Low back and neck pain is one of the most common reasons for seeking medical help. Pain is usually caused by problems with the musculoskeletal system - most pronounced in problems with 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 older age groups and affects 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 working hours.
The spine (spinal column) consists of vertebrae. Between the vertebrae are discs that absorb shocks. The discs have a firm outer layer of fibrocartilage tissue and a soft, jelly-like inner substance called the nucleus. Each vertebra has two joints behind the discs. These joints are called facet joints. The articular surfaces of one vertebral body lie on the articular surfaces of the other below it, forming a joint. The joints, and with them the whole spine, are stabilized by ligaments and muscles, as follows:
- Two iliopsoas muscles extending on either side of the spine
- Two dorsal muscles of the erector 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. Along the entire length of the spinal cord through the holes between the vertebrae on both sides come the spinal nerves whose function is to unite all the nerves in the body. The part of the spinal nerve near the spinal cord is called the root. Due to the peculiar position of the roots of the spinal nerves, they can be compressed (compressed) by spinal injuries, which leads to pain.
The lower spine (lumbar spine) at the top connects with the upper spine (thoracic spine) and below the pelvis through the sacrum. The lumbar spine is flexible enough to bend, twist and bend and provides strength while 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 repercussion pain.
Local painoccurs in a specific area of the lower back. It is the most common type of back pain. The cause is usually a disc injury, arthritis of the joint and, less commonly, muscle strain. The pain may be continuous and excruciating, or it may be replaced at some point by occasional acute pain. Sudden pain can occur when the cause is trauma. Local pain may increase or decrease by changing position. Touching the lower back can be painful. Muscle cramps are possible.
Radiating painIs a pain in the lower back that spreads to the leg. The pain may be dull or sharp and intense. It typically affects only the side or back of the leg and can extend to the foot or just 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 your upright legs can be painful. When the root of the spinal nerve is compressed, the pain can be accompanied by weakness of the leg muscles, tingling or even loss of sensation. In rare cases, there is a loss of control of urination (urinary incontinence) or loss of control over bowel movements (fecal incontinence).
Reflected painfelt in a place that is not the actual cause of the pain. For example, some people with a heart attack feel pain in their left arm. The reflected pain of the internal organs in the lower part of the back is mostly deep and painful in nature, and its exact localization is difficult to determine. As a rule, pain does not increase with movement, unlike pain that accompanies disorders of the musculoskeletal system.
Reasons
In most cases, back pain is a consequence of diseases of the spine and surrounding joints, muscles, ligaments and roots of the spinal nerves, as well as intervertebral discs. Often one specific cause cannot be identified. Any painful disease of the spine can lead to reflex contraction (spasm) of the muscles around the spine. Spasm can intensify the pain. Stress may worsen lower back pain, but the mechanism is unclear.
Sometimes back pain is caused by a disorder that does not affect the spine, such as cancer, gynecological conditions (such as premenstrual syndrome), kidney disease (such as kidney stones), urinary tract disease (such as kidney, bladder and prostate infections) and the digestive tract. 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
- Cracked or herniated disc
- Spinal stenosis in the lumbar spine
- Spondylolisthesis
- Muscle and ligament damage
- Fibromyalgia
Too badit can occur during normal activities (for example, lifting heavy objects, exercising, unexpected movement) or as a result of injuries, such as a fall or a car accident. Typically, imaging studies do not show any specific lesions, but physicians suspect that some muscles and / or ligaments are affected.
Osteoarthritis(degenerative arthritis) causes cartilage to wear between the joint surfaces and the formation of bone spines (osteophytes). This disease is partly the result of years of tissue wear. With severe degeneration and loss of disc height, osteophytes in the foramen can compress the roots of the spinal nerves. All of these changes can lead to lower back pain as well as stiffness.
Compression fractures of the spine (due to compression)(vertebral fractures) often occur when bone density decreases due to osteoporosis, which usually develops with age. However, fractures due to osteoporosis usually occur in the upper and middle part of the back and are accompanied by pain in those regions, and not in the lower part of the spine.
