Pain in the spine (dorsopathy) is a universal body language that indicates the presence of 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 into adulthood.
Dorsopathy affects almost every aspect of life. Sleep is disrupted and it becomes difficult to bend, stretch, or roll over. Difficulties arise when driving a car, walking, lifting weights and doing physical exercises. If you have spinal pain, you should see a doctor immediately. The specialist will study the medical history, collect the anamnesis and conduct an examination. If violations are detected, conservative or surgical treatment is prescribed.
Why does my spine hurt?
The cause of back pain 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 you understand the problem on a deeper level. Main parts of the spine:
- The cervical 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 more rigid thoracic part of the spine.
- Thoracic: Connected to the chest and connected to the ribs. In particular, older adults may suffer compression fractures in this area due to bone loss.
- Lumbar – lower back. Young patients are more predisposed to discogenic low back pain, while older patients are more likely to experience disorders of the joint structures.
- Sacral – the lowest part of the spine. It is made up of a flat, triangular sacrum that connects to the hips and tailbone. 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 support structures, intervertebral discs, spinal cord, nerve roots and blood vessels. The spine is more than the sum of its parts, but here's what you need to know about those parts.
The spinal column is usually made up 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 is made up 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 the movement of the ribs;
- internal – stabilize the spine, control the movement and position of the spine;
- superficial: provides 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 should be taken into consideration 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, herniated discs, spinal stenosis, sacroiliac joint dysfunction, facet joint damage, and infections are all 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 diseases
Degeneration includes endplate-related changes (sclerosis, defects, modal changes, and osteophytes) as well as disc changes (fibrosis, annular tears, desiccation, height loss, and mucinous annular degeneration).
Degenerative changes in the disc are already observed in a third of healthy people between the ages of 21 and 40. The high prevalence of asymptomatic degeneration should be taken into consideration 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 annulus fibrosus. A herniation 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 for ensuring its strength, flexibility and ability to evenly distribute load. There is a normal range of natural curves. Abnormal curvatures include lordosis, kyphosis, and scoliosis.
Abnormal lordosis
Lordosis, a disease of the spine, 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 lead to instability in gait and changes in figure: the buttocks become more noticeable. 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 cause a forward lean. In most cases it affects the thoracic or thoracolumbar region, but it can also occur in the cervical region.
The normal range of kyphosis is considered to be between 20 and 45 degrees. But when a structural abnormality causes a kyphotic curve to develop outside of 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% is due to neuromuscular, congenital, degenerative and traumatic causes.
Developmental anomalies
The symptom often manifests itself with developmental defects and can be combined with neurological manifestations.
Dorsopathy is present with the following developmental anomalies:
- Splitting – with small bone defects moderate discomfort is felt in the lumbosacral region. After some time, radicular syndrome occurs.
- Lumbarization, sacralization: compression of the roots is accompanied by stabbing or burning pain. Sensitivity disorders or paresis may be added.
- Wedge-shaped vertebrae: Discomfort occurs when you exert stress and maintain a static body position for a long time. Accompanied by chest deformation and poor posture.
Osteoporosis
It typically affects the thoracic and thoracolumbar spine and can cause debilitating pain. This disorder is caused by a loss of bone mineral density, leading to brittle bones.
Osteoporosis can cause spinal 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 abuse alcohol. An active lifestyle is also recommended.
Injuries
The severity of the back pain corresponds to the severity of the injury. As a rule, it is combined with signs of damage to nervous tissue.
Traumatic causes of spinal pain:
- A bruise is the result of a direct hit or fall on the back. Dorsopathy is local, moderate. It gradually disappears within 1-2 weeks.
- Dislocation – occurs due to a high energy impact. Accompanied by severe pain in combination with a disturbance of sensitivity and motor activity. The general condition is also affected.
- Spondylolisthesis is a traumatic injury of the spine in the lumbar region. Dorsopathy radiates to the legs, there is a positive symptom of axial load.
- Compression fracture: occurs when you fall on your buttocks or jump from a height. The pain is sharp at first, then becomes intense and progresses with movement.
Pathological fractures occurring against the background of osteoporosis or tumors are manifested by mild discomfort, nagging 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 lumbar region. 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, the mobility of the spine is limited and thoracic kyphosis forms.
Also, pain in the spine occurs with tuberculosis. Profound local discomfort is characteristic of vertebral destruction. Dorsopathy increases with exercise and is accompanied by excessive skin sensitivity. With stabbing, radiating pain, we are talking about compression of the nerve roots. The condition is complemented by the stiffness of the movement.
With osteomyelitis, intense back pain is noted. The disease is diagnosed in patients in childhood and adolescence. Characterized by hematogenous nature. The discomfort increases with movement, so the patient remains in bed. Osteomyelitis is accompanied by fever, weakness and local swelling.
Arachnoiditis manifests itself with pain that radiates to the innervation area of the nerve roots. Symptoms become constant and resemble sciatica. Added to these are motor disorders, sensitivity disorders and loss of the ability to control the pelvic organs.
Tumors
Benign neoplasms have a hidden course or are accompanied by slowly progressive and scant symptoms. Most often, hemangiomas appear, appearing only in 10-15% of cases. The discomfort is painful, local. It progresses at night and after physical activity. Spinal cord neoplasm is accompanied by radicular pain and impaired nerve conduction.
Sarcomas of the spine in the primary stage of progression are manifested by moderate intermittent 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 localization of the tumor).
Other diseases
Discomfort in the spine is also observed with:
- Spinal epidural hemorrhage - similar to signs of radiculitis, accompanied by spinal conduction disorder.
