Discomfort in the spine is the main reason people seek medical attention. Almost 80% of the adult population faces this problem. Back pain causes a significant level of disability and can be a problem that continues from childhood into adulthood.
Dorsopathy affects almost every aspect of life. Sleep is disturbed and it becomes difficult to bend, reach or turn. Difficulties occur when driving, walking, lifting and performing physical exercises. If you have pain in the spine, you should immediately consult a doctor. The specialist will study the medical history, collect anamnesis and conduct an examination. If violations are detected, conservative or surgical treatment is prescribed.
Why does my back hurt?
The cause of dorsopathy is muscle tension and spasm. Strain can be the result of heavy physical work, awkward positions and even poor posture.
Studying the anatomy of the spine can help understand the problem at a deeper level. Main parts of the spine:
- The cervix is a mobile segment subject to degenerative changes. With age, pain often occurs in the so-called "transition zone" between the flexible cervical vertebrae and the more rigid thoracic spine.
- Thoracic - related to the chest and connects to the ribs. In particular, older people can develop compression fractures in this area as a result of bone loss.
- Lumbar - lower back. Young patients are more prone to discogenic low back pain, while older patients are more prone to disorders of joint structures.
- Sacral - the lowest part of the spine. It consists of a flat triangular sacrum bone that connects to the femur and coccyx. Degeneration of this area usually occurs in older patients or after a fall.
Between the upper back and coccyx are 17 vertebral bodies, many joints, the sacrum and coccyx, as well as fibrous and muscular supporting structures, intervertebral discs, spinal cord and nerve roots, and blood vessels. The spine is more than the sum of its parts, but here's what you need to know about those parts.
The spine usually consists of 33 vertebrae, each separated by an intervertebral disc. Vertebrae are a series of small bones to which muscles are attached. Each vertebra consists of two parts: an anterior body that protects the spinal cord and nerve roots, and a posterior arch that houses the canal and also protects the spinal cord.
The muscles of the back are divided into three groups:
- intermediate - responsible for the movement of the ribs;
- internal - stabilize the spine, control the movement and position of the spine;
- superficial - provide movement of the neck and upper limbs.
The muscles that support the spine are structured in layers. They function as the main stabilizers of bone and ligament structures. Tensions of these muscles are possible in patients of different age groups.
There are other parts of the spine that must be considered when determining dorsopathy. These include ligaments and tendons, intervertebral discs and joints that provide stability and mobility.
Inflammatory disease, malignancy, pregnancy, trauma, osteoporosis, nerve root compression, radiculopathy, plexopathy, osteochondrosis, disc herniation, spinal stenosis, sacroiliac joint dysfunction, facet joint injury, and infection are part of the differential. Differentiating the signs and symptoms of nociceptive (mechanical) pain from radiculopathy (neuropathic dorsopathy) is an important first step in making the diagnosis.
Degenerative pathologies
Degeneration includes endplate-related changes (sclerosis, defects, modal changes, and osteophytes) as well as disc changes (fibrosis, annular tears, desiccation, height loss, and mucinous annular degeneration).
Degenerative changes in the disc are already observed in one third of healthy people aged 21 to 40 years. The high prevalence of asymptomatic degeneration should be considered when evaluating spinal symptoms.
With age, the intervertebral disc becomes more fibrous and less elastic. Degenerative changes progress when the structural integrity of the posterior annulus fibrosus is compromised by overuse. This will eventually lead to the formation of cracks in the annulus fibrosus. Herniation is defined as displacement of disc material (cartilage, nucleus, fragmented annulus, and apophyseal bone) outside the intervertebral disc space.
Rachiocampsis
The natural curves of the spine are important in ensuring its strength, flexibility and ability to evenly distribute the load. It has a normal range of natural curves. Abnormal curvatures include lordosis, kyphosis, and scoliosis.
Abnormal lordosis
Lordosis, a disease of the spine, is defined as a severe inward curvature of the spine. Although this disease most often affects the lumbar spine, it can also develop in the cervical spine.
The normal range of lordosis is considered to be between 40 and 60 degrees. Changes in posture can lead to instability in the gait and changes in the figure - the buttocks become more noticeable. Causes of abnormal lordosis: spondylolisthesis, osteoporosis and obesity.
Abnormal kyphosis
Kyphosis, a spinal disorder, is defined as excessive outward curvature of the spine and can result in leaning forward. It most commonly affects the thoracic or thoracolumbar region, but can also occur in the cervical region.
