Back pain in the lumbar region

Lumbar region back pain is familiar to everyone. According to statistics, he is the cause of 25% of all medical care requests. Its appearance can provoke a variety of factors, from banal fatigue to very serious illnesses. Therefore, the problem should not be ignored, especially if the discomfort occurs regularly and even more so over time. In such situations, contact a therapist as soon as possible, or contact a neurologist directly and undergo a comprehensive examination.This allows the disease to be diagnosed at an early stage of development and takes time to stop its progression. But if there is an injury or a failed fall on the eve of the onset of pain, you should immediately consult a traumatologist or spine surgeon.

Characteristics of low back pain and associated symptoms

Back pain can be of different natures and weights. They can be strong, shoot, ach, pull, and so on. They may increase during physical exertion, prolonged sessions or positions, and go through or not at rest. All of these are important diagnostic factors that allow the physician to make the correct diagnosis and find the real cause of the patient’s condition.

It is essential in making a diagnosis whether pain radiates to the hips, buttocks, knees, legs, and if so, where and how. Restriction of spinal mobility is also a serious moment, regardless of whether the patient can bend freely, turn around, or have a reduced range of motion.

Spinal pain is called lumbodynia. If it spreads to the legs, it is called lumboischialgia.

Acute pain lasts less than 3 months, otherwise it speaks of chronic pain. In the latter case, the disease often occurs with periods of exacerbation and remission.

Low back pain is rare in isolation. In most cases, there is also a complex of other disorders that are rarely associated with the patients themselves. Often, back pain is combined with

• feeling climbing in the back and / or legs, numbness;
• muscle weakness;
• pain in the joints of the hips, knees;
• disruption of pelvic organs (menstrual irregularities, potency problems, loss of urine control, defecation);
• foot paralysis.

Similar signs suggest spinal pathology.But since not only can they cause back pain, there is another group of symptoms that can accompany lower back pain and indicate pathology of internal organs or cancer. Therefore, you should be especially careful about your own status when it appears:

• fast and unnecessary weight loss;
• cuts and pain in the groin, perineum;
• increased urination, pain;
• increase in body temperature, chills;
• changes in skin color in the epicenter of pain;
• menstrual disorders, unusual discharge.

If low back pain is associated with one or more of the above symptoms, see a doctor immediately. When symptoms appear in the first group, consultation with a neurologist is required, and in the second group, the assistance of a urologist, gynecologist, endocrinologist, or other close specialist is required. Your therapist will help you understand exactly which doctor to contact.

Causes of Occurrence

All causes of back pain in the lumbar region can be divided into 2 groups: diseases of the spine and pathologies of internal organs, especially gynecological diseases, pathology of the kidneys, organs of the gastrointestinal tract, endocrine disorders. But still, most often it is a consequence of the development of changes in the spine and surrounding muscles. The most common causes of back pain are:

• osteochondrosis;
spondylosis;
• inflammatory diseases of the spine;
• myofascial syndrome;
• ankylosing spondylitis;
• scoliosis;
• injuries.

However, lower back pain can also be the result of overload or certain physiological changes. In such situations, they do not require special treatment, only a decrease in physical activity and a more gentle treatment on a daily basis.

Osteochondrosis and intervertebral hernias

Osteochondrosis is the most common disease of the spine. Its development is often accompanied by inevitable age-related changes, as almost all older people have more or less symptoms.

Osteochondrosis is the price of humanity for the ability to walk straight. It is characterized by the gradual destruction of intervertebral discs, their thinning, loss of elasticity and strength. As a result, they cease to cope with stress and may bulge. Thus, intervertebral hernias are formed.

Osteochondrosis most commonly affects the intervertebral discs of the lumbar spine. When they extend into the spinal canal or foraminal foramen, the nerves are almost inevitably damaged, leading to acute pain in the lower back and radiation to the legs and buttocks.

Spondylosis

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Spondylosis is a complication of advanced osteochondrosis, in which the intervertebral discs are almost completely destroyed, due to ongoing degenerative processes and an increase in the load on the spine, resulting in bony protrusions along the edges of the vertebrae called osteophytes.Therefore, there is a high risk of compression and damage to nearby nerves. This causes severe pain that can radiate to the legs.

