Back pain in the lumbar region

Back pain in the lumbar region is familiar to everyone. According to statistics, it is the cause of 25% of all requests for medical care. Its appearance can provoke many different factors from banal fatigue to quite serious diseases. Therefore, you should not ignore the problem, especially if the discomfort occurs regularly and even more so over time. In such situations, you should contact a therapist as soon as possible or go directly to a neurologist and undergo a thorough examination.This will allow to diagnose the disease in the early stages of development and to take timely measures to stop its progression. But if there was an injury or a failed fall on the eve of the onset of pain, you should immediately make an appointment with a traumatologist or spinal surgeon.

Characteristics of low back pain and accompanying symptoms

Back pain can be of different nature and severity. They can be strong, shoot, hurt, pull, etc. They can intensify during exercise, sit or stand for a long time and go to rest or not. All of these are important diagnostic factors that allow the doctor to make the correct diagnosis and find the true cause of the patient's condition.

Central to the diagnosis is whether the pain radiates to the thigh, buttocks, knee, foot, and if so, where and how. Also, a difficult point is the presence of restrictions on the mobility of the spine, regardless of whether the patient is free to bend, rotate the body or the range of motion is reduced.

The pain in the spine is called lumbodinia. If it spreads to the legs, it is called lumboischialgia.

Acute pains are those that last less than 3 months; otherwise they speak of chronic pain. In the latter case, the disease often progresses with periods of exacerbation and remission.

Low back pain rarely occurs in isolation. In most cases, there is an additional complex of other disorders that patients themselves rarely associate with each other. Often back pain is combined with:

• feeling of crawling in the back and / or legs, tingling;
• muscle weakness;
• pain in the hip joint, knee joints;
• pelvic disorders (menstrual disorders, problems with potency, loss of control over urination, defecation);
• leg paralysis.

Similar signs indicate pathology of the spine.But since not only can they provoke back pain, there is another group of symptoms that can accompany low back pain and indicate internal organ pathology or cancer. Therefore, you should be especially careful about your own condition when it appears:

• fast and unnecessary weight loss;
• cuts and pain in the groin, perineum;
• increased urination, soreness;
• fever, chills;
• changes in skin color in the area of ​​the epicenter of pain;
• menstrual disorders, abnormal discharge.

If low back pain is associated with one or more of the above symptoms, you should see a doctor immediately. When the symptoms appear from the first group, a consultation with a neurologist is necessary, from the second group the help of a urologist, gynecologist, endocrinologist or other narrow specialists is needed. The therapist will help you know exactly which doctor to consult.

Causes

All causes of back pain in the lumbar region can be divided into 2 groups: diseases of the spine and pathologies of internal organs, in particular gynecological diseases, pathologies of the kidneys, organs of the gastrointestinal tract, endocrine disorders. However, most often they are a consequence of the development of changes in the spine and surrounding muscles. The most common causes of back pain are:

• osteochondrosis;
• spondylosis;
• inflammatory diseases of the spine;
• myofascial syndrome;
• ankylosing spondylitis;
• scoliosis;
• injuries.

However, lower back pain can also be the result of fatigue or certain physiological changes. In such situations, they do not require special treatment, but only a reduction in physical activity and a more gentle daily routine.

Osteochondrosis and intervertebral hernias

Osteochondrosis is the most common disease of the spine. Its development is often associated with inevitable age-related changes, as almost every adult has their symptoms to a greater or lesser degree.

Osteochondrosis is the price humanity has to pay for being able to walk properly. It is characterized by gradual destruction of the intervertebral discs, their thinning, reduction of elasticity and hardness. As a result, they stop coping with stress and may swell. This creates intervertebral hernias.

Osteochondrosis most commonly affects the intervertebral discs of the lumbar spine. When they protrude into the spinal canal or foraminal opening, the nerves are almost inevitably disrupted, leading to sharp pain in the lower back and radiation to the legs and buttocks.

Spondylosis

Spondylosis is a complication of advanced osteochondrosis in which the intervertebral discs are almost completely destroyed and due to the ongoing degenerative processes and increased load on the spine at the ends of the vertebrae, bone protrusions called osteophytes are formed.Therefore, there is a high risk of compression and injury to nearby nerves. This causes severe pain that can radiate to the legs.