The normal range of kyphosis is considered to be between 20 and 45 degrees. But when a structural abnormality results in the development of a kyphotic curve outside this normal range, the curvature becomes abnormal and problematic. It is manifested by rounding the shoulders and tilting the head forward.
Scoliosis
It is defined as an abnormal lateral curvature of the spine. Scoliosis is a progressive structural disease. Lordosis and kyphosis are characterized by backward or forward curvature of the spine. Scoliosis involves an abnormal lateral curvature of the spine.
The most common form of scoliosis is juvenile scoliosis, diagnosed between the ages of 10 and 18. The remaining 20% are due to neuromuscular, congenital, degenerative and traumatic causes.
Developmental abnormalities
The symptom often occurs with developmental defects and may be combined with neurological manifestations.
Dorsopathy is manifested by the following developmental abnormalities:
- Cleavage - with small bone defects, there is moderate discomfort in the lumbosacral region. After some time, radicular syndrome appears.
- Lumbarization, sacralization - compression of the roots is accompanied by shooting or burning pain. Sensory disturbances or paresis may be added.
- Wedge-shaped vertebrae - discomfort occurs when loading and maintaining a static position of the body for a long time. Accompanied by chest deformation and bad posture.
osteoporosis
It usually affects the thoracic and thoracolumbar spine and can cause debilitating pain. This disorder is caused by loss of bone mineral density, resulting in brittle bones.
Osteoporosis can cause vertebral compression fractures, loss of height, stooped posture, and even a hunched back. To prevent osteoporosis, it is necessary to ensure a balanced diet, to give up smoking and alcohol abuse. An active lifestyle is also recommended.
Injuries
The severity of the dorsopathy corresponds to the severity of the injury. As a rule, it is combined with signs of nerve tissue damage.
Traumatic causes of spinal pain:
- The bruise is the result of a direct blow or a fall on the back. Dorsopathy is local, moderate. It gradually disappears in 1-2 weeks.
- Dislocation – occurs due to high-energy impact. Accompanied by severe pain in combination with impaired sensitivity and motor activity. The general condition also suffers.
- Spondylolisthesis is a traumatic injury to the spine in the lumbar region. Dorsopathy radiates to the legs, there is a positive symptom of axial load.
- Compression fracture - occurs when falling on the buttocks or jumping from a height. At first the pain is sharp, then becomes intense and progresses with movement.
Pathological fractures that occur against the background of osteoporosis or tumors are manifested by slight discomfort, unpleasant and painful pains. They remain unchanged for a long time.
Inflammatory and infectious diseases
Ankylosing spondylitis is accompanied by a feeling of stiffness and dull pain in the lumbar region. It has a characteristic diurnal rhythm - symptoms appear at night and intensify in the morning. The intensity decreases after physical activity and water procedures. Dorsopathy increases at rest and decreases with movement. Over time, the mobility of the spine is limited and thoracic kyphosis is formed.
Also, pain in the spine occurs with tuberculosis. Deep local discomfort is characteristic of vertebral destruction. Dorsopathy increases with physical exertion and is accompanied by excessive sensitivity of the skin. In the case of shooting and radiating pain, we are talking about compression of the nerve roots. The condition is complemented by stiffness of movements.
In osteomyelitis, intense dorsopathy is noted. The disease is diagnosed in children and adolescents. It is characterized by a hematogenous nature. Discomfort increases with movement, so the patient remains in bed. Osteomyelitis is accompanied by fever, weakness and local swelling.
Arachnoiditis is manifested by pain that radiates in the area of innervation of the nerve roots. Symptoms become constant and resemble sciatica. These are complemented by movement disorders, sensory disorders and loss of pelvic organ control.
Tumors
Benign neoplasms have a hidden course or are accompanied by slowly progressing and scarce symptoms. Most often, hemangiomas appear, which occur in only 10-15% of cases. Discomfort is painful, local. It progresses at night and after physical activity. Neoplasia of the spinal cord is accompanied by radicular pain and impaired nerve conduction.
Spinal sarcomas in the initial stage of progression are manifested by moderate intermittent pain that intensifies at night. Accompanied by limitation of motor activity and radicular syndrome. The discomfort is localized in the internal organs, legs or arms (taking into account the level of the location of the tumor).
Other diseases
Discomfort in the spine is also observed in:
- Spinal epidural hemorrhage - similar to signs of radiculitis, accompanied by a violation of spinal conduction.
- Calve's disease - radiates to the legs, appears periodically, weakly expressed. Decreases when lying down, increases with physical activity.
