Most people have back problems from time to time and pain in the lower back, neck or middle of the back. In fact, back pain is the most common physical complaint in the adult population and the main cause of temporary disability. Back pain can be mild or severe, short-term or chronic pain.
Back pain includes: pain in the muscles and tendons, herniated disc, fracture or other back problems. Most of the time, the motives have a long history. Most of the time, back pain is caused by diseases of the spine.
The column structure is designed for extreme loads. The structure of the spine is stable enough for a person to walk (stand up) and flexible enough to perform trunk movements.
A healthy spine has an elongated S shape when viewed 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 spine protects the spinal cord and the roots of the spinal cord with their bone structure, thus ensuring the normal innervation of organs and tissues.
Between each of the 24 vertebrae there are intervertebral discs that perform a cushioning function.
Reasons
Back pain refers to problems that a person usually creates for himself. Back problems and back pain are usually caused by bad habits that have built up over a long period of time. These bad habits include:
- Poor posture
- Overvoltage during work
- Incorrect posture at the table or when driving
- Repeated stretching or extension of the spine or abnormal weight lifting.
Habit results 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 of the time, back pain associated with tension, muscles occur in the lumbar spine and in the cervical spine. If muscle tension is associated with lifting heavy objects, the pain can be unbearable.
Sometimes, back pain occurs for no apparent reason. In such cases, they talk about non-specific back pain. This pain can develop due to weakened muscles that cannot cope with daily stress, such as walking, bending over and stretching. In addition, this nonspecific pain can be triggered by unsatisfactory 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 both to hormonal changes in the woman's body as well as to weight gain and excessive stress on the spine and legs.
Injuries in contact sports, accidents and falls can also cause back problems, ranging from minor muscle tension to serious injuries, such as the spine and spinal cord.
It is important to understand that back pain is one of the symptoms of the disease and not a diagnosis. Medical conditions that can cause back pain include the following:
Mechanical problems: mechanical problems are related to the movement 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 involutional changes occur in the intervertebral discs and deterioration of the disc amortization functions, which leads to the appearance of pain. Another cause of back pain is degenerative changes in the joints of the spine (spondyloarthrosis). Other mechanical causes include muscle spasms, muscle tension and herniated discs.
Injuries: Spinal injuries, such as sprains and fractures, can cause acute and chronic pain. Sprains, ruptures in the ligaments that support the spine, can occur due to torso twisting or incorrect lifting. Fractures of the vertebrae are often the result of osteoporosis, a disease in which bone density is impaired. Less commonly, back pain can be caused by more serious injuries that result from collisions and falls.
Conditions and diseases acquired. Many medical conditions can cause or contribute to pain. This includes scoliosis, kyphosis, kyphoscoliosis, in which there is usually no pain until middle age. Various types of arthritis (osteoarthritis, rheumatoid arthritis, ankylosing spondylitis), spinal canal stenosis, which affects the nerve roots of the spinal cord. Diseases like osteoporosis are painless in their own right, but they can lead to vertebral fractures, which 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 a common cause of disease, they can cause pain. If bone tissue is affected, then we are talking about osteomyelitis, if the infection reaches the intervertebral discs, then we are talking about discitis. Tumors are also relatively rare in terms of pain. Sometimes, tumors of the spine are primary, but most of the time the tumors are metastatic 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 the intensity and duration of the pain. In addition, stress and emotional well-being can affect skeletal muscle tone. Therefore, in the presence of depression and anxiety, back pain may be more severe. In addition, insomnia or lack of sleep can also contribute to or worsen pain.
Back pain is only 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 pelvic inflammatory disease).
Risk factors
- Age over 40
- Male gender
- Family history
- Previous injuries
- Pregnancy
- Surgical interventions on the spine in the past
- Congenital malformations of the spine.
- Lack of regular exercise
- A job or activity that requires sitting and lifting weights for a long time.
- Smoking. People who smoke more often than people who don't smoke experience back pain.
- Too much. Excess weight, especially those with fat around the waist, can put more pressure on your back and tend to have weak muscles and limited mobility
- Poor posture. Impaired posture leads to a disturbance in the distribution of load vectors and muscle tension, muscle spasm and pain.
- Stress. Stress and other emotional factors are believed to play an important role in back pain, especially chronic pain. Many people unknowingly tense their back muscles when they are under stress.
- Condition after a long period of depression.
- Prolonged use of medications (such as steroids) that weaken bone tissue.
- Lung diseases that lead to chronic cough.
Symptoms
Most people have experienced back pain during their lifetime. There are many reasons for back pain, some of which a person creates for himself. Other causes include accidents, muscle sprains, sports injuries and various illnesses. Although the causes may be different, in most cases they are marked with the same symptoms.
- Persistent pain or stiffness in any part of the spine, from the base of the neck to the tailbone
- Acute pain located in the neck, upper or lower back - especially after lifting heavy objects or performing strenuous activities. (Pain at the top can also be a sign of heart attack or other life-threatening conditions. )
- Chronic pain in the middle or bottom, especially after sitting or standing for a long time.
- Pain in the lower back radiating to the buttocks of the leg.
- Inability to stand upright.
But there are symptoms that justify seeking medical care
- Numbness, tingling or weakness in the arms or legs, as it may indicate spinal cord injury.
- Low back pain radiates to the leg, which may be evidence of root compression (radiculitis).
- Pain increases when coughing or leaning forward, which can be a sign of a herniated disc.
- Pain is accompanied by fever, a burning sensation when urinating, which can be a sign of urinary tract infection.
- Disorders of bowel or bladder function
- History of cancer
- Weight loss
- Long-term use of steroids
- History of trauma
- Increased malaise even after rest.
- Pain that lasts more than a month
- Night pain
- No effect of treatment
- History of drug use
Diagnosis
Due to the fact that the cause of back pain can be various conditions, so first of all, careful collection of anamnesis and symptoms by the doctor is important. Both the location of the pain and the intensity, the presence of irradiation are important. The physical examination includes a careful examination of the neurological status (reflex activity, muscle strength, sensitivity, etc. ). If you suspect pelvic organ disease, your doctor may prescribe an appointment with a gynecologist, urologist.
Instrumental research methods
Radiography is generally of little value in diagnosing spinal pain, especially if there are no significant symptoms. The use of radiography is indicated for significant acute injuries or minor injuries in patients over 50, patients with osteoporosis or a history of long-term steroid use.
Magnetic resonance imaging is the most informative diagnostic method and allows high-quality visualization of bone and soft tissue and allows the diagnosis of degenerative changes and tumors or infections.
For a clearer view of changes in bone tissue, CT may be recommended.
EMG and ENMG make it possible to determine conduction along nerve fibers and muscles and, as a rule, are used in the diagnosis of chronic back pain.
Ultrasound examination of the abdominal organs or the organs of the small pelvis, kidneys, is necessary, if it is necessary to differentiate the source of the pain.
Laboratory research methods are also used for the differential diagnosis of inflammatory diseases or infections.
Treatment
There is no universal treatment for back pain. The treatment of back pain in each individual case depends both on the genesis of the pain manifestations and on the individual characteristics of a person, since people's perception varies significantly.
Medical treatment includes the use of various medications, both conventional pain relievers and NSAIDs, as well as 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, manual therapy, acupuncture and exercise therapy, have been widely used in the treatment of back pain. These treatment methods are effective for the manifestations of acute and chronic pain associated with diseases of the spine.