Almost everyone is familiar with back pain. Such ailments, such as sciatica, lumbago, – very frequent causes of temporary disability, especially among people engaged in physical labor. Most often, back pain is associated with changes in the lumbosacral spine, which should be taken very seriously. Although painful sensations in the lumbar region can be the result of congenital anomalies of the spine and its ligaments, acute and chronic infection, intoxication or even a tumor.
Back pain sometimes are unbearable, and sometimes a person suffers them quite easily. The fact is that the reactions to pain are individual, affect mental and age factors. In old age, pain when radiculitis is very strong, although usually the perception of pain in elderly people is weakened. And in patients with mental illness, the sensitivity to pain is significantly reduced, including with sciatica.
Pain is a complex adaptive mechanism; it is sometimes called the “watchdog” of health. Caused by an external influence or malfunction in the body itself, it signals danger. After receiving a pain signal, the body includes mechanisms to protect against adverse effects. Due to pain, a number of pathological processes reveal themselves before any external symptoms of the disease occur. So pain plays a positive role: they let you know that it is time to act. If you have pain in the lower back and sacrum, do not delay the treatment to the doctor. Remember Eastern wisdom: “Treat a mild disease, so that you do not have to treat a severe one.”
In one third of patients, lumbar pains are caused by dystrophic changes in the spine, which are collectively called osteochondrosis. Osteochondrosis is a complex of changes in the bones and ligaments of the spine caused by degeneration of intervertebral discs. In addition, osteochondrosis in the spine can form bone outgrowths – osteophytes, which irritate the nerve roots and sensory nerve endings of the spine and its ligaments, causing dull aching back pain.
Intervertebral discs are biconvex lenses, in shape corresponding to small depressions on the surface of the vertebrae. With age, discs lose moisture, dry out, cracks, tears and cracks appear in them. As a result, the vertebra becomes mobile and can slide off the disk, which will lead to a narrowing of the intervertebral foramen and squeezing of the spinal nerve root passing here. The vertebrae of the lumbar spine are the most mobile and at the same time they experience the maximum load when lifting weights. Therefore, the disks between them are most susceptible to deformation.
Sufferers of lumbar osteochondrosis experience severe pain, and the cause is not only mechanical irritation of the nerve roots: when the membranes and partitions of the intervertebral disc are ruptured, substances that irritate the pain receptors are released.
At a later stage of the disease, the discs bulge out, forming the so-called intervertebral hernia, which usually occurs in people of middle and old age. The discs of the lumbar spine are most often affected, since the intervertebral holes between the IV and V lumbar vertebrae and between the V lumbar vertebra and the sacrum are the narrowest, and the nerve roots passing through them are the most massive. Intervertebral hernia is very dangerous. And it’s not just that it pinches the nerve roots, causing pain of the type of lumbosacral sciatica. Massive hernia of the disk puts pressure on the spinal cord, which can lead to loss of sensitivity or even paralysis of the legs, as well as disturbed urination.
The following symptoms are characteristic of a hernia of the lumbar disc: “spreaders” – when the patient is getting up, he has to rest his hands on his knee or chair in order to reduce the load on the affected disc; “pillows” – the inability to lie on the stomach without placing a pillow under it; “landing” – the patient, trying to lift something from the floor, does not bend, but squats on a haunches.
One of the main causes of spinal osteochondrosis is a violation of fat and salt metabolism. Sometimes osteochondrosis occurs as a result of the anomaly of the development of intervertebral discs, their innate inferiority. External factors provoking the development and exacerbations of lumbar osteochondrosis include: high humidity, sharp temperature fluctuations, drafts; significant and prolonged tension of the muscles and bone and ligament apparatus of the lumbosacral spine; his mechanical injuries and chronic infections.
The most common diagnosis for severe back pain is sciatica. For a long time it was believed that this disease has an infectious origin. However, practice shows that patients usually do not increase body temperature, do not increase the number of leukocytes in the blood and cerebrospinal fluid. Sciatica almost not get sick children. It means that in most cases the infection is unlikely to be the cause of radiculitis.
Indeed, sciatica is one of the most common manifestations of osteochondrosis. Pain in the lumbosacral region in this disease can be both acute and dull. It is usually one-sided, giving to the buttock, the posterior surface of the thigh and the outer surface of the lower leg. Pain with radiculitis may increase with a change in body position, walking, coughing, sneezing, straining . Sometimes it is combined with sensations of numbness, tingling, crawling, chills, itching. Sensitivity of skin increases, muscles of a waist, buttocks, shin are painful.
