Back pain in the lumbar region

Back pain in the lumbar region is familiar to everyone. According to statistics, it is the cause of 25% of all requests for medical care. Its appearance can be caused by many different factors, from banal fatigue to quite serious illnesses. Therefore, you should not ignore the problem, especially if the discomfort occurs 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 comprehensive examination.This will allow diagnosing the disease in its early stages of development and taking timely measures to stop its progression. But if there was an injury or a failed fall before the onset of pain, you must immediately apply for a consultation with a traumatologist or spinal surgeon.

Features of low back pain and accompanying symptoms

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

Essential for diagnosis is whether the pain radiates to the hip, buttocks, knee, foot and if so, where and how. Also, a difficult thing is the presence of restrictions on the mobility of the spine, whether the patient can bend freely, rotate the body or the range of motion is reduced.

Spinal pain is called lumbodinia. If it spreads to the legs, it is called lumboischialgia.

Acute pain is one that lasts less than 3 months; otherwise they speak of chronic pain. In the latter case, the disease often occurs with periods of exacerbation and remission.

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

• feeling of crawling in the back and / or legs, numbness;
• muscle weakness;
• pain in hips, knee joints;
• pelvic organ disorder (menstrual irregularities, potency problems, loss of control over urination, defecation);
• leg paralysis.

Similar signs indicate spinal pathology.But since they can not only cause back pain, there is another group of symptoms that can accompany lower back pain and indicate internal organ pathology or cancer. Therefore, you need to be especially careful about your own condition when it appears:

• rapid and unnecessary weight loss;
• cuts and pains in groin, perineum;
• increased urination, pain;
• increase in body temperature, chills;
• skin discoloration in the area of ​​the pain epicenter;
• 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 the symptoms appear from the first group, a consultation with a neurologist is needed, and from the second group, the help of a urologist, gynecologist, endocrinologist or other narrow specialists is needed. The therapist will help you understand exactly which doctor to see.

Causes

All causes of back pain in the lumbar region can be divided into 2 groups: diseases of the spine and pathology of internal organs, especially gynecological diseases, pathology of the kidneys, organs of the gastrointestinal tract, endocrine disorders. However, they are most often the result 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, lower back pain can also be the result of overwork or certain physiological changes. In such situations, they do not need special treatment, but only a reduction in physical activity and a more economical daily regime.

Osteochondrosis and intervertebral hernias

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

Osteochondrosis is the price humanity has to pay for the ability to walk properly. It is characterized by the gradual destruction of intervertebral discs, their thinning, reduction of elasticity and strength. As a result, they stop coping with stress and may bulge. This is how intervertebral hernias form.

Osteochondrosis most often affects the intervertebral discs of the lumbar spine. When they protrude into the spinal canal or foraminal opening, the nerves are almost inevitably damaged, which leads to the appearance of acute pain in the lower back and their 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 permanent degenerative processes and increased load on the spine, bone protrusions called osteophytes form along the edges of the spine.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

Inflammatory diseases of the spine most often occur in young people, mostly 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 more often bothers the person.

It is not uncommon for patients to seek medical attention for several years after the onset of the first symptoms. As a result of such a long course of the inflammatory process on 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 such cases, the cause of discomfort may be arthritis, osteomyelitis.

Myofascial syndrome

Myofascial syndrome is a common pathology in which pain occurs after a long stay in an uncomfortable position or after physical exertion. Myofascial syndrome is somewhat more common in women. In addition, lower back pain occurs after careless movement or physical exertion. Its recognizable characteristic is the presence of so-called trigger points on spasmodic muscles in the lumbar region and buttocks, the pressure of which leads to 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 worried about pain in the lower back and lower back and stiffness of movement, but the symptoms usually disappear without a trace in the afternoon and at night.

In addition, physical activity has a beneficial effect on patient well-being and contributes to the elimination of pain syndrome. A very specific symptom of ankylosing spondylitis is bending, arch curvature of the spine and progressive restriction 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. Because spinal deformity leads to the displacement of all anatomical structures, the nerves are often constricted, causing severe pain. In addition, other neurological signs may be present, including a feeling of numbness and paresis.

