back pain

13 October 2022

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

reasons of back ache

All causes of back pain can be divided into groups:

Musculoskeletal:
- osteochondrosis;
- disc herniation;
- compression radiculopathy;
- spondylolisthesis;
Inflammatory including infectious:
- osteomyelitis
- tuberculosis
neurological;
injuries;
endocrinological;
vascular;
Tumor.

At the first visit to the doctor with back pain, the specialist should determine the cause and type of pain, paying particular attention to the "red flags" - possible manifestations of potentially dangerous diseases. Refers to sets that require a thorough examination of the patient.

"red flag":

Patient's age at onset of pain: less than 20 or older than 50;
a serious spinal cord injury in the past;
the presence 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;
abnormal localization of pain;
increased pain in a horizontal position (especially at night), in a vertical position - weakening;
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;
drinking;
use of narcotic drugs, especially intravenously;
treatment with corticosteroids and / or cytostatics;
Pulsating nature of pain, accompanied by pain in the neck.

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

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

acute- pain lasting less than 4 weeks;
semi dilapidated- pain lasting from 4 to 12 weeks;
long term- pain lasting 12 weeks or more;
recurrence of pain- the resumption of pain if it has not occurred within the last 6 months or more;
exacerbation of chronic painRecurrence of pain less than 6 months after the last episode.

disease

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 of the vertebral discs, and later, the vertebrae themselves.

Is osteochondrosis a pseudo-diagnosis? - No. This diagnosis is present 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 refer to osteochondrosis. diagnose. This situation arose due to the fact that foreign doctors understand osteochondrosis as a disease of the spine in children and adolescents associated with development. However, this term refers exclusively to a degenerative of the spine in people of any age. Refers to the disease. Also, most often established diagnoses are dorsopathy and dorsal.

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

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

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 the nucleus pulposus is weakly expressed with their regression to the other sections, on average, up to 30 years), whichmake them more vulnerable to stress. and injury, which leads to stretching of the ligaments and the early development of degenerative changes;
Thoracalgia - pain in the thoracic spine;
Lumbodynia - pain in the lumbar spine (lower back);
Lumboischialgia is pain in the lower back that travels to the leg.

Factors leading to the development of osteochondrosis:

heavy physical exertion, lifting and moving heavy loads;
low physical activity;
sedentary work for a long time;
being in an uncomfortable position for a long time;
prolonged work at a computer with an unoptimal monitor location, which creates a load on the neck;
violation of posture;
Congenital structural features and anomalies of the spinal column;
weakness of the back muscles;
high growth;
excess body weight;
diseases of the joints of the feet (gonarthrosis, coxarthrosis, etc. ), flat feet, clubfoot, etc . ;
natural wear and tear with age;
smoking.

disc herniationThere is a protrusion of the nucleus of the intervertebral disc. This may be asymptomatic or cause compression of the surrounding structures and manifest as radicular syndrome.

Symptoms:

Violation of the speed limit;
feeling of stiffness;
muscle strain;
Radiation of pain to other areas: arm, shoulder blade, leg, groin, rectum, etc.
"shots" of pain;
Numbness;
crawling sensation;
muscle weakness;
Pelvic disorders.

The localization of pain depends on the level at which the hernia is localized.

Disc herniations often heal on their own within an average of 4-8 weeks.

compression radiculopathy

Radicular (radicular) syndrome is a complex of manifestations caused by compression of the spinal roots at the points of their departure from the spinal cord.

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

pain in the extremities of a shooting nature with radiating to the fingers, aggravated by movement or coughing;
numbness or a feeling of flies crawling in a certain area (skin);
muscle weakness;
back muscle spasms;
Violation of the strength of reflexes;
Positive symptoms of stress (the presence of pain with passive flexion of the limbs)
range of spinal mobility.

spondylolisthesis

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

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

Spondylolisthesis may cause no symptoms with minor displacement and an incidental X-ray finding.

Possible symptoms:

feeling of restlessness
pain in the back and lower extremities after physical exertion,
weakness in legs
radicular syndrome,
Pain and decreased tactile sensitivity.

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

persistent pain (both at rest and at motion),
In some cases, the pain may subside in the supine position,
The pain does not increase with coughing and sneezing,
The nature of the pain ranges from pulling to very strong,
Pelvic organ dysfunction.

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

diagnosis

collection of complaintsTo determine the localization of pain helps the doctor to suspect possible causes of the disease.

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

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

Physical Examination:Assessment of the presence of spasms of the back muscles, determination of the development of the muscle skeleton, exclusion of the presence of signs of an infectious lesion.