Inflammatory diseases of the spine

Inflammatory diseases of the spine are most common in young people, especially men. They cause severe pain that bothers at night, this is their particular difference. As it progresses, in the absence of timely treatment, the pain becomes more intense and bothers the person more often.

It is not uncommon for patients to see a doctor several years after the first symptoms appear. Such a long process of inflammatory processes in the spine can result in irreversible changes that can eventually lead to immobility and disability.

Sometimes, in addition to lower back pain, there is also discomfort in the joints of the legs and arms. In such cases, the cause of discomfort may be arthritis, osteomyelitis.

Myofascial syndrome

Myofascial syndrome is a common pathology in which pain occurs after prolonged discomfort or after physical exertion. Myofascial syndrome is slightly more common in women. This causes lower back pain after careless movement or exercise. Its distinguishing feature is the presence of so-called trigger points in the spasmodic muscles in the lumbar region and buttocks, the pressure of which leads to a sudden pain attack. Myofascial syndrome significantly impairs the quality of human life, but does not pose a serious threat.

Bechterew's disease

Ankylosing spondylitis or ankylosing spondylitis is a chronic joint disease that primarily affects the sacroiliac joint, the spinal joint, and the surrounding soft tissues. With this disease, people worry about lower back and sacrum pain and stiffness in their movements, but the symptoms usually go away without a trace in the afternoon and at night.

In addition, physical activity has a beneficial effect on the well-being of the patient and contributes to the elimination of pain syndrome. A rather specific symptom of ankylosing spondylitis is curvature, curved curvature of the spine, and gradual restriction of mobility.

scoliosis

Scoliosis is the lateral curvature of the spine. It can vary in severity, which directly affects the intensity of back pain and other symptoms. Because spinal deformity leads to displacement of all anatomical structures, nerves are often constricted, causing severe pain. In addition, other neurological symptoms may be present, including feelings of numbness and paresis.

Compression fractures

In elderly people with osteoporosis and trauma, low back pain may be the result of an undetected spinal compression fracture. As a result, the vertebrae flatten and occupy an abnormal position, leading to improper distribution of spinal load, degenerative processes in the intervertebral discs, and the appearance of pain.

Physiological causes of low back pain

Doing hard physical work, intense sports training puts an increased strain on the muscles, causing lactic acid to accumulate in them, causing pain. Back pain is not uncommon during long-term wear of uncomfortable shoes, especially heels.

Lower back pain is also common during pregnancy. In such situations, they are caused by displacement of the center of gravity and increased stress on the spine.

Diagnostics

It is recommended that you consult a neurologist to determine the cause of low back pain. You may consult a therapist initially, but it is likely that the doctor will continue to refer the patient to a neurologist.

During the meeting, the specialist will conduct a thorough survey of the patient, find out what they are worried about, what lifestyle, etc. In addition, there is a need for a study in which the physician assesses the severity of reflexes, performs neurological examinations, and evaluates patient mobility. Based on the results obtained, the doctor can make a preliminary diagnosis and understand what violations led to the appearance of back and low back pain.

In order to confirm existing assumptions and determine the exact causes of pain, a comprehensive examination of the patient is performed, which may include:

• general and biochemical blood tests - they are used to detect changes in the blood, indicating inflammatory processes in the body, the presence of an infection or tumor;
• general urine test - to differentiate kidney disease as a cause of lumbar pain;
• X-ray - shows the presence of a change in the bone structure of the spine, signs of fractures, provides information on bone density and allows the diagnosis of major diseases of the spine as well as osteoporosis (spinal pathologies can be detected by a more thorough CT or MRI examination);
CT
• CT is a modern radiological diagnostic method that allows a very clear visualization of all bone structures and the detection of the slightest deviations from the norm;
• MRI - provides comprehensive information on the condition of soft tissues and cartilage, including intervertebral discs, MRI can be used to diagnose intervertebral hernias of any size, vascular changes, tumors.

Treating low back pain

Treatment for back pain is strictly individual. However, it is always complex and includes treatment for symptomatic therapy, lifestyle changes, and elimination of discovered causes of low back pain. Therefore, if the first 2 components of therapy are generally universal and prescribed to all patients, then etiotropic therapy is developed strictly on an individual basis, taking into account the pre-existing disease.

