Almost every adult has experienced back pain in their lifetime. This is a very common problem, which can be based on various reasons, which we will analyze in this article.
Causes of back pain
All causes of back pain can be divided into groups:
Musculoskeletal:
- Osteochondrosis;
- disc herniation;
- Compressive radiculopathy;
- Spondylolisthesis;
Inflammation, including infectious:
- Osteomyelitis
- Dry cough
neurology;
injury;
Endocrinology;
Vascular;
Tumors.
At the first visit to the doctor with back pain, the specialist should determine the cause and type of pain, paying special attention to "red flags" - possible manifestations of a potentially dangerous disease. "Red flags" refer to a set of specific complaints and anamnesis data that require an in-depth examination of the patient.
"Red flag":
- age of the patient at the time of onset of illness: younger than 20 or older than 50;
- 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, etc. );
- fever;
- weight loss, loss of appetite;
- unusual localization of pain;
- increased pain in a horizontal position (especially at night), in a vertical position - debilitating;
- no improvement for 1 month or more;
- pelvic organ dysfunction, including urinary and defecation disorders, perineal numbness, symmetrical weakness of the lower extremities;
- alcoholism;
- narcotic drug use, especially intravenous;
- treatment with corticosteroids and/or cytostatics;
- with pain in the neck, throbbing nature of the pain.
The presence of one or more signs by itself does not mean the presence of a dangerous pathology, but it requires the attention of a doctor and diagnosis.
Back pain is divided into the following forms according to duration:
- acute- pain lasting less than 4 weeks;
- subacute- pain that lasts from 4 to 12 weeks;
- chronic- pain lasting 12 weeks or more;
- recurrent pain- resumption of pain if it did not occur in the last 6 months or more;
- exacerbation of chronic painRecurrence of pain less than 6 months after the previous episode.
Illness
Let's talk more about the most common musculoskeletal causes of back pain.
Osteochondrosis
This is a disease of the spine, which is based on the wear of the vertebral discs and, in turn, the vertebrae themselves.
Is osteochondrosis a pseudodiagnosis? - Nope. 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 arises due to the fact that foreign doctors understand osteochondrosis as a disease of the spine in children and adolescents related to growth. However, this term refers specifically to degenerative diseases of the spine in people of any age. Also, the diagnosis that is often set is dorsopathy and dorsalgia.
- Dorsopathy is a pathology of the spine;
- Dorsalgia is a non-specific 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 parts: cervical, thoracic, lumbar, sacral and coccygeal. Pain can occur in any of these areas, which are described by the following medical terms:
- Cervicalgia is pain in the cervical spine. Intervertebral discs in the cervical region have anatomical features (intervertebral discs are absent in the upper part, and in other parts they have a weakly expressed nucleus pulposus with its regression, on average, by 30 years), which makes it more susceptible to pressure. and injuries, which lead to ligament stretching and the early development of degenerative changes;
- Thoracalgia - pain in the thoracic spine;
- Lumbodynia - pain in the lumbar spine (lower back);
- Lumboischialgia is pain in the lower back that radiates to the legs.
Factors that lead to the development of osteochondrosis:
- heavy physical labor, lifting and moving heavy loads;
- low physical activity;
- long sedentary work;
- staying for a long time in an uncomfortable position;
- working for a long time at the computer with a non-optimal location of the monitor, which puts a strain on the neck;
- violation of posture;
- congenital structural features and spinal column anomalies;
- back muscle weakness;
- high growth;
- overweight;
- foot joint diseases (gonarthrosis, coxarthrosis, etc. ), flat feet, club feet, etc. ;
- natural wear and tear with age;
- smoking
disc herniationis the 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;
- radiating pain to other areas: arms, shoulder blades, legs, groin, rectum, etc.
- "shots" of pain;
- numbness;
- crawling sensation;
- muscle weakness;
- pelvic disorders.
The localization of pain depends on the level at which the hernia is localized.
Disc herniations often heal on their own within 4-8 weeks on average.
Compressive radiculopathy
Radicular syndrome (radicular) is a complex of manifestations that occurs as a result of compression of the spinal roots at the point of their departure from the spinal cord.
Symptoms depend on the degree to which spinal cord compression occurs. Possible manifestations:
- pain in the extremities of a shooting nature with radiation to the fingers, aggravated by movement or coughing;
- numbness or tingling sensation in certain areas (dermatome);
- muscle weakness;
- back muscle spasms;
- violation of reflex strength;
- positive symptoms of tension (appearance of pain with passive flexion of the limb)
- limitation of spinal mobility.
Spondylolisthesis
Spondylolisthesis is a displacement of the upper vertebra relative to the lower one.
This condition can occur in children and adults. Women are more often affected.
Spondylolisthesis may not cause symptoms with slight displacement and may be an incidental x-ray finding.
Possible symptoms:
- not feeling well
- pain in the back and lower legs after physical work,
- weakness in the legs
- radicular syndrome,
- reduce pain and sensitivity to touch.
The development of vertebral displacement can cause lumbar stenosis: the anatomical structure of the spine deteriorates and expands, which gradually leads to compression of nerves and blood vessels in the spinal canal. symptoms:
- constant pain (both during rest and movement),
- in some cases, the pain may decrease in the supine position,
- the pain does not worsen with coughing and sneezing,
- the nature of the pain from pulling to very intense,
- pelvic organ dysfunction.
With a strong displacement, arterial compression can occur, as a result of which the blood supply to the spinal cord is disrupted. This is indicated by a sharp weakness in the legs, a person may fall.
Diagnostics
Collection of complaintshelp the doctor to suspect the possible cause of the disease, to determine the localization of the pain.
