Almost every adult has experienced back pain in their lifetime. This is a very common problem, which can be based on different reasons, which we will analyze in this article.
Causes of back pain
All causes of back pain can be divided into groups:
Musculoskeletal:
- Osteochondrosis;
- disc herniation;
- Compression radiculopathy;
- Spondylolisthesis;
Inflammatory, including infectious:
- Osteomyelitis
- Tuberculosis
neurological;
Injuries;
Endocrinological;
Vascular;
Tumor.
During the first visit to the doctor with back pain, the specialist should determine the cause and type of pain, paying special attention to "red flags" - possible manifestations of potentially dangerous diseases. "Red flags" refer to a set of specific complaints and data from the anamnesis that require an in-depth examination of the patient.
"Red Flags":
- age of the patient at the time of onset of pain: younger than 20 or older than 50 years;
- a serious spinal injury in the past;
- occurrence of pain in patients with cancer, HIV infection or other chronic infectious processes (tuberculosis, syphilis, Lyme disease, etc. );
- fever;
- weight loss, loss of appetite;
- unusual localization of pain;
- increased pain in a horizontal position (especially at night), in a vertical position - weakening;
- no improvement for 1 month or more;
- pelvic organ dysfunction, including urination and defecation disorders, numbness of the perineum, symmetrical weakness of the lower extremities;
- alcoholism;
- use of narcotic drugs, especially intravenous drugs;
- treatment with corticosteroids and/or cytostatics;
- with pain in the neck, pulsating nature of the pain.
The presence of one or more signs by itself does not mean the presence of a dangerous pathology, but it requires the attention of a doctor and diagnosis.
Back pain is divided into the following forms according to duration:
- acute- pain lasting less than 4 weeks;
- subacute- pain lasting from 4 to 12 weeks;
- chronically- pain lasting 12 weeks or more;
- recurrence of pain- continuation of pain if it has not appeared in the last 6 months or more;
- exacerbation of chronic painRecurrence of pain less than 6 months after the previous episode.
Diseases
Let's talk more about the most common musculoskeletal causes of back pain.
Osteochondrosis
It is a disease of the spine, which is based on wear and tear of the spinal discs, and then of the vertebrae themselves.
Is osteochondrosis a pseudodiagnosis? - No. This diagnosis exists in the International Classification of Diseases ICD-10. Currently, doctors are divided into two camps: some believe that such a diagnosis is incorrect, others, on the contrary, often diagnose osteochondrosis. This situation arose due to the fact that foreign doctors understand osteochondrosis as a disease of the spine in children and adolescents associated with growth. However, this term specifically refers to degenerative spinal disease in people of any age. Also, often diagnosed are dorsopathy and dorsalgia.
- Dorsopathy is a pathology of the spine;
- Dorsalgia is a benign, non-specific back pain that spreads from the lower cervical vertebrae to the sacrum, and can also be caused by damage to other organs.
The spine has several sections: cervical, thoracic, lumbar, sacral and coccygeal. Pain can occur in any of these areas, described by the following medical terms:
- Cervicalgia is pain in the cervical spine. The intervertebral discs of the cervical region have anatomical characteristics (the intervertebral discs are absent in the upper part, and in the other parts they have a weakly expressed nucleus pulposus with withdrawal in an average of 30 years), which makes them more susceptible to stress. and injuries, which lead to stretching of ligaments and early development of degenerative changes;
- Thoracalgia - pain in the thoracic spine;
- Lumbodynia - pain in the lumbar spine (lower back);
- Lumboischialgia is pain in the lower back that spreads to the leg.
Factors that lead to the development of osteochondrosis:
- heavy physical work, lifting and moving heavy loads;
- low physical activity;
- long sitting work;
- long stay in an uncomfortable position;
- long work at the computer with a non-optimal position of the monitor, which creates strain on the neck;
- breach of posture;
- congenital structural characteristics and anomalies of the spinal column;
- back muscle weakness;
- high growth;
- excess body weight;
- leg joint diseases (gonarthrosis, coxarthrosis, etc. ), flat feet, club feet, etc. ;
- natural wear and tear with age;
- smoking.
disc herniationis a protrusion of the core of the intervertebral disc. It can be asymptomatic or cause compression of the surrounding structures and manifest as a radicular syndrome.