Inflammatory diseases of the spine

Inflammatory diseases of the spine are most common in young people, mainly men. They cause severe pain that bothers even at night, which is their specific difference. As it progresses in the absence of timely treatment, the pain becomes more intense and worries the person more often.

It is not uncommon for patients to seek medical attention several years after the onset of the first symptoms. As a result of such a long course of the inflammatory process in the spine, irreversible changes can occur, which can eventually lead to immobilization and damage.

Sometimes, in addition to low back pain, there is also discomfort in the joints of the legs and arms. In such cases, the cause of discomfort may be arthritis, osteomyelitis.

Myofascial syndrome

Myofascial syndrome is a common pathology in which pain occurs after prolonged stay in an awkward position or after exercise. Myofascial syndrome is slightly more common in women. In him, low back pain occurs after careless movement or exercise. Its distinctive feature is the presence of so-called trigger points on the spasmodic muscles in the lumbar region and buttocks, pressing on which leads to a sudden attack of pain. Myofascial syndrome significantly reduces the quality of human life, but does not pose a serious threat.

Bechterew's disease

Ankylosing spondylitis or ankylosing spondylitis is a chronic joint disease in which the sacroiliac joint, the joints of the spine and the surrounding soft tissues are primarily affected. With this disease, people are concerned about low back and sacral pain and stiffness, but the symptoms usually disappear without a trace in the afternoon and at night.

In addition, physical activity has a beneficial effect on the patient's well-being and helps to eliminate the pain syndrome. A very specific symptom of ankylosing spondylitis is bending, the arcuate curvature of the spine and the progressive restriction of mobility.

Scoliosis

Scoliosis is a lateral curvature of the spine. It can be of varying severity, which directly affects the intensity of back pain and other symptoms. As the deformation of the spine leads to the displacement of all anatomical structures, the nerves are often compressed, which causes severe pain. In addition, other neurological signs may be present, including tingling sensation and paresis.

Compression fractures

In older people with osteoporosis and trauma, lower back pain may be the result of an undetected fracture of the spine. As a result, the vertebrae are flattened and occupy an abnormal position, which leads to improper distribution of the load on the spine, degenerative processes in the intervertebral discs and the appearance of pain.

Physiological causes of low back pain

Performing heavy physical work, intense sports training creates an increased load on the muscles, as a result of which lactic acid accumulates in them, which provokes pain. Back pain is not uncommon with prolonged wearing of uncomfortable shoes, especially with heels.

Also, low back pain is common during pregnancy. In such situations, they are caused by a shift in the center of gravity and increased stress on the spine.

Diagnostics

To determine the causes of lumbar back pain, it is recommended to consult a neurologist. You can initially consult a therapist, but most likely the doctor will still refer the patient to a neurologist.

At the reception the specialist will perform an in-depth study of the patient, will understand what worries him, what lifestyle he leads, etc. In addition, an examination is required, during which the doctor assesses the severity of the reflexes, conducts neurological tests and assesses the patient's mobility. Based on the results obtained, the doctor can make a preliminary diagnosis and find out what kind of disorders have led to the appearance of back and lower back pain.

To confirm existing assumptions to determine the exact causes of pain, a comprehensive examination of the patient is performed, which may include:

• general and biochemical blood tests - they detect changes in the blood, showing inflammatory processes in the body, the presence of infection or tumor;
• general analysis of urine - used to differentiate kidney disease as a cause of lumbar pain;
• X-ray - shows the presence of changes in the bone structures of the spine, signs of fractures, gives information about bone density and allows you to diagnose major diseases of the spine, as well as osteoporosis (detection of pathologies of the spine is the cause ofmore in-depth examination using CT or MRI);

• CT is a modern method of radiation diagnosis that allows you to very clearly visualize all bone structures and detect the smallest deviations from the norm;
• MRI - provides comprehensive information about the condition of soft tissues and cartilage, including intervertebral discs, with the help of MRI it is possible to diagnose intervertebral hernias of any size, changes in blood vessels, tumors.

Treatment of low back pain

The treatment of back pain is selected strictly individually. At the same time, it is always complex and includes symptomatic therapy, lifestyle changes and treatment aimed at eliminating the identified causes of lower back pain. Therefore, if the first 2 components of therapy are usually universal and are prescribed to all patients, then the etiotropic therapy is developed strictly individually, taking into account the existing disease.

