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Back pain

Back pain is a sign of diseases of the musculoskeletal system

Almost all adults have experienced back pain in their lifetime. This is a very common problem that can be attributed to various reasons that we will analyze in this article.

Causes of back pain

All causes of back pain can be divided into groups:

  1. Locomotor:

    • Osteochondrosis;
    • disc herniation;
    • Compression radiculopathy;
    • Spondylolisthesis;

  2. Inflammatory, including infectious:

    • Osteomyelitis
    • Tuberculosis

  3. neurological;

  4. Injuries;

  5. Endocrinological;

  6. Vessel;

  7. Tumor.

During the first visit to the doctor with back pain, the specialist must 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":

  • age of the patient at the onset of pain: younger than 20 years or older than 50 years;
  • severe spinal injury in the past;
  • appearance of pain in cancer patients, 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 a vertical position - weakness;
  • no improvement for 1 month or more;
  • dysfunction of the pelvic organs, including urinary and defecation disorders, perineal numbness, symmetrical weakness of the lower limbs;
  • alcoholism;
  • use of drugs, especially intravenously;
  • treatment with corticosteroids and/or cytostatics;
  • with neck pain, the throbbing nature of the pain.

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

According to the duration of back pain, it is divided into the following forms:

  • acute- pain for less than 4 weeks;
  • subacute- pain lasting 4-12 weeks;
  • chronic- pain lasting 12 weeks or longer;
  • recurrence of pain- recurrence of pain, if it has not occurred in the last 6 months or longer;
  • 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

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

Is osteochondrosis a false diagnosis? - No. This diagnosis is included in the ICD-10 International Classification of Diseases. 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 interpret osteochondrosis as a growth-related spinal disease of children and adolescents. However, this term specifically refers to degenerative disease of the spine at any age. In addition, dorsopathy and dorsalgia are frequently established diagnoses.

  • Dorsopathy is a pathology of the spine;
  • Dorsalgia is a benign, non-specific back pain extending 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, sacrum and coccyx. Pain can occur in any of these areas, described by the following medical terms:

  • Cervicalgia is pain in the cervical spine. The intervertebral discs of the cervical region have anatomical features (the upper segment lacks the intervertebral discs, and the other segments have a weakly expressed nucleus pulposus, the regression of which decreases on average by 30 years), which makes them more sensitive to stress. and injury leading to stretching of the ligaments and early onset 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 work, lifting and moving heavy loads;
  • low physical activity;
  • long sedentary work;
  • long stay in an uncomfortable position;
  • working for a long time at the computer with a non-optimal monitor position, which strains the neck;
  • violation of posture;
  • congenital structural features and abnormalities of the spine;
  • weakness of the back muscles;
  • high growth;
  • excessive body weight;
  • diseases of the joints of the feet (gonarthrosis, coxarthrosis, etc. ), flat feet, club feet, etc. ;
  • natural wear and tear with age;
  • smoking.

disc herniationprotrusion of the core of the intervertebral disc. It can be asymptomatic, or it can cause compression of the surrounding structures and manifest as a 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.
  • "shot" of pain;
  • numbness;
  • creeping sensation;
  • muscle weakness;
  • pelvic disorders.

The localization of the pain depends on the level of localization of the hernia.

A herniated disc often resolves on its own within an average of 4-8 weeks.

Compression radiculopathy

Radicular (radicular) syndrome is a complex of manifestations that occur due to compression of the roots of the spine at the points of origin from the spinal cord.

Symptoms depend on the level at which the spinal cord is compressed. Possible manifestations:

  • shooting pain in the limbs with irradiation of the fingers, aggravated by movement or coughing;
  • numbness or tingling in a certain area (dermatomas);
  • muscle weakness;
  • spasm of the back muscles;
  • violation of the strength of reflexes;
  • positive symptoms of tension (appearance of pain with passive bending of the limbs)
  • limiting the mobility of the spine.

Spondylolisthesis

Spondylolisthesis is the displacement of the upper vertebra relative to the lower one.

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

Spondylolisthesis with mild displacement causes no symptoms and may be an incidental X-ray finding.

Possible symptoms:

  • unpleasant feeling
  • pain in the back and lower limbs after physical work,
  • weakness in the legs
  • radicular syndrome,
  • reduced pain and sensitivity to touch.

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

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

In the event of a strong displacement, compression of the arteries may occur, as a result of which the blood supply to the spinal cord is disturbed. This manifests itself in a sharp weakness of the legs, a person can fall.

Diagnostics

Complaint collectionit helps the doctor to suspect the possible causes of the disease, to determine the localization of the pain.

Assessment of pain intensity- a very important stage of diagnosis, which allows the selection of treatment and the evaluation of its effectiveness over time. In practice, the Visual Analogue Scale (VAS) is used, which is convenient for the patient and the doctor. In this case, the patient rates the severity of the pain on a scale from 0 to 10, where 0 means no pain and 10 is the worst pain a person can imagine.

Interviewenables the identification of pain-causing factors and the destruction of the anatomical structures of the spine, the identification of movements and body positions that cause, increase and relieve pain.

Physical analysis:assessment of spasm of the back muscles, determination of skeletal development, exclusion of signs of infectious lesions.

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

March test:performed in case of suspected lumbar stenosis.