Symptoms:
- violation of range of motion;
- feeling of stiffness;
- muscle tension;
- radiating pain to other areas: arms, shoulder blades, legs, groin, rectum, etc.
- "shoots" of pain;
- numbness;
- crawling sensation;
- muscle weakness;
- pelvic disorders.
The localization of the pain depends on the level at which the hernia is localized.
Herniated discs often resolve on their own in an average of 4-8 weeks.
Compression radiculopathy
Radicular (radicular) syndrome is a complex of manifestations that arise due to compression of the spinal roots at the points of their departure from the spinal cord.
Symptoms depend on the level at which spinal cord compression occurs. Possible manifestations:
- pain in the extremity of a shooting nature with radiation to the fingers, aggravated by movement or coughing;
- numbness or the sensation of flies crawling over a certain area (dermatomas);
- muscle weakness;
- back muscle spasm;
- violation of reflex power;
- positive symptoms of tension (appearance of pain with passive bending of the limbs)
- limitation of spinal mobility.
Spondylolisthesis
Spondylolisthesis is a displacement of the upper vertebra in relation to the lower one.
This condition can occur in both children and adults. Women are more often affected.
Spondylolisthesis may not cause symptoms with mild displacement and may be an incidental finding on x-ray.
Possible symptoms:
- a feeling of discomfort
- pain in the back and lower extremities after physical work,
- weakness in the legs
- radicular syndrome,
- reduction of pain and tactile sensitivity.
Progression of vertebral displacement can lead to lumbar stenosis: the anatomical structures of the spine degenerate and grow, which gradually leads to compression of nerves and blood vessels in the spinal canal. Symptoms:
- constant pain (both at rest and in motion),
- in some cases, the pain may be reduced by lying down,
- the pain is not aggravated by coughing and sneezing,
- the nature of the pain ranges from pulling to very severe,
- pelvic organ dysfunction.
With a strong movement, the arteries can be compressed, due to which the blood supply to the spinal cord is disturbed. This is manifested by sharp weakness in the legs, the person may fall.
Diagnostics
Collection of complaintshelps the doctor to suspect the possible causes of the disease, to determine the localization of the pain.
Assessment of pain intensity- a very important stage of diagnosis, which allows you to choose a treatment and evaluate its effectiveness over time. In practice, the Visual Analogue Scale (VAS) is used, which is suitable for both the patient and the doctor. In this case, the patient evaluates the intensity of pain on a scale from 0 to 10, where 0 points is no pain and 10 points is the worst pain a person can imagine.
Interviewallows you to identify factors that cause pain and destruction of the anatomical structures of the spine, to identify movements and positions that cause, intensify and relieve pain.
Overview:assessing the presence of back muscle spasms, determining the development of the muscular skeleton, excluding the presence of signs of an infectious lesion.
Assessment of neurological status:muscle strength and its symmetry, reflexes, sensitivity.
March Test:it is carried out in cases of suspected lumbar stenosis.
Important!Additional studies are not recommended for patients without "red flags" with a classic clinical picture.
radiography:performed functional tests on suspected instability of spinal structures. However, this diagnostic method is uninformative and is carried out mostly with limited financial resources.
Computed tomography (CT) and/or magnetic resonance imaging (MRI):the doctor will prescribe based on clinical data, because these methods have different indications and advantages.
CT |
MRI |
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Important!In most people, in the absence of complaints, instrumental examination methods reveal degenerative changes in the spine.
Bone densitometry:performed to assess bone density (confirmation or exclusion of osteoporosis). This study is recommended for postmenopausal women with a high risk of fracture and always at the age of 65, regardless of risk, men older than 70, fracture patients with minimal history of trauma, long-term use of glucocorticosteroids. The 10-year fracture risk is assessed using the FRAX scale.
Bone scintigraphy, PET-CT:carried out in the presence of suspicion of oncological disease according to other examination methods.
back pain treatment
For acute pain:
- painkillers are prescribed for the course, mainly from the group of non-steroidal anti-inflammatory drugs (NSAIDs). The specific drug and dose are selected depending on the severity of the pain;
- maintaining moderate physical activity, special exercises to relieve pain;
Important!Physical inactivity with back pain increases the pain, prolongs the duration of symptoms and increases the likelihood of chronic pain.
- muscle relaxants for muscle spasm;
- it is possible to use vitamins, however, their effectiveness according to various studies remains unclear;
- manual therapy;
- lifestyle analysis and elimination of risk factors.