In most cases, patients are initially offered conservative treatment, the main component of which is medication. In more difficult cases, an additional course of physiotherapy procedures, manual therapy and exercises is recommended.

But in any case, all patients with low back pain should:

• give up lifting heavy objects and grueling sports;
• for weight loss in the presence of obesity;
• take regular breaks to warm up if a person is forced to sit for a long time;
• to increase the level of physical activity, but avoid fatigue and hard work (daily walks, morning exercises, performing a special complex for therapeutic exercises, swimming)
• use a supportive bandage that will relieve the load on the lower back and thus provide favorable conditions for early recovery of the spine.

Depending on the source of pain, patients may be advised to stay in bed for several days or, conversely, to increase their level of physical activity, but within reasonable limits. For example, the pain caused by pinching a nerve requires you to rest your back for a few days. In other diseases, on the contrary, moderate physical activity is one of the mandatory components of therapy. It helps to increase the effectiveness of drug treatment, reduce the risk of complications and prevent injury.

Unfortunately, conservative therapy cannot always be used to treat low back pain. In some cases, it proves ineffective and does not give any results even after several months of unwavering compliance with medical recommendations. In other situations, the results of the examination show the presence of pathology that can no longer be eliminated by any non-surgical methods. In such situations, patients are advised to consult a neurosurgeon and perform appropriate surgery to restore the normal anatomy of the spine.

Drug therapy

To improve the patient's condition and quickly relieve pain are prescribed:

• NSAIDs in the form of tablets, injections and topical preparations - have analgesic and anti-inflammatory properties;
• corticosteroids - are given in short courses to control severe inflammation;
• muscle relaxants - needed to relieve muscle spasm, which is often a reflex reaction of the body to pain and worsens it;
• B vitamins - improve nerve conduction by normalizing the nutrition of nerve fibers and increase the speed of transmission of nerve impulses.

In severe, unbearable pain, blockages may occur. The procedure involves injecting an anesthetic solution directly into the area of ​​pain or the passage of nerve fibers. In this way, it is possible to completely stop the pain syndrome for some time and improve the patient's well-being.

But the blockade has only a temporary effect and its application is possible only in a medical institution, as most often requires injection of the drug at points located near the spine, where a mass of nerves passes. Therefore, illiterate application of the procedure can lead to severe and sometimes fatal consequences.

In addition to the drugs listed above, a set of others is prescribed to help eliminate the underlying disease that caused the pain syndrome. Therefore, patients may also be prescribed antibiotics, chondroprotectors, immunomodulators, and drugs from other groups.

Physiotherapy

Physiotherapy is often prescribed to patients with spinal diseases. Thanks to the correctly chosen method of physical impact and the frequency of procedures, it is possible to achieve a pronounced anti-inflammatory, analgesic effect, as well as to improve microcirculation, accelerate the elimination of local swelling, muscle spasms and more. process.

Patients are most often prescribed:

• electrophoresis;
UHF;
• ultrasound therapy;
• magnetic therapy;
• reflexology;
• diadynamic currents, etc.

As a rule, the course of procedures includes 8-10 sessions, which are held with a certain frequency.

Manual therapy

In osteochondrosis, scoliosis and a number of other diseases, manual therapy sessions can have a truly amazing effect on the condition of the spine. But only a qualified chiropractor can competently conduct a chiropractic session and benefit the patient, not harm.

The use of special techniques of manual impact allows to achieve not only the improvement of microcirculation, relaxation of overly toned and overly relaxed muscles, but also increase of the distance between the vertebrae, as well as normalization of their position. A qualified chiropractor is able to find the place where the nerve is compressed and relieve the pressure of the anatomical structures on it.

Literally, after the first session, the majority of patients notice an improvement in their well-being and a significant reduction in the severity of the pain syndrome until it is completely eliminated. However, in order to consolidate the results obtained, it is recommended that you undergo a full course of manual therapy and take maintenance courses in the future.

exercise therapy

Physiotherapy exercises help the body cope with the stress placed on it. A special set of exercises has been developed for each disease, the regular implementation of which allows solving the most important tasks in the current situation. So, with the help of a properly selected set of physiotherapy exercises it is possible to return the muscles to normal tone and strengthen them. Thanks to this, the spine will have less load, which will become an effective prevention of disease progression and will create favorable conditions for its recovery.

