle spasms;
  • it is possible to use vitamins, but their effectiveness according to various studies remains unclear;
  • manual therapy;
  • lifestyle analysis and elimination of risk factors.

For subacute or chronic pain:

  • use of pain relievers on demand;
  • special physical exercises;
  • assessment of psychological status, as it may 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;
  • lifestyle analysis and elimination of risk factors.

In radicular syndrome, blocks (epidural injections) or intraosseous blocks are used.

Surgical treatment is indicated in case of rapid increase in symptoms, presence of spinal cord compression, with significant stenosis of the spinal canal and ineffectiveness of conservative therapy. Urgent surgical treatment is performed in the presence of: pelvic disorders with numbness in the anogenital area and ascending weakness of the feet (cauda equina syndrome).

Rehabilitation

Rehabilitation should begin as soon as possible and have the following goals:

  • improving the quality of life;
  • removal of pain, and if it is impossible to remove it completely - relief;
  • restoration of functioning;
  • rehabilitation;
  • self-service and safe driving training.

Basic rules for rehabilitation:

  • the patient must feel his own responsibility for his health and compliance with the recommendations, but the doctor must choose the methods of treatment and rehabilitation that the patient can comply with;
  • systematic training and compliance with safety rules when 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 must feel comfortable and safe when performing movements;
  • the patient must feel the positive impact of rehabilitation on his condition;
  • the patient must develop skills to respond to pain;
  • the patient must associate the movement with positive thoughts.

Rehabilitation methods:

  1. walking
  2. Physical exercise, gymnastics, gymnastics programs in the workplace;
  3. Individual orthopedic devices;
  4. Cognitive behavioral therapy;
  5. Patient education:
    • Avoid excessive physical activity;
    • Combating low physical activity;
    • Exclusion of prolonged static loads (standing, 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 incidents. The most optimal physical activity is walking more than 90 minutes a week (at least 30 minutes at a time, 3 days a week).

With prolonged sedentary work, it is necessary to take warm-up breaks every 15-20 minutes and follow the rules of sitting.

To make your life easier:how to sit

  • avoid overly upholstered furniture;
  • the legs must 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 length of the hips;
  • sit straight, maintain a correct posture, the back should fit tightly against the back of the chair to avoid straining the back muscles;
  • the head when reading a book or working on a computer should be in a physiological position (look straight ahead, not constantly down). To do this, it is recommended to use special stands and install the computer monitor at an optimal height.

With prolonged work in a standing position, it is necessary to change the position every 10-15 minutes, successively changing the supporting leg and, if possible, walking in place and moving.

Avoid prolonged lying down.

To make your life easier:how to sleep

  • you 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 straining the neck;
  • when sleeping in a supine position, it is recommended to place a small pillow under the abdomen.

Quit smoking: If you're having trouble, see your doctor, who will refer you to a smoking cessation program.

Frequently Asked Questions

  1. I use ointments with glucocorticosteroids. Am I at increased risk of osteochondrosis or osteoporosis?

    No. External glucocorticosteroids (ointments, creams, gels) do not penetrate in significant quantities into the systemic circulation and therefore do not increase the risk of developing these diseases.

  2. Is surgery necessary in every case of a herniated disc?

    No. Surgical treatment is performed only if indicated. On average, only 10-15% of patients need surgery.

  3. Should you stop exercising if you have back pain?

    No. If, as a result of the additional research methods, the doctor does not find anything that significantly limits the degree of load on the spine, then it is possible to continue playing sports, but after undergoing a course of treatment and adding certain exercises from a course of physical therapy exercises and swimming.

  4. Can my back pain go away forever if I have a herniated disc?

    They can after a course of productive conservative therapy, with further implementation of the recommendations of the treating neurologist, compliance with the rules of prevention, regular exercise and swimming.