Treatment of back pain

Back pain is only a symptom, an external manifestation of any disease or pathology.Any pain has its cause.There are many causes of back pain.

Patients are often told that back pain is caused by overuse of muscles and ligaments.Unfortunately, if the cause was only in the muscles, then it would be very easy to relieve the pain.For example, a massage that should bring relief.But massage does not always help, because it removes the cause of pain.

Sharp back pain can occur due to a herniated disc or a prolapsed disc.If the herniated disc is on the right side, you may experience right-sided back pain, right-sided pain, or right-sided leg pain (sciatica with large herniation).If the hernia is on the left side, then you may feel pain in the back on the left side, and you may experience pain on the left side. 

If the hernia is large and compresses the root of the left lumbar (sciaticaleft), then lumbago may occur in the left leg and pain may begin in the left leg.A large hernia often causes a posture disorder in the form of distortion of the torso with acute "twisted" pain, when it is impossible to straighten and straighten (the so-called antalgic position of the body).

Back pain in the lower right side can be the result of a hernia or problems with the right joint of the spine or pathology of the sacral area (right iliosacral joint).

Pain in the left shoulder (or pain under the left shoulder blade) can be the result of a hernia or joint pathology, or as a result of heart problems.Such pain can be caused by angina and heart attack.Pain between the shoulder blades occurs not only with spine pathology and osteochondrosis, but also with diseases of the stomach (gastritis, ulcer, cancer, etc.) and often intestines.

Cholecystitis and cholelithiasis most often cause pain in the back on the right and pain under the right shoulder.Gallbladder pathology is often manifested as pain under the right rib.Diagnosis is required.

Rashesdisks, more often there are incidental findings on MRI, whichcanContinue without pain.disc herniation- It is not a common cause of severe back pain.However, the formation of a hernia, for example, when lifting heavy objects, causes lumbar or thoracic lumbago (sharp pain in the back).If you have persistent back pain, a hernia on an MRI may have nothing to do with it.The causes of such constant pain are often different. Diagnostics will help you figure this out.

Therefore, effective treatment of back and lower back pain requires:

1. Determine the cause of back pain (diagnose).
2. The cause of back pain will be determined by a neurologist, orthopedic traumatologist in the field of vertebrology and vertebroneurology, or a vertebrologist (vertebroneurologist).Diagnosis is established by clinical and technical examination.
3. Low back pain treatment tactics according to the diagnosed cause.
4. If you have back pain, it is important to make sure that the pain does not recur.To achieve this, we offer various methods, including physical rehabilitation of the spine.

Lower back pain.Why does my lower back hurt?

Low back pain refers to pain localized between the 12th pair of ribs and the gluteal folds.Such pain is already a social problem.It is a fact that the lower back is the most loaded part of the spine, which withstands daily and hourly loads.85% of people have experienced lower back pain at least once in their life.what is the reason

Pain in the lower backThere may be many reasons.The most common causes are osteochondrosis, disc herniation, sciatica and pathology of lumbar joints.

Osteochondrosis

Osteochondrosis-Natural aging of the back tissue.

It is generally accepted that osteochondrosis is a sign of spinal disease accompanied by pain.This is a little different.

The image below shows a normal disk being damaged (see the damaged disk in the image).These injuries can accelerate the disc's aging and loss of height (see "Narrowing of the intervertebral space").Next, aging begins to affect the bone tissue of the spine itself, and osteophytes (see "Osteophytes" in the picture) grow.

Previously, it was believed that osteochondrosis was associated with pain.Therefore, at that time they tried to explain the cause of pain in the spine and back, namely osteochondrosis.For this reason, the question of the failure of vertebroneurology even arose.In 1978, the first research laboratory for problems with osteochondrosis of the spine was created, which studied the issue of osteochondrosis for more than 10 years and proved that the cause of pain is not osteochondrosis, but pathology of the joints. 

Osteochondrosis is not accompanied by pain, because the disc does not have nerve endings.Therefore, there is no pain during osteochondrosis.

disc herniation

Disc herniation as a possible cause of pain.The image above shows several herniated discs - a small herniated (protrusion) and a large herniated disc.A herniated disc itself does not hurt.

