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Back ache

Back pain is a sign of diseases of the musculoskeletal system

Almost all adults have suffered from back pain in their lifetime. This is a very common problem, which can be based on various reasons, which we will analyze in this article.

Causes of back pain

All causes of back pain can be divided into groups:

  1. Musculoskeletal:

    • Osteochondrosis;
    • herniated disc;
    • Compression radiculopathy;
    • Spondylolisthesis;

  2. Inflammatory, including infectious:

    • Osteomyelitis
    • Tuberculosis

  3. neurological;

  4. injuries;

  5. endocrinological;

  6. Vascular;

  7. Tumor.

During the first visit to the doctor with back pain, the specialist should determine the cause and type of pain, paying special attention to "red flags" - possible manifestations of potentially dangerous diseases. "Red flags" refer to a set of specific complaints and anamnesis data that require a thorough examination of the patient.

"Red Flags":

  • patient's age at the onset of pain: less than 20 years or more than 50 years;
  • a serious spinal injury in the past;
  • the appearance 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 localization of pain;
  • increased pain in a horizontal position (especially at night), in an upright position - weakening;
  • no improvement for 1 month or more;
  • dysfunction of the pelvic organs, including disturbances in urination and defecation, numbness of the perineum, symmetrical weakness of the lower limbs;
  • alcoholism;
  • the use of narcotics, especially intravenously;
  • treatment with corticosteroids and/or cytostatics;
  • with pain in the neck, throbbing nature of pain.

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

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

  • acute- pain lasting less than 4 weeks;
  • subacute- pain lasting from 4 to 12 weeks;
  • chronic- pain lasting 12 weeks or more;
  • recurrence of pain- resumption of pain if it has not occurred for 6 months or more;
  • exacerbation of chronic painRecurrence of pain less than 6 months after the previous episode.

Diseases

Let's talk more about the most common musculoskeletal causes of back pain.

Osteochondrosis

It is a disease of the spine, which is based on the wear and tear of the vertebral discs and, subsequently, of the vertebrae themselves.

Is osteochondrosis a pseudodiagnosis? - Not. 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 incorrect, others, on the contrary, often diagnose osteochondrosis. This situation is due to the fact that foreign doctors consider osteochondrosis to be a disease of the spine in children and adolescents associated with growth. However, this term specifically refers to a degenerative disease of the spine in people of any age. Also, the diagnoses often made are dorsopathy and back pain.

  • Dorsopathy is a pathology of the spine;
  • Back pain is nonspecific mild low back pain that spreads from the lower cervical vertebrae to the sacrum, which can also be caused by damage to other organs.

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

  • Neck pain 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 in other sections they have a weakly expressed pulpy nucleus with its regression, on average, by 30 years), whichmakes them more susceptible to stress and injury, which leads to stretching of ligaments and 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 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 a non-optimal monitor location, which creates a load on the neck;
  • violation of posture;
  • congenital structural features and anomalies of the spine;
  • weak back muscles;
  • high increase;
  • excess body weight;
  • leg joint diseases (gonarthrosis, coxarthrosis, etc. ), flat feet, clubfoot, etc. ;
  • natural wear with age;
  • smoking.

herniated discis a protrusion from the core of the intervertebral disc. It may be asymptomatic or cause compression of surrounding structures and manifest as radicular syndrome.

Symptoms:

  • violation of range of motion;
  • feeling of stiffness;
  • muscle tension;
  • radiation of pain to other areas: arms, shoulder blade, legs, groin, rectum, etc.
  • "strokes" of pain;
  • numbness;
  • crawling sensation;
  • muscular weakness;
  • pelvic disorders.

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

Herniated discs often go away on their own in an average of 4 to 8 weeks.

Compression radiculopathy

Radicular (radicular) syndrome is a complex of manifestations due to compression of the vertebral roots at the starting points of the spinal cord.

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

  • pain in extremity of throbbing nature radiating to fingers, worse on movement or coughing;
  • numbness or feeling of flies crawling in a certain area (dermatomas);
  • muscular weakness;
  • back muscle spasm;
  • violation of the strength of reflexes;
  • positive symptoms of tension (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 vertebra.

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

Spondylolisthesis may cause no symptoms with mild displacement and may be an incidental finding on X-rays.

Possible symptoms:

  • feeling of discomfort
  • pain in the back and lower limbs after physical work,
  • weakness in the legs
  • radicular syndrome,
  • decrease in pain and tactile sensitivity.

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

  • constant pain (at rest and in motion),
  • in some cases, the pain may decrease in the supine position,
  • the pain is not aggravated by coughing and sneezing,
  • the nature of the pain from pulling to very strong,
  • dysfunction of the pelvic organs.

