Most people experience back problems from time to time and experience pain in the lower back, neck or middle back. In fact, back pain is the most common physical complaint among the elderly and the main cause of temporary disability. Back pain can be mild or severe, the pain can be short-term or chronic.
Back pain includes: muscle and tendon pain, disc herniation, fracture or other back problems. Most often, the reasons have a long history. Most often, back pain is caused by diseases of the spine.
The structure of the spine is designed for extreme loads. The structure of the spine is stable enough for a person to walk (stand) and flexible enough to perform movements of the trunk.
A healthy spine has an elongated S-shape, seen from the side, and has natural curves in the lumbar, thoracic and cervical spine. The spine is the main supporting part of the torso. In addition, the spinal cord protects the spinal cord and the roots of the spinal cord with its bone structure, thus providing normal innervation of organs and tissues.
Between each of the 24 vertebrae, there are intervertebral discs that perform a cushioning function.
Causes
Back pain refers to problems that a person most often creates. Back problems and back pain are most often caused by bad habits that have accumulated over a long period of time. These bad habits include:
- Bad stand
- Overvoltage during operation
- Improper desk posture or driving
- Repeated stretching or stretching of the spine or unusually abrupt lifting of weights.
The results of habits rarely appear immediately, but more often their negative effects accumulate over time. One of the most common types of back pain is pain associated with tension in the muscles around the spine. Most often, back pain associated with tension, muscles appear in the lumbar spine and cervical spine. If muscle tension is associated with lifting heavy objects, then the pain can be excruciating.
Sometimes back pain occurs for no apparent reason. In such cases, they talk about non-specific back pain. Such pain can develop due to weakened muscles that cannot cope with daily stress, such as walking, bending and stretching. In addition, such nonspecific pain can be caused by poor sleep, general fatigue, or exposure to stressful situations.
Chronic pain in myofascial pain syndrome is caused by localized muscle tension. Sometimes this localized muscle tension is due to stress or other emotional problems.
Pregnancyis often the cause of the disease and this is due to both hormonal changes in a woman's body and weight gain and excessive stress on the spine and legs.
Contact sports injuries, accidents and falls can also cause back problems, ranging from minor muscle strain to serious injuries to the spine and spinal cord.
It is important to understand that back pain is one of the symptoms of the disease and is not a diagnosis. Medical conditions that can cause back pain include the following:
Mechanical problems: Mechanical problems are related to the movements of the spine or the sensations that a person experiences when performing certain movements. The most common mechanical cause is degeneration of the intervertebral discs (osteochondrosis), when there are involuntary changes in the intervertebral discs and deterioration of the cushioning functions of the discs, which leads to pain. Another cause of back pain is degenerative changes in the joints of the spine (spondyloarthritis). Other mechanical causes include muscle spasms, muscle tension and disc herniation.
Injuries: Spinal injuries such as sprains and fractures can cause both acute pain and chronic pain. Sprains, ruptures of the ligaments that support the spine, can occur from twisting the torso or improper lifting. Vertebral fractures are often the result of osteoporosis, a disorder in which bone density is disrupted. Less commonly, back pain can be caused by more severe injuries resulting from accidents and falls.
Acquired conditions and diseases. Many medical conditions can cause or contribute to pain. These include scoliosis, kyphosis, kyphoscoliosis, in which there is usually no pain until middle age. Different types of arthritis (osteoarthritis, rheumatoid arthritis, ankylosing spondylitis), stenosis of the spinal canal, which affects the nerve roots of the spinal cord. Diseases such as osteoporosis are painless in themselves, but can lead to vertebral fractures that will manifest as severe pain. Other causes of back pain include pregnancy, kidney infections or urolithiasis, endometriosis, fibromyalgia, which is characterized by chronic fatigue and diffuse muscle pain.
Infections and tumors. Although infections are not common causes of illness, infections can still cause pain. If the bone tissue is affected, then we talk about osteomyelitis, if the infection affects the intervertebral discs, then we talk about disc. Tumors are also relatively rare in pain. Sometimes spinal tumors are primary, but most often the tumors are of metastatic origin and the main focus is on another part of the body.
Although the causes of back pain are usually physical, it is important to understand that emotional stress can play a role in both the intensity of the pain and the duration. In addition, stress and emotional state can affect skeletal muscle tone. So in the presence of depression and anxiety, back pain may be more intense. In addition, insomnia or lack of sleep can also contribute to or worsen pain.
