Spinal discomfort is the main reason people seek medical help. Almost 80% of the adult population faces this problem. Back pain causes significant disability and can be a problem from childhood to adulthood.
Dorsopathy affects almost all areas of life. Sleep will be disrupted and it will be difficult to bend, reach or turn. Difficulties arise during driving, walking, lifting and physical exercises. If you feel pain in the spine, see a doctor immediately. The specialist studies the medical history, collects an anamnesis and performs an examination. If any violations are detected, conservative or surgical treatment is prescribed.
Why does my spine hurt?
The cause of dorsopathy is muscle tension and spasm. Tension can be the result of hard physical work, uncomfortable positions, or even poor posture.
Studying the anatomy of the spine can help you gain a deeper understanding of the problem. Main parts of the spine:
- The cervix is a mobile segment that is subject to degenerative changes. As we age, the pain often occurs in the so-called "transition zone", between the flexible cervical vertebrae and the more rigid thoracic part of the spine.
- Thoracic - connects to the chest and connects to the ribs. Especially in older adults, a compression fracture can occur in this area as a result of bone loss.
- Groin - lower back. Young patients are more prone to discogenic low back pain, while older patients are more likely to experience abnormalities of the joint structures.
- Sacral – the lowest part of the spine. It consists of a flat, triangular sacrum that connects to the hip and coccyx. Degeneration of this area usually occurs in older patients or after a fall.
Between the upper back and the tailbone are 17 vertebral bodies, many joints, the sacrum and coccyx, as well as fibrous and muscular supporting structures, intervertebral discs, the spinal cord and nerve roots, and blood vessels. The spine is more than the sum of its parts, but here's what you need to know about those parts.
The spine usually consists of 33 vertebrae, each of which is separated by intervertebral discs. Vertebrae are a series of small bones with muscles attached to them. Each vertebra consists of two parts: the anterior body, which protects the spinal cord and nerve roots, and the posterior arch, which accommodates the canal and also protects the spinal cord.
Back muscles can be divided into three groups:
- intermediate - responsible for the movement of the ribs;
- internal – stabilizes the spine, regulates the movement and position of the spine;
- superficial - ensures the movement of the neck and upper limbs.
The muscles supporting the spine are built up in layers. They act as the main stabilizers of bone and ligament structures. Tension of these muscles is possible in patients of different age groups.
There are other parts of the spine that must be considered when determining dorsopathy. These include ligaments and tendons, intervertebral discs and joints that provide stability and mobility.
Inflammatory disease, malignancy, pregnancy, trauma, osteoporosis, nerve root compression, radiculopathy, plexopathy, osteochondrosis, herniated disc, spinal stenosis, sacroiliac joint dysfunction, facet joint damage, and infection are all part of the difference. Differentiating the signs and symptoms of nociceptive (mechanical) pain from radiculopathy (neuropathic dorsopathy) is an important first step in establishing a diagnosis.
Degenerative pathologies
Degeneration includes endplate-related changes (sclerosis, defects, modal changes, and osteophytes) as well as disc changes (fibrosis, annulus rupture, desiccation, height loss, and mucinous annulus degeneration).
A third of healthy people between the ages of 21 and 40 already have degenerative disc changes. The high prevalence of asymptomatic degeneration must be taken into account when evaluating spinal symptoms.
As we age, the intervertebral disc becomes more fibrous and less flexible. Degenerative changes progress when the structural integrity of the posterior annulus fibrosus is compromised by overload. This eventually leads to the formation of cracks in the annulus fibrosus. Displacement of the disc material (cartilage, nucleus, fragmented annular tissue and apophyseal bone) beyond the intervertebral disc space is considered a hernia.
Rachiocampsis
The natural curves of the spine are important to ensure its strength, flexibility and even distribution of the load. Natural curves have a normal range. Abnormal curves include lordosis, kyphosis, and scoliosis.
Abnormal lordosis
Lordosis, a spinal disorder, is defined as a severe inward curvature of the spine. Although this disease most often affects the lumbar spine, it can also develop in the cervical spine.
The normal range of lordosis is between 40 and 60 degrees. Postural changes can lead to unsteady gait and shape changes - the bottom becomes more noticeable. Causes of pathological lordosis: spondylolisthesis, osteoporosis and obesity.
Abnormal kyphosis
Kyphosis, a spinal condition, is defined as an excessive outward curvature of the spine and can result in a forward lean. It most often affects the thoracic or chest region, but can also occur in the neck region.