For subacute or chronic pain:
- use of painkillers on demand;
- special physical exercises;
- assessment of mental state, because it can be a significant factor in the development of chronic pain, and psychotherapy;
- drugs from the group of antidepressants or antiepileptics for the treatment of chronic pain;
- manual therapy;
- lifestyle analysis and elimination of risk factors.
Blockades (epidural injections) or intraosseous blocks are used for radicular syndrome.
Surgical treatment is indicated with a rapid increase in symptoms, the presence of spinal cord compression, significant stenosis of the spinal canal and ineffectiveness of conservative therapy. Urgent surgical treatment is carried out in the presence of: pelvic disorders with numbness in the anogenital region and ascending weakness of the feet (cauda equina syndrome).
Rehabilitation
Rehabilitation should be started as soon as possible and have the following goals:
- improving the quality of life;
- removal of pain, and if it is impossible to completely eliminate it - relief;
- restoration of functioning;
- rehabilitation;
- self-service and safe driving training.
Basic rules of rehabilitation:
- the patient must feel his own responsibility for his health and adherence to recommendations, however, the doctor must choose treatment and rehabilitation methods that the patient can adhere to;
- systematic training and compliance with safety rules when performing exercises;
- pain is not an obstacle to exercise;
- a relationship of trust must be established between the patient and the doctor;
- the patient should not focus and focus on the cause of pain in the form of structural changes in the spine;
- the patient should feel comfortable and safe when performing movements;
- the patient should feel the positive impact of rehabilitation on his condition;
- the patient needs to develop skills to respond to pain;
- the patient should associate movement with positive thoughts.
Rehabilitation methods:
- walking;
- Physical exercises, gymnastics, gymnastics programs at the workplace;
- Individual orthopedic devices;
- Cognitive behavioral therapy;
- Patient education:
- Avoid excessive physical activity;
- Fight against low physical activity;
- Exclusion of long-term static loads (standing, staying in an uncomfortable position, etc. );
- Avoid hypothermia;
- Sleep organization.
Prevention
Optimal physical activity: strengthens the muscle frame, prevents bone resorption, improves mood and reduces the risk of cardiovascular accidents. The most optimal physical activity is walking more than 90 minutes a week (at least 30 minutes, 3 days a week).
During prolonged sitting work, it is necessary to take warm-up breaks every 15-20 minutes and observe the rules of sitting.
Life hack:
how to sit
- avoid excessively upholstered furniture;
- the legs should rest on the floor, which is achieved by the height of the chair equal to the length of the lower leg;
- it is necessary to sit at a depth of up to 2/3 of the length of the hips;
- sit upright, maintain proper posture, your back should fit tightly against the back of the chair to avoid straining your back muscles;
- the head when reading a book or working at the computer should have a physiological position (look straight ahead, not constantly down). To do this, it is recommended to use special stands and install the computer monitor at an optimal height.
During prolonged standing work, it is necessary to change the position every 10-15 minutes, alternately changing the supporting leg, and if possible, walk in place and move.
Avoid lying down for long periods of time.
Life hack:
how to sleep
- sleep better on a semi-hard surface. If possible, you can choose an orthopedic mattress so that the spine maintains physiological curves;
- the pillow should be soft enough and of medium height to avoid pressure on the neck;
- when sleeping in a lying position, it is recommended to put a small pillow under your stomach.
Quit smoking: If you are having difficulty, see your doctor who will refer you to a smoking cessation program.
Frequently Asked Questions
I use ointments with glucocorticosteroids. Am I at increased risk of osteochondrosis or osteoporosis? no. External glucocorticosteroids (ointments, creams, gels) do not penetrate in significant quantities into the systemic circulation, and therefore do not increase the risk of developing these diseases.
Is surgery necessary in every case of a herniated disc? no. Surgical treatment is performed only if indicated. On average, only 10-15% of patients need surgery.
Should you stop exercising if you have back pain? no. If as a result of additional examination methods, the doctor does not find anything that would significantly limit the degree of load on the spinal column, then it is possible to continue playing sports, but after completing the course of treatment and adding certain exercises from the course of physiotherapy exercises and swimming.
Can my back pain go away forever if I have a herniated disc? They can after a course of productive conservative therapy, with further implementation of the neurologist's recommendations, compliance with the rules of prevention, regular exercise therapy and swimming.