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 factors other than banal fatigue to rather serious diseases. Therefore, you shouldn't 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 allow to diagnose the disease in the early stages of development and to take timely measures to stop its progression. But if an injury or an unsuccessful fall occurred on the eve of the onset of pain, you should immediately sign up for a consultation with a traumatologist or spinal surgeon.

Characteristics of low back pain and associated symptoms

Back pain can be of different nature and severity. They can be strong, pulling, aching, pulling, etc. They can intensify during physical exertion, sitting or standing for a long time, and switch to 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.

Crucially important in making a diagnosis is whether the pain radiates to the hip, buttocks, knee, foot and, if so, where and how. In addition, a heavy moment is the presence of restrictions on the mobility of the spine, regardless of whether the patient can freely perform bends, turns of the body or the range of motion is reduced.

Pain in the spine is called lombodynia. 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 often manifests itself with periods of exacerbation and remission.

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

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

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 pathology of internal organs or cancer. Therefore, you need to be especially careful about your status when it appears:

• rapid and unnecessary weight loss;
• cuts and pains 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 lower back pain is associated with one or more of the above symptoms, you should see a doctor immediately. When symptoms appear from the first group, consultation of a neurologist is required, from the second, the help of a urologist, gynecologist, endocrinologist or other narrow specialists is required. Your therapist will help you figure out 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 the internal organs, in particular, gynecological diseases, pathologies of the kidneys, organs of the gastrointestinal tract, endocrine disorders. However, most often they are a consequence of the development of changes in the spine and 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 some physiological changes. In such situations, they do not require special treatment, but only a decrease in physical activity and a more sparing daily regimen.

Osteochondrosis and intervertebral hernias

Osteochondrosis is the most common disease of the spine. Its development is often associated with inevitable age-related changes, as nearly every elderly person experiences their symptoms to a greater or lesser extent.

Osteochondrosis is the price to pay for humanity 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 cease to cope with stress and can swell. 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 are almost inevitably compromised, which leads to the appearance of acute pain in the lower back and their 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 an increased load on the spine, bony protrusions called osteophytes are formed alongthe 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 often, inflammatory diseases of the spine occur in young people, mainly in men. They cause severe pain that bother even at night, which is their specific difference. As it progresses, in the absence of timely treatment, the pain becomes more intense and disturbs the person more often.

It is not uncommon for patients to seek medical attention 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 lower back pain, there is discomfort in the joints of the legs and arms. In these cases, the cause of discomfort can 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 the so-called trigger points on the spasmodic muscles of the lumbar region and buttocks, the pressure on which causes a sudden attack of pain. Myofascial syndrome significantly reduces the quality of human 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, spinal joints and surrounding soft tissues are primarily affected. With this disease, people are concerned about back pain and sacrum pain and stiffness of movement, but the symptoms usually go away without a trace in the afternoon and at night.

In addition, physical activity has a beneficial effect on the patient's well-being and contributes to the elimination of the pain syndrome. A fairly specific symptom of ankylosing spondylitis is curvature, arched curvature of the spine and 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. Since the deformation of the spine leads to a displacement of all anatomical structures, the nerves are often pinched, which causes severe pain. Also, other neurological signs may be present, including a feeling of numbness and paresis.

Compression fractures

In older people with osteoporosis and trauma, lower back pain may be the result of an undetected spinal compression fracture. As a result, the vertebrae are flattened and occupy an abnormal position, which leads to an incorrect distribution of the load on 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 which lactic acid accumulates in them, causing pain. Back pain is not uncommon with long-term use of uncomfortable shoes, especially heels.

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

Diagnostics

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

At the appointment, the specialist will conduct a thorough investigation 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 reflexes, conducts 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 led to the onset of back pain and low back pain.

To confirm existing hypotheses, to determine the exact 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, which indicate 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 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 of pathologies of the spinevertebral is a reason for more thorough examination with CT or MRI);

• CT is a modern method of radiation diagnostics, which allows you to very clearly view all bone structures and detect the slightest deviations from the norm;
• MRI - provides comprehensive information on the condition of soft tissues and cartilage, including intervertebral discs, using magnetic resonance 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 individually. At the same time, it is always complex and includes symptomatic therapy, lifestyle changes and treatments aimed at eliminating the found causes of 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, it is also recommended to conduct a course of physiotherapy, manual therapy and physical therapy procedures.