The normal range for kyphosis is between 20 and 45 degrees. But when a structural abnormality leads to a kyphotic curve outside of this normal range, the curve becomes abnormal and problematic. It manifests itself in the rounding of the shoulders and the tilting of the head forward.
Scoliosis
It is defined as an abnormal lateral curvature of the spine. Scoliosis is a progressive structural disease. Lordosis and kyphosis are characterized by backward or forward curvature of the spine. Scoliosis is an abnormal lateral curvature of the spine.
The most common form of scoliosis is adolescent scoliosis, which is diagnosed between the ages of 10 and 18. The remaining 20% can be attributed to neuromuscular, congenital, degenerative and traumatic causes.
Developmental anomalies
The symptom often occurs with developmental disorders and can be combined with neurological manifestations.
Dorsopathy is associated with the following developmental disorders:
- Splitting - moderate discomfort occurs in the lumbosacral region with small bone defects. After a while, radicular syndrome occurs.
- Lumbarization, sacralization - compression of the roots causes shooting or burning pain. Sensory disturbances or paresis may occur.
- Wedge-shaped vertebrae - discomfort occurs when exerting tension and maintaining a static body position for a long time. It is accompanied by chest deformation and bad posture.
Osteoporosis
It typically affects the thoracic and thoracic spine and can cause debilitating pain. This disorder is caused by a decrease in bone mineral density, which makes the bones brittle.
Osteoporosis can cause vertebral compression fractures, loss of height, stooped posture and even hunchback. In order to prevent osteoporosis, it is necessary to take care of a balanced diet, smoking and alcohol abuse. An active lifestyle is also recommended.
Injuries
The severity of dorsopathy corresponds to the severity of the injury. It is usually combined with signs of nerve tissue damage.
Traumatic causes of spine pain:
- A bruise is the result of a direct blow or a fall on the back. The dorsopathy is local, moderate. It gradually disappears in 1-2 weeks.
- Dislocation - occurs due to high energy impact. It is accompanied by severe pain combined with disturbance of sensitivity and motor activity. The general condition also suffers.
- Spondylolisthesis is a traumatic injury to the spine in the lumbar region. Dorsopathy radiates to the legs, there is a positive sign of axial load.
- Compression fracture - occurs when falling on the bottom or jumping from a height. At first, the pain is sharp, then becomes intense and progresses with movement.
Abnormal fractures that occur in the background of osteoporosis or tumors are manifested by minor discomfort, nagging and aching pain. They remain unchanged for a long time.
Inflammatory and infectious diseases
Ankylosing spondylitis is associated with a feeling of stiffness and dull pain in the lumbar region. There is a typical circadian rhythm - symptoms appear at night and increase in the morning. The intensity decreases after physical activity and water procedures. Dorsopathy increases at rest and decreases with movement. Over time, spinal mobility is limited and thoracic kyphosis develops.
In addition, spinal pain occurs with tuberculosis. Deep local discomfort is characteristic of vertebral destruction. Dorsopathy is aggravated by exercise and is accompanied by excessive skin sensitivity. In the case of shooting and radiating pain, we are talking about compression of the nerve roots. The condition is complemented by the stiffness of the movement.
Intense dorsopathy is observed in osteomyelitis. The disease is diagnosed in children and adolescents. It is characterized by hematogenous nature. Discomfort increases with movement, so the patient stays in bed. Osteomyelitis is accompanied by fever, weakness and local swelling.
Arachnoiditis manifests itself in pain that radiates to the innervation area of the nerve roots. Symptoms become constant and resemble sciatica. They are complemented by motor disturbances, sensitivity disturbances and the loss of control ability of the pelvic organs.
Tumors
Benign tumors have a hidden course or are slowly progressive and accompanied by minor symptoms. Most often, hemangiomas appear, which appear in only 10-15% of cases. The discomfort is painful, local. Advances at night and after physical activity. Spinal cord neoplasia is accompanied by radicular pain and nerve conduction disturbances.
Spinal sarcomas manifest themselves in the primary stage of progression as moderate intermittent pain that worsens at night. It is accompanied by limitation of motor activity and radicular syndrome. The discomfort is localized in the internal organs, legs or arms (taking into account the level of the location of the tumor).
Other diseases
Spinal discomfort can also be observed in the following cases:
- Spinal epidural hemorrhage - similar to the signs of radiculitis, accompanied by a spinal conduction disorder.
- Calvet's disease - radiates to the legs, occurs periodically, is mildly expressed. Decreases when lying down, increases during physical activity.
