Backache

Low back pain is often referred to as lumbago or lumbodynia. Lumbago or "lumbago" is an attack of acute lower back pain, which is usually associated with hypothermia and energy. Lumbago occurs in many people and is often the cause of temporary disability. Often, a sports injury or sprain can be the cause of lumbago, but sometimes the factors that give rise to the appearance of pain are still unknown. Lumbago is characterized by pain without radiating to the feet. Low back pain (lumbago) can appear acutely and gradually develop throughout the day. Often there is stiffness in the morning and gradually the stiffness turns into pain syndrome. Curvature of the spine (antalgic scoliosis) may also be due to muscle spasms. The pain itself may be due to muscle spasm, which in turn is related to other causes. These can be overload or sprains, sports injuries, herniated discs, spondyloarthrosis (spondylosis), kidney disease (infection or kidney stones). Sometimes patients accurately determine the causal relationship of the appearance of malaise with energy, hypothermia, but often the pain appears for no apparent reason. Occasionally, back pain can appear even after sneezing, bending over, or wearing shoes. This can be facilitated by deformed spinal diseases, such as scoliosis.

Unlike lumbago, the term lumbodynia means not acute pain, but subacute or chronic pain. As a rule, pain with lumbodynia appears gradually over several days. Pain can also occur in the morning and may decrease with physical activity. Lumbodynia is characterized by increased pain during prolonged static load (sitting, uncomfortable body position). It is also a feature of lumbodynia that the pain is relieved by lying down in a certain position. Lumbodynia patients have difficulty performing routine activities such as washing or wearing shoes due to muscle spasms. Due to this disease, there is a decrease in the amount of trunk movement (leaning forward or, to a lesser extent, leaning sideways or extended). Due to pain syndrome, patients often have to change positions when they need to sit or stand. Unlike lumbago, muscle spasms are less pronounced and, as a rule, do not cover the entire lower back, and there are often signs of the prevalence of spasms on one side.

Causes of back pain

Back pain is a symptom. The most common causes of back pain are diseases (injuries) of muscles, bones, and intervertebral discs. Sometimesbackachecan be caused by diseases of the abdominal cavity, small pelvis and chest. Such pain is called reflected pain. Abdominal diseases (e. g. , appendicitis), aortic aneurysms, kidney diseases (urolithiasis, kidney infections, bladder infections), infections of the pelvic organs, ovaries - all these diseases can manifest.backache. . . Even a normal pregnancy can cause lower back pain due to sprains in the pelvic area, muscle spasms due to stress, and nerve irritation.

Oftenbackacheassociated with the following diseases:

• Nerve root compression, which causes sciatica symptoms and is most often caused by a herniated disc. As a rule, when the nerve root is compressed, the pain is acute, has impaired irradiation and sensitivity in the nerve root conservation zone. Disc herniation occurs primarily as a result of disc degeneration. There is a bulging of the gelatin portion of the disc from the central cavity and pressure on the nerve root. The degenerative process in the intervertebral disc begins at the age of 30 years and older. But the presence of a hernia does not always lead to an effect on the nerve structure.
• Spondylosis - degenerative changes occur in the vertebrae themselves, bone growth (osteophytes) occurs, which can affect nearby nerves, leading to pain.
• Spinal stenosis can occur as a result of degenerative changes in the spine (spondylosis and osteochondrosis). Patients with spinal stenosis in the lumbar region may experience lower back pain that radiates to both legs. Low back pain can appear as a result of standing or walking.
• Cauda equina syndrome. This is a medical emergency. Cauda equina syndrome occurs as a result of compression of the cauda equina element (the terminal part of the spinal cord). Patients with cauda equina syndrome may experience pain and impaired bowel and bladder function (urinary incontinence and atonia). This syndrome requires emergency surgery.
• Pain syndromes such as myofascial pain syndrome or fibromyalgia. Myofascial pain syndrome is characterized by pain and soreness at a particular point (trigger point), a decrease in the amount of muscle movement in the painful area. Pain syndrome is reduced by relaxing the muscles located in the painful area. With fibromyalgia, aches and pains are common throughout the body. Fibromyalgia is not characterized by muscle tightness and pain.
• Bone infections (osteomyelitis) of the spine are rarely the cause of this disease.
• Non -communicable inflammatory diseases of the spine (ankylosing spondylitis) can cause stiffness and pain in the spine (including the lower back), which is worse in the morning.
• Tumors, often cancer metastases, can be a cause of lower back discomfort.
• Inflammation of the nerves and, thus, manifestations of pain (in the chest or in the lumbar region) can be caused by damage to the nerves themselves (e. g. , with shingles)
• Given the various causes of symptoms, such as acute or subacute low back pain, it is very important to fully evaluate the patient and perform all necessary diagnostic procedures.

symptoms

Pain in the lumbosacral region is the main symptom of lumbago, lumbodynia, lumboishalgia.

