Backache

Low back pain and neck pain are one of the most common reasons to seek medical attention. Pain is usually caused by problems with the musculoskeletal system - most notably problems with the spine, including the bones of the spine (vertebrae), the discs and muscles, and the ligaments that support them. Sometimes back pain is caused by a condition that does not affect the musculoskeletal system.

Low back pain is most common in older age groups, affecting more than half of people over 60 years old. This leads to significant costs in terms of health care payments, disability benefits and lost working hours.

The spine (spine) consists of vertebrae. There are shock absorbing discs between the vertebrae. The discs have a hard outer layer of fibrocartilaginous tissue and a soft inner, jelly-like substance called the nucleus. Each vertebra has two nodes behind the discs. These nodes are called facet nodes. The articular surfaces of one vertebral body extend to the articular surfaces of the other below it, forming a joint. The joints, and with them the entire spine, are stabilized by ligaments and muscles, namely:

• Two iliopsoas muscles running on either side of the spine
• Two back lift muscles that run the entire length of the spine behind it
• Many short paravertebral muscles located between the vertebrae

The spinal cord is located in the spinal canal. Throughout the length of the spinal cord, through the holes between the vertebrae on both sides, the spinal nerves emerge, the function of which is the union of all the nerves in the body. The part of the spinal nerve near the spinal cord is called the root. Due to the peculiarities of the position of the spinal nerve roots, they can be compressed (compression) with spinal cord injuries, which leads to pain.

The lower spine (lumbar spine) in the upper part connects to the upper spine (thoracic spine) and down the pelvis through the sacrum bones. The lumbar spine is flexible enough to bend, twist and bend, and provides strength when standing, walking and lifting. Thus, the lower back is involved in almost all types of daily activities. Low back pain can interfere with various activities and worsen the quality of life.

Types of back pain

Common types of low back pain include localized, radiating, and repercussive pain.

Local painappears in a certain area of the lower back. Typically the most common type of back pain. The cause is usually a disc injury, ankle arthritis and, less commonly, a muscle strain. The pain may be persistent and painful, or at some point may be replaced by persistent acute pain. Sudden pain may appear when trauma is the cause. Local pain may increase or decrease with a change in position. Touching the lower back can be painful. Muscle spasms are possible.

Radiant painPainless back pain that spreads to the legs. The pain can be dull or sharp and strong. Typically, it touches only the side or back of the foot and may extend to the foot or simply to the knee. Radiation pain is usually a manifestation of spinal nerve root compression in disorders such as disc herniation, sciatica, osteoarthritis, or spinal stenosis. Coughing, sneezing, straining or bending over with straight legs can be painful. When a spinal nerve root is compressed, pain can be accompanied by weakness in the leg muscles, tingling sensation, or even loss of sensation. In rare cases, loss of urinary control (urinary incontinence) or loss of control over bowel movements (fecal incontinence) occurs.

Reflected painfelt in a place other than the actual cause of the pain. For example, some people with a heart attack feel pain in their left arm. The pain reflected by the internal organs in the lower back is mostly deep and painful in nature, and its exact location is difficult to determine. As a rule, with movement, the pain does not increase, in contrast to the pain that accompanies disorders of the musculoskeletal system.

reason

In most cases, back pain is a consequence of diseases of the back and surrounding joints, muscles, ligaments and spinal nerve roots, as well as intervertebral discs. Often, a single specific cause cannot be identified. Any painful spinal disease can lead to reflex contraction (spasm) of the muscles around the spine. Spasms can increase pain. Stress can worsen back pain, but the mechanism is not clear.

Sometimes, back pain is caused by a disorder that does not affect the spine, such as cancer, gynecological conditions (such as pre-menstrual syndrome), kidney disease (such as kidney stones), urinary tract disease (such as infections of the kidneys, bladder, and prostate) and the digestive tract (for example, diverticulitis), as well as diseases of the large arteries located near the spine.

