Back pain in the lumbar region.

Back pain in the lumbar region is familiar to everyone. According to statistics, it is she who becomes the cause of 25% of all requests for medical care. Its appearance can provoke many different factors, from banal fatigue to quite serious diseases. Therefore, you should not ignore the problem, especially if the discomfort appears regularly, and even more so over time. In such situations, you should contact a therapist as soon as possible or go directly to a neurologist and undergo a full examination.This will make it possible to diagnose the disease in the early stages of development and take timely action to stop its progression. But if on the eve of the onset of pain there was an injury or a failed fall, you should immediately sign up for a consultation with a traumatologist or spine surgeon.

Characteristics of low back pain and accompanying symptoms

Back pain can be of different nature and severity. They can be loud, shoot, whine, pull, etc. They are able to intensify during physical exertion, sitting or standing for a long time, and pass at rest or not. These are all important diagnostic factors that allow the doctor to make the correct diagnosis and find the true cause of the patient's condition.

It is of fundamental importance to make a diagnosis if the pain radiates to the hips, buttocks, knees, feet and, if so, where and how. In addition, a weight moment is the presence of restrictions in the mobility of the spine, whether the patient can freely perform curves, body turns, or the range of motion is reduced.

Pain in the spine is called lumbodynia. If it spreads to the legs, it is called lumboischialgia.

Acute pains are those that persist for less than 3 months, otherwise, they speak of chronic pain. In the latter case, the disease usually presents 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 with each other. Back pain is often combined with:

• tingling sensation in the back and / or legs, numbness;
• muscle weakness;
• hip pain, knee joints;
• alteration of the pelvic organs (menstrual irregularities, potency problems, loss of control of urination, defecation);
• leg paralysis.

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

• rapid and unnecessary weight loss;
• cuts and pain in 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 of the first group appear, the consultation of a neurologist is required, of the second, the help of a urologist, gynecologist, endocrinologist or other narrow specialists is needed. The therapist will help you understand exactly which doctor to contact.

Causes of occurrence

All causes of back pain in the lumbar region can be divided into 2 groups: diseases of the spine and pathologies of internal organs, in particular, gynecological diseases, pathologies of the kidneys, organs of the gastrointestinal tract, endocrine disorders. But still, most of the time they are a consequence of the development of changes in the spine and the surrounding 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 such situations, they do not require special treatment, but only a decrease in physical activity and a more moderate daytime regimen.

Osteochondrosis and intervertebral hernias

Osteochondrosis is the most common disease of the spine. Its development is usually associated with unavoidable changes related to age, since almost all elderly people present their symptoms to a greater or lesser extent.

Osteochondrosis is the price that humanity must pay for the ability to walk straight. It is characterized by a gradual destruction of the intervertebral discs, their thinning, a decrease in elasticity and firmness. As a result, they stop coping with stress and can bulge out. Thus, intervertebral hernias are formed.

Most often, osteochondrosis affects the intervertebral discs of the lumbar spine. When they protrude into the spinal canal or foraminal foramen, the nerves almost inevitably deteriorate, which leads to the appearance of acute pain in the lower back and its radiation 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 ongoing degenerative processes and increased load on the spine, bony protrusions called osteophytes form aalong 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

More often, inflammatory diseases of the spine occur in young people and mainly in men. They cause severe pain that bothers even at night, which is their specific difference. As it progresses, in the absence of timely treatment, the pain becomes more intense and bothers the person more often.

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 ultimately 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 discomfort may be arthritis, osteomyelitis.

Myofascial syndrome

Myofascial syndrome is a common pathology in which pain occurs after a prolonged stay in an uncomfortable position or after physical exertion. A little more often, myofascial syndrome occurs in women. With it, back pain occurs after careless movement or physical exertion. Its distinctive feature is the presence of so-called trigger points in the spasmodic muscles in the lumbar region and buttocks, pressing on 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, the joints of the spine and the surrounding soft tissues are mainly affected. With this disease, people are concerned about back and sacrum pain and stiffness of movements, but symptoms usually disappear without a trace in the afternoon and evening.

Furthermore, physical activity has a beneficial effect on the patient's well-being and contributes to the elimination of pain syndrome. A fairly specific symptom of ankylosing spondylitis is stooping, arcuate curvature of the spine, and progressive limitation of mobility.

Scoliosis

Scoliosis is a lateral curvature of the spine. It can be of varying severity, directly affecting the intensity of back pain and other symptoms. Since the deformity of the spine leads to a displacement of all anatomical structures, the nerves are often pinched, causing severe pain. In addition, other neurological signs may be present, including a feeling of numbness and paresis.

Compression fractures

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

Physiological causes of low back pain

When doing hard physical work, intense sports training creates a greater load on the muscles, as a result of which lactic acid accumulates in them, causing pain. Back pain is not uncommon with prolonged wear of uncomfortable shoes, especially with heels.

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

Diagnosis

To determine the causes of back pain in the lumbar region, it is recommended to consult a neurologist. Initially, you can consult a therapist, but the doctor will most likely still refer the patient to a neurologist.

