Low back pain is probably familiar to almost every modern person. Employment can be affected for a variety of reasons. Among them are back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be unaware of this, because back pain can not only reach an extraordinary force, making a person's life unbearable, but also turns out to be a symptom of more dangerous diseases.
Pain in the lower back can be different: acute or dull, aching or burning, local (appearing in one place) or spreading all over the back. Unpleasant feelings also appear in different ways: sometimes suddenly, suddenly and sometimes gradually, intensifying every day.
The response to pain and the ability to tolerate it depends on many factors: age, mental characteristics, accompanying symptoms, and other factors. But in any case, you can not leave the disease in the hands of fate. Timely treatment will help to avoid dangerous consequences.
To diagnose the cause of back pain, a spinal examination and some additional procedures are needed: X-ray examination, computer imaging, or magnetic resonance imaging. Lumbosacral pain attacks occur during life, in about 80% of modern inhabitants of European countries.
Acute or chronic back pain in the lumbar region is a consequence of a number of neurological, degenerative-dystrophic diseases of women and men. In some cases, back pain is a consequence of diseases of internal organs, obesity, stress, mental disorders.
Pain syndrome - primary and secondary
Understanding why the lower back hurts, we must not forget that the causes of such pain are in the dozens, and a non-professional will never be able to determine the true source of the problems. In general, the medical classification separates primary and secondary pain syndromes that may affect the lumbar region.
Primary back pain syndrome appears as a consequence of musculoskeletal changes of a morphofunctional nature. It is the one that is the cause of the vast majority of cases of back pain in the lumbar region. The most significant causes are degenerative-dystrophic changes that occur in different parts of the spine:
- osteochondrosis, which is a lesion of bone and cartilage tissue, this disease has dystrophic character. With it, the intervertebral disc and adjacent vertebrae are affected, spondylosis begins to develop.
- spondyloarthritis is a form of osteoarthritis in which the disease affects the intervertebral joints, which are responsible for spinal mobility, or synovial joints.
Secondary pain syndrome has many different causes of pain:
- scoliosis, which is a curvature of the spine, as well as some other growth diseases;
- various inflammations that have a non-infectious nature. For example, rheumatoid arthritis, Reiter syndrome, etc. ;
- a tumor located in the vertebrae, in the spinal cord itself or in the retroperitoneal space, whether it is primary or caused by metastases;
- fracture of one or more dorsal vertebrae. This is probably one of the most serious causes of back pain;
- various infectious diseases leading to damage to the vertebrae and intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
- stroke conditions in which there is a serious violation of the blood supply to the spinal cord. In this case, there may also be a feeling that the lower back hurts;
- diseases of the gastrointestinal tract. For example, acute appendicitis with atypical course, intestinal obstruction;
- often back pain is of a reflected nature. A similar problem can occur with some diseases of organs located in the pelvic area. For example, renal colic, venereal disease (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, annexitis - all of these diseases cause back pain).
Acute and chronic low back pain
Pain in the lumbar region is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. The so-called displaced pain in the lower back is also often observed: in this case, there is a translation of pain sensations from the internal organs and structures located deeper in the body; in other words, the patient seems to have pain in the lower back, but in fact a completely different part of the body is affected.
Most often, the back hurts in the lumbar region, when pain is projected into this area by the pelvic organs, kidneys, pancreas, colon or tumors located behind the peritoneum. Many patients do not know what to do if their lower back hurts. But there is a clear recommendation, what exactly should not be done: self-medicate. The causes of pain are so diverse that only a qualified specialist can make an accurate diagnosis.
Possible causes of acute back pain include:
- The pain is accompanied by an acute stretching of the muscles. In this case, the pain signals are localized in the spine, they are supplied by the long spasmodic muscles. The pain does not tend to move in the groin or leg area. Human mobility is limited.
- One of the most common and severe causes of severe back pain is a fracture of the spine (fractures of the vertebrae, including those of the spine). As a rule, this happens with an unsuccessful fall, back flexion and other injuries; but if a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, has cancerous tumors and their metastases to the vertebral region or other lesions of the skeletal system, vertebral fractures can occur literally "out of the blue". , even without fixation by the patient's sensations at the time of the fracture.
- An equally uncomfortable situation in which the lower back hurts badly is the displacement of the intervertebral discs that has occurred in the vertebral region. According to the frequency of lesions, areas are distinguished: LV-SII - most often; LIV-LV - second in frequency; LIII-LIV and above are rarer cases.
Symptoms include severe lower back pain, forced posture, limited mobility. Participation in the pathological process of nerve roots is indicated by:
- radicular pain, usually unilateral;
- sensitivity disorders (numbness, increase or decrease in the level of sensitivity);
- decrease or disappearance of the Achilles reflex (in case of damage to the roots of S or S2);
- decrease in intensity or absence of a knee jerk (indicates damage to the L3-L4 area).
The general tendency is for an elongated intervertebral disc to affect the lower root (e. g. , LIV-LV distortion causes L5 root pathology). With the loss of the cauda equina (ponytail), bladder and rectal functions are disturbed. Also, a similar condition can occur with a strong extension of the spinal disc.