Common causes

Common causes of back pain include the following:

• Osteoarthritis
• Compression fractures of the spine
• A torn or herniated disc
• Spinal stenosis in the lumbar spine
• Spondylolisthesis
• Muscle and ligament damage
• Fibromyalgia

INJURYmay occur during normal activities (e. g. , lifting heavy objects, exercise, sudden movement) or as a result of injury, such as a fall or traffic accident. Typically, imaging studies do not show any specific damage, but doctors suspect that some muscles and / or ligaments are affected.

Osteoarthritis(degenerative arthritis) causes cartilage consumption between articular surfaces and the formation of bone spines (osteophytes). This disease is partly the result of tissue aging. With severe degeneration and loss of disc height, osteophytes in the foramen can compress the spinal nerve roots. All of these changes can lead to low back pain as well as stiffness.

Spinal compression fractures (due to compression)(vertebral fractures) often occur when bone density decreases due to osteoporosis, which usually develops with age. However, fractures due to osteoporosis tend to occur in the upper and middle back and are associated with pain in these regions rather than in the lower back.

A torn or herniated disccan cause back pain. The disc is represented by a dense outer layer and a soft, jelly-like central part. If the disc is under constant stress from the vertebrae up and down (for example, when leaning forward, especially when lifting heavy objects), its outer layer may rupture (tears), causing pain.

Spinal stenosis in the lumbar spine- Narrowing of the spinal canal (which passes through the center of the spine and contains the spinal cord and the bundle of nerves that extend down from the lower part of the spinal cord) to the lumbar region. It is a common cause of low back pain in older people. Spinal stenosis also develops in middle age in people whose spinal canal is narrow from birth. Spinal stenosis is caused by disorders such as osteoarthritis, spondylolisthesis, ankylosing spondylitis and Paget’s disease.

Spinal stenosis can cause sciatica as well as back pain.

Spondylolisthesis- partial displacement of the vertebra in the lower back. One type usually occurs during adolescence or adolescence (often in athletes) and is caused by an injury that fractures a portion of the vertebrae. If both sides of the bead are affected, the bead may slide forward over the base bead. Spondylolistemia can also occur in the elderly, but mainly as a result of degenerative disease. With the development of spondylolisthesis in adulthood, the risk of spinal stenosis in the lumbar region increases.

FibromyalgiaIt is a common cause of pain that affects many parts of the body, including the lower back. This condition results in chronic diffuse pain in the muscles and other soft tissues outside the back. Fibromyalgia is also characterized by sleep disturbances and fatigue.

polls

Tests are usually not prescribed because most back pain is due to osteoarthritis, sprains or other minor musculoskeletal disorders and resolves within 6 weeks. Imaging tests are often needed if:

• another reason is suspected;
• there are warning signs;
• back pain persists.

Evaluation may also be ordered if there is no response to initial treatment, or if symptoms worsen or change.

X-rays of the lower back can only provide an image of the bone. Such images may reveal degenerative changes due to osteoarthritis, spinal compression fractures, spondylolisthesis, and ankylosing spondylitis. However, magnetic resonance imaging (MRI) or computed tomography (CT) imaging can provide a clear image of the bone and, as is typical of MRI, show soft tissue (including discs and some nerves). An MRI or CT scan is usually needed when doctors determine the presence of disorders that lead to some changes in bone structure as well as soft tissue disease.

If spinal cord compression is suspected, MRI is done as soon as possible. In rare cases, when MRI results are unclear, it becomes necessary to do myelography with CT. Rarely, if a malignant tumor or infection is suspected, a tissue sample (biopsy) should be taken for analysis. In some cases, electromyography and examinations to study nerve conduction are performed to confirm the presence, localization, and, in some cases, the duration and severity of spinal nerve root compression.

Prophylaxis

People can reduce their risk of developing low back pain by taking the following precautions:

• physical exercises;
• exercises to strengthen and stretch muscles;
• maintaining a normal body weight;
• maintaining correct behavior;
• compliance with recommendations for safe weight lifting.

The most effective way to prevent low back pain is through regular exercise. Aerobic exercises and special exercises for the development of muscle strength and stretching are advised.