- Forestier's disease - localized in the chest area, spreads to the waist or neck. Symptoms are usually short-lived. It may be accompanied by pain in the elbow or shoulder joints. Spinal stiffness cannot be ruled out.
Dorsopathy sometimes manifests itself with mental disorders. In this case, the clinical picture is unusual - it does not fit into the symptoms of possible diseases.
Causes of back pain by location
Chronic dorsopathy of the upper back affects 15 to 19% of people worldwide. Postmenopausal women are at greater risk, possibly because of osteoporosis and vertebral compression fractures.
Professional activities also lead to back pain. Those who have to maintain a static body position for long periods of time, such as dentists or salespeople, are more likely to encounter this problem than others. Office workers experience upper back discomfort due to poor workplace ergonomics.
Dorsopathy can occur at various points on the spine. The area of localization shows the cause of the discomfort and greatly facilitates the diagnosis.
Pain on the right side
The cause is excessive body weight, slipped disc or myositis. Discomfort also occurs on the right side of the back with kyphosis.
Among the somatic pathologies are salpingitis, inflammation of the ovaries, nephritis, cholecystitis. Appendicitis and the presence of stones in the organs of the excretory system should also be emphasized.
Pain on the left side
The back on the left hurts due to splenitis (inflammation of the spleen), urolithiasis, oophoritis, duodenitis, pinched roots. Discomfort over the lower back indicates inflammation of the serous membranes of the lungs, bronchial damage, ischemia and intercostal neuralgia.
Lumbar pain
The lumbar region is more often than others the object of development of pathological processes from the spine. This is due to the fact that it carries a colossal load. An inflammatory process develops when the nerve roots are damaged. Hernial protrusion and osteochondrosis are also possible.
Less often, the cause is a combination of prostatitis and urethritis, a violation of the structure of bone tissue, reduced density, lumbar sciatica, arthritis, spinal tuberculosis. Discomfort in the lower back is in most cases chronic.
Pain in the lower back on the right
Dorsopathy occurs when:
- myositis;
- tuberculosis;
- scoliosis;
- osteomyelitis;
- spondylitis.
It may indicate the presence of a neoplasm. Speaking of sciatica. Indicates liver dysfunction.
Pain in the left lumbar region
Discomfort is localized mainly after physical activity. The condition returns to normal after rest. If the discomfort does not subside at rest, then we are talking about scoliosis, osteochondrosis, spinal infections and circulatory disorders.
A pinched nerve
In the majority of cases, the sciatic nerve is pinched (sciatica). At the same time, its myelin sheath is not damaged. It most often develops against the background of osteochondrosis. Accompanied by sharp, severe symptoms that radiate to the lower back, sacrum and lower limbs.
Spinal nerve roots are also compressed during compression radiculopathy. The cause is a herniated disc or a reduction in the distance between the vertebrae. A "superficial" discomfort is felt, which sharply intensifies during physical exertion, sneezing, coughing.
Intervertebral hernia
It is characterized by extrusion (bulging) of the nucleus in the intervertebral canal. In most cases, it develops against the background of osteochondrosis. The central part of the extruded core compresses the spinal cord. Even a light load leads to the progression of the pathological process. Dorsopathy is acute and sharp, radiating to the leg or arm.
Pain in shoulder blades
Based on the nature of the dorsopathy, a presumptive diagnosis can be determined:
- dull, growing - stomach ulcer;
- acute, worsening with movement - intercostal neuralgia;
- numbness of the hands, changes in pressure, dizziness - osteochondrosis;
- radiation under the collarbone - exacerbation of angina pectoris.
Spine and back pain
It develops due to pinching of the nerve endings against the background of curvature of the spine. If the symptoms are not clearly expressed, we can talk about a protrusion. Increased symptoms indicate osteochondrosis, myositis or fracture.
Severe discomfort along the spine indicates wear or thinning of the intervertebral discs. It may indicate spondyloarthrosis. The pain is constant and sharp.
Pain below the waist
They are most often found in spondyloarthrosis and osteochondrosis. It is less often observed in diseases of the female genital area (oophoritis, cervicitis, endometritis, etc. ). They can appear during pregnancy, during menstruation, with appendicitis, ulcerative colitis. In men, they indicate diseases of the bladder or prostate.
Diagnosis
First, a physical examination is performed to identify signs that indicate the need for further investigation. The medical examination includes the following procedures:
- Examination of the back and posture to identify anatomical abnormalities.
