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Back pain

Back pain is a sign of diseases of the musculoskeletal system.

Almost all adults have experienced back pain during their life. This is a very common problem, which can be due to various reasons, which we will discuss in this article.

Causes of back pain

All causes of back pain can be divided into groups:

  1. Musculoskeletal:

    • osteochondrosis;
    • disc herniation;
    • compression radiculopathy;
    • spondylolisthesis;

  2. Inflammatory, including infectious:

    • Osteomyelitis
    • Tuberculosis

  3. neurological;

  4. injuries;

  5. endocrinological;

  6. Vascular;

  7. Tumor.

At 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 an in-depth examination of the patient.

"Red flags":

  • patient's age at the time of onset of pain: younger than 20 years or older than 50;
  • 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 location 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 disorders of urination and defecation, numbness of the perineum, symmetrical weakness of the lower extremities;
  • alcoholism;
  • the use of narcotics, especially intravenous;
  • treatment with corticosteroids and/or cytostatics;
  • with 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 requires a doctor's attention and diagnosis.

Back pain is divided into the following forms depending on the duration:

  • sharp- pain lasting less than 4 weeks;
  • subacute- pain lasting 4 to 12 weeks;
  • chronic- pain lasting 12 weeks or more;
  • recurrence of pain- resumption of pain if it has not occurred in the last 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 of the vertebral discs and, subsequently, of the vertebrae themselves.

Is osteochondrosis a pseudodiagnosis? - 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 as 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. In addition, the diagnoses often established are dorsopathy and back pain.

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

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

  • Cervicalgia 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 nucleus pulposus with its regression, on average, at 30 years), which make them more susceptible to stress. and injury, leading to stretching of the ligaments and the 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 to the leg.

Factors leading to the development of osteochondrosis:

  • heavy physical labor, lifting and moving heavy loads;
  • low physical activity;
  • prolonged sedentary work;
  • long stay in an uncomfortable position;
  • prolonged work at the computer with a non-optimal monitor location, which creates a load on the neck;
  • posture violation;
  • congenital structural features and abnormalities of the spine;
  • weak back muscles;
  • high growth;
  • excess body weight;
  • diseases of the leg joints (gonarthrosis, coxarthrosis, etc. ), flat feet, club feet, etc. ;
  • natural wear with age;
  • of smoking.

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

Symptoms:

  • violation of the range of motion;
  • feeling of stiffness;
  • muscle tension;
  • pain irradiation to other areas: arms, shoulder blades, legs, groin, rectum, etc.
  • "shots" of pain;
  • numbness;
  • Tingling sensation;
  • muscular weakness;
  • pelvic disorders.

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

Herniated discs often resolve on their own in an average of 4 to 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 spinal cord compression occurs. Possible manifestations:

  • pain in the limb of a stabbing nature with irradiation to the fingers, aggravated by movement or coughing;
  • numbness or a feeling of flies crawling in a certain area (dermatomas);
  • muscular weakness;
  • spasm of the back muscles;
  • violation of the strength of reflexes;
  • positive symptoms of tension (the appearance of pain with passive flexion of the limbs)
  • Limited mobility of the spine.

spondylolisthesis

Spondylolisthesis is the displacement of the upper vertebra with respect to the lower one.

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

Spondylolisthesis may not cause symptoms with slight displacement and may be an incidental radiographic finding.

Possible symptoms:

  • feeling of discomfort
  • pain in the back and lower extremities after physical labor,
  • leg weakness
  • root syndrome,
  • decreased pain and tactile sensitivity.

The progression of vertebral displacement can lead to lumbar stenosis - the anatomical structures of the spinal column 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 on movement),
  • 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 of pulling too hard,
  • pelvic organ dysfunction.

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

Diagnostics

Collection of complaintshelps the doctor to suspect the possible causes of the disease, to determine the location of the 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 Analog Scale (VAS) is used, which is convenient for the patient and the doctor. In this case, the patient evaluates the severity of the 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.

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

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

Evaluation of neurological status:muscle strength and its symmetry, reflexes, sensitivity.

