Lower back pain is probably familiar to almost every modern person. Employability can be affected by a wide variety of reasons. Among them are back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be inattentive to this, because back pain can not only reach incredible strength, making a person's life unbearable, but also turn out to be a symptom of the most dangerous diseases.
Low back pain can be varied: sharp or dull, painful or burning, local (appearing in one place) or extending to the entire back. Unpleasant sensations also appear in different ways: sometimes abruptly, suddenly, and sometimes gradually, intensifying every day.
The response to pain and the ability to tolerate it depends on many factors: age, mental characteristics, accompanying symptoms and other factors. But in any case, you can not leave the disease to chance. Prompt treatment will help to avoid dangerous consequences.
To diagnose the cause of back pain, it is necessary to examine the spine and some additional procedures: X-ray examination, magnetic or calculated resonance imaging. Pain attacks, lumbosacral, appear during life, in about 80% of modern residents of European countries.
Acute or chronic back pain in the lumbar region is a consequence of a variety of neurological, degenerative-dystrophic diseases of women and men. In some cases, low back pain is a consequence of diseases of internal organs, obesity, stress, mental disorders.
Pain syndrome - primary and secondary
Understanding why the lower back hurts, we must not forget that the causes of such pain are in the dozens, and a non-professional will never be able to determine the true source of the problems. In general, medical classification separates primary and secondary pain syndromes that can affect the lumbar region.
Primary low back pain syndrome occurs as a result of musculoskeletal changes of a morphofunctional nature. It is he who causes the vast majority of cases of back pain in the lumbar region. The most important cause is the degenerative-dystrophic changes occurring in various parts of the spine:
- osteochondrosis, which is a lesion of bone and cartilage tissue, this disease has a dystrophic character. With it, the intervertebral disc and adjacent vertebrae are affected, spondylosis begins to develop.
- spondylarthrosis is a form of osteoarthritis, in which the disease affects the intervertebral joints, which are responsible for the mobility of the spine, or the synovial joints.
Secondary pain syndrome has much more diverse causes of pain:
- scoliosis, which is a curvature of the spine, as well as certain other growth disorders;
- various inflammations of a non-infectious nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
- a tumor located on the vertebrae, in the spinal cord itself or in the retroperitoneal space, whether primary or caused by metastases;
- fracture of one or more dorsal vertebrae. This is perhaps one of the most serious causes of back pain.
- various infectious diseases leading to damage to the vertebrae and intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
- stroke conditions in which there is a severe violation of blood supply to the spinal cord. In this case, there may also be a feeling that the lower back hurts;
- diseases of the gastrointestinal tract. For example, acute appendicitis with atypical course, bowel obstruction;
- often back pain is of a reflective nature. A similar problem can occur with certain diseases of the organs located in the pelvic region. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - all these diseases cause referred back pain).
Acute and chronic low back pain
Pain in the lumbar region is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. The so-called displaced low back pain is also often observed: in this case, there is a translation of pain sensations from more deeply located internal organs and body structures; in other words, it seems to the patient that the lower back hurts, but in fact a completely different part of the body is affected.
Most often, the back hurts in the lumbar region, when the pain is referred to this area from the pelvic organs, kidneys, pancreas, colon or tumors located behind the peritoneum. Many patients do not know what to do if their lower back hurts. But there is a clear recommendation, what not to do exactly: self-medication. The causes of pain are so diverse that only a qualified specialist can make a correct diagnosis.
Possible causes of acute lower back pain include:
- The pain is accompanied by a sharp stretching of the muscles. In this case, pain signals are localized in the back, they are supplied by spastic long muscles. The pain does not tend to travel to the groin or leg area. Human mobility is limited.
- One of the most common and serious causes of severe back pain is a spinal fracture (fractures of the vertebrae, including compression fractures). As a rule, this occurs with an unsuccessful fall, bending of the back and other injuries; but in the event that a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, there are cancerous tumors and their metastases in the vertebral region or other lesions of the skeletal system, vertebral fractures can occur literally "out of the blue", and even without fixation by the patient's sensations at the time of the fracture.
- An equally unpleasant situation in which the lower back hurts badly is the displacement of the intervertebral discs that has occurred in the vertebral region. According to the frequency of lesions, zones are distinguished: LV-SII - most often; LIV-LV - second in frequency; LIII-LIV and above are rarer cases.
Symptoms include severe lower back pain, forced posture, limited mobility. Participation in the pathological process of the nerve roots is indicated by:
- root pain, usually unilateral;
- sensitivity disorders (numbness, increase or decrease in the level of sensitivity);
- decrease or disappearance of the Achilles reflex (in case of damage to the roots of S or S2);
- decrease in intensity or absence of patellar reflex (indicates damage to the L3-L4 area).
The general tendency is for a protruding intervertebral disc to affect the underlying root (eg, LIV-LV misalignment causes L5 root pathology). With the defeat of the ponytail (ponytail), the functions of the bladder and rectum are disturbed. Also, a similar condition can occur with a strong protrusion of the vertebral disc.
