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Backache

Back pain is a sign of diseases of the musculoskeletal system

Almost every adult has experienced back pain in their lifetime. This is a very common problem, which can be based on different reasons, which we will analyze in this article.

Causes of back pain

All causes of back pain can be divided into groups:

  1. Musculoskeletal:

    • Osteochondrosis;
    • disc herniation;
    • compression radiculopathy;
    • Spondylolisthesis;

  2. Inflammatory, including infectious:

    • Osteomyelitis
    • Tuberculosis

  3. neurological;

  4. Injuries;

  5. Endocrinological;

  6. Vascular;

  7. The tumor.

At the first visit to the doctor with back pain, the specialist must determine the cause and type of pain, paying special attention to "red flags" - possible manifestations of potentially dangerous diseases. "Red flags" refer to a set of specific complaints and anamnesis data that require an in-depth examination of the patient.

"Red Flags":

  • age of the patient at the time of onset of pain: younger than 20 or older than 50;
  • a serious spinal cord injury in the past;
  • the appearance of pain in patients with cancer, HIV infection or other chronic infectious processes (tuberculosis, syphilis, Lyme disease and others);
  • fever;
  • weight loss, loss of appetite;
  • unusual localization of pain;
  • increased pain in a horizontal position (especially at night), in a vertical position - weakness;
  • no improvement for 1 month or more;
  • dysfunction of the pelvic organs, including urination and defecation disorders, numbness of the perineum, symmetrical weakness of the lower extremities;
  • alcoholism;
  • the use of narcotic drugs, especially intravenous;
  • treatment with corticosteroids and/or cytostatics;
  • with pain in the neck, the pulsating nature of the pain.

The presence of one or more signs in itself does not mean the presence of a dangerous pathology, but requires the doctor's attention and diagnosis.

Back pain according to duration is divided into the following forms:

  • acute- pain lasting less than 4 weeks;
  • subacute- pain that lasts from 4 to 12 weeks;
  • CHRONIC- pain lasting 12 weeks or more;
  • recurrence of pain- resumption of pain if it did not occur within the last 6 months or more;
  • worsening of chronic painPain recurs less than 6 months after the previous episode.

Diseases

Let's talk more about the most common, musculoskeletal causes of back pain.

Osteochondrosis

This is a disease of the spine, which is based on the wear and tear of the vertebral discs and, subsequently, the vertebrae themselves.

Is osteochondrosis a pseudodiagnosis? - No. This diagnosis exists in the International Classification of Diseases ICD-10. Currently, doctors are divided into two camps: some believe that such a diagnosis is incorrect, others, on the contrary, often diagnose osteochondrosis. This situation arose due to the fact that foreign doctors understand osteochondrosis as a disease of the spine in children and adolescents that is related to growth. However, this term specifically refers to a degenerative disease of the spine in people of any age. Also, often established diagnoses are dorsopathy and dorsalgia.

  • Dorsopathy is a pathology of the spine;
  • Dorsalgia is a benign, non-specific back pain that spreads from the lower cervical vertebrae to the sacrum, which can also be caused by damage to other organs.

The spine has several sections: cervical, thoracic, lumbar, sacral and coccygeal. Pain can occur in any of these areas, which is described by the following medical terms:

  • Cervicalgia is pain in the cervical spine. The intervertebral discs of the cervical region have anatomical features (the intervertebral discs are absent in the upper part and in other sections have a weakly expressed nucleus pulposus with its regression on average 30 years), which makes them more sensitive to stress. and injury, which leads to the stretching of ligaments and the early development of degenerative changes;
  • Thoracalgia - pain in the thoracic spine;
  • Lumbodynia - pain in the lumbar spine (in the lower back);
  • Lumboischialgia is pain in the lower back that radiates to the legs.

Factors leading to the development of osteochondrosis:

  • heavy physical work, lifting and moving heavy loads;
  • low physical activity;
  • long sedentary work;
  • long stay in an uncomfortable position;
  • long work at the computer with a non-optimal location of the monitor, which creates a load on the neck;
  • violation of standing;
  • congenital structural features and anomalies of the spine;
  • weakness of back muscles;
  • high growth;
  • excess body weight;
  • ankle diseases (gonarthrosis, coxarthrosis, etc. ), flat feet, bedsores, etc. ;
  • natural wear and tear with age;
  • smoking.

disc herniait is an extension of the nucleus of the intervertebral disc. It can be asymptomatic or cause compression of surrounding structures and present as a radicular syndrome.

Symptoms:

  • violation of range of motion;
  • feeling of stiffness;
  • muscle tension;
  • pain radiation to other areas: arms, shoulder blade, legs, hips, rectum, etc.
  • "shots" of pain;
  • numbness;
  • crawling sensation;
  • muscle weakness;
  • pelvic disorders.

