Lower back pain is probably familiar to almost every modern person. Employability can be affected by a number of reasons. These include back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be careless about that, because back pain can not only reach incredible strength, making a person's life unbearable, but it also turns out to be a symptom of the most dangerous diseases.
Lower back pain can be different: acute or dull, painful or burning, local (occurs in one place) or spreads to the entire back. Unpleasant sensations also occur in different ways: sometimes suddenly, suddenly, and sometimes gradually, intensifying every day.
The response to pain and the ability to endure pain depend on many factors: age, mental characteristics, accompanying symptoms and other factors. But in any case, you can't leave the disease to chance. Timely treatment will help avoid dangerous consequences.
To diagnose the cause of back pain, a spine examination and some additional procedures are necessary: X-ray examination, computer or magnetic resonance imaging. Attacks of pain, lumbosacral, occur during life, in about 80% of modern inhabitants of European countries.
Acute or chronic back pain in the lumbar region is a consequence of a number of neurological, degenerative-dystrophic diseases in women and men. In some cases, lower back pain is a consequence of diseases of internal organs, obesity, stress, mental disorders.
Pain syndrome - primary and secondary
Understanding why lower back pain hurts, we must not forget that the causes of such pain are dozens, and a non-professional will never be able to determine the true source of the problem. In general, medical classification separates primary and secondary pain syndromes that may affect the lumbar region.
The primary low back pain syndrome occurs as a result of musculoskeletal changes of a morphofunctional nature. It is the cause of the vast majority of cases of back pain in the lumbar region. The most significant of the causes are degenerative-dystrophic changes that occur in different parts of the spine:
- osteochondrosis, which is a lesion of bone and cartilage tissue, this disease has a dystrophic character. In addition, the intervertebral disc and adjacent vertebrae are affected, and spondylosis begins to develop.
- spondyloarthritis is a form of osteoarthritis in which the disease affects the intervertebral joints, which are responsible for the mobility of the spine, or synovial joints.
Secondary pain syndrome has much more diverse causes of pain:
- scoliosis, which is a curvature of the spine, as well as some other growth diseases;
- various inflammations that are non-infectious in nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
- a tumor located on the vertebrae, in the spinal cord itself or in the retroperitoneal space, regardless of whether it is primary or caused by metastases;
- fracture of one or more dorsal vertebrae. This is perhaps one of the most serious causes of back pain;
- various infectious diseases that lead to damage to the spine and intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
- stroke conditions in which there is a serious injury to the blood supply to the spinal cord. In this case, there may also be a feeling of lower back pain;
- diseases of the gastrointestinal tract. For example, acute appendicitis with atypical course, intestinal obstruction;
- often back pain is of a reflected nature. A similar problem can occur with some diseases of the organs located in the pelvic area. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - all these diseases cause back pain).
Acute and chronic low back pain
Pain in the lumbar region is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. The so-calleddisplaced pain in the lower back: in this case there is a translation of the feeling of pain from the deeper located internal organs and body structures; in other words, the patient appears to have lower back pain and is actually affected by a completely different part of the body.
The most common back pain is in the lumbar region, when pain is projected into this area from the pelvic organs, kidneys, pancreas, colon or tumors located behind the peritoneum. Many patients do not know what to do if their lower back hurts. But there is a clear recommendation, what exactly should not be done: self-medicate. The causes of pain are so diverse that only a qualified professional can make a correct diagnosis.
Possible causes of acute lower back pain include:
- The pain is accompanied by acute stretching of the muscles. In this case, the pain signals are localized in the back, supplied by spasmodic long muscles. The pain does not tend to spread to the groin or leg area. Human mobility is limited.
- One of the most common and severe causes of severe back pain is a fracture of the spine (vertebral fractures, including compression fractures). As a rule, this happens with unsuccessful falls, back bends and other injuries; but if the patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, there are cancerous tumors and their metastases in the vertebrae or other lesions of the skeletal system, vertebral fractures can occur literally "out of the blue" and even without fixation. sensations of the patient at the time of fracture.
- An equally uncomfortable situation in which the lower back hurts sharply is the displacement of the intervertebral discs that occurred in the spine. According to the frequency of lesions, the following areas differ: LV-SII - most common; LIV-LV - second in frequency; LIII-LIV and more are less common cases.
Symptoms include severe lower back pain, forced posture, and limited mobility. Participation in the pathological process of nerve roots is indicated:
- radicular pain, usually unilateral;
- sensitivity disorders (numbness, increase or decrease in sensitivity levels);
- reduction or disappearance of the Achilles reflex (in case of root damage S or S2);
- decreased intensity or absence of knee twitching (indicates damage to the L3-L4 area).
The general trend is that a protruding intervertebral disc affects the basal root (e. g. , LIV-LV mismatch causes L5 root pathology). The defeat of the cauda equina (horsetail) disrupted the functions of the bladder and rectum. Also, a similar condition can occur with a strong protrusion of the spinal disc.