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

• Stop lifting heavy objects and practicing exhausting sports;
• to reduce weight in the presence of obesity;
• taking regular breaks to warm up if a person is forced to sit for a long time;
• increase the level of physical activity, but avoid overwork and hard work (daily walks, morning exercises, performing a special physical therapy complex, swimming);
• uses a support bandage, which relieves the load on the lower back and thus provides favorable conditions for the 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, 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.

Unfortunately, conservative therapy cannot always be used to treat low back pain. In some cases it is ineffective and gives no results even after several months of unshakable adherence to medical recommendations. In other situations, the results of the examination show the presence of pathologies that can no longer be eliminated by non-surgical methods. In such situations, patients are advised to consult a neurosurgeon and perform appropriate surgery 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;
• Vitamins of group B: improve nerve conduction by normalizing the nutrition of nerve fibers and increasing the transmission speed of nerve impulses.

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

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

In addition to the drugs listed above, a number of 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 of other groups.

Physiotherapy

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

Very often, patients are prescribed:

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

As a rule, the course of procedures includes 8-10 sessions, which are carried out with some 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 conduct a manual therapy session and benefit the patient, not harm.

The use of special manual exposure techniques allows to obtain not only an improvement in microcirculation, a relaxation of excessively toned and too 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 point where the nerve is pinched and relieve the pressure of 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 complete elimination. But to consolidate the results obtained, it is recommended to undergo a full course of manual therapy and in the future to take support courses.

physical therapy

Physical therapy helps the body cope with the stress it is subjected to. For each disease, a special set of exercises has been developed, the regular performance of which allows you 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 the muscles to normal tone and strengthen them. Thanks to this, the spine will have less stress, which will become an effective prevention of the progression of the disease and create favorable conditions for its recovery.

Physical therapy also helps to improve blood circulation in the affected area, which accelerates the course of inflammatory processes and more likely leads to a complete recovery. Exercise correct for many conditions can help reduce low back pain and reduce the frequency of its occurrence.

For each patient, the training program is developed individually. 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 patient's level of fitness, his age and other factors. Only a specialist is able to correctly choose the most effective and safe set of exercises.

It is under his supervision that the first lessons are held. 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 optimum level. But it is not recommended to increase the number of repetitions of the exercises alone or to complicate them. Any changes to the physical therapy program are only introduced by a specialist.

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

Back pain surgery

Most often, the help of a spinal surgeon is needed for intervertebral hernias, the formation of which led to the violation of the spinal root and the development of radicular pain. If the protrusion has already formed, it is impossible to force its withdrawal in modern non-invasive ways. The only way to eliminate it and at the same time to get rid of low back pain is to remove the intervertebral hernia surgically.

There are different types of surgeries used for intervertebral hernias. The specific tactics of surgical intervention is determined based on the type, location and size of the hernia:

• Nucleoplasty and hydroplasty are methods of percutaneous surgery that allow you to remove a part of the nucleus pulposus through a puncture of tissues with a diameter of several centimeters and reduce the size of the hernia.
• Microdiscectomy is a radical way to solve the problem of an intervertebral hernia, which involves the removal of it or the entire disc through an incision up to 3 cm long, but, unlike other methods, it allowseliminate a hernia of any size, regardless of its location in the spinal canal, and release a pinched nerve in even the most difficult part of the spine.
• Endoscopic surgery - involves the removal of a herniated disc through punctures up to 1 cm in diameter using special equipment with a video camera. It can be used to remove hernias of any size, but the technique cannot be used to remove neoplasms in anatomically difficult places.

Also, the help of a spinal 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 stretched virtually all over the back. But today it is possible to correct the deformity of the spine in a minimally invasive way through miniature incisions.

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

Surgery cannot be avoided in case of spinal fractures. In such situations, it is possible to eliminate pain in the back and lower back only by restoring the normal shape, size and position of the vertebrae. Kyphoplasty and vertebroplasty have recently been performed for this purpose. The essence of both operations boils down to the fact that through a thin 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. 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 the 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 can be the result of physiological changes, joint muscle fatigue or a symptom of serious pathologies of the spine or internal organs. Therefore, if they occur regularly and especially against the background of the action of the same factors, do not hesitate and ignore the problem. Contact qualified specialists so that the treatment is 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 eliminated surgically with the minimum risk of complications.