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back pain

Back pain is a sign of diseases of the musculoskeletal system

Almost every adult has experienced back pain at some point in their lives. This is a very common problem that can have different reasons that we are going to analyze in this article.

Causes of back pain

All causes of back pain can be divided into groups:

  1. musculoskeletal system:

    • osteochondrosis;
    • Disc prolapse;
    • compression radiculopathy;
    • spondylolisthesis;

  2. Flammable, including infectious:

    • osteomyelitis
    • tuberculosis

  3. neurological;

  4. injuries;

  5. endocrinological;

  6. Vessel;

  7. Tumor.

At the first visit to the doctor with back pain, the specialist should determine the cause and nature of the pain, paying special attention to "red flags" - possible manifestations of potentially dangerous diseases. "Red flags" refers to a set of specific ailments and anamnesis data that require a detailed examinationof the patient require.

"Red Flags":

  • Age of patient at onset of pain: younger than 20 or older than 50;
  • a history of serious spinal injury;
  • the occurrence 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 pain localization;
  • increased pain in a horizontal position (especially at night), in a vertical position - weakening;
  • no improvement for 1 month or more;
  • Functional disorders of the pelvic organs, including disorders of urination and defecation, numbness of the perineum, symmetric weakness of the lower extremities;
  • Alcoholism;
  • the use of narcotics, especially intravenous;
  • Treatment with corticosteroids and/or cytostatics;
  • for 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 it does require the attention of a doctor and a diagnosis.

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

  • acute- pain lasting less than 4 weeks;
  • subacute- pain lasting 4 to 12 weeks;
  • chronic- pain lasting 12 weeks or more;
  • recurrence of pain- recurrence of pain if it has not occurred within the past 6 months or more;
  • exacerbation of chronic painPain recurrence 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 intervertebral discs and thus the vertebrae themselves.

Is osteochondrosis a pseudo-diagnosis? - 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 wrong, others, on the contrary, often diagnose osteochondrosis. This situation arose because foreign doctors understand osteochondrosis to be a disease of the spine in children and adolescents that is associated with growth. However, this term specifically refers to a degenerative disease of the spine in people of all ages. Also frequently established diagnoses are dorsopathy and dorsalgia.

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

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

  • Cervicalgia is pain in the cervical spine. The intervertebral discs of the cervical region have anatomical features (intervertebral discs are absent in the upper section, and in other sections they have a poorly developed nucleus pulposus with its regression on average by 30 years) that make them more susceptible to stress and injuries leading to ligament stretchingand early development of degenerative changes;
  • Thoracalgia - pain in the thoracic spine;
  • Lumbodynia - pain in the lumbar spine (lower back);
  • Lumbar sciatica is pain in the lower back that radiates down the leg.

Factors leading to the development of osteochondrosis:

  • heavy physical labor, lifting and moving heavy loads;
  • low physical activity;
  • long sedentary work;
  • long stay in an uncomfortable position;
  • long work at the computer with non-optimal monitor position, which strains the neck;
  • violation of posture;
  • congenital structural features and anomalies of the spine;
  • weakness of the back muscles;
  • high growth;
  • overweight;
  • Diseases of the joints of the legs (gonarthrosis, coxarthrosis, etc. ), flat feet, clubfeet, etc. ;
  • natural age-related wear and tear;
  • Smoking.

disc prolapseis a protrusion of the nucleus of the intervertebral disc. It can be asymptomatic or cause compression of surrounding structures and manifest as a radicular syndrome.

Symptoms:

  • violation of the range of motion;
  • feeling of stiffness;
  • muscle tension;
  • Radiating pain to other areas: arms, shoulder blade, legs, groin, rectum, etc.
  • "shots" of pain;
  • Deafness;
  • crawling feeling;
  • muscle weakness;
  • pelvic diseases.

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

Herniated discs often go away on their own within an average of 4-8 weeks.

compression radiculopathy

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

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

  • Pain in the limb of a shooting nature with irradiation of the fingers, aggravated by movement or coughing;
  • numbness or a feeling of flies crawling in a certain area (dermatomes);
  • muscle weakness;
  • spasm of the back muscles;
  • violation of reflex strength;
  • positive tension symptoms (the appearance of pain with passive flexion of the limbs)
  • Limitation of spinal mobility.

spondylolisthesis

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

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

Spondylolisthesis may cause no symptoms when displaced slightly and may be an incidental radiographic finding.

Possible symptoms:

  • feeling of discomfort
  • pain in the back and lower extremities after physical work,
  • weakness in the legs
  • radicular syndrome,
  • decreased sensitivity to pain and touch.

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

  • constant pain (both at rest and while moving),
  • in some cases, the pain may decrease in the supine position,
  • Pain is not aggravated by coughing and sneezing
  • the type of pain from aching to very strong,
  • Functional disorders of the pelvic organs.

