Backache

Back pain and neck pain are among the most common reasons for seeking medical treatment. Pain is usually caused by problems with the musculoskeletal system - most notably with problems in the spine, including the bones of the spine (vertebrae), discs, and the muscles and ligaments that support them. Sometimes back pain is caused by a condition that does not affect the musculoskeletal system.

Low back pain is more common in the older age group, affecting more than half of people over the age of 60. This leads to significant costs in terms of health care payments, disability benefits and missed work hours.

The spine (vertebral column) is made up of vertebrae. There is a disc that absorbs shocks between the vertebrae. The disc has a hard outer layer of fibrocartylaginous tissue and a soft jelly -like inner substance called the core. Each vertebra has two joints behind the disc. These joints are called facet joints. The articular surface of one vertebral body lies on the articular surface of the other beneath it, forming a joint. The joints, and with them the whole spine, are stabilized by ligaments and muscles, namely:

• Two iliopsoas muscles that move on either side of the spine
• Two erectile back muscles that run the entire spine behind him
• Many short paravertebral muscles are located between the vertebrae

The spinal cord is located in the spinal canal. Along the entire spinal cord, through the holes between the spines on both sides, the spinal nerves come out, whose function is to unite all the nerves in the body. The part of the spinal cord near the spinal cord is called the root. Because of the peculiarity of the position of the spinal cord roots, they can be compressed (compression) with spinal cord injury, which causes pain.

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

Kind of back pain

Types of low back pain include local pain, radiating, and consequent pain.

Local painappear in certain areas of the lower back. It is the most common type of back pain. The causes are usually disc injuries, joint arthritis, and, more rarely, muscle tension. The pain can be persistent and painful, or at some point it can be replaced by intermittent acute pain. Sudden pain can appear when trauma is the cause. Local pain may increase or decrease with a change of position. Touching the lower back can be painful. Muscle cramps are possible.

Radiating painIs back pain that spreads to the legs. The pain can be dull or sharp and intense. Usually, it only affects the foot or back of the foot and can extend to the foot or just to the knee. Radiant pain is usually a manifestation of spinal nerve root compression in disorders such as herniated discs, sciatica, osteoarthritis, or spinal stenosis. Coughing, sneezing, straining, or bending with straight legs can be painful. When the spinal cord root is pressed, the pain may be accompanied by weakness in the leg muscles, a tingling sensation, or even loss of sensation. In rare cases, loss of urinary control (urinary incontinence) or loss of bowel movement control (stool incontinence) occurs.

Reflected painfelt in a place other than the actual cause of the pain. For example, some people who have a heart attack feel pain in their left arm. Pain reflected from internal organs in the lower back is usually deep and painful, and its exact localization 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.

The reasons

In most cases, back pain is the result of disease of the spine and surrounding joints, muscles, ligaments and nerve roots of the spine, as well as the intervertebral disc. Often, a specific cause cannot be identified. Any painful spinal disease can cause reflex contraction (spasm) of the muscles around the spine. Cramps can increase pain. Stress can make lower back pain worse, but the mechanism is unclear.

Sometimes, back pain is caused by disorders that do not affect the spine, such as cancer, gynecological conditions (such as premenstrual syndrome), kidney disease (such as kidney stones), urinary tract disease (such as infections of the kidneys, bladder, and prostate). and gastrointestinal tract (e. g. , diverticulitis), as well as diseases of the large arteries located near the spine.

Common Causes

Common causes of back pain include the following:

• Osteoarthritis
• Spinal compression fractures
• The disc is ruptured or herniated
• Spinal stenosis in the lumbar spine
• Spondylolisthesis
• Damage to muscles and ligaments
• Fibromyalgia

Damagecan occur during normal activities (e. g. , lifting heavy objects, exercising, unexpected movements) or as a result of an injury, such as a fall or traffic accident. Usually, imaging studies do not show specific lesions, but doctors suspect that some muscles and / or ligaments are affected.

Osteoarthritis(degenerative arthritis) causes wear of the cartilage between the articular surface and the formation of the spine (osteophytes). The disease is partly caused by tissue wear over many years. With severe degeneration and loss of disc height, osteophytes in the foramen can compress spinal nerve roots. All of these changes can cause lower back pain as well as stiffness.

Spinal compression fracture (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 accompanied by pain in this area than in the lower part of the spine.