- Forestier's disease - localized in the chest region, spreading to the lower back or neck. Symptoms are usually short-lived. It may be accompanied by pain in the elbow or shoulder joints. Spinal stiffness cannot be ruled out.
Dorsopathy is sometimes associated with mental disorders. In this case, the clinical picture is unusual - it does not match the symptoms of possible diseases.
Causes of back pain by location
Chronic upper back dorsopathy affects 15-19% of people worldwide. Postmenopausal women are at higher risk, possibly due to osteoporosis and compression vertebral fractures.
Professional activities also lead to back pain. People who have to maintain a static posture for long periods of time, such as dentists or salespeople, are more likely to encounter this problem than others. Office workers experience upper back discomfort due to poor workplace ergonomics.
Dorsopathy can occur at different points of the spine. The localization area indicates the cause of the discomfort and greatly facilitates the diagnosis.
Pain on the right side
This is due to excess body weight, slipped disc or myositis. Discomfort on the right side of the back also occurs with kyphosis.
Somatic pathologies include salpingitis, ovarian inflammation, nephritis, cholecystitis. Appendicitis and the presence of stones in the organs of the urinary system should also be highlighted.
Pain in the left side
Pain in the left back due to splenitis (inflammation of the spleen), urolithiasis, oophoritis, duodenitis, pinched roots. Discomfort above the lower back indicates inflammation of the serous membrane of the lungs, bronchial damage, ischemia and intercostal neuralgia.
Pain in the lumbar region
The lumbar region is more often than others exposed to the development of pathological processes originating from the spinal column. This is due to the fact that it carries a huge load. If the nerve roots are damaged, an inflammatory process develops. Hernia protrusion and osteochondrosis are also possible.
Less often, the cause is a combination of prostatitis and urethritis, a violation of the structure of bone tissue, a decrease in density, lumbar sciatica, arthritis, tuberculosis of the spine. In most cases, the discomfort experienced in the lower back is chronic.
Pain in the lower back on the right side
Dorsopathy occurs when:
- myositis;
- tuberculosis;
- scoliosis;
- osteomyelitis;
- spondylitis.
It may indicate the presence of a neoplasm. We are talking about radiculitis. Indicates liver dysfunction.
Pain in the left lumbar region
The discomfort is mainly localized after physical activity. After rest, the condition returns to normal. If the discomfort does not last even with rest, then we are talking about scoliosis, osteochondrosis, spinal infections and circulatory disorders.
A pinched nerve
In the vast majority of cases, the sciatic nerve is pinched (sciatica). At the same time, the myelin sheath is not damaged. It most often develops against the background of osteochondrosis. It is accompanied by acute, severe symptoms that radiate to the lower back, sacrum, and lower limbs.
During compression radiculopathy, the spinal nerve roots are also compressed. The cause is disc herniation or a decrease in the distance between the vertebrae. A "superficial" discomfort can be felt, which sharply intensifies during exercise, sneezing, and coughing.
Intervertebral hernia
It is characterized by the protrusion (protrusion) of the core into the intervertebral canal. In most cases, it develops against the background of osteochondrosis. The central part of the extruded core compresses the spinal cord. Even a small load leads to the progression of the pathological process. Dorsopathy is sharp and acute, radiating to the leg or arm.
Pain in the shoulder blades
Based on the nature of the dorsopathy, a presumptive diagnosis can be determined:
- dull, increasing - gastric ulcer;
- acute intercostal neuralgia that worsens with movement;
- numbness of the hands, changes in pressure, dizziness - osteochondrosis;
- radiating below the clavicle - exacerbation of angina pectoris.
Pain along the spine and in the back
It develops due to pinching of nerve endings behind the curvature of the spinal column. If the symptoms are not clearly expressed, then we can talk about a protrusion. Increased symptoms indicate osteochondrosis, myositis or a fracture.
Severe discomfort along the spine indicates wear or thinning of the intervertebral discs. It may indicate spondyloarthritis. The pain is constant and sharp.
Pain below the waist
They occur most often in spondyloarthrosis and osteochondrosis. It is less often observed in diseases of the female genital organs (oophoritis, cervicitis, endometritis, etc. ). They can appear during pregnancy, menstruation, appendicitis, ulcerative colitis. In men, indicate diseases of the bladder or prostate.
Diagnostics
First, a physical exam is performed to identify signs that indicate the need for further testing. The medical examination includes the following procedures:
- Examination of the back and posture to identify anatomical abnormalities.