The disc has no nerve endings (not innervated).The pain of a herniated or protruding disc occurs when the herniated disc puts pressure on the innervated tissue.For example, onspineor onrearyuyuLongitudinalwowbundleson.In the first case, radicular pain appears - sciatica (see below).In the second, when the receptors of the posterior longitudinal ligament are irritated, back pain (lumbodynia) or acute pain - lumbago (lumbago) appears.

Disc herniation is often treated without surgery.

Spondyloarthrosis

Spondyloarthrosis is arthrosis of the joints of the spine.Arthritis itself is characterized by joint cartilage disease.In this case, the cartilage decreases in height (degenerates, "drying"), the articular surfaces of the bones lose their protective cartilage layer.The joints of the spine begin to ache.This pain is similar to lower back pain.

sciatica

Sciatica is inflammation of the root.Sciatica most often occurs when the root is damaged by a herniated disc or spinal joints.It's usually not lower back pain as much as leg pain, buttock pain, and pain or numbness even in the toes.

Sciatica is most effectively treated by releasing the root.If it is caused by a herniated disc, you need to reduce the hernia that puts pressure on the root.

Pain in the back and lower back due to pathology of internal organs

Back pain is possible due to pathology of internal organs.for exampleBack pain in womenIt can be the result of diseases of the pelvic organs.

Back pain in women

Lower back pain in women can be caused by inflammatory diseases of the female genital organs.

If a woman has pain in the pelvis and lower back, then you should always remember the gynecologist.Inflammatory diseases of female genital organs are not uncommon.The reason can be inflammation of the appendages, inflammatory diseases of the vagina and vulva, salpingitis, salpingoophoritis, endometritis, bacterial vaginitis, etc.More often, such inflammatory diseases in women are caused by infections of the genital area, including sexually transmitted infections.

If the lower back hurts and hurts, and at the same time there is pain in the lower abdomen, then a woman needs to be examined by a gynecologist.To clarify the diagnosis, it is necessary to conduct a gynecological ultrasound.

Constant aching pain in the lower back also occurs whenOncology in gynecology.

Cancer and back pain in women

Cancer does not hurt at first.When pain appears in the lower back or sacrum, it may be too late.

Many people think that cancer is accompanied by pain.This is incorrect.In the initial stages of tumor development, a person does not feel pain.A person feels practically healthy.For example, cervical cancer in the genital organs is asymptomatic.It begins to manifest when the tumor grows.In this case, pain often occurs in the lower back and lower back.The pain in the lower back is in the area of the palate.

With cancer, you do not suffer from severe pain in the lower back at first.Rather, your lower back doesn't hurt, but it does.Such pain can be the first call that will help a woman to prevent the critical growth of the tumor and make a correct diagnosis in time.If you suffer from lower back or sacral pain all the time, you should pay special attention to it so you don't miss a disaster.

Unfortunately, if you do not pay attention to aching pain or discomfort in the lower back, the next sign of cervical cancer can be uterine bleeding.This is the stage when the tumor begins to break down, when there may already be metastases.including in the spine, when there is already severe pain in the lower back.

Important Takeaway:If your lower back hurts, it's not necessarily osteochondrosis or a herniated disc.And it never hurts to have a preventive consultation with a gynecologist.Cervical erosion detected during examination is a pre-cancerous condition.

Why does my back hurt due to urological or urogenital problems (inflammations)?

Acute lower back pain may be due to kidney disease

You have severe lower back pain with kidney disease such as pyelonephritis.

Pyelonephritis is an infectious disease that is most often caused by an ascending infection.This can be related to both sexually transmitted infections and other types of household infections that are transmitted through swimming pools, baths and personal hygiene products.For example, everything lives longer in unwashed towels.

Inflammation activates pain receptors in the soft tissues of the pelvic organs.The pain signal (impulse) reaches the spine through sensitive roots, activating its tissues.The soft tissues of the spine and the attachment points of the back muscles reflexively loosen (inflammation).And my lower back hurts.

Constant pain in the back and lower back due to dysfunction of the gastrointestinal tract and other diseases

During intestinal spasms, bloating, ulcerative or ulcerative colitis, stomach ulcers and gastritis, the back usually hurts.

Stomach cancer is associated with back pain

Treatment of back pain caused by pathology of the gastrointestinal tract will not lead to improvement.The cause needs treatment.