The back hurts sharply in the lumbar region with facet syndrome: in this case, the disc remains intact, and the pain occurs as a result of compression of the root itself at the exit from the spinal canal. The most commonly observed facet syndrome of the unilateral type in the L5 root area; it results from an increase in the facets of the intervertebral joint (upper and lower) and, as a result, a narrowing of the intervertebral foramen.
Also, severe lower back pain is accompanied by an epidural abscess, a serious disease that requires urgent diagnosis and urgent treatment. Most often the inflammatory process develops in the thoracic spine; the pain becomes particularly strong by mechanical action on the area of pathology (pressure, tapping).
If there are signs of spinal cord compression, all highly effective medical measures are recommended, including surgery. Another reason why lower back pain can be hip disease - primarily coxarthrosis. This case is characterized by pain that spreads to the lower back, buttocks, and also to the legs to the knees.
Diseases characterized by chronic lower back pain:
- Deforming spondylosis is a disease in which there is a dystrophic change in the lumbar spine, calcification of their ligament apparatus and further bone growth; bone growths press on the root and narrow the spinal canal. In the case of lower back pain accompanied by weakness in the legs, numbness and other neurological symptoms, the possibility of intermittent claudication syndrome should be considered, which can be caused by narrowing of the spinal canal. An examination is necessary, the results of which make the final diagnosis.
- Ankylosing spondylitis (or Bechterew's disease). In the early phase, it is characterized by limited mobility, especially in the morning, by reducing the movement of the chest during breathing. There is traction pain in the lower back; the curvature of the spine in the thoracic part further develops and progresses. X-ray examination reveals anomalies of the sacroiliac joints: destruction, changes in structure, "bamboo" spine. A detailed examination and detection of the reasons why the lower back hurts is necessary, because similar symptoms and limited mobility of the lower spine can cause other diseases - Reiter's syndrome, psoriatic arthritis, chronic colitis.
- Oncological diseases (tumors, metastases), metabolic disorders (including NBO). It is necessary to exclude such causes of back pain: metastatic cancer of the lungs, breast, prostate and thyroid gland, kidneys, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). The exception is the method of X-ray examination and myelography.
- Osteomyelitis also causes prolonged lower back pain. If this disease is suspected, an X-ray of the bone tissue, a skin test with tuberculin and an ESR test are performed to determine the presence / absence of tuberculosis bacteria or pyogenic (pyogenic) bacteria in the body, most often staphylococci - the causes of osteomyelitis.
- Spinal cord tumors (intradural tumors) of various types. Diseases such as lipoma, neurofibroma, meningioma can cause constant back pain, initially without any accompanying neurological symptoms.
Causes of back pain of an occasional nature. Many diseases of the internal organs cause periodic, sharp or dragging pains in the lower back. At the same time, patients do not have a feeling of stiffness in the back area, there is no clear localization of pain, and the pain does not increase with the widest possible range of motion. When asked what to do if your lower back hurts not constantly, but from time to time, the answer is simple: do not wait for it to hurt "properly", but consult a doctor.
There is a clear influence of the pathology of one or another organ on a particular part of the spine. Thus, from the pelvic organs the pain radiates to the sacrum, in diseases of the organs lying in the lower abdominal cavity, it radiates to the lower back (segments L3-L5), and in the upper part - to segments of the upper lumbar zone or lower chest zone.
Diseases - causes of lower back pain, and area of pain distribution:
- If the pelvic organs are affected, along with endometriosis, ovarian or uterine cancer, the lower back hurts. In men, such intermittent pain may be caused by chronic prostatitis or the development of prostate cancer.
- Various kidney diseases cause pain at the junction of the ribs and the spine.
- Tumors of the stomach, duodenum, peptic ulcer, tumors of the pancreas (especially if the disease spreads outside the peritoneum) - the pain spreads to the spinal segments T10-L2;
- In ulcerative colitis, diverticulitis, or colon tumors, the lower back hurts;
- If the back hurts in the thoracic / lumbar region, aortic dissection (dissecting aneurysm) should be ruled out.
Diagnosis of lower back pain
For pain in the lower back and lumbago, computer (shows the condition of the bone tissue of the spine) and magnetic resonance imaging (allows you to assess the condition of soft tissues) tomography and ultrasound examination of internal organs are recommended.
One of the methods of diagnosis is radiography, which is relatively cheap and can be useful in detecting a number of disorders, from bone fractures to kidney stones. Many of the detected changes only point to a correct diagnosis, and additional studies may be needed to confirm them. In addition, some radiological changes may be accompanying findings that are not the cause of the pain.
It all starts with a neurological and orthopedic examination by a doctor. During this examination, the neurological status of the patient is assessed, possible injuries in the biomechanics of the spine are determined, with the obligatory assessment of the condition of the back muscles and the gluteal region. Already at this stage of the study, a patient with osteochondrosis of the spine and pain in the back and lower back can be diagnosed and treated.