In most cases, patients are initially offered conservative treatment, the main component of which is medication. In more complex cases, physiotherapy treatments, manual therapy and exercise are also recommended.

But in any case, for all patients with low back pain:

• Give up lifting heavy objects and exhausting sports;
• to reduce weight in case of obesity;
• take regular breaks to warm up if you are forced to sit for a long time;
• increases the level of physical activity, but avoid overload and hard work (daily walks, morning exercises, performing a special exercise complex, swimming);
• Use a support bandage that relieves the load on the lower back and thus provides favorable conditions for early spinal recovery.

Depending on the source of the pain, patients may be advised to stay in bed for a few days or, conversely, to increase their physical activity, but within reasonable limits. For example, because of the pain caused by nerve compression, you need to rest your back for a few days. In other diseases, on the contrary, moderate physical activity is a mandatory component of therapy. It helps increase the effectiveness of medication, reduce the risk of complications, and prevent disability.

Unfortunately, conservative therapy is not always used to treat low back pain. In some cases, it proves ineffective and does not work even after months of unwavering adherence to medical recommendations. In other cases, the results of the tests show the presence of a pathology that can no longer be eliminated by any non-surgical method. In such cases, patients are advised to consult a neurosurgeon and undergo appropriate surgery to restore the normal anatomy of the spine.

Drug therapy

In order to improve the patient's condition and relieve pain quickly, the following is prescribed:

• Non-steroidal anti-inflammatory drugs in the form of tablets, injections and topical preparations - have analgesic and anti-inflammatory properties;
• Corticosteroids - given in short courses to treat severe inflammation
• muscle relaxants - needed to relieve muscle cramps, which are often a painful and aggravating reaction of the body;
• B vitamins - improve nerve conduction by normalizing the nutrition of nerve fibers and increasing the rate of transmission of nerve impulses.

In case of severe pain that cannot be tolerated, blockages can be performed. The procedure involves injecting an anesthetic solution directly into the area of ​​pain or nerve fiber passage. Thus, it is possible to completely stop the pain syndrome for a while and improve the patient’s well-being.

But the blockade has only a temporary effect and can only be carried out in a medical institution, as the drug is most often given at points in the immediate vicinity of the spine where the nerve mass passes through. Therefore, illiterate execution of the procedure can have serious, sometimes fatal, consequences.

In addition to the medications listed above, a number of other medications are prescribed to help eliminate the underlying disease that causes pain syndrome. Therefore, patients may also be prescribed antibiotics, chondroprotectors, immunomodulators, and drugs from other groups.

Physiotherapy

Physiotherapy treatments are often prescribed for patients with spinal disease. Thanks to the right method of physical action and the frequency of the procedures, we can achieve a pronounced anti-inflammatory and analgesic effect, as well as improve microcirculation, accelerate local edema, muscle cramps, etc. Termination. Physiotherapy significantly increases the effectiveness of other treatment methods, but is mainly used only after discontinuation of acute treatment. process.

Patients are most often prescribed:

• electrophoresis;
• UHF;
• ultrasound therapy;
• magnetic therapy;
• reflexology;
• diadynamic currents, etc.

As a general rule, procedures consist of 8-10 sessions, which are performed with a certain frequency.

Manual therapy

In osteochondrosis, scoliosis, and many other diseases, manual therapies can have a truly amazing effect on the condition of the spine. But only a qualified chiropractor can competently conduct manual therapy and benefit the patient, not harm it.

The use of special techniques of manual exposure not only improves microcirculation, relaxes muscles that are too toned and too loose, but also increases the distance between vertebrae and normalizes their position. A trained chiropractor is able to find the place where the nerve gets stuck and relieves the pressure on the anatomical structures on it.

Literally, after the first session, the majority of patients show improvement in their well-being and significantly reduce the severity of the pain syndrome until it completely disappears. But in order to consolidate the results achieved, it is recommended to attend a full hand therapy and attend supportive courses in the future.

gym therapy

Physiotherapy helps the body cope with the stress on it. A separate set of exercises has been developed for each disease, the regular implementation of which allows to solve the most important tasks in the current situation. So with the right choice of physiotherapy practices, muscles can be repaired and strengthened. As a result, the spine will have less stress, which is an effective prevention of disease progression and creates favorable conditions for its recovery.