Aerobic exercises, such as swimming and walking, improve general condition and strengthen muscles.

Special exercises for developing muscle strength and stretching the muscles of the abdominal wall, buttocks and back (deep trunk muscles) allow you to stabilize the spine and reduce the stretch of the discs that absorb the spine and the ligaments that hold them.

Strength training exercises include pelvic floor exercises and abdominal presses. Stretching exercises involve stretching by bending the knees to the chest. In some people, stretching exercises can lead to increased back pain, so caution should be exercised. The basic rule is that any exercise that causes or worsens back pain should be stopped. Exercises should be repeated until slight (but not extreme) muscle fatigue is felt. Breathing is essential during exercise. People with back pain should consult their doctor before exercising.

Pelvic tilt Take a supine position with your knees bent, heels on the floor, load on the heels. Press your back to the floor, tense your glutes (lift about half an inch off the floor) and tense your abdominal muscles. Hold this position for a count of 10. Repeat 20 times.
Crunches lying down Lie down with your knees bent and your feet flat on the floor. Fold the arms over the chest. Tighten the abdominal muscles, slowly lift the shoulders about 10 inches off the floor, keeping the head straight (the chin should not touch the chest). Relax the abdominal muscles, slowly lower the shoulders. Do 3 sets of 10 reps.
Lie with your knees on your chest Take a supine position, head up. Place both palms under one knee and press it to your chest. Hold the position for a count of 10. Slowly lower the leg and repeat the exercise on the other leg. Do the exercise 10 times.

Exercise also makes it easier to maintain the desired body weight. Exercise also helps maintain bone density. Thus, exercise can reduce the risk of developing two conditions that can cause low back pain: overweight and osteoporosis.

Proper posture while standing and sitting reduces stress on the back. Touching should be avoided. The chair seats should be adjusted in height so that the legs are flat on the floor, the knees are slightly bent and the lower back is smooth behind the back of the chair. If the chair does not provide support for the lower back, a cushion can be placed under it. In a sitting position, it is recommended to place your feet on the floor, not to cross your legs. People who are sick should not stay or sit for long periods. If you have to stand or sit for a long time, frequent position changes can reduce the strain on your back.

treatment

If it is possible to determine a specific cause, the disease is treated. For example, antibiotics are used to treat a prostate infection. However, there is no cure for cramping pain in the musculoskeletal system, or pain caused by other conditions. However, the situation can be improved through general measures. Typically, such measures are also used when squeezing the spinal nerve root.

General measures for back pain

Possible measures include:

• Making changes to activities
• Taking pain relievers
• Placing heat or cold on the painful area
• Light exercise, if tolerated

For the most recent back pain, treatment begins by eliminating activities that strain the back and cause pain, such as lifting weights and bending. Bed rest does not speed up pain relief, and most professionals recommend doing light work. The rest of the bed, needed to relieve severe pain, should not last more than 1 or 2 days. Prolonged bed rest weakens core muscles and increases stiffness, leading to stronger back pain and slower healing. Corsets and traction are ineffective. Withdrawal may slow healing.

Over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Opioid analgesics are sometimes prescribed if NSAIDs do not provide sufficient pain relief, but they should only be used for a short time, as long-term use of opioid analgesics, on the contrary, may increase pain sensitivity, cause side effects, and increase risk. of addiction and dependence.

Muscle relaxants can sometimes relieve muscle spasms, but their effectiveness is questionable. These medications are not recommended for elderly patients who are more likely to develop side effects such as drowsiness and disorientation. Doctors try not to prescribe muscle relaxants if the patient does not have visible and palpable muscle spasms. If muscle relaxants are prescribed, they should not be used for more than 72 hours. Doctors sometimes recommend taking them just before bedtime.

Massage can provide temporary relief from low back pain. Several studies have shown positive results in acupuncture; others have disputed these findings. Spinal manipulation by chiropractors or other physicians (such as osteopaths), combined with an exercise program, can also relieve pain. However, spinal manipulation can increase the risk of additional damage and should be avoided in individuals with inflammatory arthritis, neck problems that cause cervical instability, or herniated discs.