Neurological status assessment:Muscle strength and its symmetry, reflexes, sensitivity.

March test:Performed in cases of suspected lumbar stenosis.

important!It is not recommended to conduct additional studies in patients without "red flags" having a classic clinical picture.

Radiography:Performed with functional tests for suspected instability of the spinal structures. However, this diagnostic method is uninformed and mainly performed with limited financial resources.

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

whistle	MRI
Evaluates bone structures (vertebrae). Allows you to see the later stages of osteochondrosis, in which bone structures are affected, compression fractures, destruction of the vertebrae in metastatic lesions, spondylolisthesis, anomalies in the structure of the vertebrae, osteophytes. It is also used for contraindications to MRI.	Evaluates soft tissue structures (intervertebral discs, ligaments, etc. ). 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 according to instrumental examination methods.

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

Bone Scintigraphy, PET-CT:According to other methods of examination carried out in the presence of suspicion of oncological disease.

back pain treatment

For acute pain:

Painkillers are prescribed in a course, mainly from the group of non-steroidal anti-inflammatory drugs (NSAIDs). The specific drug and dosage is selected depending on the severity of the pain;
maintaining moderate physical activity, special exercises to relieve pain;
important!Physical inactivity with back pain exacerbates 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 is unclear according to various studies.
manual therapy;
Lifestyle analysis and elimination of risk factors.

For subacute or chronic pain:

use of painkillers on demand;
special physical exercises;
Assessment of psychological status, as this may be an important factor in the development of chronic pain and psychosis;
drugs from the group of antidepressants or antiepileptic drugs for the treatment of chronic pain;
manual therapy;
Lifestyle analysis and elimination of risk factors.

In radicular syndrome, blockades (epidural injections) or intrauterine blocks are used.

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

rehabilitation

Rehabilitation should be started as early as possible and should have the following goals:

improving the quality of life;
eliminate pain, and if it is impossible to eliminate it completely - relief;
resumption of work;
rehabilitation;
Self service and safe driving training.

Basic rules of rehabilitation:

The patient should feel his own responsibility for his health and compliance with the recommendations, however, the doctor should choose the methods of treatment and rehabilitation that the patient can comply with;
systematic training and compliance with safety rules when performing exercises;
Pain does not hinder exercise;
A trusting relationship between patient and physician should be established;
The patient should not focus and focus on the cause of the pain in the form of structural changes in the spine;
The patient should feel comfortable and safe when performing movements;
the patient should feel the positive effect of rehabilitation on his condition;
The patient needs to develop pain response skills;
The patient should associate the movement with positive thoughts.

Rehabilitation Methods:

walk;
physical exercises, gymnastics, gymnastics programs in the workplace;
personal orthopedic equipment;
cognitive behavioral therapy;
patient education:
- Avoid excessive physical activity;
- fighting low physical activity;
- the exclusion of static loads for a long time (standing, being in an uncomfortable position, etc. );
- Avoid hypothermia;
- sleep organization.

Redressal

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

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

life hack:how to sit

Avoid highly upholstered furniture;

feet should rest on the floor, which is achieved 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 correct posture, the back should fit snugly against the back of the chair to avoid straining the back muscles;

There should be an anatomical position of the head when reading a book or working at a computer (look straight ahead, not constantly down). To do this, it is recommended to use special stands and install the computer monitor at the optimum height.

With prolonged standing work, it is necessary to change position every 10-15 minutes, alternately changing the supporting leg, and if possible, walking and moving in place.

Avoid lying down for a long time.

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 an anatomical curve;

The pillow should be soft enough and of medium height to avoid strain on the neck;

When sleeping in a prone position, it is advisable to place a small pillow under the stomach.

Smoking cessation: If you are having difficulty, visit your doctor who will refer you to a smoking cessation program.

most frequently asked questions

I use ointments with glucocorticosteroids. Am I at increased risk of osteochondrosis or osteoporosis?

No. External glucocorticosteroids (ointments, creams, gels) do not enter the systemic circulation in significant quantities, and therefore do not increase the risk of developing these diseases.
Is surgery necessary in every case of herniated disc?

No. Surgical treatment is done only when indicated. On average, only 10-15% of patients require surgery.
Should you stop exercising when 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 spinal column, you can continue to play sports, but to undergo a course of treatment andCourse of physiotherapy exercises and swimming after adding some exercises.
Can back pain go away permanently if I have a herniated disc?

They can be followed by 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.