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Backache

Back pain is a sign of diseases of the musculoskeletal system

Almost every adult has experienced back pain in their lifetime. This is a very common problem, which can be based on several reasons, which we will analyze in this article.

Causes of back pain

All causes of back pain can be divided into groups:

  1. Skeletal muscle:

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

  2. Inflammatory, including infectious:

    • osteomyelitis
    • Tuberculosis

  3. neurological;

  4. injuries;

  5. Endocrinology;

  6. Vascular;

  7. Tumor.

At 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" refers to a set of specific complaints and anamnesis data that require an in-depth examination of the patient.

"Red Flags":

  • patient age at onset of pain: less than 20 years or more than 50 years;
  • a severe spinal cord 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;
  • pelvic organ dysfunction, including urination and defecation disorders, perineal numbness, symmetrical weakness of the lower extremities;
  • alcoholism;
  • the use of narcotics, mainly intravenous;
  • treatment with corticosteroids and/or cytostatics;
  • with neck pain, 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 the attention of a doctor and diagnosis.

Back pain is broken down into the following forms by duration:

  • acute- 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.

Illnesses

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 vertebral discs and, later, 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 this diagnosis is incorrect, others, on the contrary, often diagnose osteochondrosis. This situation arose from the fact that foreign doctors understood 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, frequently established diagnoses are dorsopathy and back pain.

  • Dorsopathy is a pathology of the spine;
  • Dorsalgia is benign non-specific 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 are described by the following medical terms:

  • Cervicalgia is pain in the cervical spine. The intervertebral discs of the cervical region have anatomical characteristics (the intervertebral discs are absent in the upper part, and in other sections they have a poorly expressed nucleus pulposus with their regression, on average, in 30 years), which makes them more susceptible to stress and injury, which leads 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 that lead 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;
  • long computer work with a non-ideal location of the monitor, which creates a load on the neck;
  • violation of posture;
  • congenital structural features and spinal anomalies;
  • weakness of the back muscles;
  • high growth;
  • excess body weight;
  • leg joint diseases (gonarthrosis, coxarthrosis, etc. ), flat feet, clubfoot, etc. ;
  • natural wear and tear with age;
  • smoke.

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

Symptoms:

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

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

Disc herniations usually 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 exit from the spinal cord.

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

  • pain in extremity of a stabbing nature radiating to fingers, aggravated by movement or coughing;
  • numbness or the sensation of flies crawling in a certain area (dermatomes);
  • muscle weakness;
  • back muscle spasm;
  • violation of the strength of reflexes;
  • positive tension symptoms (the onset of pain with passive flexion of the limbs)
  • limitation of spinal mobility.

spondylolisthesis

Spondylolisthesis is the displacement of the upper vertebra in relation to the lower one.

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

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

Possible symptoms:

  • feeling of discomfort
  • back and lower extremity pain after physical work,
  • leg weakness
  • root syndrome,
  • decreased pain and tactile sensitivity.

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 (at rest and on movement),
  • in some cases, the pain may subside in the supine position,
  • 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 can occur, resulting in disturbances in the blood supply to the spinal cord. This is manifested by a strong weakness in the legs, a person may fall.

Diagnosis

Complaint collectionhelps 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, allowing you to choose a treatment and evaluate its effectiveness over time. In practice, the Visual Analog Scale (VAS) is used, which is convenient for both the patient and the physician. 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 you 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 back muscle spasm, determination of skeletal muscle development, exclusion of the presence of signs of infectious injury.

Neurological status assessment:muscle strength and its symmetry, reflexes, sensitivity.

March test:performed in cases of suspected lumbar stenosis.

Important!Patients without "red flags" with a classic clinical picture are not recommended for further studies.

X-ray:performed with functional tests for suspected instability of spinal structures. However, this diagnostic method is uninformative and is mainly performed 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).

  • It allows to see the later stages of osteochondrosis, in which the 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 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 age 65 regardless of risk, men over 70 years of age, fracture patients with minimal trauma history, prolonged use of glucocorticosteroids. The 10-year fracture risk is assessed using the FRAX scale.

Bone scintigraphy, PET-CT:performed in the presence of suspected oncological disease according to other examination methods.

back pain treatment

For acute pain:

  • pain relievers are prescribed in a course, mainly from the group of non-steroidal anti-inflammatory drugs (NSAIDs). The specific drug and dosage is selected depending 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;
  • it is possible to use vitamins, however, their effectiveness according to several studies remains uncertain;
  • manual therapy;
  • lifestyle analysis and elimination of risk factors.

For subacute or chronic pain:

  • use of analgesics on demand;
  • special physical exercises;
  • psychological status assessment, as it can be a significant factor in the development of chronic pain, and psychotherapy;
  • drugs 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 with a rapid increase in symptoms, presence of spinal cord compression, significant stenosis of the spinal canal and ineffectiveness of conservative therapy. Emergency surgical treatment is performed 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 objectives:

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

Basic Rehabilitation Rules:

  • 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 must feel comfortable and safe when performing the movements;
  • the patient must feel the positive impact of rehabilitation on his condition;
  • the patient needs to develop pain response skills;
  • the patient must associate movement with positive thoughts.

Rehabilitation methods:

  1. Walking;
  2. Physical exercises, gymnastics, labor gymnastics programs;
  3. Individual orthopedic devices;
  4. Cognitive behavioral therapy;
  5. Patient education:
    • Avoid excessive physical activity;
    • Combat low physical activity;
    • Exclusion of prolonged static loads (standing, in an uncomfortable position, etc. );
    • Avoid hypothermia;
    • Sleep organization.

Prevention

Ideal physical activity: strengthens muscle structure, prevents bone resorption, improves mood and reduces the risk of cardiovascular accidents. The most ideal 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 warm-up breaks every 15-20 minutes and follow the rules of the session.

Life hack:how to sit

  • avoid overly upholstered furniture;
  • the legs must rest on the floor, which is reached by the height of the chair equal to the length of the leg;
  • it is necessary to sit at a depth of up to 2/3 of the length of the hips;
  • sit up straight, maintain the correct posture, your back should fit snugly 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 (looking straight ahead and not constantly looking 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 positions every 10-15 minutes, alternating the supporting leg and, if possible, walking in place and moving.

Avoid lying down for a long time.

Life hack:how to sleep

  • sleep better on a semi-hard surface. If possible, you can opt for 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 in the prone position, it is recommended to place a small pillow under the stomach.

Smoking Cessation: If you are having difficulties, see your doctor who will refer you to a smoking cessation program.

Common questions

  1. I use glucocorticosteroid ointments. Am I at increased risk of osteochondrosis or osteoporosis?

    Not. 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 every case of herniated disc, is surgery necessary?

    Not. 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?

    Not. If, as a result of additional examination methods, the doctor does not find anything that significantly limits the degree of load on the spine, it is possible to continue playing sports, but after undergoing treatment and adding certain exercises from the course of physical therapy 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 assistant neurologist, compliance with the rules of prevention, regular exercise therapy and swimming.