Assessment of Pain Intensity- a very important stage of diagnosis, allowing you to choose treatment and evaluate its effectiveness over time. In practice, the Visual Analogue Scale (VAS) is used, which is suitable for patients and for doctors. In this case, patients rate the severity of pain on a scale from 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 the factors that trigger pain and the destruction of the anatomical structure of the spine, to identify movements and postures that cause, intensify and relieve pain.
Physical examination:evaluation of the presence of back muscle spasms, determination of skeletal muscle development, exclusion of the presence of signs of infectious lesions.
Assessment of neurological status:muscle strength and symmetry, reflexes, sensitivity.
Mac Test:carried out in cases of suspected lumbar stenosis.
Important!Patients without "red flags" with a classic clinical picture are not recommended to conduct additional studies.
Radiography:carried out with functional tests for suspected instability of the spinal structure. However, this diagnostic method is uninformative and is carried out mainly with limited financial resources.
Computed tomography (CT) and/or magnetic resonance imaging (MRI):the doctor will prescribe based on clinical data, because this method has different indications and benefits.
CT |
MRI |
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Important!In most people, if there are no complaints, degenerative changes in the spine are detected by instrumental examination methods.
Bone densitometry:performed to assess bone density (confirmation or exclusion of osteoporosis). This study is recommended for postmenopausal women with a high risk of fracture and always at the age of 65, regardless of risk, men over 70, fracture patients with a minimal history of trauma, long-term use of glucocorticosteroids. The 10-year fracture risk was assessed using the FRAX scale.
Bone scintigraphy, PET-CT:carried out in the presence of suspicion of oncological disease according to other examination methods.
back pain treatment
For acute pain:
- painkillers are prescribed in the course, mainly from the group of non-steroidal anti-inflammatory drugs (NSAIDs). Certain drugs and dosages are chosen depending on the severity of the pain;
- maintaining moderate physical activity, special exercises to relieve pain;
Important!Physical inactivity 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, however, their effectiveness according to various studies is still unclear;
- manual therapy;
- lifestyle analysis and elimination of risk factors.
For subacute or chronic pain:
- use of painkillers on demand;
- special physical training;
- evaluation of the psychological state, as 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;
- lifestyle analysis and elimination of risk factors.
In radicular syndrome, blockade (epidural injection) or intraosseous block is used.
Surgical treatment is indicated with a rapid improvement in symptoms, the presence of spinal cord compression, with significant stenosis of the spinal canal, and ineffectiveness of conservative therapy. Emergency surgical treatment is carried out in the presence of: pelvic disorders with numbness in the anogenital area and weakness of ascending legs (cauda equina syndrome).
Restoration
Rehabilitation should begin as soon as possible and have the following goals:
- improve quality of life;
- elimination of pain, and if it is impossible to eliminate it completely - relief;
- functional recovery;
- recovery;
- self-service training and safe driving.
Basic rules of recovery:
- the patient must feel his own responsibility for his health and compliance with the recommendations, however, the doctor must choose treatment and rehabilitation methods that the patient can adhere to;
- systematic training and compliance with safety rules during training;
- 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 when moving;
- the patient should feel the positive effect of rehabilitation on his condition;
- patients need to develop pain response skills;
- the patient should associate movement with positive thinking.
Recovery method:
- walk;
- Physical training, gymnastics, gymnastics programs at work;
- Individual orthopedic devices;
- Cognitive behavioral therapy;
- Patient Education:
- Avoid excessive physical activity;
- Fight low physical activity;
- Exclusion of prolonged static load (standing, being in an uncomfortable position, etc. );
- Avoid hypothermia;
- Sleep organization.
Prevention
Optimal physical activity: strengthens the muscular skeleton, 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 at a time, 3 days a week).
With prolonged sedentary work, it is necessary to take a break to warm up every 15-20 minutes and follow the rules of sitting.
life hack:
how to sit
- avoid furniture that is too soft;
- the feet should rest on the floor, which is achieved with 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 upright, maintain correct posture, the back should fit the back of the chair to avoid tense back muscles;
- the head when reading a book or working on the computer should have a physiological position (look straight ahead, and not always down). To do this, it is recommended to use a special stand and install the computer monitor at the optimal height.
With prolonged standing work, it is necessary to change the position every 10-15 minutes, alternately change the supporting leg, and, if possible, walk in place and move.
Avoid prolonged lying down.
life hack:
how to sleep
- sleep better on a semi-rigid surface. If possible, you can choose an orthopedic mattress so that the spine maintains a physiological curve;
- the pillow should be soft enough and of medium height to avoid pressure on the neck;
- when sleeping on your back, it is recommended to place a small pillow under your stomach.
Quit smoking: If you are having difficulty, see your doctor who will refer you to a smoking cessation program.
Frequently asked questions
I use ointment with glucocorticosteroids. Am I at increased risk of osteochondrosis or osteoporosis? Nope. External glucocorticosteroids (ointment, cream, gel) do not penetrate in significant amounts into the systemic circulation, and therefore do not increase the risk of developing this disease.
In every case of herniated disc, surgery is necessary? Nope. Surgical treatment is carried out only if indicated. On average, only 10-15% of patients require surgery.
Should you stop exercising if you have back pain? Nope. If, as a result of additional examination methods, the doctor does not find anything that will significantly limit the level 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 physiotherapy and swimming.
Can back pain go away forever if I have a herniated disc? They can after a productive course of conservative therapy, subject to further implementation of the recommendations of the attending neurologist, compliance with preventive rules, regular exercise therapy and swimming.