With a strong displacement, compression of the arteries can occur, which disrupts the blood supply to the spinal cord. This is manifested by strong weakness in the legs, a person can fall.

Diagnostic

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 diagnostic step, allowing you to choose a treatment and assess its effectiveness over time. In practice, the visual analogue scale (VAS) is used, which is convenient for the patient and for the doctor. In this case, the patient rates the severity of pain on a scale of 0 to 10, where 0 points is no pain and 10 points is the worst pain a person can imagine.

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

Physical examination:assessment of the presence of spasms of the muscles of the back, determination of the development of the muscular skeleton, exclusion of the presence of signs of an infectious lesion.

Neurological Status Assessment: muscle strength and symmetry, reflexes, sensitivity.

march test:performed in case of suspected lumbar stenosis.

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

X-ray:carried out with functional tests for suspected instability of the structures of the spine. However, this diagnostic method is not very informative and is carried out mainly with limited financial resources.

Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI):the doctor will prescribe based on clinical data, since these methods have different indications and advantages.

CT

MRI
  • Evaluates bony structures (vertebrae).

  • Allows to see later stages of osteochondrosis, in which bone structures are affected, compression fractures, destruction of vertebrae in metastatic lesions, spondylolisthesis, abnormalities in the structure of vertebrae, osteophytes.

  • It is also used for MRI contraindications.
  • Assesses 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 by instrumental methods of examination.

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 still aged 65, regardless of risk, for men over 70, for fractured patients with minimal traumatic history, for long-term use of glucocorticoids. The risk of fracture at 10 years is assessed using the FRAX scale.

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

back pain treatment

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 selected based on the severity of the pain;
  • maintain moderate physical activity, special exercises to relieve pain;

    Important!Physical inactivity accompanied by back pain increases 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 according to various studies remains uncertain;
  • 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 state, as it may be an important factor in the development of chronic pain, and psychotherapy;
  • medicines from the group of antidepressants or antiepileptics for the treatment of chronic pain;
  • manual therapy;
  • lifestyle analysis and elimination of risk factors.

In radicular syndrome, blockages (epidural injections) or intraosseous blocks are used.

Surgical treatment is indicated with a rapid increase in symptoms, the presence of compression of the spinal cord, with significant stenosis of the spinal canal and the ineffectiveness of conservative treatment. Emergency surgical treatment is carried out in the presence of: pelvic disorders with numbness in the anogenital region and upward weakness of the feet (cauda equina syndrome).

Rehabilitation

Rehabilitation should be started as soon as possible and have the following objectives:

  • improve the quality of life;
  • elimination of pain, and if it is impossible to completely eliminate it - relief;
  • restoration of functioning;
  • rehabilitation;
  • self-service and safe driving training.

Basic rules of rehabilitation:

  • the patient should feel responsible 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 observance of safety rules when performing exercises;
  • pain is not a barrier to exercise;
  • a relationship of trust must be established between the patient and the 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 safe when performing movements;
  • the patient must feel the positive impact of rehabilitation on his condition;
  • the patient must develop pain response skills;
  • the patient must associate the movement with positive thoughts.

Rehabilitation methods:

  1. While walking;
  2. Physical exercises, gymnastics, workplace gymnastics programs;
  3. individual orthopedic appliances;
  4. Cognitive-behavioral therapy;
  5. Patient education:
    • Avoid excessive physical activity;
    • Fight against low physical activity;
    • Exclusion of prolonged static loads (standing, being in an awkward position, etc. );
    • Avoid hypothermia;
    • Organization of sleep.

Prevention

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

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

Life Tip:how to sit

  • avoid overstuffed furniture;
  • the legs should rest on the floor, which is achieved by the height of the chair being 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 up straight, maintain correct posture, the back should fit snugly against the back of the chair to avoid straining the back muscles;
  • the head when reading a book or working at a computer should have a physiological position (looking straight ahead, and not constantly down). To do this, it is recommended to use special stands and install the computer screen 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, walk in place and move.

Avoid prolonged lying positions.

Life Tip:how to sleep

  • sleep better 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 stressing the neck;
  • when sleeping in the supine position, it is recommended to put a small pillow under the belly.

Smoking cessation: If you experience difficulties, consult 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 for 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.

  2. In each case of herniated disc, is surgery necessary?

    No. Surgical treatment is performed only if indicated. On average, only 10-15% of patients need surgery.

  3. Should you stop exercising if 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 spine, then it is possible to continue playing sports, but after undergoing treatment and addingcertain exercises from physiotherapy and swimming exercise classes.

  4. Can back pain go away permanently if I have a herniated disc?

    They can after 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.