The location of the pain depends on the level at which the hernia is located.

Herniated discs often resolve on their own within 4-8 weeks on average.

Compression radiculopathy

Radicular (radicular) syndrome is a complex of manifestations that occur due to compression of the spinal roots at the points of their departure from the spinal cord.

Symptoms depend on the level at which spinal cord compression occurs. Possible manifestations:

  • pain in extremity of a shooting, radiating nature in fingers, aggravated by motion or coughing;
  • numbness or a feeling of flies crawling in a certain area (dermatome);
  • muscle weakness;
  • back muscle spasm;
  • violation of the strength of reflexes;
  • positive tension symptoms (appearance of pain with passive flexion of limbs)
  • limitation of spinal mobility.

Spondylolisthesis

Spondylolisthesis is the displacement of the upper vertebra relative to the lower one.

This condition can occur in both children and adults. Women are more often affected.

Spondylolisthesis may not cause symptoms with mild displacement and may be an incidental x-ray finding.

Possible symptoms:

  • feeling uncomfortable
  • pain in the back and lower extremities after physical work,
  • weakness in the legs
  • radicular syndrome,
  • reduction of pain and tactile sensitivity.

Progression of vertebral displacement can lead to lumbar stenosis: the anatomical structures of the spine degenerate and grow, which gradually leads to compression of nerves and blood vessels in the spinal canal. Symptoms:

  • persistent pain (both at rest and on movement),
  • in some cases, the pain may decrease in the lying position,
  • the pain is not aggravated by coughing and sneezing,
  • the nature of the pain from withdrawal to very strong,
  • dysfunction of the pelvic organs.

With a strong displacement, compression of the arteries can occur, as a result of which the blood supply to the spinal cord is disturbed. This is manifested by a sharp weakness in the legs, a person can fall.

Diagnosing

Collection of complaintshelps the doctor to suspect the possible causes of the disease, to determine the localization of the pain.

Assessment of Pain Intensity- a very important stage of diagnosis, which allows you to choose a treatment and evaluate its effectiveness over time. In practice, the Visual Analogue Scale (VAS) is used, which is convenient for the patient and the doctor. In this case, the patient evaluates the severity of the pain on a scale from 0 to 10, where 0 points is no pain and 10 points is the worst pain a person can imagine.

interviewallows you to identify the factors that provoke pain and destruction of the anatomical structures of the spine, to identify the movements and positions that cause, intensify and relieve pain.

Physical examination:assessment of the presence of spasm of the back muscles, determination of the development of the muscular skeleton, exclusion of the presence of signs of an infectious lesion.

Assessment of neurological status:muscle strength and symmetry, reflexes, sensitivity.

March Test:performed in suspected cases of lumbar stenosis.

Important!Patients without "red flags" with a classic clinical picture are not recommended to perform additional studies.

X-ray:performed with functional tests for suspected instability of spinal structures. However, this diagnostic method is uninformative and is mainly performed with limited financial resources.

Computed tomography (CT) and/or magnetic resonance imaging (MRI):the doctor will prescribe based on clinical data, as these methods have different indications and benefits.

c T

MRI
  • Assesses bony structures (vertebrae).

  • It allows you to see the later stages of osteochondrosis, in which bone structures are affected, compression fractures, destruction of vertebrae in metastatic lesions, spondylolisthesis, abnormalities in the structure of vertebrae, osteophytes.

  • It is also used for MRI contraindications.
  • It evaluates soft tissue structures (intervertebral discs, ligaments, etc. ).
  • It allows you to see the first signs of osteochondrosis, intervertebral hernia, diseases of the spinal cord and roots, metastases.

Important!In most people, in the absence of complaints, degenerative changes in the spine are detected by instrumental examination methods.

Bone densitometry:performed to assess bone density (confirmation or exclusion of osteoporosis). This study is recommended for postmenopausal women with a high risk of fracture and always at the age of 65, regardless of the risk, men over 70, fracture patients with a minimal history of trauma, long-term use of glucocorticosteroids. The 10-year risk of fracture is assessed using the FRAX scale.

Bone scintigraphy, PET-CT:performed in the presence of suspicion of oncological diseases according to other examination methods.

treatment of back pain

For acute pain:

  • sedatives are prescribed in a course, mainly from the group of non-steroidal anti-inflammatory drugs (NSAIDs). The drug and specific dosage are chosen depending on the severity of the pain;
  • maintaining moderate physical activity, special exercises to relieve pain;

    Important!Physical inactivity with back pain increases pain, prolongs the duration of symptoms, and increases the likelihood of chronic pain.