- Palpation/percussion of the spine - assessment of the condition of the spine and painful areas.
- Neurological examination - assessment of reflexes, spinal sensitivity and gait characteristics. In patients suspected of having radiculopathy, the neurologic examination should focus on the L5 and S1 nerve roots.
Patients with a psychological disorder contributing to back pain may have accompanying physical signs, also known as Waddell's signs. These include patient overreaction during physical examination, superficial tenderness, and unexplained neurologic deficits (eg, loss of sensation, sudden weakness, or jerks during motor testing). The presence of multiple Waddell signs indicates a psychological component of dorsopathy.
Treatment of spinal pain
In cases of dorsopathy, the treatment must be carried out by a doctor. The specialist refers the patient for an examination and, based on the results, prescribes an effective therapy.
Additional therapeutic measures should be used with caution and after consultation with a physician. Any type of medicine is associated with possible risks and side effects, so self-medication is not acceptable.
Help before diagnosis
Basic home remedies that can be effective in combating mild to severe pain caused by muscle tension include:
- A short rest period. Many episodes of low back pain can be relieved by eliminating physical activity. It is not recommended to rest for more than 2-3 days, as prolonged inactivity interferes with healing.
- Change in activity. It is recommended that you stay active but avoid activities and body positions that aggravate dorsopathy. For example, if sitting for long periods of time in a car or at a table increases discomfort, then you should warm up every 20 minutes.
- Exposure to heat or cold. A heating pad or warm bath relaxes tense muscles and improves blood flow, reducing discomfort. If your lower back hurts due to inflammation, you can use ice or cold compresses to reduce swelling.
The most common over-the-counter medications for dorsopathy are ibuprofen, naproxen, and acetaminophen. Medicines relieve inflammation and reduce discomfort in the lower back.
Conservative therapy
Oral drug therapy:
- Analgesics. Patients are prescribed drugs from the anilide group, such as paracetamol. Provide a long-lasting analgesic effect. They have a synergistic effect with NSAIDs and are used in combination to improve pain relief without increasing toxicity.
- Nonsteroidal anti-inflammatory drugs. They have analgesic properties. At higher doses, they have an anti-inflammatory effect.
- Muscle relaxants. They act centrally by influencing the activity of muscle stretch reflexes. The combination of an NSAID and a muscle relaxant provides significant relief of dorsopathy. The main side effects are drowsiness, headache, dizziness and dry mouth.
- Neuropathic pain relievers. Tricyclic antidepressants relieve chronic pain. Low doses may be sufficient to control symptoms. They do not work immediately and may need to be continued for several weeks before symptoms improve. It plays a potential role when discomfort is mediated by both peripheral and central mechanisms.
Local or regional anesthesia administered by injection is part of the treatment regimen for some patients with back pain. The injection site can be an area of local injury or a myofascial trigger point (painful area of the muscle).
Epidural corticosteroid injections are used for radicular pain that does not respond to less invasive treatment. It is used to alleviate the condition of intervertebral hernias, spinal stenosis and radiculopathy. Reduction of dorsopathy and rapid recovery of sensory functions.
surgery
A small percentage of people with back pain need surgery to improve their condition. Indications for surgery vary depending on the patient's characteristics and include:
- severe radicular symptoms, especially in the presence of progressive neurological motor deficit;
- radicular symptoms that do not respond to conservative treatment.
The choice of surgical intervention is determined by the characteristics of the spinal injury. The operation is most effective when the clinical picture in patients is dominated by manifestations of nerve compression. The most common problem is inadequate neural decompression. Related diseases, including hip arthritis, osteoporosis and cardiovascular disease.
Surgery for patients with radicular pain due to disc herniation primarily involves decompression. Bulging, extruded or isolated disc material is removed. The nerve root is explored and released.
Prevention
Complications are largely determined based on etiology. They are divided into physical and social. The first includes chronic pain, deformity, neurological effects with motor or sensory deficits, bowel or bladder damage. In social terms, complications are usually measured by disability and reduced work capacity.
Patients of all ages should:
- eliminating bad habits;
- lead an active lifestyle;
- strengthening the protective functions of the body;
- lift heavy objects properly;
- undergo preventive examinations with a doctor.
It is important not to slouch and keep your back straight. The place to sleep and work must be organized properly. It is recommended to perform light gymnastic exercises every day after waking up. You should also balance your diet by enriching your diet with foods with sufficient vitamins and minerals. It is recommended to take a contrast shower in the morning.