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back pain

back pain in the lumbar region

Lower back pain is often referred to as lumbago or lumbodia. Lumbago or "lumbago" is an attack of acute lower back pain, usually associated with hypothermia and exertion. Lumbago occurs in many people. and is often the cause of temporary disability. Often, a sports injury or sprain may be the cause of lumbago, but sometimes the factor provoking the appearance of pain is unknown. Lumbago is pain without radiating to the legsLower back pain (lumbago) can appear acutely and gradually increase throughout the day. Stiffness often occurs in the morning and gradually turns into a pain syndrome. It is also possible to result in a curvature of the spine (antalgic scoliosis). The pain itself may be caused by muscle spasms, which in turn are related to other causes. This may be due to overloading or sprains, sports injuries, herniated discs, spondyloarthrosis (spondylosis), kidney disease (infection or kidney stones) may occur. Sometimes the patient is unwell with exertion, hypothermiaThe presence of the condition accurately determines the cause-and-effect relationship, but often the pain appears for no apparent reason. Sometimes, back pain may also appear after sneezing, bending over, or wearing shoes. This can be facilitated by deforming diseases of the spine such as scoliosis.

Unlike lumbago, the term lumbodynia does not mean acute pain, but rather sub-acute or chronic pain. As a rule, pain with lumbodynia appears gradually over several days. The pain may also occur in the morning. and can be reduced by physical activity. Lumbodynia is characterized by increased pain during prolonged static loads (sitting, uncomfortable body position). Lumbodynia is also characterized by pain relief from lying down in a fixed positionMuscle spasms make it difficult for patients with lumbago to perform routine activities such as washing or wearing shoes. Due to the disease, there is a decrease in the amount of movements of the trunk (bending forward or, to a lesser extent, side or extension). Leaning to the side). Due to the pain syndrome, the patient often has to change positions from a sitting or standing position. Unlike lumbago, muscle spasms are less pronounced and, as a rule, cover the entire lower backdoes not, and there are often indications of the prevalence of convulsions on one side.

reasons of back ache

Back pain is a symptom. The most common causes of back pain are diseases (injuries) of the muscles, bones, and intervertebral discs. Occasionallyback painMay be caused by diseases of the abdominal cavity, small pelvis and chest. Such pain is called reflex pain. Diseases of the abdomen (eg, appendicitis), aortic aneurysm, kidney disease (urolithiasis, kidney infection, bladder infection), infections of the pelvic organs, ovaries - all these diseases can manifestback pain. . . Even in a normal pregnancy, sprains in the pelvic region, muscle spasms due to tension, and nerve irritation can lead to lower back pain.

oftenback painAssociated with the following diseases:

  • Compression of the nerve root, which causes the symptoms of sciatica and is often caused by a herniated disc. As a rule, when the nerve root is compressed, the pain is intense, radiating to the innervation zone of the nerve root and impairedSensitivity occurs. A herniated disc primarily results from disc degeneration. The gelatinous portion of the disc protrudes from the central cavity and presses on the nerve roots. Degenerative processes in the intervertebral disc begin at age 30 and older. But the presence of a hernia does not always affect nerve structures.
  • Spondylosis - degenerative changes occur in the vertebrae themselves, bone growths (osteophytes) occur, which can affect nearby nerves, causing pain.
  • Spinal stenosis can result from degenerative changes in the spine (spondylosis and osteochondrosis). A patient with spinal stenosis in the lumbar region may experience low back pain that radiates to both legs. Lower back painMay appear as a result of standing or walking.
  • Cauda equina syndrome. This is a medical emergency. Cauda equina syndrome occurs as a result of compression of the cauda equina (terminal portion of the spinal cord) elements. A patient with cauda equina syndrome may experience pain and impaired bowel and bladder function (urinary incontinence and atony) may be experienced. This syndrome requires emergency surgery.
  • Pain syndromes such as myofascial pain syndrome or fibromyalgia. Myofascial pain syndrome is characterized by aches and pains at certain points (trigger points), a decrease in the amount of muscle movement in the painful areas. The pain syndrome is reduced by relaxing the muscles located in the pain areasWith fibromyalgia, it is common to have pain and soreness throughout the body. Fibromyalgia is not characterized by stiffness and muscle pain.
  • Spinal cord infection (osteomyelitis) is rarely the cause of the disease.
  • Non-infectious inflammatory diseases of the spine (ankylosing spondylitis) can cause stiffness and pain in the spine (including the lower back), which is especially worse in the morning.
  • Tumors, most often cancer metastases, can be a source of discomfort in the lower back.
  • Inflammation of the nerves and, accordingly, the manifestations of pain (in the chest or in the lumbar) can be caused by damage to the nerves themselves (for example, with shingles)
  • Given the various causes of symptoms, such as acute or low back pain, it is very important to thoroughly evaluate the patient and perform all necessary diagnostic procedures.

Symptoms

Pain in the lumbosacral region is the main symptom of lumbago, lumbodynia, lumboishalgia.