The back hurts badly in the lumbar region with facet syndrome: in this case, the disc remains unchanged, and the pain appears as a result of compression of the root itself at the exit from the spinal canal. The most commonly observed facet syndrome of the unilateral type in the L5 root region; arises on the basis of an increase in the facets of the intervertebral joint (upper and lower) and, as a result, a narrowing of the intervertebral foramen.
Additionally, severe lower back pain accompanies an epidural abscess, a serious condition that requires urgent diagnosis and immediate treatment. Most often, the inflammatory process develops in the thoracic region of the spine; the pain becomes especially strong with a mechanical effect on the area of pathology (pressure, tapping).
If there are signs of spinal cord compression, all highly effective medical measures are recommended, including surgery. Another reason why the lower back hurts can be diseases of the hip joint - mainly coxarthrosis. In this case, the pain is characteristic, radiating to the lower part of the lower back, buttocks, as well as the legs to the knees.
Diseases characterized by chronic low back pain:
- Spondylosis deformans is a disease characterized by dystrophic change in the lumbar vertebrae, calcification of their ligamentous apparatus and additional bone growth. the bony growths press on the roots and narrow the spinal canal. If aching lower back pain is accompanied by weakness in the legs, numbness and other neurological symptoms, the possibility of intermittent claudication syndrome, which may be caused by anarrowing of the spinal canal, should be considered. An examination is necessary, the results of which establish the definitive diagnosis.
- Ankylosing spondyloarthrosis (or Bechterew's disease). At an early stage, it is characterized by limited mobility, especially in the morning, by a decrease in chest movements during breathing. There are drawing pains in the lower back; arises and further progresses the curvature of the spine in the thoracic region. An x-ray examination fixed abnormalities of the sacroiliac joints: destruction, modification of structure, vertebral column in "bamboo". A thorough examination and finding out why the lower back hurts is necessary, since similar symptoms and limited mobility of the lower spine can also cause other diseases - Reiter's syndrome, psoriatic arthritis, colitischronic.
- Oncological diseases (tumors, metastases), metabolic disorders (including NBO). It is necessary to exclude such causes of back pain: metastatic carcinoma of the lungs, breast, prostate and thyroid glands, kidneys, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). An exception is made by the method of X-ray examination and myelography.
- Osteomyelitis also causes prolonged, aching pain in the lower back. If this disease is suspected, an x-ray of the bone tissue is performed, a tuberculin skin test and an ESR determination are performed to determine the presence / absence of tuberculosis bacteria or pyogenic (pyogenic) bacteria inthe body, usually staphylococci - the causative agents of osteomyelitis.
- Spinal cord tumors (intradural tumors) of various types. Diseases such as lipoma, neurofibroma, meningioma can cause constant back pain, initially without any associated neurological symptoms.
Causes of back pain of an intermittent nature. Many diseases of the internal organs cause periodic, sharp or pulling pains in the lower back. At the same time, patients do not have a feeling of stiffness in the back region, there is no clear localization of pain, and the pain does not increase with the maximum possible range of motion. To the question of what to do if the lower back does not hurt constantly, but from time to time, the answer is simple: do not wait until it hurts "as it should", but consult a doctor.
There is a clear influence of the pathology of one or another organ on a certain section of the spine. So, from the pelvic organs, the pain radiates to the sacrum, in diseases of the organs located in the lower part of the abdominal cavity, it radiates to the lower back (L3-L5 segments), and in the upper part - to the segmentsfrom the upper part of the lumbar area or from the lower part of the thoracic area.
Diseases - the causes of lower back pain and the area of pain distribution:
- If the pelvic organs are affected, with endometriosis, ovarian or uterine carcinoma, the lower back hurts. In men, such intermittent pain can be caused by chronic prostatitis or the development of prostate carcinoma.
- Various kidney diseases cause pain at the junctions of the ribs and spine.
- Tumors of the stomach, duodenum, peptic ulcer, pancreatic tumors (especially if the disease spreads beyond the peritoneum) - the pain spreads in the region of the spinal segments T10-L2;
- With ulcerative colitis, diverticulitis, or colon tumors, the lower back hurts;
- If the back hurts in the thoracic/lumbar regions, an aortic dissection (dissecting aneurysm) should be ruled out.
Diagnosis of low back pain
For lower back pain and lumbago, it is recommended to undergo computed tomography (shows the condition of the bone tissues of the spine) and magnetic resonance (allows you to assess the condition of the soft tissues) and ultrasound of theinternal organs.
One diagnostic method is x-rays, which are relatively inexpensive and can be useful in detecting a range of disorders, from bone fractures to kidney stones. Many of the changes detected only suggest the correct diagnosis, and additional studies may be needed to confirm this. In addition, some radiological changes may be concomitant signs that are not the cause of the pain.
It all starts with a neurological and orthopedic examination by a doctor. During this examination, the neurological state of the patient is assessed, as well as possible violations of the biomechanics of the spine are identified with a mandatory assessment of the condition of the muscles of the back and gluteal region. Already at this stage of the study, a patient with osteochondrosis of the spine and pain in the back and lower back can be diagnosed and treated.