Symptoms of sciatica are quite pronounced. At the patient gait, a bearing change, there are characteristic movements and poses. When walking, he tilts his torso forward and in the direction of a healthy leg. In the standing position, the sore leg is half bent, which reduces the tension of the nerve trunks. Body movements in the lumbar spine are limited. On the sore side, the back muscles are tense. When radiculitis is often a curved spine. The patient sits on a healthy buttock, tilting the body back with an inclination in the direction of a healthy leg. If he needs to lift an object from the floor, he crouches down or tilts his torso forward, while bending the sore leg. When lying down, the sore leg is usually half bent.
Mild forms of sciatica practically do not limit the patient in motion. If the disease progresses, muscle tone decreases, muscle weakness appears, patients are disturbed by itching, feeling of “crawling goosebumps”. Lying in bed, the sufferers for hours can not find a comfortable position. Often they feel cold, dry, or, conversely, moisture feet. The skin on the feet fades or acquires a bluish tint and becomes thinner. But when these symptoms appear, you should not make a hasty diagnosis of radiculitis. A similar picture is given by panniclosis – inflammation of the subcutaneous fat on the basis of metabolic disorders in adipose tissue, as well as lesions of the leg joints.
In addition to recurrent sciatica, an acute form of lumbar spine disease, such as lumbago, or backache, is very common. When lumbago nerve roots are irritated and there is a sharp severe pain. It most often occurs in people engaged in heavy physical labor, as a result of lumbar muscle overstrain, and often during hypothermia. But sometimes lumbago attack can cause acute and chronic infections, it can also be one of the manifestations of sciatica. The pain usually stops after a few days, but sometimes lasts two to three weeks. Until the attack does not let go, the patient is better to comply with bed rest.
A special form of lumbago develops when, after severe physical exertion, muscle strains, tendons, or hemorrhage into muscles occur. This type of lumbago shows sore back along the entire length of the spine and a feeling of general muscular fatigue.
It should be especially emphasized: if you have a low backache, this does not mean that the spine is affected. The cause of lumbar pain may be myositis (inflammatory process) of the lumbar muscles. The disease lasts a long time. Muscle pain is not as strong as with lumbago, but dull, aching. In this case, the muscles are sealed, painful with feeling and stretching. In patients with chronic infections and metabolic disorders, lumbar muscle myositis may be associated with joint pain.
Back pains are so severe that they cannot do without treatment. Regardless of the cause that caused the attack, in the first days you need to stay in bed. In the following days, as the pain calms down, the patient is allowed to walk, and at first it is desirable on crutches to relieve the spine. The bed should be hard – a thin mattress, laid on a wooden shield.
Local heating in the most painful area used irritating ointment: finalgon, kapsin, Nikofleks, tiger ointment, cream “Chaga”, as well as mustard or pepper patch. They bring relief from a warm woolen shawl, an electric heater, a bag of heated sand, leeches. Well helps rubbing such anti-inflammatory and painkillers such as indomethacin , ortofenovaya , voltarenova and other ointments. Relieving pain is irrigation of the lower back with ethyl chloride. With myositis help hot compresses.
Electrical procedures have a pain relief effect : transcutaneous electroanalgesia , sinusoidal modulated currents, diadynamic currents, novocaine electrophoresis and others. For the same purpose, reflexology (acupuncture, cauterization, electroacupuncture , laser therapy) and novocainic blockades are used. In radiculitis caused by intervertebral disc displacement, traction therapy is used — stretching the body on the bed or under water. These procedures should be carried out in a hospital. Balneotherapy is effective – sodium chloride, radon, sulfide, turpentine, bromine baths, naphthalan , low temperature mud baths .
One of the actively developing types of treatment for back pain has become the “biofeedback” method. His principle was based on the outstanding domestic physiologist PK Anokhin back in the 1930s. The method involves learning how to control the functions of your body. Here is how it is used to treat back pain.The patient is tasked with maximally relaxing the back muscles. The patient sees his own electromyogram , which reflects the tension of the muscles, on the monitor screen and, when they tense strongly, he hears a beep. When relaxing, the amplitude of the electromyogram decreases, the sound disappears. As a result, the patient is motivated to reduce the pathological muscle tension. As a rule, the results are not achieved immediately. In order for the patient to learn to relax and control the muscle tone, you need to spend five or six sessions. In the future, patients are able to control the relaxation of the back muscles independently.