The disc is ruptured or herniatedcan cause back pain. The disc is symbolized by a dense outer layer and a soft jelly -like middle part. If the disc experiences constant pressure from the vertebrae above and below (for example, when bending forward, especially when lifting heavy objects), its outer layer can rupture (tear), causing pain.

Spinal stenosis in the lumbar spine- Narrowing of the spinal canal (which crosses the center of the spine and contains the spinal cord and nerve bundles that extend downward from the lower part of the spinal cord) in the lumbar region. This is a common cause of back pain in the elderly. Spinal stenosis also develops in middle age in people whose spinal canals are narrow at 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 vertebrae in the lower part of the spine. One type usually occurs during adolescence or adolescence (often in athletes) and is caused by an injury that breaks part of the spine. If both sides of the vertebra are affected, the vertebra can slide forward over the underlying vertebra. Spondylolisthesis can also occur in the elderly, but mainly as a result of degenerative diseases. With the development of spondylolisthesis in adulthood, the risk of spinal stenosis in the lumbar region increases.

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

Review

The test is usually not prescribed because most back pain is caused by osteoarthritis, sprains, or minor musculoskeletal disorders and heals within 6 weeks. Imaging tests are often required if:

• other reasons are suspected;
• there are warning signs;
• persistent back pain.

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

X-rays of the lower back can only give a picture of the bones. Such images can detect degenerative changes due to osteoarthritis, vertebral fractures, spondylolisthesis, and ankylosing spondylitis. However, magnetic resonance imaging (MRI) or computed tomography (CT) can provide a clear picture of bone and, as is common for MRI, display soft tissue (including discs and some nerves). MRI or CT scans are usually needed when a doctor determines the presence of a disorder that causes some changes in bone structure, as well as soft tissue disease.

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

Prophylaxis

People can reduce their risk of back pain by taking the following steps:

• physical training;
• exercises to strengthen and stretch muscles;
• maintain a normal weight;
• maintain proper posture;
• compliance with recommendations for safe weight lifting.

The most effective method of preventing back pain is to exercise regularly. Aerobic exercise and special exercises for strength development and muscle stretching are recommended.

Aerobic exercise, such as swimming and walking, improves overall fitness and strengthens muscles.

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

Strength building exercises include pelvic tilt and abdominal pain. Stretching exercises include stretching by bending the knees to the chest. In some people, stretching exercises can cause increased back pain, so caution must be exercised. The basic rule is that any exercise that causes or worsens back pain must be stopped. Exercises should be repeated until mild (but not extreme) muscle fatigue is felt. Breathing is important during exercise. People with back pain should see a doctor before exercising.

Sloping pelvis Take a supine position with knees bent, heels on the floor, fit on the heels. Press your buttocks to the floor, tighten your stickers (lift them about half an inch off the floor) and tighten your abdominal muscles. Hold this position by a count of 10. Repeat 20 times.
Lying Lie down while sleeping with your knees bent and your feet flat on the floor. Fold the arms over the chest. Tighten your abdominal muscles, slowly lift your shoulders about 10 inches off the floor, keep your head straight (your chin should not touch your chest). Relax your abdominal muscles, slowly lower your shoulders. Do 3 sets of 10 repetitions.
Stretch with knees to chest Take a supine position, straighten. Place both palms under one knee and press to your chest. Hold the position for a count of 10. Slowly lower your leg and repeat the exercise on the other leg. Do the exercise 10 times.

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

Proper posture while standing and sitting reduces pressure on the back. Burping should be avoided. The chair seat should be adjusted in height so that the feet are flat on the floor, the knees are slightly bent, and the lower back is hooked behind the chair. If the chair does not provide support for the lower back, a pillow can be placed under it. In a sitting position, it is recommended to place your feet on the floor, not across your feet. Sick people cannot stand or sit for long periods of time. If you have to stand or sit for a long time, frequent position changes can reduce tension in the back.

Treatment

If it is possible to determine a specific cause, the disease is treated. For example, antibiotics are used to treat prostate infections. However, there is no cure for sprained 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 pressing on the spinal cord roots.

Common measures for back pain

Possible steps include:

• Make activity changes
• Taking painkillers
• Apply hot or cold to the painful area
• Light exercise, if acceptable

For newer back pain, treatment begins by eliminating activities that stretch the back and cause pain, such as weight lifting and bending. Bed rest does not speed up pain relief, and most professionals recommend doing light work. Bed rest, which is necessary to relieve severe pain, should not last more than 1 or 2 days. Prolonged bed rest weakens core muscles and increases stiffness, resulting in more severe back pain and slower recovery. Corsets and traction are ineffective. Attraction can delay healing.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can treat and reduce inflammation. Opioid analgesics are sometimes prescribed if NSAIDs do not provide adequate pain, but can only be used for a short time, as long-term use of opioid analgesics can, in turn, increase sensitivity to pain, cause side effects, and increase the risk of addiction and dependence. .