Sometimes, depending on the results of an examination by an orthopedist of a patient with a painful symptom on the background of osteochondrosis of the spine, the following additional diagnostic procedures may be prescribed:
- x-ray of the lumbosacral spine with functional tests;
- CT scan of the lumbosacral spine;
- MRI of the lumbosacral spine.
The center of the intervertebral disc is occupied by the gelatinous nucleus pulposus. It is surrounded and supported by a fibrous ring, made up of fibrous cartilage and connective tissue. You can read more about this in the article Human Spine and Spinal Cord Anatomy.
The thickness of the discs decreases, the vertebral bodies move closer together, reducing the intervertebral foramina and endangering the nerves and vessels located there (osteochondrosis).
The protrusion of the discs (protrusion of the intervertebral disc) with their further prolapse into the lumen of the spinal canal (herniated disc) most often leads to compression of the nerve roots, causing pain along the compressed nerve (pain that radiates to the leg, arms, back of the head, neck, intercostal spaces depending on the level of nerve compression) with a weakening of muscle strength in the areas of their innervation and a violation of sensitivity.
Often, a protrusion or herniation of the intervertebral disc is accompanied by muscle pain along the path of the nerve (along the arm or leg). In this case, one or immediately (rarely) two nerves are compressed.
In addition to nerve compression, the stability of the spinal segment may also be impaired. With spinal instability, the vertebrae move forward (anterolisthesis) or backward (retrolisthesis). To clarify the diagnosis, an x-ray of the lumbosacral spine with functional tests may be necessary.
Most often, the nerve bundles that form the sciatic nerve due to their anatomical location suffer from compression of a hernia or a protrusion of the intervertebral disc. The sciatic nerve consists of fibers L5, S1, S2, S3 - spinal nerves.
The focus of chronic inflammation in the lumen of the spinal canal can lead to the formation of its narrowing (spinal canal stenosis) and compression of the nerves and spinal cord passing through it. That is why, in case of stenosis of the spinal canal, it is always necessary to carry out a comprehensive treatment using a whole arsenal of different treatment methods, and in case of ineffectiveness - surgical treatment.
Which doctor should I contact?
In case of pain in the spine, you should first contact a neurologist in the district clinic, if the patient's condition is stable, or call an ambulance. Low back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.
Lower back pain is associated with various infections, limb injuries. Pain in the lower back with diseases of the heart and lungs is not excluded. This is established by a thorough examination. After the diagnosis of the patient, he is usually prescribed drugs that reduce back pain, normalize blood circulation and help restore nerve tissue. These can be tablets, gels, ointments or injections that relieve inflammation and spasms.
Surgery is usually required when diagnosing a herniated disc, which is a complication of osteochondrosis. The hernia compressing the nerve root is removed, it is restored, and the pain passes over time.
It is best to relax the spine and paravertebral muscles if you sleep on a hard mattress with a small pillow under your knees. At the same time, bed rest should not last too long, as this leads to weakening of the paravertebral muscles, which will only exacerbate the problem. Even with severe pain, you should try to maintain at least low physical activity.
How to relieve back pain
The appearance of a pain symptom is often due to muscle spasm, which can be eliminated with the help of special means - muscle relaxants. These drugs are actively used in the treatment of diseases of the spine.
So, with unexpected strong pain in the lower back, it is recommended to take a muscle relaxant tablet, rub the back with warming anesthetic gel. When using funds, you must strictly follow its instructions.
In cases where an unpleasant symptom is due to the presence of inflammatory diseases of internal organs, it is recommended not to delay contacting a doctor, if at some point it is impossible to consult a specialist and the pain is too severe, you may take Pentalgin or No-shpu. The sore spot should not be warmed with a heating pad, since the heat contributes to the spread of the inflammatory process and, accordingly, to the strengthening of the accompanying symptoms.
Ointment for back pain
Preparations in the form of ointments are often used in the treatment of diseases of the lower spine. These drugs include drugs that have pronounced anti-inflammatory, mild analgesic and antipyretic effects.
The course of treatment is prescribed taking into account the severity of the pain symptom. Ointment for back pain is used as the main or auxiliary treatment. With pronounced symptoms of osteochondrosis, it is indicated to rub the lower back with ointments based on ketoprofen, a substance with a strong analgesic effect.
The main advantage of local preparations is due to their effect not on the whole body as a whole, but on a specific area that requires treatment. Painkillers and anti-inflammatory ointments have fewer contraindications and side effects compared to similar drugs in tablet form.
exercises for back pain
Gymnastics is considered an additional method of treating diseases of the lower spine. The exercises shown to patients are quite simple and are not accompanied by a special load on the body. For example, the usual suspension on the crossbar of the horizontal bar has a beneficial effect on the condition of the spine, helps to relax the muscles and eliminate lumbago - pain caused by pinching its nerve roots. Therapeutic exercises for diseases of the back, accompanied by pain in its lower part, include exercises:
- raise the legs (so that the knee touches the chin);
- "bicycle", performed lying on your back;
- walk on your knees.
Every day it is recommended to do no more than 10-15 minutes of exercises, with pronounced pain - to refuse to perform them.