The spine hurts badly in the lumbar region with aspect syndrome: in this case, the disc remains intact and the pain appears as a result of compression of the root itself at the exit of the spinal canal. The most common unilateral type aspect syndrome in the L5 root area; arises on the basis of an increase in aspects of the intervertebral node (upper and lower), and, as a result, narrowing of the intervertebral foramen.
Also, severe back pain accompanies an epidural abscess, a serious disease that requires urgent diagnosis and immediate treatment. Most often, the inflammatory process takes place in the thoracic region of the spine; the pain becomes particularly strong with a mechanical effect in the area of pathology (pressure, knocking).
If there are signs of spinal cord compression, any very effective medical measures, including surgery, are recommended. Another reason why the lower back hurts may be diseases of the hip joint - mainly coxarthrosis. In this case, the pain is characteristic, which radiates to the lower back, buttocks, as well as to the legs up to the knees.
Diseases characterized by chronic low back pain:
- Deformative spondylosis is a disease in which there is a dystrophic change in the lumbar vertebrae, calcification of their ligament apparatus, and further bone growth; bone outlets crush the roots and narrow the spinal canal. In case the pain in the lower back is accompanied by leg weakness, numbness and other neurological symptoms, the possibility of intermittent claudication syndrome should be considered, which may be caused by narrowing of the spinal canal. An examination is needed, the results of which determine the final diagnosis.
- Ankylosing spondylitis (or Bechterew's disease). At an early stage, it is characterized by limited mobility, especially in the morning, by a decrease in chest movements during breathing. There is traction pain in the lower back; further arises and advances the curvature of the spine in the thoracic region. An X-ray examination corrects the anomalies of the sacroiliac joints: destruction, change in structure, "bamboo" spine. A thorough examination and finding out why the lower back hurts is necessary, as similar symptoms and limited mobility of the lower spine can also cause other diseases - Reiter syndrome, psoriatic arthritis, chronic colitis.
- Oncological diseases (tumors, metastases), metabolic disorders (including NBO). It is necessary to exclude such causes of back pain: metastatic carcinoma of the lung, breast, prostate and thyroid gland, kidney, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). An exception is the method of X-ray examination and myelography.
- Osteomyelitis also causes prolonged and painful pain in the lower back. If the disease is suspected, a bone tissue radiograph is performed, a skin test with tuberculin is performed, and an ESR is performed to determine the presence / absence of tuberculosis bacteria or pyogenic bacteria in the body, usually staphylococci - The causative agents of osteomyelitis.
- Spinal cord tumors (intradural tumors) of various types. Diseases such as lipoma, neurofibroma, meningioma can provoke persistent back pain, initially without any accompanying neurological symptoms.
Causes of back pain of a permanent nature. Many diseases of the internal organs provoke periodic, sharp or excruciating pain in the lower back. At the same time, patients do not have a feeling of stiffness in the back area, there is no clear localization of pain and the pain does not increase with the maximum possible range of motion. To the question of what to do if the lower back does not hurt constantly, but occasionally, the answer is simple: do not wait until it hurts "properly", but consult a doctor.
There is a clear influence of the pathology of one or another organ on a certain section of the spine. So, from the pelvic organs, the pain radiates to the sacrum, in diseases of the organs that lie in the lower part of the abdominal cavity, it radiates to the lower back (segments L3-L5), and in the upper part - to segmentsof the upper part of the middle area or of the lower part of the chest area.
Diseases - causes of back pain and area of pain distribution:
- If the pelvic organs are affected, with endometriosis, ovarian or uterine carcinoma, the lower back hurts. In men, such permanent pain can be caused by chronic prostatitis or the development of prostate cancer.
- Various kidney diseases provoke pain at the junctions of the ribs and spine.
- Tumors of the stomach, duodenum, peptic ulcer, pancreatic tumors (especially if the disease spreads beyond the peritoneum) - the pain spreads to the region of the spinal segments T10-L2;
- With ulcerative colitis, diverticulitis or tumors of the colon, the lower back hurts;
- If the back hurts in the chest / lumbar regions, aortic dissection (dissecting aneurysm) should be ruled out.
Diagnosis for low back pain
For back and lumbar pain, it is recommended to undergo a computer (shows the condition of the bone tissue of the spine) and magnetic resonance (allows you to assess the condition of the soft tissues) tomography and an ultrasound scan of the internal organs. .
One diagnostic method is radiography, which is relatively inexpensive and can be helpful in detecting a range of disorders, from bone fractures to kidney stones. Many of the changes detected suggest only the correct diagnosis and additional studies may be required to confirm it. In addition, some radiological changes may be concomitant findings that are not the cause of the pain.
It all starts with a neurological and orthopedic examination by a doctor. During this examination the neurological condition of the patient is assessed, as well as possible violations in the biomechanics of the spine are identified with a mandatory assessment of the condition of the muscles of the back and gluteal region. Already at this stage of the study, a patient with osteochondrosis of the spine and pain in the back and lower back can be diagnosed and treated.
