Back pain in the lower back

Back pain in the lower back is known to everyone. According to statistics, it is she who becomes the cause of 25% of requests for medical assistance. Its appearance can provoke a series of different factors, from banal fatigue to very serious diseases. Therefore, you should not ignore the problem, especially if the discomfort appears regularly and more so over time. In these situations, you should contact a therapist as soon as possible or go directly to a neurologist and have a complete examination.This will allow the diagnosis of the disease in the early stages of development and the adoption of timely measures to stop its progression. But if on the eve of the onset of pain there was an injury or an unsuccessful fall, you need to sign up immediately for an appointment with a traumatologist or spinal surgeon.

Features of low back pain and associated symptoms

Back pain can be of different nature and severity. They can be strong, shooting, whining, pulling, etc. They are able to intensify during physical exertion, sitting or standing for a long time, and to pass at 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.

Of fundamental importance when making a diagnosis is whether the pain radiates to the hips, buttocks, knee, foot and, if so, where and how. In addition, a weight point is the presence of restrictions on spinal mobility, whether the patient can freely turn, turn the body or reduce the range of motion.

Pain in the spine is called lumbodynia. If it spreads to the legs, it is called low back pain.

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

Low back pain rarely occurs in isolation. In most cases, a complex of other disorders is also present, which patients themselves rarely associate. Often, back pain is combined with:

• feeling of crawling on the back and / or legs, numbness;
• muscle weakness;
• pain in the hip, knee joints;
• disturbance of Organs pelvic organs (menstrual irregularities, problems with potency, loss of control over urination, defecation);
• paralysis of the leg.

Similar signs indicate pathology of the spine.But since not only can they cause back pain, there is another group of symptoms that can accompany low back pain and indicate the pathology of internal organs or cancer. Therefore, you need to be especially careful with your own state when it appears:

• rapid and unnecessary weight loss;
• cuts and pain in the groin, perineum;
• increased urination, pain;
• increased body temperature, chills;
• changes in skin color in the area of ​​the epicenter of pain;
• menstrual irregularities, unusual discharge.

If low back pain is associated with one or more of the above symptoms, you should see a doctor immediately. When symptoms appear in the first group, consultation with a neurologist is necessary; in the second, the help of a urologist, gynecologist, endocrinologist or other restricted specialists is required. The therapist will help you understand exactly which doctor to contact.

Causes of the occurrence

All causes of back pain in the lower back can be divided into 2 groups: diseases of the spine and pathologies of Organs internal organs, in particular, gynecological diseases, pathologies of the kidneys, organs of the gastrointestinal tract, endocrine diseases. Even so, most of the time, they are a consequence of the development of changes in the spine and in the adjacent muscles. The most common causes of back pain are:

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

However, low back pain can also be the result of overwork or certain physiological changes. In these situations, they do not require special treatment, but only a decrease in physical activity and a more economical daily regimen.

Osteochondrosis and intervertebral hernias

Osteochondrosis is the most common disease of the spine. Its development is often associated with the inevitable changes related to aging, since almost all the elderly have their symptoms to a greater or lesser extent.

Osteochondrosis is the price that humanity pays for the ability to walk in a straight line. It is characterized by a gradual destruction of the intervertebral discs, their thinning, decreased elasticity and firmness. As a result, they stop dealing with stress and can swell. Thus, intervertebral hernias are formed.

In most cases, osteochondrosis affects the intervertebral discs of the lumbar spine. When projecting into the spinal canal or foraminal foramen, the nerves are almost inevitably damaged, which leads to the appearance of acute pain in the lower back and its irradiation 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 the increased load on the spine, bony bumps called osteophytes are formed along the edges of the vertebrae.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

Most of the time, inflammatory diseases of the spine occur in young people and mainly in men. They cause severe pain that bothers you at night, which is your specific differential. As you progress, in the absence of timely treatment, the pain becomes more intense and bothers you more.

It is not uncommon for patients to seek medical help several years after the first symptoms appear. As a result of such a long course of the inflammatory process in the spine, irreversible changes can occur, which can lead to immobility and disability.

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

Myofascial syndrome

Myofascial syndrome is a common condition in which pain occurs after a prolonged stay in an uncomfortable position or after physical exertion. A little more frequently, myofascial syndrome occurs in women. With it, low back pain occurs after a careless movement or physical effort. Its distinguishing feature is the presence of the so-called trigger points in the spasmodic muscles of the lower back and buttocks, pressing which leads to a sudden attack of pain. Myofascial syndrome significantly reduces human quality of 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, spine joints and surrounding soft tissues are mainly affected. With this disease, people are concerned about low back and sacral pain and stiffness of movement, but symptoms usually disappear without a trace in the afternoon and evening.