  • The pain may radiate down the front, side, or back (lumbar ischalgia) of the leg, or it may be localized only in the lumbar region (lumbago, lumbodynia).
  • The feeling that the lower back hurts may intensify after exertion.
  • Sometimes the pain may increase at night or with prolonged sitting, such as during a long car journey.
  • Perhaps the presence of numbness and weakness in the part of the leg, which is located in the zone of innervation of the compressed nerve.

For timely diagnosis and treatment, a number of criteria (symptoms) deserve special attention:

  • Recent history of injury, such as a fall from a height, a traffic accident, or similar incidents.
  • The presence of minor injuries in patients over 50 years of age (for example, a fall from a low height as a result of slipping and landing on the buttocks).
  • History of long-term use of steroids (eg, these are patients with bronchial asthma or rheumatic diseases).
  • Any patient with osteoporosis (mostly elderly women).
  • Any patient over 70 years of age: This age is more prone to cancer, infections and diseases of the abdominal organs, which can lead to lower back pain.
  • history of oncology
  • Presence of infectious diseases in recent times
  • Temperatures over 100F (37. 7 C)
  • Drug use: Drug use increases the risk of infectious diseases.
  • Lower back pain aggravates at rest: as a rule, this nature of pain is associated with oncology or infection, and such pain may also occur with ankylosing spondylitis.
  • Significant weight loss (for no apparent reason).
  • The presence of any acute disease of the nerve is an indication for immediate medical attention. For example, it is a violation of walking, leg dysfunction, as a rule, are symptoms of acute nerve injury or compression. In some circumstances, suchSymptoms may require emergency neurosurgical operation.
  • Bowel or bladder dysfunction (both incontinence and urinary retention) can be a sign of a medical emergency.
  • Failure of recommended treatment or increased pain may also require medical attention.

The presence of any of the above factors (symptoms) is an indication to seek medical help within 24 hours.

diagnosis

Medical history is important to make an accurate diagnosis, as various conditions can cause low back pain. Time of onset of pain, association with physical exertion, presence of other symptoms such as cough, increased temperature, bladder orIntestinal dysfunction, presence of seizures, etc. A physical examination is performed: identification of pain points, the presence of muscle spasms, neurological status is studied. If diseases of the abdominal cavity or pelvic organs are suspected, an examination(ultrasound of the abdominal organs, ultrasound of the pelvis and pelvic organs, urine blood test).

If the somatic origin of lower back pain is excluded, instrumental research methods such as radiography, CT or MRI may be prescribed.

X-ray is the initial examination method and allows you to determine the presence of changes in bone tissue and indirect signs of changes in the intervertebral discs.

CT allows you to visualize the presence of various changes both in bone tissue and in soft stones (especially in contrast).

MRI is the most informative research method that allows to diagnose morphological changes in various tissues.

Densitometry is necessary if osteoporosis is suspected (usually in women over 50)

EMG (ENMG) is used to determine the violation of conduction along nerve fibers.

Laboratory tests are prescribed (blood test, urine test, blood biochemistry) primarily to exclude inflammatory processes in the body.

pain treatment

exercises for back pain

After diagnosis and confirmation of vertebral origin with lumbago and lumbodynia, a definitive treatment is prescribed for low back pain.

In acute pain, rest for 1-2 days is necessary. Bed rest can reduce muscle spasm and muscle spasm. In most cases, when the pain syndrome is due to muscle spasm, the pain syndrome is somewhatWithin days it subsides without the use of drugs, due only to rest.

Medicines. For pain syndrome, drugs of the NSAID group are used. COX-2 inhibitors have fewer side effects, but long-term use of these drugs also has some risks. Given that not all of this groupMedicines have a lot of side effects, taking drugs in this group should be short-term and under the mandatory supervision of a physician.

Muscle relaxants can be used to relieve spasms. But these drugs are effective only in the presence of convulsions.

Steroids can be used to treat pain, especially when there are symptoms of sciatica. But because of the presence of obvious side effects, steroid use should be selective and short-term.

Hand treatment. This technique can be very effective in the presence of muscle block or subluxation of the facial joints. Mobilizing the motor segment can reduce both muscle spasms and lower back pain.

Physiotherapy. There are many modern physiotherapy procedures that can reduce both pain and inflammation, improve microcirculation (for example, electrophoresis, cryotherapy, laser therapy, etc. ).

Exercise therapy. Exercise is not recommended for acute pain in the lower back. Connection of exercise therapy is possible after reducing the pain syndrome. In the presence of chronic pain, in the strengthening of the muscle corset and in the biomechanics of the spineExercise can be very effective in improving. Exercise should be chosen only with an exercise medicine practitioner, as often independent exercise can lead to an increase in the manifestation of pain. Systematic exercise therapy, especially the presence of degenerative changes in the spineIn (osteochondrosis, spondylosis), can maintain the functionality of the spine and significantly reduce the risk of pain syndrome.