Equally important for the elimination of pain and the prevention of seizures is the wearing of external supporting devices — orthoses : a corset, a semi- corset , a posture corrector; reklinator (special corset, eliminating the slope), bandage, as well as belts: corset, anti- radiculitis , elastic, weightlifter belt or installer. All of them prevent spinal deformity, improve venous and lymphatic outflow, and give a slender figure. Well, if the composition of the material from which the belt is made, includes wool.
It should only be borne in mind that if you do not follow the medical recommendations, then regular wearing of orthoses can also cause harm. First, wear them over lingerie to avoid scuffing. Too tight tightening of the orthoses makes breathing, digestion and blood circulation in the lower half of the body difficult. If you do not part with them either day or night, the muscles of the lumbar spine can atrophy. Orthoses are useful for prolonged sitting at a table, intense physical exertion, and riding in public transport. The rest of the time it is better to do without them – the muscles should work. The ideal remedy for back pain has been and remains physical therapy exercises. Own muscular “corset” makes artificial “supports” for the spine unnecessary.
Sometimes, in order to relieve a painful attack, patients have to resort to receiving anti-inflammatory and analgesics. With very strong pain, they are more effective in the form of intramuscular injections. Usually prescribed analgesics (analgin, baralgin, sedalgin , spazgan ) and nonsteroidal anti-inflammatory drugs (ibuprofen, ortofen , diclofenac, voltaren ). It should be noted that indomethacin , donalgin , nise and piroxicam are poorly combined with certain drugs (antihypertensives, diuretics, etc.). Anti-inflammatory nonsteroidal drugs also should not be abused. Contraindications to their use are peptic ulcer and 12 duodenal ulcers in the acute phase, pronounced disorders of the liver. To avoid complications, you need to take only one medication in short courses of 5-7 days, after selecting it, taking into account the individual characteristics of the organism.
In old age (over 65 years) with hypertension, heart failure NOSTA or peptic ulcer drugs nonsteroidal better to replace the so-called cyclooxygenase-2 inhibitors such as celecoxib or Celebrex, rofecoxib or Vioxx, meloxicam or movalis, Melox, nimesulide or nimesil, Mesulid. These medicines practically do not irritate the gastrointestinal tract and do not have other side effects. Not bad to hold a course of injections of vitamins, especially group B.
But in any case, painkillers and anti-inflammatory drugs relieve only the symptoms of the disease, without eliminating its cause. The so-called disease – modifying , basic or slow-acting drugs: glucosamine sulfate (Don) in powders and ampoules and chondroitin sulfate ( Strumatum ) in capsules can improve the functional state of the spine . There are also preparations that combine these two components in a single dosage form: “ Chondro ” and “ Artra ”. These drugs are natural polysaccharides, which are mainly found in cartilage tissue. Due to the viscosity, they play the role of lubrication of the articular surfaces, as well as participate in the synthesis of new bone and cartilage tissue. Therefore, preparations of these polysaccharides slow down the process of destruction of cartilage tissue, that is, prevent the development of osteochondrosis.
Usually, drug treatment relieves pain. But sometimes, with a herniated disc, intense pain persists after prolonged treatment. Then you have to remove the hernia surgically.
When the acute period of the disease has passed, doctors usually prescribe a massage, physical therapy or manual therapy. Patients are recommended sanatorium-resort treatment in sanatoriums for patients with diseases of the organs of movement and the peripheral nervous system.
In conclusion, I would like to emphasize once again that the causes of lumbosacral pain are very different. The pathological processes causing these pains may lie, as in the lumbosacral region itself (spine, muscular-ligamentous apparatus, nerve roots, nerve nodes), and beyond. The famous Russian neurologist V.K. Khoroshko wrote: “At least the entire lower half of the human body is interested in the development of lumbar pain.” Sometimes pains occur in certain diseases of the central nervous system, circulatory disorders in the abdominal aorta, diseases of the abdominal organs and small pelvis, and neuroses. It is not only frivolous, but also dangerous to explain back pain with radiculitis, without confirming the diagnosis with examinations. Diagnostics often causes difficulty even among doctors and requires a number of additional studies, including the most complex modern ones, which have been applied in the past two decades: computed tomography, positron emission tomography, nuclear magnetic resonance, ultrasound examination. Therefore, before you begin treatment, by all means consult with a neurologist.
The illustration “Five vertebrae make up the lumbar spine.”.
Five vertebrae make up the lumbar spine. The vertebrae, formed by bone tissue, are separated by soft pads – discs that absorb the vertebrae during movement. The spinal cord passes through a canal formed by vertebral plates. Nerves or roots go through the holes on both sides of the lumbar spine.