In addition, physical activity has a beneficial effect on the well-being of the patient and contributes to the elimination of the painful syndrome. A very specific symptom of ankylosing spondylitis is the arched curvature of the spine and the progressive limitation 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 spinal deformity leads to the displacement of all anatomical structures, the nerves are usually pinched, which causes severe pain. In addition, other neurological signs may be present, including numbness and paresis.

Compression fractures

In elderly people with osteoporosis and trauma, low back pain may be the result of an undetected spinal compression fracture. As a consequence, the vertebrae become flattened and occupy an abnormal position, which leads to incorrect load distribution in the spine, degenerative processes in the intervertebral discs and the appearance of pain.

Physiological causes of low back pain

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

In addition, low back pain is often seen during pregnancy. In these situations, they are due to a change in the center of gravity and increased stress on the spine.

Diagnosis

It is recommended to consult a neurologist to determine the causes of back pain in the lower back. Initially, you can see a therapist, but the doctor will probably still refer the patient to a neurologist.

In the consultation, the specialist will do a thorough research of the patient, find out what concerns him, what lifestyle he leads, etc. In addition, an examination is necessary, during which the doctor assesses the severity of reflexes, performs neurological tests and assesses the patient's mobility. Based on the results obtained, the doctor can make a preliminary diagnosis and understand what kind of violations have led to the appearance of back and lower back pain.

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

• general and biochemical blood tests - with their help, changes in the blood are detected, indicating inflammatory processes in the body, the presence of an infection or tumor;
• general urinalysis - used to differentiate kidney disease as a cause of pain in the lower back;
• X-ray - shows the presence of an alteration in the bone structures of the spine, signs of fractures, provides information on bone density and allows the diagnosis of the main diseases of the spine, as well as osteoporosis (the detection of spinal pathologies isreason for further examination with CT or MRI);

• CT is a modern radiation diagnosis method, which allows you to clearly see all bone structures and detect the smallest deviations from the norm;
• MRI - provides complete information on 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 for low back pain

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

In most cases, patients initially receive conservative treatment, the main component of which is drug treatment. In more complex cases, it is additionally recommended to take a course in physiotherapeutic procedures, manual therapy and exercise therapy.

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

• Give up lifting heavy objects and exhausting sports;
• to reduce weight in the presence of obesity;
• take regular breaks to warm up if the person is forced to sit for a long time;
• increases the level of physical activity, but avoids overwork and hard work (daily walks, morning exercises, performing a special exercise therapy complex, swimming);
• use a support bandage, which will relieve the load on the lower back and thus provide favorable conditions for early recovery of the spine.

Depending on the source of the pain, patients may be advised to stay in bed for a few days or, on the contrary, to increase their level of physical activity, but within reasonable limits. For example, pain caused by nerve compression 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, to reduce the risk of complications and to prevent disabilities.

But, unfortunately, conservative therapy cannot always be used to treat low back pain. In some cases, it turns out to be ineffective and does not give any results, even after several months of unwavering adherence to medical recommendations. In other situations, the test result shows the presence of a pathology that can no longer be eliminated by any non-surgical method. In such situations, patients are advised to consult a neurosurgeon and perform an appropriate surgical intervention to restore the normal anatomy of the spine.

Medical therapy

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

• NSAIDs in the form of pills, injections and topical preparations - have analgesic and anti-inflammatory properties;
• corticosteroids - administered in short cycles to control severe inflammation;
• muscle relaxants - necessary to relieve muscle spasm, which is usually a reflex reaction of the body to pain and worsens it;
• B vitamins - improve nerve conduction by normalizing nerve fiber nutrition and increasing the speed of transmission of nerve impulses.

For severe pain that cannot be tolerated, blockages can be performed. The procedure involves injecting an anesthetic solution directly into the area of ​​pain or in the passage of nerve fibers. Thus, it is possible for a while to completely stop the painful syndrome and improve the patient's well-being.

But the block has only a temporary effect, and its implementation is only possible in a medical institution, since in most cases it is necessary to inject the drug in the points located in the immediate vicinity of the spine, where a mass of nerves passes. Therefore, an illiterate execution of the procedure can result in serious and sometimes fatal consequences.