• The pain may radiate to the front, side, or back of the leg (lumbar ischalgia), or it may be localized only in the lumbar region (lumbago, lumbodynia).
• The feeling that the lower back hurts can increase after exercising.
• Sometimes the pain can be worse at night or when sitting for a long time, such as during a long car trip.
• Probably the presence of numbness and weakness in the legs, which are located in the conservation zone of compressed nerves.

For timely diagnosis and treatment, several criteria (symptoms) deserve special attention:

• A history of recent injuries, such as falling from a height, road accident or similar incident.
• The presence of minor injuries in patients older than 50 years (e. g. , falling from a low height due to sliding and landing on the back).
• History of long -term use of steroids (for example, this is a patient with bronchial asthma or rheumatological disease).
• Any patient with osteoporosis (mostly elderly women).
• Any patient over the age of 70: at this age, there is a high risk of getting cancer, infections and diseases of the abdominal organs, which can cause lower back pain.
• History of oncology
• The presence of infectious diseases in the past
• Temperatures above 100F (37. 7 C)
• Drug use: Drug use increases the risk of infectious diseases.
• Lower back pain worsens at rest: as a rule, the nature of this pain is associated with oncology or infection, and such pain can also occur with ankylosing spondylitis (ankylosing spondylitis).
• Significant weight loss (for no apparent reason).
• The presence of any acute nerve dysfunction is a signal for immediate medical treatment. For example, this is a violation of walking, foot dysfunction, as a rule, is a symptom of acute nerve injury or compression. In certain circumstances, such symptoms may require emergency neurosurgery.
• Bowel or bladder dysfunction (both incontinence and urinary retention) can be a sign of a medical emergency.
• Failure of recommended treatment or increased pain may also require seeking medical attention.

The presence of any of the above factors (symptoms) is a signal to seek medical help within 24 hours.

Diagnostics

Medical history is important to make an accurate diagnosis, as a variety of conditions can cause lower back pain. Time of onset of pain, contact with physical effort, presence of other symptoms such as cough, rise in temperature, dysfunction of the bladder or intestines, the presence of seizures, etc. Physical examination is carried out: identification of pain points, the presence of muscle spasms, study of neurological status is carried out. If there is a suspicion of disease of the abdominal cavity or pelvic organs, then an examination is carried out (ultrasound of the abdominal organs, ultrasound of the pelvic and pelvic organs, urine blood test).

If the somatic genesis of lower back pain is excluded, then instrumental research methods such as radiography, CT or MRI may be prescribed.

X-rays are a method of initial examination and allow you to determine the presence of changes in bone tissue and indirect signs of changes in the intervertebral disc.

CT allows you to visualize the presence of various changes, both in bone tissue and in soft stones (especially with contrast).

MRI is the most informative research method that allows diagnosing morphological changes in various tissues.

Densitometry is required when osteoporosis is suspected (usually in women over 50 years of age)

EMG (ENMG) is used to determine conduction violations along nerve fibers.

Laboratory tests are prescribed (blood tests, urine tests, blood biochemistry) mainly to exclude inflammatory processes in the body.

Pain treatment

After diagnosis and confirmation of vertebral genesis with lumbago and lumbodynia is established, specific treatments for lower back pain are prescribed.

In acute pain, rest is required for 1-2 days. Bed rest can reduce muscle tension and muscle cramps. In most cases, when the pain syndrome is caused by muscle spasm, the pain syndrome subsides in a few days without the use of medication, simply because of rest.

Medicine. For pain syndrome, drugs of the NSAID group are used. COX-2 inhibitors have fewer side effects, but long-term use of these drugs also has certain risks. Since all drugs in this group have many side effects, the intake of drugs in this group should be short -term and under the mandatory supervision of a physician.

Muscle relaxation can be used to relieve cramps. But the use of these drugs is effective only in the presence of cramps.

Steroids can be used to treat pain, especially when there are signs of sciatica. But due to the presence of significant side effects, steroid use should be selective and short -term.

Manual therapy. This technique can be very effective in the presence of muscle blocks or subluxation of facet joints. Moving motor segments can reduce muscle spasms and lower back pain.

Physiotherapy. There are many modern physiotherapy procedures that can reduce pain and inflammation, improve microcirculation (e. g. , electrophoresis, cryotherapy, laser therapy, etc. ).

Exercise therapy. Exercise is not recommended for severe back pain. Continuation of exercise therapy is possible after reducing the pain syndrome. With the presence of chronic pain, exercise can be very effective in strengthening the muscular corset and improving the biomechanics of the spine. Exercise should be chosen only with an exercise therapy doctor, because often independent exercise can lead to increased manifestations of pain. Systematic exercise therapy, especially in the presence of degenerative changes in the spine (osteochondrosis, spondylosis), can maintain spinal function and significantly reduce the risk of pain syndrome.