Another possible cause of lower back pain is back strain

Excessive strain on the lower back is a common cause of back pain or its exacerbation.Overloading often affects the lower back joints, lower back ligaments, tendons or muscles.Moreover, the back muscles work actively under load.Therefore, if you have spinal pain in the lower back after exercise, it is not necessarily a disease.It could be a muscle tear.If this pain does not disappear in 1-2 days, then you should think about back problems.Especially if this pain is aggravated by movement.

The causes of such pain are often excessive inflammation of the muscles and their attachments.or – inflammation of joint capsules.

If such aggravation occurs once a year, you should look for the cause of such aggravation.For this, it is not enough to consult a doctor and perform manipulations, take painkillers, massages and other procedures.

Investigation is needed to determine the cause of such frequent exacerbations.

Damage to the soft tissue of the lower back

Sharp pain in the lower back when moving awkwardly or lifting something heavy is most likely a spinal injury.

If you suffer from pain on this side, for example, pain in the lower back on the right, then you should think about the pathology of the joint on the right.or about the hernia of the right side of the lumbar spine.

Types of back pain

Depending on the duration, the pain can be acute, chronic or transitory in nature.

The pains are as follows:

• local pain- Pain exclusively in the lower back.
• directed pain- when the pain occurs not only in the lower back, but also, for example, in the buttock, in the pelvis.Or, the pathology of the internal organs causes pain in the lower back.In such cases, they talk about referred pain.
• radicular pain- differs in significant intensity and is localized in the borders of the innervation of the root (from the spine to the periphery).The reason is a violation of the nerve root of the spinal nerve (stretching, compression, curvature, compression).Mobility or even coughing intensifies the so-called painimpulse to cough.This is a severe pain in the lower back that can shoot (radiate) into the leg.
• Myopsian pain- It is the result of reflex muscle spasm.The causes of myofascial pain can be diseases of internal organs or damage to the spine itself.Muscle spasm significantly disrupts the biomechanics of human movements.Chronic muscle spasms can also cause aching and cramping lower back pain.

In what cases should you consult a doctor for back pain and what should we do?

• with sharp (acute) pain in the lower back;
• If the pain in the back or lower back continues for more than 3 days;
• if back pain appeared after an injury;
• if the pain is localized simultaneously in the back, leg and lower leg;
• If the pain in the lower back is combined with numbness in the thigh, buttock, leg, foot, groin;
• if the pain in the lower back is accompanied by cramps in the muscles of the limbs (fasciculations);
• if the function of urination and defecation is impaired (retention of urine, incontinence, frequent urination or false desire to urinate);
• If the perineum is numb.
• If the pain in the back or lower back (sacrum) is constant, it is worse in the morning

What should you do if you have back pain?

The causes of lower back pain are varied, so the treatment of lower back pain should be carried out only after diagnosis and diagnosis by a qualified doctor.Any pain in the spine requires a medical examination and finding out the cause of its occurrence.

A visit to the doctor has three purposes:

1. Make the correct diagnosis.
2. elimination of pain.
3. Establish measures that will help to maintain the health of the patient so that the pain does not recur.

Possible causes of back pain

The following diseases can be the cause of your complaints in the lower back:

• osteochondrosis;
• Osteoarthritis;
• Spondylolisthesis;
• spondylosis;
• Ankylosing spondylitis;
• Spondyloarthropathy;
• muscle damage;
• ligament damage;
• disc herniation "hernia98% of discs are treated without surgery (world statistics)";
• Atherosclerosis of the abdominal aorta;
• Malignant neoplasms of the spine;
• Metastases in the spine;
• Urinary tract infections;
• spinal stenosis;
• Diseases of the biliary tract;
• Penetrating duodenal ulcer;
• Pancreatitis;
• Kidney disease;
• Abdominal aortic dissection aneurysm;
• Bleeding in the retroperitoneal tissue;
• Inflammatory diseases of female genital organs;
• Oncological diseases of female genital organs;
• Endometriosis;
• prostatitis;
• prostate cancer;
• Epithelial coccygeal duct abscess;
• Embolism of lower limb arteries;
• Intermittent claudication;
• Pseudo-intermittent claudication;
• Obstructive atherosclerosis of vessels of the lower extremities;
• Rheumatoid spondylitis;
• Polymyalgia rheumatica;
• Fibromyalgia
• Depression;
• other.