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

Physiotherapy

Physical therapy treatments are often prescribed for patients with spinal disorders. Thanks to the correctly selected physical impact method and the frequency of the procedures, it is possible to achieve a pronounced anti-inflammatory and analgesic effect, as well as improve microcirculation, accelerate the elimination of local edema, muscle spasms, etc. Physiotherapy significantly increases the effectiveness of other treatment methods, but it is mainly used only after the elimination of acute process symptoms.

Most of the time, patients are prescribed:

electrophoresis

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

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

Manual therapy

With osteochondrosis, scoliosis and a host of other illnesses, manual therapy sessions can have a truly amazing effect on your spine condition. But only a qualified chiropractor can competently conduct a manual therapy session and benefit the patient, not harm.

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

Literally, after the first session, most patients notice an improvement in their well-being and a significant decrease in the severity of the pain syndrome until it is completely eliminated. However, to consolidate the results obtained, it is recommended to take a complete course in manual therapy, and in the future to take support courses.

exercise therapy

Physiotherapy helps the body deal with the stress caused by it. For each disease, a special set of exercises was developed, whose regular application allows solving the most important tasks in the current situation. Thus, with the help of a complex of physiotherapeutic exercises properly selected, it is possible to restore muscle tone and strengthen it. Thanks to this, the spine will have less stress, which will become an effective prevention of disease progression and create favorable conditions for its recovery.

Exercise therapy also helps to improve blood circulation in the affected area, which speeds up the course of inflammatory processes and, more likely, leads to a complete recovery. Correct exercise for many conditions can help reduce low back pain and reduce the frequency of its 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 an expert is able to correctly choose the most effective and safe set of exercises.

It is under your supervision that the first classes take place. In the course of them, the patient learns to correctly perform each proposed exercise so that it is beneficial. Gradually, the load is increased, bringing it to the ideal level. But it is not recommended to increase the number of repetitions of the exercises or to complicate them. Any changes to the physical therapy exercise program are made 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. Any sudden movements are not allowed. But if pain arises during class, exercise should be stopped immediately and consult your doctor as soon as possible.

Surgery for back pain

In most cases, the help of a spinal surgeon is necessary 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 by modern non-invasive methods. The only way to eliminate 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 surgeries used for intervertebral hernias. Specific surgical intervention tactics are determined based on the type, location and size of the hernia:

• Nucleoplasty and hydroplasty are percutaneous surgery methods that allow the removal of a 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, involving the removal of it or the entire disc through an incision up to 3 cm in length. But, unlike other methods, it allows you to eliminate a hernia of any size, regardless of its location in the spinal canal, and to release a compressed nerve, even in the most difficult part of the spine.
• Endoscopic surgery - involves the removal of a herniated disc by means of punctures up to 1 cm in diameter, using special equipment with a video camera. It can be used to resect hernias of any size, but the technique cannot be used to remove neoplasms in anatomically difficult locations.

In addition, the help of a spinal surgeon is required for scoliosis. In this case, all forces are directed to restore the normal spine axis. Previously, this required making a large incision extending virtually across the back. But today it is possible to correct spinal deformity in a minimally invasive way through miniature incisions.

Various types of metal structures are used to restore the normal spine axis, but their essence is approximately the same. The construction is fixed to the vertebrae with special screws and correcting their tension at different points, it is possible to return the displaced vertebrae to their place and fix them in the correct position. Modern types of metal structures allow, over time, to improve the initial result of the operation without reintervention in the body. This is achieved by correcting the position of the installed structure using special screws.

Surgical intervention cannot be avoided in the case of spinal fractures. In these situations, getting rid of back and lower back pain is only possible 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, through a fine puncture needle, a special bone cement is injected into the destroyed vertebra as a result of an injury. Fills all free space and hardens after 10 minutes. In severe compression fractures, the preference is for kyphoplasty, as it can also help restore the normal shape of the vertebra, which will ensure the correct distribution of the load on the spine in the future and reduce the risk of complications. This operation involves the preliminary introduction of a special balloon in the destroyed vertebra, which is gradually inflated, returning the vertebra to its original appearance. Then, the balloon is lowered and removed, and the cavity formed is filled with bone cement.

Thus, back pain can be the result of physiological changes, common muscle fatigue or a symptom of severe pathologies of the spine or internal organs. Therefore, if they occur regularly and especially in the context 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 could not be recognized in the early stages of development, the modern level of neurosurgery will make it possible to eliminate it surgically with a minimal risk of complications.