Exercise therapy also helps to improve blood circulation in the affected area, which speeds up the course of inflammatory processes and is likely to lead to a full recovery. Proper exercise can in many cases reduce low back pain and reduce its incidence.

The training program is developed individually for each patient. This takes into account not only the type and severity of the pathology uncovered, but also the presence of concomitant diseases, the level of physical fitness of the patient, age, and other factors. Only a professional can correctly select the most effective and safest set of exercises.

The first classes are kept under his supervision. In doing so, the patient learns to perform all the suggested exercises correctly to be useful. The load gradually increases, raising it to the optimal level. But it is not recommended to increase or complicate the number of repetitions of the exercises yourself. Any changes in physiotherapy practices should only be introduced by a professional.

The patient should only strictly follow his recommendations and exercise daily in a comfortable environment. All exercises are performed at a slow pace. Sudden movements are not allowed. But if you experience pain during the lesson, the exercise should be stopped immediately and you should consult your doctor as soon as possible.

Surgery for back pain

Most often, the help of a spinal surgeon is needed for intervertebral hernias, the development of which has led to damage to the spinal root and the development of radical pain. Once the protrusion has developed, it is impossible to retreat with modern, non-invasive methods. The only way to eliminate it and at the same time get rid of low back pain is to surgically remove the intervertebral hernia.

Several surgeries are used for intervertebral hernias. The specific tactics of surgery are determined by the type, location, and size of the hernia:

• Nucleoplasty and hydroplasty are methods of percutaneous surgery that allow a part of the nucleus pulposus to be removed by piercing tissues several centimeters in diameter and reduce the size of the hernia.
• Microdiscectomy is a radical method of solving the problem of the intervertebral hernia, which involves removing it or the entire plate with an incision up to 3 cm long. But unlike other methods, it allows you to eliminate a hernia of any size, regardless of its location in the spinal canal, and releases a pinched nerve even in the heaviest part of the spine.
• Endoscopic surgery - involves the removal of a disc herniation with 1 cm in diameter punctures with special equipment with a video camera. It can be used to resect a hernia of any size, but the technique cannot be used to remove neoplasms in anatomically difficult areas.

The help of a spine surgeon is also needed for scoliosis. In this case, all forces are directed to restore the normal axis of the spine. Previously, this required a large incision that extends virtually across the entire back. But nowadays, spinal deformity can be corrected in a minimally invasive way with miniature incisions.

Different types of metal structures are used to restore the normal axis of the spine, but their essence is nearly the same. The structure is fixed to the vertebrae with special screws, and by correcting its tension at different points, it is possible to return the displaced vertebrae to their place and fix them in the correct position. Modern types of metal structures make it possible to improve the initial result of the operation over time without the body having to intervene again. This can be achieved by correcting the position of the built-in structure with special screws.

In case of spinal fractures, surgery cannot be avoided. In such situations, the relief of back and low back pain is only possible by restoring the normal shape, size and position of the vertebrae. Recently, kyphoplasty and vertebroplasty have been performed for this purpose. The essence of both operations is to inject a special bone cement into the vertebrae destroyed as a result of the injury using a thin piercing needle. Fills all free space and hardens in 10 minutes. But in severe compression fractures, kyphoplasty is preferred because it can also help restore the normal shape of the vertebrae, ensuring proper distribution of spinal load in the future and reducing the risk of complications. This operation involves pre-inserting a special balloon into the destroyed vertebra, which gradually inflates and returns the vertebra to its original appearance. The balloon is then deflated and removed, and the formed cavity is filled with bone cement.

Back pain can therefore be a symptom of physiological changes, frequent muscle fatigue, or severe disease of the spine or internal organs. Therefore, if they occur regularly, especially under the influence of the same factors, do not hesitate and do not take into account the problem. Contact a qualified professional to make treatment as quick and easy as possible. And if the disease cannot be detected at an early stage of development, the modern level of neurosurgery allows for surgical termination with minimal risk of complications.