Occasionally, following the results of an orthopedic examination of a patient with a symptom of pain on the background of spinal osteochondrosis, the following additional diagnostic procedures may be prescribed:
- lumbosacral spine radiography with functional tests;
- CT scan of the lumbosacral spine;
- MRI of the lumbosacral spine.
The center of the intervertebral disc is occupied by the gelatinous nucleus pulposus. It is surrounded and supported by a fibrosus annulus, composed of fibrous cartilage and connective tissue. You can read more about this in the article about the anatomy of the human spine and spinal cord.
The thickness of the discs decreases, the vertebral bodies approaching each other, reducing the intervertebral foramina and endangering the nerves and vessels located in them (osteochondrosis).
Creeping of the discs (protrusion of the intervertebral disc) with their further prolapse into the lumen of the spinal canal (disc herniation) most often leads to compression of the nerve roots, causing pain along the compressed nerve (radiating pain in the leg, arm, the back of the head, neck, intercostal spaces depending on the level of nerve compression) with a weakening of muscle strength in the areas of their innervation and a violation of sensitivity.
Often, an extension or hernia of the intervertebral disc is accompanied by muscle pain along the nerve flow (along the arm or leg). In this case, one or immediately (rarely) two nerves are suppressed.
In addition to nerve compression, the stability of the spinal segment can also be impaired. With spinal instability, the vertebrae move forward (anterolisthesis) or backward (retrolisthesis). To clarify the diagnosis, a lumbosacral spine radiograph with functional tests may be required.
Most often, the nerve bundles that form the sciatic nerve due to their anatomical location suffer from compression of a hernia or elongation of the intervertebral disc. The sciatic nerve consists of fibers L5, S1, S2, S3 - spinal nerves.
The focus of chronic inflammation in the lumen of the spinal canal can lead to the formation of its narrowing (stenosis of the spinal canal) and the compression of the nerves and spinal cord that pass through it. This is why in case of spinal canal stenosis, it is always necessary to carry out a full course of treatment using a whole arsenal of different treatment methods, and in case of ineffectiveness, surgical treatment.
Which doctor should I contact?
With back pain, first of all, you should contact a neurologist at the district clinic, if the patient's condition is stable, or call an ambulance. Pain in the lower back can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.
Pain in the lower back is combined with various infections, injuries of the limbs. Pain in the lower back with heart and lung disease is not excluded. This is confirmed by in-depth examination. Once the patient is diagnosed, medications are usually prescribed that reduce back pain, normalize blood circulation, and help restore nerve tissue. These can be tablets, gels, ointments or injections that relieve inflammation and spasms.
Surgical intervention is usually required when a disc herniation is diagnosed, which is a complication of osteochondrosis. The hernia that compresses the nerve root is removed, restored and the pain passes over time.
It is best to relax your spine and paravertebral muscles if you sleep on a firm mattress with a small pillow below your knees. At the same time, bed rest should not last too long as this is fraught with weakening of the paravertebral muscles, which will only make the problem worse. Even with severe pain, you should try to maintain at least some poor physical activity.
How to relieve back pain
The appearance of a pain symptom is often due to muscle spasm, which can be eliminated with the help of special tools - muscle relaxants. Such drugs are actively used in the treatment of spinal diseases.
So, with a strong, sudden pain in the lower back, it is recommended to take a muscle relaxing tablet, rub the back with a warming anesthetic gel. When using funds, you should strictly follow his instructions.
In cases where an unpleasant symptom is due to the presence of inflammatory diseases of the internal organs, it is recommended not to delay to contact a doctor, if at some point it is impossible to visit a specialist and the pain is very strong, youcan take Pentalgin or No-shpu. The injured area should not be heated with a heating pad, as the heat contributes to the spread of the inflammatory process and, consequently, to the strengthening of the symptoms that accompany it.
Ointment for back pain
Preparations in the form of ointments are often used in the treatment of diseases of the lower spine. These drugs include drugs that have a pronounced anti-inflammatory, mild analgesic and antipyretic effect.
The course of treatment is prescribed taking into account the severity of the pain symptoms. Ointment for back pain is used as a main or auxiliary treatment. With pronounced symptoms of osteochondrosis, rubbing of the lower back with ketoprofen-based ointments, a substance with a strong analgesic effect, is indicated.
The main plus of local preparations is due to their effect not on the whole body as a whole, but on a specific area that needs treatment. Painkillers and anti-inflammatory ointments have fewer contraindications and side effects compared to similar tablets.
Exercises for back pain
Gymnastics is considered as an additional method of treating diseases of the lower back. The exercises shown to patients are quite simple and are not associated with a particular load on the body. For example, the usual hanging on the horizontal bar has a beneficial effect on the condition of the spine, helps to relax the muscles and eliminate the lumbar - pain caused by the tightening of its nerve roots. Therapeutic exercises for back diseases, accompanied by pain in the lower back, include exercises:
- raising the legs (so that the knee touches the chin);
- "bicycle", carried lying on his back;
- walking on his knees.
Every day it is recommended to give exercises no more than 10-15 minutes, with pronounced pain - to refuse to perform them.