At the appointment, the specialist will conduct a thorough examination of the patient, find out what worries him, what kind of lifestyle he leads, etc. In addition, an examination is required, during which the doctor assesses the severity of the 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 kinds of violations led to the appearance of back pain and low back pain.

To confirm existing assumptions, to find out exactly what causes the pain, a full 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 lumbar region;
• X-ray - shows the presence of a change in the bone structures of the spine, signs of fractures, provides information on bone density and allows you to diagnose the main diseases of the spine, as well as osteoporosis (the detection ofpathologies of the spine is a reason for a more complete examination with CT or MRI);

• CT is a modern method of radiation diagnosis, which allows you to very clearly visualize all bone structures and detect the slightest deviations from the norm;
• MRI - provides comprehensive information on the state 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 of low back pain

The treatment of back pain is selected strictly on an individual basis. At the same time, it is always complex and includes symptomatic therapy, lifestyle changes, and treatment aimed at eliminating the discovered causes of low back pain. Therefore, if the first 2 components of therapy are usually universal and are prescribed to all patients, then etiotropic therapy is developed strictly individually, taking into account the existing disease.

In most cases, patients are initially offered conservative treatment, the main component of which is drug treatment. In more difficult cases, a course of physiotherapy procedures, manual therapy and exercise therapy is also recommended.

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

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

Depending on the source of pain, patients may be advised to stay in bed for a couple of days or, conversely, 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, reduce the risk of complications, and prevent disability.

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

Drug therapy

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

• NSAIDs in the form of tablets, injections and topical preparations - have analgesic and anti-inflammatory properties;
• corticosteroids: given in short courses to control severe inflammation;
• muscle relaxants - needed to relieve muscle spasm, which is often a reflex reaction of the body to pain and aggravates it;
• B vitamins: improve nerve conduction by normalizing the nutrition of nerve fibers and increasing the speed of transmission of nerve impulses.

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

But the blockade has only a temporary effect, and its implementation is possible only in a medical institution, since most often it is required to inject the drug into points located in the immediate vicinity of the spine, where a mass passesOf nerves. Therefore, an illiterate implementation of the procedure can have serious and sometimes fatal consequences.

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

Physiotherapy

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

Most often, patients are prescribed:

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

As a general rule, the course of procedures includes 8-10 sessions, which are carried out with a certain frequency.

Manual therapy

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

The use of special techniques of manual influence makes it possible to achieve not only the improvement of 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 can find where the nerve is pinched and relieve pressure from the 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. But in order to consolidate the results obtained, it is recommended to undergo a full course of manual therapy and, in the future, take support courses.

exercise therapy

Physical therapy helps the body cope with the stresses imposed on it. For each disease, a special set of exercises has been developed, the regular implementation of which makes it possible to solve the most important tasks in the current situation. Thus, with the help of a properly selected complex of physiotherapy exercises, it is possible to restore normal tone to the muscles and strengthen them. Thanks to this, the spine will have a lower load, which will become an effective prevention of the progression of the disease and create favorable conditions for its recovery.

Exercise therapy also helps improve blood circulation in the affected area, accelerating the course of inflammatory processes and probably leading to a full recovery. The correct exercise for many conditions can help reduce 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, her age and other factors. Only a specialist can correctly choose the most effective and safe set of exercises.

It is under your supervision that the first classes are held. In the course of them, the patient learns to correctly perform each exercise proposed so that it is beneficial. Little by little, the load increases, bringing it to the optimum level. But it is not recommended to increase the number of repetitions of exercises yourself or complicate them. Any change in the physical therapy program is introduced only by a specialist.

The patient only needs to strictly follow their recommendations and practice daily in a comfortable environment. All exercises are done at a slow pace. Sudden movements are not allowed. But if pain arises during the lesson, the exercise should be stopped immediately and consult your doctor as soon as possible.

Surgery for back pain

Very often, the help of a spinal surgeon is necessary for intervertebral hernias, the formation of which has led to infringement of the spinal root and the development of radicular pain. If the lump has already formed, it is impossible to force it out in modern non-invasive ways. The only way to eliminate it and at the same time get rid of low back pain is to remove the intervertebral hernia by 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 methods of percutaneous surgery that allow a part of the nucleus pulposus to be removed by puncturing tissues with a diameter of several centimeters and to reduce the size of the hernia.
• Microdiscectomy is a radical way to solve the problem of an intervertebral hernia, involving the removal of this or the entire disc through an incision up to 3 cm long, but, unlike other methods, it allows to eliminatea hernia of any size, regardless of its location in the spinal canal, and release a pinched nerve even in the most difficult part of the spine.
• Endoscopic surgery: consists of 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.

Also, the help of a spine surgeon is needed for scoliosis. In this case, all forces are directed to restore the normal axis of the spine. Previously, this required making a large incision that spanned virtually the entire back. But today it is possible to correct the deformity of the spine in a minimally invasive way using miniature incisions.

Various types of metal structures are used to restore the normal axis of the spine, but their essence is roughly the same. The structure is fixed to the vertebrae with special screws and by 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 reoperation on the body. This is achieved by correcting the position of the installed structure with special screws.

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

Therefore, back pain may be the result of physiological changes, common muscle fatigue, or a symptom of serious 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 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 allow it to be surgically removed with minimal risk of complications.