Muscle relaxation can sometimes relieve muscle spasms, but its effectiveness is questionable. This medication is not recommended for elderly patients who are more likely to experience side effects such as drowsiness and disorientation. Doctors try not to prescribe muscle relaxants if the patient does not experience visible and palpable muscle cramps. If muscle relaxants are prescribed, they should not be used for more than 72 hours. Doctors sometimes recommend taking it before bed.

Massage can provide some relief from lower back pain. Several studies have shown positive results in acupuncture; others contradict this finding. Manipulation of the spine by a chiropractor or other doctor (such as an osteopath), combined with an exercise program, can also relieve pain. However, spinal manipulation can increase the risk of additional injury and should be avoided in individuals with arthritis, neck problems that cause cervical instability, or herniated discs.

It is recommended to sleep comfortably on a modest mattress. People who sleep on their backs should have pillows under their knees. The patient sleeping next to him should use a pillow that allows his head to be kept in a neutral position (without bending the neck up or down). The patient should place a second pillow between the knees, with the knees and hips slightly bent, if this relieves lower back pain. The patient can still sleep on his stomach if he feels comfortable.

Continue or start taking other preventative measures (correct posture, proper weight lifting techniques). While doing such incidents, back pain attacks mostly disappear in a few days to 2 weeks. Regardless of treatment, 80 to 90% of these attacks can be resolved within 6 weeks.

Treatment of chronic lower back pain

Additional measures are needed to treat chronic back pain. Aerobic exercise is recommended, and weight loss is recommended if necessary. If analgesics are not effective, other treatments should be prescribed.

Transcutaneous electroneurostimulation (TENS) is possible. The CHENS device produces a weak alternating current that causes a slight 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 ranging from 20 minutes to several hours, depending on the severity of the pain.

Sometimes corticosteroids with a local anesthetic are injected periodically into the spinal joint 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 caused by a herniated disc than lumbar spine 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 to relieve long -term pain.

Back pain surgery

In cases where the herniated disc causes persistent or chronic sciatica, weakness, loss of sensitivity or discontinuity of stool and urine, it may be necessary to remove the protruding part of the disc (dysectomy) and, in some cases, the vertebral part (laminectomy).

In severe spinal stenosis, a large portion of the posterior vertebra (lamellae of the vertebral arch) can be removed to expand it (lumbar laminectomy). General anesthesia is usually required. The length of stay in the hospital is usually 4 to 5 days. The patient will be able to return to normal activities in 3-4 months. Adequate or complete recovery was observed in about two-thirds of patients. For the rest of the patients, surgery like this can prevent pain and worsen other symptoms.

If the spine is unstable (which can be caused by a severe herniated disc, spondylolisthesis, or laminectomy for spinal stenosis), surgery can be performed to unite the vertebrae (called lumbar vertebral arthrodesis). However, smelting restricts movement, can be accompanied by excessive mechanical stress on other parts of the spine, and cause problems in the future.

Spinal compression fractures

Spinal compression fractures are common in women over 50 years of age. They can be treated conservatively without surgery, with dental braces, painkillers, and perhaps a nasal spray of calcitonin, which will not help bone healing but can reduce pain.

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

• 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.

However, recent studies show that in the long run, the effectiveness of these surgical procedures does not exceed the effectiveness of non -surgical treatment options.

Main topic

• Low back pain is common. It is usually caused by musculoskeletal spine disorders and factors such as fatigue, obesity and inadequate physical activity.
• Low back pain is rare at a young age and testing is usually not needed unless symptoms persist for several weeks.
• Patients with warning signs or patients over 55 years of age should see a physician immediately.
• Strengthening the muscles of the abdominal and back wall with certain exercises helps prevent the most common types of back pain.
• For back pain, most often, adequate treatment is by excluding measures that lead to mechanical impact on the back, taking painkillers, and, in some cases, using cold or warm compresses.
• Prolonged bed rest and stretching can slow recovery.
• In severe cases, such as abnormal sensations and weakness in the legs, surgery may be needed.
• Vertebral compression fractures can be treated conservatively (with braces, painkillers and nasal sprays) or, in some cases, more aggressively with surgery.