Back pain (dorsopathy) is a universal body language that indicates that there are disorders in the body. There are almost as many causes as there are terms used to describe the symptoms.
Spinal discomfort is the main reason people seek medical help. Almost 80% of the adult population faces this problem. Back pain causes a significant level of disability and can be a problem that lasts from childhood to adulthood.
Dorsopathy affects almost all aspects of life. Sleep is interrupted and it becomes difficult to bend, reach or turn over. Difficulties arise when driving a car, walking, lifting weights and doing physical exercise. If you experience back pain, consult a doctor immediately. The specialist will study the medical history, take anamnesis and perform an examination. If any violations are detected, conservative or surgical treatment is prescribed.
Why does my back hurt?
The cause of dorsopathy is muscle tension and spasm. Tension can be the result of hard physical work, awkward positions, and even poor posture.
Studying the anatomy of the spine can help understand the problem on a deeper level. Main parts of the column:
- The neck 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 stiffer thoracic part of the spine.
- Thoracic - connected to the chest and ribs. In particular, older adults can suffer 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 likely to experience disorders in the joint structures.
- Sacral – the lowest part of the spine. It consists of a flat, triangular sacral bone that connects to the hips and coccyx. Degeneration of this area usually occurs in elderly patients or after a fall.
Between the upper back and the 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. A speed bump is more than the sum of its parts, but here's what you need to know about those parts.
The spine generally consists of 33 vertebrae, each of which is divided by an intervertebral disc. Vertebrae are a series of small bones to which muscles are attached. Each vertebra consists of two parts: the anterior body, which protects the spinal cord and nerve roots, and the posterior arch, which houses the canal and also protects the spinal cord.
The back muscles are divided into three groups:
- intermediate - responsible for moving 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 diseases, malignancies, pregnancy, trauma, osteoporosis, nerve root compression, radiculopathy, plexopathy, osteochondrosis, disc herniation, spinal stenosis, sacroiliac joint dysfunction, facet injury and infection are part of the differential. Distinguishing the signs and symptoms of nociceptive (mechanical) pain from radiculopathy (neuropathic dorsopathy) is an important first step in making a diagnosis.
Degenerative pathologies
Degeneration includes endplate-related changes (sclerosis, defects, modal changes, and osteophytes) as well as disc changes (fibrosis, annular tears, desiccation, loss of height, and mucinous annular degeneration).
Degenerative disc changes are already observed in a third of healthy people aged between 21 and 40 years. The high prevalence of asymptomatic degeneration must be taken into account 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 fibrous ring is compromised by overload. This will eventually lead to the formation of cracks in the fibrous ring. A hernia is defined as displacement of disc material (cartilage, nucleus, fragmented annular tissue, and apophyseal bone) beyond the intervertebral disc space.
Rachiocampsis
The natural curves of the spine are important to ensure its strength, flexibility and ability to distribute load evenly. There is a normal range of natural curves. Abnormal curvatures include lordosis, kyphosis and scoliosis.
Abnormal lordosis
Lordosis, a spinal disorder, 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 cause instability in gait and changes in figure - the buttocks become more visible. Causes of abnormal lordosis: spondylolisthesis, osteoporosis and obesity.
Abnormal kyphosis
Kyphosis, a spinal disorder, is defined as an excessive outward curvature of the spine and can result in forward bending. It most often affects the thoracic or thoracolumbar region, but it can also occur in the cervical region.
The normal range for 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 manifests itself by rounding the shoulders and tilting the head forward.
Scoliosis
Defined as an abnormal lateral curvature of the spine. Scoliosis is a progressive structural disease. Lordosis and kyphosis are characterized by a backward or forward curvature of the spine. Scoliosis involves an abnormal lateral curvature of the spine.
The most common form of scoliosis is adolescent scoliosis, diagnosed between the ages of 10 and 18. The remaining 20% are due to neuromuscular, congenital, degenerative and traumatic causes.
Developmental anomalies
The symptom usually occurs with developmental defects and may be associated with neurological manifestations.
Dorsopathy is present with the following developmental anomalies:
- Division – with small bone defects there is moderate discomfort in the lumbosacral region. After some time, radicular syndrome occurs.
- Lumbarization, sacralization - compression of the roots is accompanied by sharp or burning pain. Sensitivity disorders or paresis may be added.
- Wedge-shaped vertebrae - discomfort occurs when exerting stress and maintaining a static position of the body for a long time. Accompanied by chest deformation and poor 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, which leads to brittle bones.