Back pain is just a symptom and can be reflected. Many diseases of the peritoneum and pelvic organs can cause back pain (appendicitis, aneurysm, kidney disease, bladder disease, infections and inflammatory diseases of the pelvis).
Risk Factors
- Age over 40
- Male
- Family History
- Previous injuries
- Pregnancy
- Previous spinal surgeries
- Congenital malformations of the spine.
- Lack of regular exercise
- Work or activity that requires prolonged sitting and lifting weights.
- Smoking. People who smoke more often than non-smokers experience back pain.
- Overweight. Overweight, especially those with low back fat, can put more strain on the back and have weak muscles and limited mobility
- Bad stand. Impaired posture leads to a violation of the distribution of load vectors and to muscle tension, muscle spasm and pain.
- Stress. Stress and other emotional factors are thought to play an important role in back pain, especially chronic pain. Many people unknowingly tense their back muscles when under stress.
- Condition after a long period of depression.
- Long-term use of drugs (such as steroids) that weaken bone tissue.
- Lung diseases that lead to chronic cough.
Symptoms
Most people have experienced back pain in their lifetime. There are many causes of back pain, some of which one creates for oneself. Other causes include accidents, muscle sprains, sports injuries and various diseases. Although the causes may be different, most often they are marked with the same symptoms.
- Constant pain or stiffness in every part of the spine, from the base of the neck to the coccyx
- Acute, localized pain in the neck, upper back or lower back - especially after lifting heavy objects or performing heavy activities. (Upper pain can also be a sign of a heart attack or other life-threatening condition. )
- Chronic pain in the middle or lower part, especially after prolonged sitting or standing.
- Lower back pain radiating to the back of the legs.
- Unable to stand upright.
But there are symptoms that require medical attention
- Feeling of tingling, numbness or weakness in the arms or legs, as this may mean damage to the spinal cord.
- Lower back pain radiates to the legs, which may be evidence of root compression (radiculitis).
- The pain is more severe when coughing or leaning forward, which may be a sign of a herniated disc.
- The pain is accompanied by a high fever, a burning sensation when urinating, which may be a sign of a urinary tract infection.
- Bowel or bladder dysfunction
- History of Cancer
- Weight loss
- Long-term use of steroids
- Trauma history
- Increased malaise even after a break.
- Pain that lasts more than a month
- Night pain
- No treatment effect
- History of drug use
Diagnostics
Due to the fact that the cause of back pain can be different conditions, in the first place it is important to carefully collect the history and symptoms by the doctor. Both the localization of the pain and the intensity and the presence of radiation are important. The physical examination includes a careful examination of the neurological status (reflex activity, muscle strength, sensitivity, etc. ). If you suspect a disease of the pelvic organs, the doctor may prescribe a consultation with a gynecologist, urologist.
Instrumental research methods
Radiography is usually of little value in diagnosing back pain, especially if there are no significant symptoms. The use of radiography is indicated in acute significant injuries or minor injuries in patients over 50 years of age, patients with osteoporosis, or a history of long-term steroid use.
MRI is the most informative diagnostic method and allows high-quality visualization of both bone and soft tissue and allows the diagnosis of both degenerative changes and tumors or infections.CT may be recommended for clearer visualization of bone changes.
EMG and ENMG allows to determine the conduction of nerve fibers and muscles and is usually used in the diagnosis of chronic back pain.
Ultrasound examination of the abdominal organs or pelvic organs, kidneys is necessary in cases where it is necessary to distinguish the source of pain.
Laboratory testing methods are also used for the differential diagnosis of inflammatory diseases or infections.
Treatment
There are no universal treatments for back pain. The treatment of back pain in each case depends on both the genesis of the manifestations of pain and the individual characteristics of a person, as people's perception varies considerably.
Medical treatment involves the use of various drugs, both conventional analgesics or NSAIDs and muscle relaxants or antibiotics for infections. In chronic pain syndrome, it is possible to use antidepressants, tranquilizers or neuroleptics.
Non-drug treatments such as physiotherapy, massage, chiropractic, acupuncture and exercise are widely used in the treatment of back pain. These treatments are effective for both acute and chronic manifestations of pain associated with spinal diseases.