- Palpation/percussion of the spine - assessment of the condition of the spine and painful areas.
- Neurological examination - assessment of sensitivity of reflexes, spine and gait characteristics. In patients with suspected radiculopathy, the neurologic examination should focus on the L5 and S1 nerve roots.
Patients with psychological disorders contributing to back pain may have accompanying physical symptoms, also known as Waddell's symptoms. These include the patient's overreaction on physical examination, superficial tenderness, and unexplained neurologic deficits (eg, sensory loss, sudden weakness, or jerking movements on motor examination). The presence of multiple Waddell signs indicates a psychological component of dorsopathy.
Treatment of spinal pain
In the case of dorsopathy, the treatment must be carried out by a doctor. The specialist refers the patient to an examination and prescribes an effective therapy based on the results obtained.
Additional therapeutic measures should be used with caution and after consulting a doctor. Any type of medication can have risks and side effects, so self-medication is not acceptable.
Help before diagnosis
Basic home remedies that can be effective in treating mild to severe pain caused by muscle tension include:
- Short rest period. Many episodes of low back pain can be alleviated by eliminating physical activity. It is not recommended to rest for more than 2-3 days, as prolonged inactivity hinders healing.
- Change in activity. We recommend that you stay active, but avoid activities and positions that worsen dorsopathy. For example, if sitting in a car for a long time or sitting at a table increases the discomfort, it should be warmed up every 20 minutes.
- Exposure to heat or cold. A heating pad or warm bath relaxes tense muscles and improves blood flow, reducing discomfort. If you have lower back pain due to inflammation, applying ice or cold compresses can reduce the swelling.
The most common over-the-counter medications for dorsopathy are ibuprofen, naproxen, and acetaminophen. Medicines relieve inflammation and reduce discomfort in the lower back.
Conservative therapy
Oral drug therapy:
- Pain relievers. Patients are prescribed drugs from the anilide group, such as paracetamol. It provides a long-lasting pain-relieving effect. They act synergistically with NSAIDs and are used in combination to enhance analgesia without increasing toxicity.
- Nonsteroidal anti-inflammatory drugs. They have pain-relieving properties. In larger doses, they have an anti-inflammatory effect.
- Muscle relaxants. They act centrally, affecting the activity of muscle tension reflexes. The combination of an NSAID and a muscle relaxant significantly alleviates dorsopathy. The main side effects are drowsiness, headache, dizziness and dry mouth.
- Neuropathic pain relievers. Tricyclic antidepressants relieve chronic pain. Low doses may be sufficient to treat symptoms. They do not work immediately and may need to be continued for several weeks before symptoms improve. It may play a potential role when discomfort is mediated by both peripheral and central mechanisms.
Injection of local or regional anesthesia is part of the treatment regimen for some patients with back pain. The injection site can be an area of local injury or a myofascial trigger point (painful muscle area).
Epidural corticosteroid injections are used for radicular pain that does not respond to less invasive treatments. It is used to alleviate the condition of intervertebral hernia, spinal stenosis and radiculopathy. Reduce dorsopathy and quickly restore sensory functions.
Surgery
A small percentage of people with back pain require surgery to improve their condition. Indications for surgery vary depending on the patient's characteristics and are as follows:
- severe radicular symptoms, especially in progressive neurological motor deficits;
- radicular symptoms that are not amenable to conservative treatment.
The choice of surgical intervention is determined by the characteristics of the spinal injury. Surgery is most effective when the clinical picture of patients is dominated by manifestations of nerve compression. The most common problem is inadequate nerve decompression. Associated diseases including hip arthritis, osteoporosis and cardiovascular disease.
Surgery for patients with radicular pain due to disc herniation primarily involves decompression. Any protruding, extruded or isolated sheet material is removed. The nerve root is examined and released.
Prevention
Complications are largely determined by etiology. They can be divided into physical and social groups. The first include chronic pain, deformity, neurological effects with motor or sensory deficits, bowel or bladder damage. In social terms, complications are usually measured by disability and reduced performance.
For patients of all ages:
- elimination of bad habits;
- lead an active lifestyle;
- strengthens the body's protective functions;
- lift heavy objects properly;
- a preventive examination must be carried out by a doctor.
It is important not to slouch and keep your back straight. The sleeping and workplace must be properly organized. We recommend that you do light gymnastic exercises every day after waking up. You should also balance your diet by enriching your diet with foods that contain enough vitamins and minerals. A contrast shower is recommended in the morning.