Osteoporosis can cause vertebral compression fractures, loss of height, hunched posture and even a hunchback. To prevent osteoporosis it is necessary to ensure a balanced diet, stop smoking and alcohol consumption. An active lifestyle is also recommended.
Injuries
The severity of dorsopathy corresponds to the severity of the injury. As a rule, it is associated with signs of damage to nervous tissue.
Traumatic causes of back pain:
- A bruise is the result of a direct blow or a fall on the back. Dorsopathy is local, moderate. Gradually disappears over 1-2 weeks.
- Dislocation – occurs due to high energy impact. Accompanied by severe pain in combination with disturbance of 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 it becomes intense and progresses with movement.
Pathological fractures that occur against the background of osteoporosis or tumors are manifested by slight discomfort, dull and aching pain. 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 lower back. There is a characteristic circadian rhythm - symptoms occur 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, spinal mobility is limited and thoracic kyphosis forms.
Also, back pain occurs with tuberculosis. Deep local discomfort is characteristic of vertebral destruction. Dorsopathy increases with exercise and is accompanied by excessive skin sensitivity. With acute, radiating pain, we are talking about compression of the nerve roots. The condition is complemented by stiffness of movements.
In osteomyelitis, severe dorsopathy is observed. The disease is diagnosed in patients in childhood and adolescence. Characterized by hematogenic nature. The 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 to the area of innervation of the nerve roots. Symptoms become constant and resemble sciatica. They are complemented by motor disorders, sensitivity disorders and loss of the ability to control the pelvic organs.
Tumors
Benign neoplasms have a latent course or are accompanied by slowly progressive and meager symptoms. Most often, hemangiomas appear, which appear only in 10-15% of cases. The discomfort is painful, local. It progresses at night and after physical activity. Spinal cord neoplasia is accompanied by radicular pain and impaired nerve conduction.
Spinal sarcomas in the primary stage of progression are manifested by intermittent moderate pain, which 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 location of the tumor).
Other diseases
Spinal discomfort is also seen with:
- Spinal epidural hemorrhage - similar to signs of radiculitis, accompanied by spinal conduction disorder.
- Calvet's disease - radiates to the legs, occurs periodically and is mildly expressed. Decreases when lying down, increases during physical activity.
- Forestier's disease - located in the thoracic region, spreads to the lower back 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 occurs 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 upper back dorsopathy affects 15 to 19% of people worldwide. Postmenopausal women are at greater risk, likely due to osteoporosis and vertebral compression fractures.
Professional activities also cause back pain. Those who need to maintain a static body position for long periods of time, such as dentists or salespeople, are more likely to face this problem than others. Office workers experience upper back discomfort due to poor workplace ergonomics.
Dorsopathy can occur at various points in the spine. The location area indicates the cause of the discomfort and greatly facilitates diagnosis.
Pain on the right side
The cause is excessive body weight, herniated disc or myositis. On the right side of the back, discomfort also occurs with kyphosis.
Among somatic pathologies are salpingitis, inflammation of the ovaries, nephritis, cholecystitis. Also worth mentioning is appendicitis and the presence of stones in the urinary tract organs.
Pain on the left side
The back on the left hurts due to splenitis (inflammation of the spleen), urolithiasis, oophoritis, duodenitis, pinched roots. Discomfort above the lower back indicates inflammation of the serous membranes of the lungs, bronchial injury, ischemia, and intercostal neuralgia.
Pain in the lower back
The lumbar region is most often subject to the development of pathological processes of the spine. This is due to the fact that it withstands a colossal load. When nerve roots are damaged, an inflammatory process develops. Hernial protrusion and osteochondrosis are also possible.
Less commonly, the cause is a combination of prostatitis and urethritis, violation of the structure of bone tissue, decreased density, lumbar sciatica, arthritis, spinal tuberculosis. Discomfort in the lower back, in most cases, is 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. Talking about radiculitis. Indicates liver dysfunction.
Pain in the left lower back
The discomfort is mainly localized after physical activity. The condition returns to normal after rest. If the discomfort does not subside at rest, we are talking about scoliosis, osteochondrosis, spinal infections and circulatory disorders.
Pinched nerve
In the vast majority of cases, the sciatic nerve is compressed (sciatica). At the same time, its myelin sheath is not damaged. Most often it develops against the background of osteochondrosis. Accompanied by acute and severe symptoms that radiate to the lumbar region, sacrum and lower extremities.
Spinal nerve roots are also compressed during compression radiculopathy. The cause is a herniated disc or a decrease in the distance between the vertebrae. "Superficial" discomfort is felt, which sharply intensifies during exercise, sneezing, coughing.