Sometimes, according to the results of the examination by an orthopedist of a patient with a symptom of pain on the background of osteochondrosis of the spine, the following additional diagnostic procedures may be prescribed:
- radiography of the lumbosacral spine with functional tests;
- CT of the lumbosacral spine;
- MRI of the lumbosacral spine.
The center of the intervertebral disc is occupied by the gelatinous nucleus pulposus. It is surrounded and supported by a fibrous ring, which consists of fibrous cartilage and connective tissue. You can read more about this in the article on the anatomy of the human spine and spinal cord.
The thickness of the discs decreases, the vertebral bodies get closer to each other, reducing the intervertebral openings and endangering the nerves and vessels that are in them (osteochondrosis).
Disc protrusion (intervertebral disc protrusion) with their further prolapse into the lumen of the spinal canal (disc herniation) most often leads to compression of nerve roots, causing pain along the compressed nerve (pain radiating to the leg, arm, nape, neck, intercostal spaces depending on the degreenerve compression) with weakening of muscle strength in the areas of their innervation and violation of sensitivity.
Often, protrusion or hernia of the intervertebral disc is accompanied by muscle pain along the course of the nerve (along the arm or leg). In this case, one or immediately (rarely) two nerves are compressed.
In addition to nerve compression, the stability of the spinal segment may be impaired. In spinal instability, the vertebrae move forward (anterolyses) or backward (retrolisthesia). An X-ray of the lumbosacral spine with functional tests may be needed to clarify the diagnosis.
Most often, the nerve bundles that form the femoral nerve due to their anatomical location suffer from compression of the hernia or protrusion of the intervertebral disc. The sciatic nerve consists of fibers L5, S1, S2, S3 - spinal nerves.
The focus of chronic inflammation in the lumen of the spinal canal can lead to the creation of its narrowing (spinal canal stenosis) and compression of the nerves and spinal cord that pass through it. Therefore, in the case of spinal canal stenosis, it is always necessary to carry out the entire course of treatment using a whole arsenal of different treatment methods, and in case of inefficiency, surgical treatment.
Which doctor should I go to?
In case of back pain, first of all, you should contact a neurologist at the district clinic, if the patient's condition is stable, or call an ambulance. Lower back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.
Lower back pain is combined with various infections, limb injuries. Lower back pain with heart and lung disease is not excluded. This is determined by detailed examination. Once a patient is diagnosed, he or she is usually prescribed medications that reduce back pain, normalize blood circulation, and help repair nerve tissue. These can be tablets, gels, ointments or injections that relieve inflammation and cramps.
Surgical intervention is usually required when a herniated disc is diagnosed, which is a complication of osteochondrosis. The hernia that compresses the nerve root is removed, restored, and the pain passes over time.
It is best to relax the spine and paravertebral muscles if you sleep on a hard mattress with a small pillow below the knee. At the same time, bed rest should not last too long, because it is fraught with weakening of the paravertebral muscles, which will only worsen the problem. Even with severe pain, you should try to maintain at least low physical activity.
How to relieve back pain
The appearance of symptoms of pain is often the result of muscle spasm, which can be eliminated with the help of special means - muscle relaxants. Such drugs are actively used in the treatment of spinal diseases.
So, in case of strong, unexpected pain in the lower back, it is recommended to take a muscle relaxation tablet, rubbing the back with a gel to warm the anesthetic. When using the funds, you must strictly follow his instructions.
In cases when the unpleasant symptom is caused by the presence of inflammatory diseases of internal organs, it is recommended not to delay contacting a doctor, if at a certain time it is impossible to visit specialists and the pain is too intense, I can take Pentalgin or No-shpu. The sore spot should not be heated with a heating pad, because the heat contributes to the spread of the inflammatory process, and thus to the strengthening of the symptoms that accompany it.
Ointment for back pain
Ointment preparations are often used in the treatment of diseases of the lower spine. These drugs include drugs that have pronounced anti-inflammatory, mild analgesic and antipyretic effects.
The course of treatment is prescribed taking into account the severity of pain symptoms. Ointment for back pain is used as a main or auxiliary treatment. In addition to the pronounced symptoms of osteochondrosis, rubbing the lower back with ketoprofen-based ointment, a substance with a strong analgesic effect, is indicated.
The main plus of topical preparations is their effect not on the whole body as a whole, but on a specific area to be treated. Painkillers and anti-inflammatory ointments have fewer contraindications and side effects compared to similar drugs in tablet form.
Exercises for back pain
Gymnastics is considered an additional method of treating lower back disease. The exercises that are shown to patients are quite simple and are not accompanied by a special load on the body. For example, the usual hanging on the bar of a horizontal bar has a beneficial effect on the condition of the spine, helps to relax muscles and remove lumbago - pain caused by pinching its nerve roots. Therapeutic exercises for back pain, followed by lower back pain, include exercises:
- lifting the leg (so that the knee touches the chin);
- "bicycle" is performed lying on your back;
- walking on your knees.
It is recommended to give the exercises no more than 10-15 minutes every day, with severe pain - refuse to perform them.