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Backache

Back pain is a sign of diseases of the musculoskeletal system

Almost every adult has experienced back pain during 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;
    • 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" refers 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 time of onset of pain: younger than 20 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 localization of pain;
  • increased pain in a horizontal position (especially at night), in a vertical position - weakening;
  • no improvement for 1 month or more;
  • dysfunction of the pelvic organs, including urination and defecation disorders, numbness of the perineum, symmetrical weakness of the lower extremities;
  • alcoholism;
  • the use of narcotic drugs, 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 it requires the attention of a doctor and diagnosis.

Back pain is divided into the following forms by duration:

  • acute- pain lasting less than 4 weeks;
  • subacute- pain lasting from 4 to 12 weeks;
  • chronic- pain lasting 12 weeks or more;
  • pain recurrence- resumption of pain if it has not occurred within the last 6 months or more;
  • exacerbation of chronic painPain recurrence 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 of the vertebral discs and, subsequently, 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 arose due to the fact that foreign doctors understand osteochondrosis as a disease of the spine in children and adolescents associated with growth. However, this term refers specifically to a degenerative disease of the spine in people of any age. Also, often established diagnoses are dorsopathy and dorsalgia.

  • Dorsopathy is a pathology of the spine;
  • Dorsalgia is a benign non-specific 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:

  • Cervicalgia is pain in the cervical spine. The intervertebral discs of the cervical region have anatomical features (intervertebral discs are absent in the upper section, and in other sections they have a weakly expressed nucleus pulposus with its regression, on average, by 30 years), which make them more susceptible to stress and injury, which leads to stretchingligaments 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 to 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 spinal column;
  • weakness of the back muscles;
  • high growth;
  • excess body weight;
  • diseases of the joints of the legs (gonarthrosis, coxarthrosis, etc. ), flat feet, clubfoot, etc. ;
  • natural wear and tear with age;
  • smoking.

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

Symptoms:

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

Localization of pain depends on the level at which the hernia is localized.

Disc herniations often resolve on their own within 4-8 weeks on average.

Compression radiculopathy

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

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

  • pain in the extremity of a shooting nature with irradiation to the fingers, aggravated by movement or coughing;
  • numbness or a feeling of flies crawling in a certain area (dermatomes);
  • muscle 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)
  • limitation of spinal mobility.

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 may cause no symptoms with slight displacement and may be an incidental x-ray finding.

Possible symptoms:

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

The 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 blood vessels in the spinal canal. Symptoms:

  • constant pain (both at rest and in motion),
  • in some cases, the pain may decrease in the supine position,
  • 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, as a result of which the blood supply to the spinal cord is disturbed. This is manifested by a sharp weakness in the legs, a person may fall.

Diagnostics

Collection of complaintshelps the doctor to suspect the possible causes of the disease, to determine the localization of pain.

Pain Intensity Assessment- a very important stage of diagnosis, allowing you to choose a treatment and evaluate 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 evaluates the severity of pain on a scale from 0 to 10, where 0 points is no pain, and 10 points is the worst pain that a person can imagine.

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

Physical examination: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.

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

March test:carried out in cases of suspected lumbar stenosis.

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

Radiography:carried out with functional tests for suspected instability of the structures of the spine. 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, as these methods have different indications and benefits.

CT

MRI
  • Evaluates bone structures (vertebrae).

  • Allows you to see the later 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 for MRI.
  • Evaluates 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 according to instrumental examination methods.

Bone densitometry:performed to assess bone density (confirmation or exclusion of osteoporosis). This study is recommended for postmenopausal women with a high risk of fractures and always at the age of 65, regardless of risk, men over 70, patients with fractures 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:carried out in the presence of 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 non-steroidal anti-inflammatory drugs (NSAIDs). The specific drug and dosage are selected depending on the severity of pain;
  • maintaining 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 spasm;
  • it is possible to use vitamins, however, their effectiveness according to various studies remains unclear;
  • manual therapy;
  • analysis of lifestyle and elimination of risk factors.

For subacute or chronic pain:

  • use of painkillers on demand;
  • special physical exercises;
  • assessment of the psychological state, as it can be a significant factor in the development of chronic pain, and psychotherapy;
  • drugs from the group of antidepressants or antiepileptic drugs for the treatment of chronic pain;
  • manual therapy;
  • analysis of lifestyle and elimination of risk factors.

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

Surgical treatment is indicated with a rapid increase in symptoms, the presence of spinal cord compression, 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 be started as soon as possible and have the following goals:

  • improving 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 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 trusting relationship 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 his condition;
  • the patient needs to develop pain response skills;
  • the patient should associate movement with positive thoughts.

Rehabilitation methods:

  1. Walking;
  2. Physical exercises, gymnastics, gymnastics programs in the workplace;
  3. Individual orthopedic devices;
  4. Cognitive Behavioral Therapy;
  5. Patient Education:
    • Avoid excessive physical activity;
    • Fighting low physical activity;
    • Exclusion of prolonged static loads (standing, being in an uncomfortable position, etc. );
    • Avoid hypothermia;
    • Sleep organization.

Prevention

Optimal physical activity: strengthens the muscle frame, 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 prolonged sedentary work, it is necessary to take breaks for a warm-up every 15-20 minutes and follow the rules of sitting.

Life hack:how to sit

  • avoid overly upholstered furniture;
  • the legs should rest on the floor, which is achieved by 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 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 (look straight ahead, and not constantly down). To do this, it is recommended to use special stands 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 in place and move.

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

Smoking cessation: If you are having difficulty, see 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 of osteochondrosis or osteoporosis?

    No. External glucocorticosteroids (ointments, creams, gels) do not penetrate in significant amounts into the systemic circulation, and therefore do not increase the risk of developing these diseases.

  2. In each case of a herniated disc, surgery is 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 would significantly limit the degree of load on the spinal column, then it is possible to continue playing sports, but after undergoing a course of treatment and adding certain exercises from the course of 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 attending neurologist, compliance with the rules of prevention, regular exercise therapy and swimming.