- Calvet's disease - radiates to the legs, occurs periodically, is mildly expressed. It decreases when lying down, increases during physical activity.
- Forestier's disease - localized in the thoracic region, spreads to the lower back or neck. Symptoms are generally short-lived. It may be accompanied by pain in the elbow or shoulder joints. Stiffness of the spine cannot be ruled out.
Dorsopathy sometimes manifests itself 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 based on position
Chronic upper back back pain affects 15 to 19 percent of people worldwide. Postmenopausal women are at increased risk, possibly due to osteoporosis and vertebral compression fractures.
Professional activities also lead to back pain. Those who must maintain a static body position for long periods of time, such as dentists or salespeople, are more likely to encounter 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 localization area indicates the cause of discomfort and greatly facilitates the diagnosis.
Pain on right side
The cause is excessive body weight, a herniated disc or myositis. On the right side of the back, discomfort with kyphosis also occurs.
Somatic pathologies include salpingitis, inflammation of the ovaries, nephritis, cholecystitis. Also noteworthy are appendicitis and the presence of stones in the organs of the urinary system.
Pain on 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 damage, ischemia and intercostal neuralgia.
Pain in the lumbar region
The lumbar region is most often subject to the development of pathological processes from the spine. This is due to the fact that it bears 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. Let's talk about radiculitis. Indicates liver dysfunction.
Pain in the left lumbar region
The discomfort is localized mainly after physical activity. The condition returns to normal after rest. If the discomfort does not decrease 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 pinched (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 radiating to the lower back, sacrum and lower extremities.
Spinal nerve roots are also compressed during compressive 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 nucleus compresses the spinal cord. Even a slight load leads to the progression of the pathological process. Dorsopathy is sharp and acute, radiating to the leg or arm.
Shoulder blade pain
Based on the nature of the Dorsopathy, a presumptive diagnosis can be determined:
- dull, growing – stomach ulcer;
- acute, worsening with movement – intercostal neuralgia;
- numbness of the hands, changes in pressure, dizziness – osteochondrosis;
- irradiated under the clavicle - exacerbation of angina pectoris.
Pain along the spine and back
It develops due to pinched nerve endings against the background of the curvature of the spine. If the symptoms are not clearly expressed we can speak of protrusion. Increased symptoms indicate 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 area (oophoritis, cervicitis, endometritis, etc. ). They can appear during pregnancy, during menstruation, with appendicitis, ulcerative colitis. In men, they indicate bladder or prostate disease.
Diagnostics
First, a physical exam 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 state of the spine and painful areas.
- Neurological examination: evaluation of reflexes, spinal sensitivity and gait characteristics. For patients with suspected radiculopathy, the neurologic examination should focus on the L5 and S1 nerve roots.
Patients with a psychological disorder contributing to back pain may have accompanying physical signs, also known as Waddell signs. These include patient overreaction during physical examination, superficial tenderness, and unexplained neurologic deficits (eg, loss of sensation, sudden weakness, or jerky movements during motor examination). The presence of multiple Waddell signs indicates a psychological component of the Dorsopathy.
Treatment of spinal pain
In case of back pain, treatment should be carried out by a doctor. The specialist directs the patient to the examination and, based on the results obtained, prescribes an effective therapy.
Further therapeutic measures should be used with caution and after consulting a doctor. Any type of medication carries 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 tension 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 prevents healing.
- Change of activity. It is recommended to stay active, but avoid activities and body positions that worsen back pain. For example, if sitting for long periods in a car or at a table increases discomfort, then you should do a warm-up every 20 minutes.
- Exposure to heat or cold. A heating pad or warm bath relaxes tight muscles and improves blood flow, reducing discomfort. If your lower back hurts due to inflammation, you can use ice or cold compresses to reduce swelling.
The most common over-the-counter medications for back pain are ibuprofen, naproxen, and acetaminophen. The drugs relieve inflammation and reduce discomfort in the lower back.
Conservative therapy
Oral drug therapy:
- Analgesics. Patients are prescribed drugs from the anilide group, such as paracetamol. Provide a long-lasting analgesic effect. They have a synergistic effect with NSAIDs and are used in combination to improve pain relief without increasing toxicity.
- Non-steroidal anti-inflammatory drugs. They have analgesic properties. At higher doses they have an anti-inflammatory effect.
- Muscle relaxants. They act at a central level, 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 painkillers. Tricyclic antidepressants relieve chronic pain. Low doses may be sufficient to control symptoms. They do not work immediately, and you may need to continue them for several weeks before your symptoms improve. They play a potential role when distress is mediated by both peripheral and central mechanisms.
Local or regional anesthesia, given 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 relieve conditions of intervertebral hernias, spinal stenosis and radiculopathy. Reduces back pain and quickly restores sensory functions.
Surgery
A small percentage of people with back pain require surgery to improve their condition. The indications for surgery vary depending on the characteristics of the patient 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 lesion. The operation is most effective when the clinical picture of patients 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 a herniated disc primarily involves decompression. Protruding, extruded, or isolated disc material is removed. The nerve root is examined and released.
Prevention
Complications are largely determined by etiology. They are divided into physical and social. The first includes chronic pain, deformity, neurological effects with motor or sensory deficits, damage to the intestine or bladder. In social terms, complications are usually 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 bend over and keep your back straight. The place to sleep and work must be properly organized. It is recommended to perform light gymnastic exercises every day after waking up. You should also balance your diet by enriching your diet with foods with sufficient vitamins and minerals. It is recommended to take a contrast shower in the morning.