If the displacement is severe, it can compress the arteries, disrupting the blood supply to the spinal cord. This is manifested by a strong weakness in the legs, a person can fall.

diagnosis

collection of complaintshelps the doctor to suspect the possible causes of the disease, to determine the localization of 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 both the patient and the doctor. In this case, the patient rates the severity of the pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain a person can imagine.

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

Physical examination:Assess the presence of spasms of the back muscles, determine the development of the muscular skeleton, exclude the presence of signs of an infectious lesion.

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

March test:performed if lumbar stenosis is suspected.

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

Roentgen:performed with functional tests in case of suspected instability of the structures of the spine. However, this diagnostic method is not very informative and is mainly carried out with limited financial resources.

Computed tomography (CT) and/or magnetic resonance imaging (MRI):The doctor prescribes based on clinical data, since these methods have different indications and benefits.

CT

MRI
  • Assesses 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 with contraindications for 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, without complaints, degenerative changes in the spine are detected by instrumental methods of research.

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

Bone scintigraphy, PET-CT:if there is a suspicion of an oncological disease, carried out according to other examination methods.

treatment of back pain

For acute pain:

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

    Important!Physical inactivity with back pain increases the 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, according to various studies, their effectiveness is unclear;
  • manual therapy;
  • Analysis of lifestyle and elimination of risk factors.

For subacute or chronic pain:

  • taking painkillers as needed;
  • special physical exercises;
  • Mental health assessment, as this can be a major factor in the development of chronic pain, and psychotherapy;
  • Medicines from the group of antidepressants or antiepileptics used to treat chronic pain;
  • manual therapy;
  • Analysis of lifestyle and elimination of risk factors.

In the case of radicular syndrome, blockages (epidural injections) or intraosseous blockages are used.

Surgical treatment is indicated with a rapid increase in symptoms, the presence of spinal cord compression, significant stenosis of the spinal canal, and the ineffectiveness of conservative therapy. Emergency surgical treatment is carried out in the case of: Pelvic diseases with numbness in the anogenital area and ascending foot weakness (cauda equina syndrome).

rehabilitation

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

  • improving the quality of life;
  • Elimination of pain, and if it is impossible to get rid of it completely - relief;
  • restoration of operability;
  • Rehabilitation;
  • Self-service and driving safety training.

Basic rules of rehabilitation:

  • The patient must feel responsible for his own health and compliance with the recommendations, but the doctor must choose the methods of treatment and rehabilitation that the patient can follow.
  • systematic training and compliance with safety rules when conducting exercises;
  • Pain is not a barrier to movement;
  • a trusting relationship must be established between patient and 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 confident when performing movements;
  • the patient should feel the positive effects of rehabilitation on their condition;
  • the patient must develop pain response skills;
  • The patient should associate movement with positive thoughts.

Rehabilitation methods:

  1. Walk;
  2. physical exercise, gymnastics, gymnastics programs at work;
  3. Individual orthopedic devices;
  4. cognitive behavioral therapy;
  5. Patient education:
    • Avoid excessive physical activity;
    • fight against low physical activity;
    • Exclusion of prolonged static loads (standing, uncomfortable posture, etc. );
    • avoid hypothermia;
    • sleep organization

prevention

Optimal physical activity: strengthens the muscular structure, prevents bone loss, improves mood and reduces the risk of cardiovascular accidents. Optimal physical activity is more than 90 minutes of walking per week (at least 30 minutes at a time, 3 days per week).

With prolonged sedentary work, it is necessary to take a warm-up break every 15-20 minutes and observe the rules of sitting.

lifehack:like sitting

  • avoid overly upholstered furniture;
  • the legs 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 hip length;
  • Sit up straight, maintain a correct posture, the back should be tight against the back of the chair to avoid straining the back muscles;
  • The head should be in a physiological position (looking straight ahead and not constantly looking down) when reading a book or working on a computer. To do this, it is recommended to use special stands and install the computer monitor at the optimal 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 long periods.

lifehack:how to sleep

  • Better sleep 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 strain on the neck;
  • When sleeping on your stomach, it is advisable to place a small pillow under your stomach.

Smoking cessation: If you have difficulty, contact your doctor who will refer you to a smoking cessation program.

frequently asked Questions

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

    noExternal glucocorticosteroids (ointments, creams, gels) do not penetrate the systemic circulation in significant quantities, and therefore do not increase the risk of developing these diseases.

  2. Is an operation necessary for every herniated disc?

    noSurgical treatment is only carried out when indicated. On average, only 10-15% of patients require surgery.

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

    noIf, based on additional research methods, the doctor does not find anything that would significantly reduce the degree of stress on the spine, it is possible to continue playing sports, but after treatment and adding certain exercises from the course of physiotherapy exercises and swimming.

  4. Can back pain from a herniated disc go away forever?

    You can after 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.