Intervertebral hernia
It is characterized by the extrusion (protrusion) of the nucleus into 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 slight load leads to the progression of the pathological process. Dorsopathy is acute and sharp, radiating to the leg or arm.
Pain in the shoulder blades
Based on the nature of the dorsopathy, a presumptive diagnosis can be determined:
- opaque, growing – stomach ulcer;
- acute, worsening with movement – intercostal neuralgia;
- numbness of the hands, pressure changes, dizziness – osteochondrosis;
- radiating under the clavicle - exacerbation of angina pectoris.
Pain along the spine and back
It develops due to compressed nerve endings against the background of curvature of the spine. If the symptoms are not clearly expressed, we can talk about protrusion. An increase in symptoms indicates osteochondrosis, myositis or fracture.
Severe discomfort along the spine indicates wear or thinning of the intervertebral discs. May indicate spondyloarthritis. The pain is constant and sharp.
Pain below the waist
Most often they occur with spondyloarthrosis and osteochondrosis. Less commonly observed in diseases of the female genital region (oophoritis, cervicitis, endometritis, etc. ). They can appear during pregnancy, during menstruation, with appendicitis, ulcerative colitis. In men, they indicate bladder or prostate diseases.
Diagnosis
First, a physical examination is performed to identify signs that indicate the need for further testing. 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. For patients with suspected radiculopathy, the neurological examination should focus on the L5 and S1 nerve roots.
Patients with a psychological disorder that contributes to back pain may experience accompanying physical signs, also known as Waddell signs. These include patient overreaction during physical examination, superficial tenderness, and unexplained neurological deficits (eg, sensory loss, sudden weakness, or jerky movements during motor examination). The presence of multiple Waddell signs indicates a psychological component of dorsopathy.
Spine pain treatment
In cases of dorsopathy, treatment must be carried out by a doctor. The specialist sends the patient for examination and, based on the results obtained, prescribes effective therapy.
Additional therapeutic measures should be used with caution and after consultation with a doctor. Any type of medication has 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 strain include:
- 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 impedes healing.
- Change in activity. It is recommended to stay active, but avoid activities and body positions that worsen dorsopathy. For example, if sitting for long periods in the car or at a desk increases discomfort, you should warm up every 20 minutes.
- Exposure to heat or cold. A heating pad or a hot bath relaxes tense muscles and improves blood flow, reducing discomfort. If your lower back hurts due to inflammation, you can use ice or cold packs to reduce swelling.
The most common over-the-counter medications for dorsopathy are ibuprofen, naproxen, and acetaminophen. The medications relieve inflammation and reduce discomfort in the lower back.
Conservative therapy
Oral drug therapy:
- Painkillers. Patients receive drugs from the anilide group, such as paracetamol. Provides 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. In higher dosages they have an anti-inflammatory effect.
- Muscle relaxants. They act centrally, influencing the activity of muscle stretch reflexes. The combination of an NSAID and a muscle relaxant provides significant relief from back pain. The main side effects are drowsiness, headache, dizziness and dry mouth.
- Neuropathic analgesics. 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. They play a potential role when discomfort is mediated by 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 may 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 treatments. Used to alleviate the condition of intervertebral hernias, spinal stenosis and radiculopathy. Reduce dorsopathy and quickly restore sensory functions.
Surgery
A small percentage of people with back pain require surgery to improve their condition. Indications for surgery vary according to the patient's characteristics and include:
- severe radicular symptoms, especially in the presence of progressive neurological motor deficits;
- radicular symptoms that are not amenable to conservative treatment.
The choice of surgical intervention is determined by the characteristics of the spinal cord injury. The operation is most effective when the patients' clinical picture is dominated by manifestations of nerve compression. The most common problem is inadequate neural decompression. Associated diseases including hip arthritis, osteoporosis and cardiovascular disease.
Surgery for patients with radicular pain due to herniated disc primarily involves decompression. Protruding, extruded, or isolated material from the disc is removed. The nerve root is examined 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, damage to the intestines or bladder. In social terms, complications are generally measured by disability and decreased performance.
Patients of all ages should:
- eliminate bad habits;
- live an active lifestyle;
- strengthen the protective functions of the body;
- lift heavy objects correctly;
- undergo preventive examinations with a doctor.
It is important not to slouch and keep your back straight. The place for sleeping and working must be organized correctly. It is recommended to perform light gym exercises every day when you wake up. You should also balance your diet by enriching it with foods with sufficient vitamins and minerals. It is recommended to take a contrast shower in the morning.