Compression breaks

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 incorrect distribution of the load on the spine, degenerative processes on the intervertebral discs and the appearance of pain.

Physiological causes of low back pain

Engaged in heavy physical work, intense sports training creates an increased load on the muscles, as a result of which lactic acid accumulates in them, which causes pain. Back pain is not uncommon when wearing uncomfortable shoes for a long time, especially on the heels.

Also, lower back pain is often seen during pregnancy. In such situations, they are caused by shifting the center of gravity and increased stress on the spine.

Diagnostics

It is recommended to consult a neurologist to determine the causes of back pain in the lumbar region. You can consult a therapist at first, but, most likely, the doctor will still refer the patient to a neurologist.

At the meeting, the specialist will conduct a thorough survey of the patient, find out what worries him, what kind of lifestyle he leads, etc. Further, an examination is required, during which the physician assesses the severity of the reflex, conducts neurological tests, and assesses the patient’s mobility. Based on the results obtained, the doctor can make a preliminary diagnosis and understand what injuries have led to the appearance of back and lower back pain.

To confirm the existing assumptions, in order to accurately identify the 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 indicates inflammatory processes in the body, the presence of infection or tumors;
• general analysis of urine - used to distinguish kidney disease as a cause of pain in the lumbar region;
• X-ray - shows the presence of changes in the bone structures of the spine, signs of fractures, provides information on bone density and allows you to diagnose major diseases of the spine, as well as osteoporosis (detection of spinal pathologies is the reason for more thorough examination by CT or MRI);

• CT is a modern method of radiation diagnostics that allows you to very clearly visualize all bone structures and detect the smallest deviations from the norm;
• MRI - provides comprehensive information on the condition of soft tissues and cartilage, including intervertebral discs, using MRI you can diagnose intervertebral hernias of any size, changes in blood vessels, tumors.

Treatment of low back pain

The treatment of back pain is chosen strictly individually. At the same time, it is always complex and includes symptomatic therapy, lifestyle changes, and treatment aimed at eliminating the identified causes of lower 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 whose main component is drug treatment. In severe cases, it is additionally recommended to conduct a course of physiotherapy procedures, manual therapy and exercise therapy.

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

• give up lifting heavy objects and exhausting sports;
• for weight loss in the presence of obesity;
• take regular warm-up breaks if the person is forced to sit for a long time;
• increase the level of physical activity, but avoid excessive work and hard work (daily walks, morning exercises, performing a special exercise complex, swimming);
• use a wearing bandage that will relieve the lower back and thus provide favorable conditions for early recovery of the spine.

Depending on the source of the pain, patients may be advised to stay in bed for a few 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. On the contrary, in other diseases, moderate physical activity is one of the mandatory components of therapy. It helps 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 turns out to be 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 pathology that can no longer be removed by any non-surgical methods. In such situations, patients are advised to consult a neurosurgeon and perform appropriate surgical intervention in order to establish a normal anatomy of the spine.

Drug Therapy

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

• NSAIDs in the form of tablets, injections and topical preparations - have analgesic and anti-inflammatory properties;
• corticosteroids - are given in short courses to control severe inflammation;
• muscle relaxants - necessary to relieve muscle spasm, which is often a reflex reaction of the body to pain and worsens 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, blockages can be performed. The procedure involves injecting an anesthetic solution directly into the area of ​​pain or the passage of nerve fibers. Therefore, it is possible to completely stop the pain syndrome for some time 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, because it is usually necessary to inject the drug into places located near the spine, where the mass of nerves passes. Therefore, illiterate conduct of the proceedings can result in serious and sometimes fatal consequences.

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

Physiotherapy

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

Patients are usually prescribed:

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

The procedure usually includes 8-10 sessions that are performed with a certain frequency.