March test:in cases of suspected lumbar stenosis.

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

Bone scan:performed with functional tests for suspected instability of spinal structures. However, this diagnostic method is uninformative 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 benefits.

Connecticut

magnetic resonance
  • Evaluates bony structures (vertebrae).

  • It allows to see the last 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 for contraindications to MRI.
  • Evaluates soft tissue structures (intervertebral discs, ligaments, etc. ).
  • It 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 according to instrumental examination methods.

Bone densitometry:performed to assess bone density (confirmation or exclusion of osteoporosis). This study is recommended for postmenopausal women at high risk of fractures and always at the age of 65 years, regardless of risk, men over 70 years of age, patients with fractures with minimal history of trauma, prolonged use of glucocorticoids. Fracture risk at 10 years is assessed using the FRAX scale.

Bone scan, PET-CT:carried out in the presence of suspected 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 with back pain increases pain, prolongs the duration of symptoms, and increases the likelihood of chronic pain.

  • muscle relaxants for muscle spasms;
  • vitamins can be used, however their effectiveness based on various studies remains unclear;
  • manual therapy;
  • lifestyle analysis and elimination of risk factors.

For subacute or chronic pain:

  • use of analgesics on demand;
  • special physical exercises;
  • evaluation of the psychological state, since it can 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, blocks (epidural injections) or intraosseous blocks are used.

Surgical treatment is indicated in the face of 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 therapy. Emergency surgical treatment is carried out in the presence of: pelvic disorders with numbness in the anogenital region and ascending weakness of the feet (cauda equina syndrome).

Rehabilitation

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

  • Improve Life Quality;
  • elimination of pain, and if it is impossible to completely eliminate it, relief;
  • restoration of operation;
  • rehabilitation;
  • self-service and safe driving training.

Basic rules of rehabilitation:

  • the patient must feel his own responsibility for his health and compliance with the recommendations, however, the doctor must choose the methods of treatment and rehabilitation that the patient can comply with;
  • systematic training and compliance with safety rules when performing exercises;
  • pain is not an obstacle 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 should feel the positive impact of rehabilitation on her condition;
  • the patient needs to develop pain response skills;
  • the patient must associate the movement with positive thoughts.

Rehabilitation methods:

  1. Walking;
  2. Physical exercises, gymnastics, fitness programs in the workplace;
  3. individual orthopedic devices;
  4. Cognitive behavior therapy;
  5. Patient education:
    • Avoid excessive physical activity;
    • Fight against low physical activity;
    • Exclusion of prolonged static loads (standing, in an awkward position, etc. );
    • Avoid hypothermia;
    • Sleep organization.

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 a week (at least 30 minutes at a time, 3 days a week).

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

life hack:how to sit

  • avoid overly upholstered furniture;
  • the legs should rest on the floor, which is achieved with 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 length of the hips;
  • sit up straight, maintain correct posture, your back should be snug against the back of the chair to avoid straining your back muscles;
  • the head when reading a book or working on a computer should have a physiological position (look forward, and not constantly down). To do this, it is recommended to use special brackets and install the computer monitor at the optimal height.

With prolonged standing work, it is necessary to change the position every 10-15 minutes, alternately changing the supporting leg, and, if possible, walk on the spot and move.

Avoid lying down for a long time.

life hack: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 must be soft enough and of medium height to avoid tension in the neck;
  • when sleeping prone, it is recommended to place a small pillow under the stomach.

Quit smoking: If you are having trouble, see your doctor, who will refer you to a smoking cessation program.

Frequent questions

  1. I use glucocorticoid ointments. Am I at increased risk for osteochondrosis or osteoporosis?

    No. External 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. In every case of disc herniation, is surgery necessary?

    No. Surgical treatment is carried out 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 significantly limits the degree of load on the spine, then it is possible to continue playing sports, but after undergoing treatment and adding certain exercises to the course physiotherapy exercises and swimming.

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

    They can after a course of productive conservative therapy, subject to further implementation of the recommendations of the treating neurologist, compliance with the rules of prevention, regular exercise therapy and swimming.