Exercise also helps to improve blood circulation in the affected area, which accelerates the course of inflammatory processes and is more likely to lead to complete recovery. Proper exercise for many conditions can help reduce back pain and reduce the frequency of their occurrence.

The training program is developed individually for each patient. This takes into account not only the type of pathology detected and the degree of its severity, but also the presence of concomitant diseases, the level of physical fitness of the patient, his age and other factors. Only a specialist is able to choose the right most effective and safe set of exercises.

The first lessons are held under his supervision. In the course of them, the patient learns to perform correctly each proposed exercise so that it is useful. Gradually the load increases, bringing it to the optimal level. But it is not recommended to increase the number of repetitions of the exercises yourself or to complicate them. All changes in the physical therapy program are introduced only by a specialist.

The patient only needs to strictly follow his recommendations and practice daily in a comfortable environment. All exercises are performed at a slow pace. No sudden movements are allowed. But if pain occurs during the lesson, the exercise should be stopped immediately and you should consult your doctor as soon as possible.

Back pain surgery

Most often the help of a spinal surgeon is needed for intervertebral hernias, the formation of which has led to a violation of the spinal root and the development of radicular pain. If the bulge has already formed, it is impossible to force it to be pulled back by modern non-invasive methods. The only way to remove it and at the same time get rid of low back pain is to remove the intervertebral hernia through surgery.

There are several types of surgery used for intervertebral hernias. The specific tactics of the surgery are determined based on the type, location and size of the hernia:

• Nucleoplasty and hydroplasty are methods of percutaneous surgery that allow the removal of part of the pulpal nucleus by puncturing tissues with a diameter of several centimeters and reducing the size of the hernia.
• Microdiscectomy is a radical way to solve the problem of an intervertebral hernia, which involves removing it or the entire disc through an incision up to 3 cm long. But unlike other methods, it allows you to remove a hernia of any size, regardlessfrom its location in the spinal canal, and release the pinched nerve even in the most difficult part of the spine.
• Endoscopic surgery - involves the removal of a disc herniation by puncture punctures up to 1 cm in diameter using special equipment with a video camera. It can be used for hernia resection of any size, but the technique cannot be used to remove tumors in anatomically difficult areas.

Also, scoliosis requires the help of a spinal surgeon. In this case, all forces are aimed at restoring the normal axis of the spine. Previously, it was necessary to make a large incision that extends to almost the entire back. But today it is possible to correct spinal deformities in a minimally invasive way through miniature incisions.

Different types of metal structures are used to restore the normal axis of the spine, but their essence is approximately the same. The structure is fixed on the vertebrae with special screws and by adjusting its tension at different points it is possible to return the displaced vertebrae in place and to fix them in the correct position. Modern types of metal structures allow over time to improve the initial result of the operation without re-intervention in the body. This is achieved by adjusting the position of the mounted structure with the help of special screws.

Surgery cannot be avoided in case of spinal fractures. In such situations, the elimination of back and lower back pain is possible only by restoring the normal shape, size and position of the vertebrae. Recently, kyphoplasty and vertebroplasty have been performed for this purpose. The essence of both operations comes down to the fact that a special bone cement is injected into the vertebrae, destroyed as a result of injury, by means of a thin drilling needle. It fills all the free space and hardens after 10 minutes. However, in severe compression fractures, kyphoplasty is preferred, as it can also help restore the normal shape of the vertebrae, which will ensure the correct distribution of the load on the spine in the future and reduce the risk of complications. This operation involves pre-inserting a special balloon into the destroyed vertebra, which gradually inflates, returning the vertebrae to their original shape. The balloon is then lowered and removed and the cavity formed is filled with bone cement.

Thus, back pain can be the result of physiological changes, general muscle fatigue or a symptom of serious pathologies of the spine or internal organs. Therefore, if they appear regularly and especially against the background of the action of the same factors, do not hesitate and ignore the problem. Contact qualified specialists to make the treatment as quick and easy as possible. And if the disease cannot be recognized in the early stages of development, the current level of neurosurgery will make it possible to remove it surgically with minimal risk of complications.