  • muscle relaxants for muscle spasms;
  • it is possible to use vitamins, however, their effectiveness according to various studies remains unclear;
  • manual therapy;
  • lifestyle analysis and elimination of risk factors.

For subacute or chronic pain:

  • use of sedatives on demand;
  • special physical exercises;
  • assessment of the psychological state, as it can be an important factor in the development of chronic pain and psychotherapy;
  • drugs from the group of antidepressants or antiepileptics for the treatment of chronic pain;
  • manual therapy;
  • lifestyle analysis and elimination of risk factors.

Blockades (epidural injections) or intraosseous blocks are used in radicular syndrome.

Surgical treatment is indicated with a rapid increase in symptoms, the presence of compression of the spinal cord, with significant stenosis of the spinal canal and the ineffectiveness of conservative therapy. Emergency surgical treatment is performed in the presence of: pelvic disorders with numbness in the anogenital region and weakness in leg extension (cauda equina syndrome).

reHabiLitatiON

Rehabilitation should begin as soon as possible and have the following goals:

  • improving the quality of life;
  • elimination of pain, and if it is impossible to eliminate it completely - relief;
  • restore operation;
  • rehabilitation;
  • self-service and safe driving training.

Basic rules of rehabilitation:

  • the patient must feel his responsibility for his health and compliance with the recommendations, however, the doctor must choose treatment and rehabilitation methods that the patient can comply with;
  • systematic training and compliance with safety rules while performing exercises;
  • pain is not an obstacle to exercise;
  • a relationship of trust must be established between the patient and the doctor;
  • the patient should not focus and focus on the cause of pain in the form of structural changes in the spine;
  • the patient should feel comfortable and safe when performing movements;
  • the patient must feel the positive impact of rehabilitation on his condition;
  • the patient must develop pain response skills;
  • the patient should associate the movement with positive thoughts.

Rehabilitation methods:

  1. Walk;
  2. Physical exercises, gymnastics, gymnastics programs in the workplace;
  3. Individual orthopedic equipment;
  4. Cognitive behavioral therapy;
  5. Patient education:
    • Avoid excessive physical activity;
    • Fighting low physical activity;
    • Exclusion of prolonged static loads (standing, staying in an uncomfortable position, etc. );
    • Avoid hypothermia;
    • Sleep organization.

prevention

Optimal physical activity: strengthens the muscle frame, prevents bone resorption, improves mood and reduces the risk of cardiovascular accidents. The most optimal physical activity is walking more than 90 minutes a week (at least 30 minutes at a time, 3 days a week).

With prolonged sitting work, it is necessary to take warm-up breaks every 15-20 minutes and follow the rules of sitting.

Life hack:how to sit

  • avoid overly upholstered furniture;
  • the feet must rest on the floor, which is reached by the height of the chair equal to the length of the lower leg;
  • it is necessary to sit at a depth of up to 2/3 of the length of the hips;
  • sit straight, maintain the correct posture, the back should fit well with the back of the chair to avoid straining the back muscles;
  • the head when reading a book or working on the computer should have a physiological position (look straight ahead, and not constantly down). To do this, it is recommended to use special stands and install the computer monitor at the optimal height.

With prolonged work on the feet, it is necessary to change the position every 10-15 minutes, alternately changing the supporting leg and, if possible, walk in place and move.

Avoid prolonged stretching.

Life hack:how to sleep

  • sleep better on a semi-rigid surface. If possible, you can choose an orthopedic mattress so that the spine maintains physiological curves;
  • the pillow should be soft enough and of medium height to avoid stress on the neck;
  • when sleeping in the lying position, it is recommended to place a small pillow under the stomach.

Quit smoking: If you are having trouble, see your doctor who will refer you to a smoking cessation program.

Frequently asked questions

  1. I use glucocorticosteroid ointments. Am I at increased risk of osteochondrosis or osteoporosis?

    No. External glucocorticosteroids (ointments, creams, gels) do not penetrate in significant quantities into the systemic circulation, and therefore do not increase the risk of developing these diseases.

  2. In every case of a herniated disc, is surgery necessary?

    No. Surgical treatment is performed only if indicated. On average, only 10-15% of patients need surgery.

  3. Should you stop exercising if you have back pain?

    No. If, as a result of additional examination methods, the doctor does not find anything that would significantly limit the degree of load on the spine, then it is possible to continue playing sports, but after going through a course of treatment and adding some exercises fromcourse of physiotherapy exercises and swimming.

  4. Can my back pain go away forever if I have a herniated disc?

    They can after a course of productive conservative therapy, subject to further implementation of the recommendations of the attending neurologist, compliance with the rules of prevention, regular exercise therapy and swimming.