Important!Patients with a classic clinical picture without "red flags" are not recommended to undergo further tests.

Radiography:with functional tests due to the suspicion of instability of the spinal structures. However, this diagnostic method is not informative and is mainly carried out with limited financial resources.

Computed tomography (CT) and/or magnetic resonance imaging (MRI):the doctor will prescribe it based on clinical data, since these methods have different indications and advantages.

CT

MRI
  • It evaluates the bone structures (vertebrae).

  • It allows viewing the later stages of osteochondrosis, in which the bone structures are affected, compression fractures, destruction of the vertebrae in metastatic lesions, spondylolisthesis, anomalies of the structure of the vertebrae, osteophytes.

  • It is also used for MRI contraindications.

  • 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 of the spine are detected using instrumental examination methods.

Bone densitometry:performed to evaluate bone density (confirm or rule out osteoporosis). This test is recommended for postmenopausal women with a high risk of fractures and always at age 65 regardless of risk, men over 70, fracture patients with a minimal history of trauma, long-term use of glucocorticosteroids. The 10-year risk of fracture is assessed using the FRAX scale.

Bone scintigraphy, PET-CT:in case of suspicion of oncological disease, it is carried out according to other examination methods.

back pain treatment

For acute pain:

  • a pain reliever is prescribed in a course, mainly from the group of non-steroidal anti-inflammatory drugs (NSAIDs). The specific drug and the dose are selected depending on the severity of the pain;
  • maintaining moderate physical activity, special exercises to relieve pain;

    Important!Physical inactivity associated with back pain increases the pain, prolongs the duration of symptoms, and increases the likelihood of chronic pain.

  • muscle relaxants to treat muscle spasms;
  • vitamins can be used, but their effectiveness remains unclear according to various studies;
  • manual therapy;
  • analysis of lifestyle and elimination of risk factors.

For subacute or chronic pain:

  • use of pain relievers as needed;
  • special physical exercises;
  • assessment of psychological status, as it can be a significant factor in the development of chronic pain, and psychotherapy;
  • drugs belonging to the class of antidepressants or antiepileptics for the treatment of chronic pain;
  • manual therapy;
  • analysis of lifestyle and elimination of risk factors.

Blockades (epidural injections) or intraosseous blocks are used in radicular syndrome.

Surgical treatment is justified by the rapid increase in symptoms, the presence of spinal cord compression, significant narrowing of the spinal canal and the ineffectiveness of conservative therapy. Emergency surgical treatment is performed in the presence of: pelvic disorders with numbness of the anogenital region and increasing weakness of the legs (cauda equina syndrome).

Rehabilitation

Rehabilitation should be started as soon as possible and the following goals should be set:

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

Basic rules of rehabilitation:

  • the patient must feel his own responsibility for his health and for following the recommendations, at the same time the doctor must choose the treatment and rehabilitation methods that the patient can comply with;
  • systematic training and compliance with safety rules during exercises;
  • pain is not an obstacle to training;
  • 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 while performing the movements;
  • the patient must feel the positive effect of rehabilitation on his condition;
  • the patient must develop pain response skills;
  • the patient must associate movement with positive thoughts.

Rehabilitation methods:

  1. Walk;
  2. Physical exercises, gymnastics, gymnastics programs at the workplace;
  3. Custom orthopedic devices;
  4. Cognitive behavioral therapy;
  5. Patient education:
    • Avoid excessive physical activity;
    • Combating low physical activity;
    • Exclusion of long-lasting static load (standing, uncomfortable position, etc. );
    • Avoid hypothermia;
    • Sleep management.

Prevention

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

In the case of prolonged sitting work, warm-up breaks must be taken every 15-20 minutes and the rules of the seat must be observed.

Life Hack:how to sit

  • avoid overly upholstered furniture;
  • the legs must rest on the floor, which is achieved with a chair height equal to the length of the lower leg;
  • sit no more than 2/3 of the length of the hips;
  • sit straight, keep the correct posture, the back should fit tightly to the back of the chair to avoid straining the back muscles;
  • the head when reading a book or working on a computer should be in a physiological position (look straight ahead and not continuously down). For this, it is recommended to use special stands and place the computer monitor at the optimal height.

In case of prolonged standing work, the position should be changed every 10-15 minutes, alternating the supporting leg and, if possible, walking and moving in place.

Avoid prolonged lying down.

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 its physiological curves;
  • the pillow should be soft enough and of medium height to avoid stress on the neck;
  • when sleeping on your back, it is recommended to put a small pillow under your stomach.

Stop smoking: If you are having difficulty, see your doctor who can refer you to a smoking cessation program.

Frequently Asked Questions

  1. I use ointments containing glucocorticosteroids. Increased risk of osteochondrosis or osteoporosis?

    No. External glucocorticosteroids (ointments, creams, gels) do not penetrate the systemic circulation in significant quantities, so they do not increase the risk of developing these diseases.

  2. Do all herniated discs require surgery?

    No. Surgical treatment is only performed in justified cases. 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 the additional examination methods, the doctor does not find anything that would significantly limit the amount of stress on the spinal column, then sports can be continued, but completing a course of treatment and supplementing certain exercises with physiotherapy exercises and swimming.

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

    After the productive conservative therapy, further implementation of the treating neurologist's recommendations, adherence to the rules of prevention, regular exercise and swimming.