Manual therapy

In addition to osteochondrosis, scoliosis and 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 techniques of manual exposure enables not only the improvement of microcirculation, relaxation of too tense and too relaxed muscles, but also increase of the distance between the vertebrae, as well as normalization of their position. A qualified chiropractor is able to find the place 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 reduction in the severity of the pain syndrome until it is completely eliminated. But in order to consolidate the obtained results, it is recommended to take the entire course of manual therapy, and to attend accompanying courses in the future.

exercise therapy

Physical therapy helps the body cope with the stress put on it. A special set of exercises has been developed for each disease, the regular implementation of which enables the solution of the most important tasks in the current situation. So, with the help of a properly selected complex of physiotherapeutic exercises, it is possible to return the muscles to normal tone and strengthen them. Thanks to this, the spine will have less stress, which will be an effective prevention of disease progression and create favorable conditions for its recovery.

Exercise therapy also helps to improve blood circulation in the affected area, which speeds up the course of inflammatory processes and is more likely to lead to complete recovery. Proper exercise for many conditions can help reduce back pain and reduce the frequency of their occurrence.

The training program is developed individually for each patient. This takes into account not only the type of detected pathology and the degree of its severity, but also the presence of concomitant diseases, the level of physical readiness of the patient, his age and other factors. Only an expert is able to correctly choose the most effective and safest set of exercises.

The first classes are held under his supervision. During them, the patient learns to perform each suggested exercise correctly so that it is useful. Gradually the load increases, bringing it to the optimal level. But it is not advisable to increase the number of repetitions of exercises yourself or to complicate them. All changes in the physiotherapy exercise program are introduced only by an expert.

The patient should only strictly follow his recommendations and exercise daily in a comfortable environment. All exercises are performed at a slow pace. Sudden movements are not allowed. But if pain occurs during classes, 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 necessary for intervertebral hernias, the formation of which led to the disruption of the spinal root and the development of radicular pain. If the protrusion has already been created, it is impossible to force it to withdraw in a modern non-invasive way. The only way to eliminate this and at the same time get rid of lower back pain is to remove the intervertebral hernia with surgery.

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

• Nucleoplasty and hydroplasty are methods of percutaneous surgery that allow the removal of part of the pulp of the nucleus by puncturing tissue a few centimeters in diameter and reducing the size of the hernia.
• Microdiscectomy is a radical way to solve the problem of intervertebral hernia, involving the removal of it or the entire disc through an incision up to 3 cm long. But, unlike other methods, it allows you to remove a 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 - involves the removal of a herniated disc through puncture holes up to 1 cm in diameter using special equipment with a video camera. It can be used to resect a hernia of any size, but the technique cannot be used to remove tumors in anatomically difficult places.

Scoliosis also requires the help of a spinal surgeon. In that case, all forces are focused on restoring the normal axis of the spine. Previously, this required a large incision that extended to almost the entire back. But today, with miniature incisions, it is possible to correct the deformation of the spine in a minimally invasive way.

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 on the vertebrae with special screws, and by correcting its tension at different points it is possible to return the displaced vertebrae in their place and fasten them in the correct position. Modern types of metal constructions 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 with special screws.

Surgery cannot be avoided in case of spinal fractures. In such situations, resolving back and lower back pain 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 comes down to the fact that through a thin needle for injection, a special bone cement is injected into the spine destroyed due to injury.Fills all free space and hardens after 10 minutes. But in severe compression fractures, kyphoplasty is preferred because it can also help restore the normal shape of the spine, which will ensure proper 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 gradually inflates, restoring the vertebra to its original appearance. After that, the balloon is lowered and removed, and the formed cavity is filled with bone cement.

Thus, back pain can be the result of physiological changes, normal muscle fatigue or symptoms of serious pathologies of the spine or internal organs. Therefore, if they occur regularly, and especially in the background of the action of the same factors, do not hesitate and ignore the problem. Consult qualified professionals 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 enable its surgical removal with minimal risk of complications.