Treatment of low back pain (back pain)

At the initial treatment stage, a primary diagnosis is made with pain in the lower back.This is done on the basis of a survey, medical history, neurological and orthopedic examinations.At this stage, medications may be prescribed to reduce pain, relieve tissue swelling, and general anti-inflammatory therapy.Reflexology, local healing effects, regional anesthesia, various injection methods for treating back pain, laser therapy, etc. are effective.Rest is important during drug therapy in acute and subacute periods.Physiotherapy, massage, manual therapy, which can worsen the process, are not indicated.In the acute period, traction is also not used: equipment, on inclined boards, wall bars.

To treat lower back pain more effectively, you need to understand the cause.For this purpose, further examination of the patient to clarify the diagnosis.There can be many causes of lower back pain.Above is an indicative list of diseases that are accompanied by back pain.Each of them has its own treatment protocol with a list of the most effective approaches, medications and procedures.The protocols also contain data on methods that are not indicated for this disease.For example, in case of inflammatory diseases of the spine (spondylitis, spondyloarthropathy, spondyloarthritis, myositis, ligamentitis, etc.), manual therapy, massage and physiotherapy are not shown due to ineffectiveness and risk of complications.It is necessary to determine the cause of inflammation and treat it.

Radiographically visible spondylosis can occur without clinical symptoms and often masks a more complex disease.Therefore, the treatment of spondylosis is useless and often dangerous: removing bone formations in the spine is unrealistic and not necessary.The patient may face exotic diagnoses such as "muscle injury," "muscle spasm," "ligamentUnfortunately, talking about muscle spasm as the cause of pain is not always true. Muscle spasm of the paravertebral muscles is a reflex act and usually accompanies most diseases, including those not related to the spine. Muscles actively participate in the segmental reflex process and can respond to any irritation both inside and outside the spine. The so-called "spasms" should be distinguished from the lower back.From reflected or projected pain, which may be caused by pathology of internal organs: diseases of the pelvic organs, diseases of the retroperitoneal space, diseases of the kidneys, pancreas and prostate glands, gynecological diseases of inflammatory or tumor origin, diseases of the aorta, bleeding in more tissues, retro.Osteopathic techniques for working with secondary spastic paravertebral muscles at the reflex level can temporarily relieve the condition.Manual therapy, osteopathic techniques, tilting board, massage, traction, physical therapy, for example, will not help with prostatitis or adenomatosis.The so-called "therapeutic removal""Muscle spasms" in this case are just the wishes of the manipulator.

Treatment of herniated discs and herniated discs in the lower back

Often, an MRI reveals a hernia or protrusion, which is interpreted as the cause of low back pain.The question immediately arises: remove the hernia or try to cope without surgery?

The first thing you should do- Specify how clinically important this hernia is.The fact is, if you take 100 perfectly healthy people with no back pain and do an MRI scan, 80% of them have some kind of disc bulge ("herniated") that causes no symptoms.

Often, a herniated disc can be an incidental finding, often attributed to another cause of pain.

At the same time, practice shows that not all hernias are clinically significant.In order to find out the causes of the pain, a thorough medical history is taken, a neurological examination is performed to detect neurological deficits, the functioning of the pelvic organs is determined, etc.

It turns out that not all herniated discs and herniated discs require surgery.Patients who need such an operation are no more than 2%.

Neurosurgeons have prescribed absolute indications for surgery, which are clearly defined.More often than not, the presence of a herniated disc is not a reason for emergency surgery.

There is a sufficient arsenal for the treatment of disc herniations and protrusions, including traction, formation of stable motor patterns in the back, local and general drug therapy methods, physical therapy, reflexology, etc.Calibrated treatment without surgical intervention is often accompanied by regression of symptoms, and the hernia (protrusion) may decrease over time.

When making a decision on surgical intervention, comparative indicators of surgical treatment, which are officially established by neurosurgeons, should be taken into account.Each specific case is considered separately, taking into account clinical symptoms, medical history, anamnesis, neurological and orthopedic examinations, equipment and laboratory tests. 

It should be especially noted that surgical intervention is often associated with a number of complications, the resolution of which after surgery is many times more intense than pain relief before surgery.

Degenerative changes of the spine, such as osteochondrosis, spondyloarthrosis, spondylosis, etc., are treated based on the identification of the causes of the pain syndrome. 

Massage and manual therapy are quite effective methods of treatment if there are indications for their use.Over the past three decades, the Institute has developed optimal protocols for the management of patients with low back pain, considering the possible spectrum of causes.