It is recommended to sleep in a comfortable position on a firm medium mattress. People who sleep on their backs should have a pillow under their knees. Patients sleeping on their side should use a pillow that allows their head to be held in a neutral position (without tilting the neck up or down). Patients should place a second pillow between the knees, with the knees and hips slightly bent, if this relieves back pain. Patients can still sleep on their stomachs if they feel comfortable.

Continue or start taking other preventative measures (correct posture, proper weight lifting technique). When you perform such events, back pain attacks mostly disappear in the period from a few days to 2 weeks. Regardless of treatment, 80 to 90% of these attacks resolve within 6 weeks.

Treatment of chronic low back pain

Additional measures are needed to treat chronic low back pain. Aerobic exercise is advised and weight loss is recommended if necessary. If analgesics are ineffective, other treatments should be prescribed.

Transcutaneous electroneurostomy (TENS) stimulation is possible. CHENS devices generate a weak alternating current that causes a tingling sensation. This current can block the transmission of some pain sensations from the spinal cord to the brain. The current can be applied to the painful area several times a day, the duration of the session varies from 20 minutes to several hours, depending on the severity of the pain.

Sometimes corticosteroids with a local anesthetic are injected periodically into the facial joint of the spine or into the epidural space - between the spine and the outer layer of tissue that covers the spinal cord. Epidural injections may be more effective for sciatica, which is more due to a disc herniation than lumbar spinal stenosis. However, they may not have long-term beneficial effects. They usually last only a few days or weeks. Their main purpose is to relieve pain so that you can exercise for long-term pain relief.

Back pain surgery

In cases where a disc herniation leads to persistent or chronic sciatica, weakness, loss of sensation, or fecal and urinary incontinence, it may be necessary to surgically remove the protruding part of the disc (discectomy) and, in some cases, part of thevertebrae (laminectomy).

In severe spinal stenosis, a large portion of the posterior vertebra (vertebral arch lamellae) can be removed to extend it (lumbar laminectomy). General anesthesia is usually needed. The length of hospital stay is usually 4 to 5 days. Patients will be able to return to normal activities in 3-4 months. Proper or complete healing is seen in about two-thirds of patients. For the rest of the patients, such surgery can prevent pain and worsening of other symptoms.

If the spine is unstable (which can result from a severe disc herniation, spondylolisthesis, or laminectomy for spinal stenosis), surgery can be performed to join the vertebrae (called lumbar vertebral arthrodesis). However, the joint restricts movement, can be associated with excessive mechanical stress on the rest of the spine and cause problems in the future.

Compression fractures of the spine

Spinal compression fractures are quite common in women over 50 years of age. They can be treated conservatively without surgery, with retainers, pain relievers and preferably nasal calcitonin spray, which will not help bone healing but may reduce pain.

If adequate pain control cannot be achieved, two surgical options are available:

• Vertebroplasty: injection of cement mortar into a broken bone.
• Kyphoplasty: Inserting a balloon into a broken bone to create space. The balloon is then filled with cement.

Recent studies, however, have shown that in the long run, the effectiveness of these surgical procedures does not exceed the effectiveness of non-surgical treatment options.

Main points

• Low back pain is common. It is usually caused by musculoskeletal disorders of the spine and factors such as fatigue, overweight and insufficient physical activity.
• Low back pain is rarely severe at a young age and testing is usually unnecessary if symptoms persist for many weeks.
• Patients with warning signs or patients over the age of 55 should see a doctor immediately.
• Strengthening the abdominal and back wall muscles with specific exercises helps prevent the most common types of low back pain.
• For back pain, most often, sufficient treatment is to exclude measures leading to mechanical effects on the back, take pain relievers, and, in some cases, apply a cold or warm compress.
• Rest and prolonged bed rest can slow healing.
• In severe cases, such as abnormal sensations and weakness in the legs, surgery may be required.
• Bead compression fractures can be treated conservatively (with retainers, pain relievers, and nasal sprays) or, in some cases, more aggressively with surgery.