Cracked or herniated disccan cause back pain. The disc is represented by a thick outer layer and a soft jelly-like central part. If the disc is under constant strain on the vertebrae above and below (for example, when bending forward, especially when lifting heavy objects), its outer layer may rupture, 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 from the lower part of the spinal cord down) in the lumbar region. It is a common cause of low back pain in the elderly. 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 movement 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 spine can slide forward over the underlying vertebra. Spondylolisthesis can also occur in the elderly, but mainly as a result of degenerative disease. The development of spondylolisthesis in adulthood increases the risk of spinal stenosis in the lumbar region.
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 muscles and other soft tissues outside the lower back. Fibromyalgia is also characterized by sleep disorders and fatigue.
Polls
Tests are not usually prescribed because most back pain is caused by osteoarthritis, sprains or other minor musculoskeletal disorders and goes through 6 weeks. Image tests are often required if:
- another reason is suspected;
- there are warning signs;
- back pain still persists.
An assessment 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 a picture of the bones. 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) can provide a clear picture of the bone and, as is typical for 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 diseases.
If spinal cord compression is suspected, MRI should be performed as soon as possible. In rare cases, when MRI results are ambiguous, it becomes necessary to perform 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 nerve conduction studies are performed to confirm the presence, location, and, in some cases, duration and severity of spinal nerve root compression.
Prophylaxis
People can reduce their risk of developing low back pain by taking the following measures:
- physical exercises;
- muscle strengthening and stretching exercises;
- maintaining a normal body weight;
- maintaining proper posture;
- adherence to safe weight lifting recommendations.
The most effective way to prevent low back pain is to exercise regularly. Aerobic exercises and special exercises for developing muscle strength and stretching are recommended.
Aerobic exercises, such as swimming and walking, improve overall fitness and strengthen muscles.
Special exercises to develop muscle strength and stretch the muscles of the abdominal wall, buttocks and back (deep torso muscles), 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 and abdominal tilts. Stretching exercises include stretching by bending the knees in the chest. In some people, stretching exercises can lead to increased back pain, so care must be taken. 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 necessary during exercise. People with back pain should consult a doctor before exercising.
The pelvis tilts Take a lying position with bent knees, heels on the floor, load on the heels. Press your back to the floor, tense your gluteus (lift them about half an inch from the floor) and tense your abdominal muscles. Hold this position by counting 10. Repeat 20 times. |
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Liar belly Lie on your knees with your knees bent and your feet on the floor. Cross your arms over your chest. Tighten your abdominal muscles, slowly lift your shoulders about 10 inches off the floor, keeping your head upright (your chin should not touch your chest). Relax your abdominal muscles, slowly lower your shoulders. Do 3 sets of 10 reps each. |
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He stretches his knees to his chest Take a lying position, straighten up. Place both palms under one knee and press it to your chest. Hold the position by counting 10. Slowly lower your leg and repeat the exercise on the other leg. Do the exercise 10 times. |
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Exercise also makes it easier to maintain your desired weight. Exercise also helps maintain bone density. Therefore, exercise can reduce the risk of developing two conditions that can cause low back pain: obesity and osteoporosis.
Proper posture while standing and sitting reduces stress on the back. Mess should be avoided. The seat of the chair should be adjusted in height so that the feet are placed on the floor, the knees are slightly bent, and the lower back is glued to the back of the chair. If the chair does not support the lower back, a pillow can be placed under it. In a sitting position, it is recommended to place your feet on the floor and not cross your legs. People who are sick should not stand or sit for long periods of time. 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 sprains in the musculoskeletal system or pain caused by other conditions. However, the situation can be improved by general measures. Typically, such measures are also used when the spinal nerve root is compressed.
General measures for back pain
Possible measures include:
- Making changes to activities
- Taking painkillers
- Applying heat or cold to the painful area
- Light exercise, if tolerated
For newer back pain, treatment begins by removing activities that strain the back and cause pain, such as lifting weights and bending. Rest in bed does not speed up pain relief, and most experts recommend light work. Bed rest, necessary to relieve severe pain, should not last longer than 1 or 2 days. Prolonged bed rest weakens the core muscles and increases stiffness, which leads to worsening of back pain and slower recovery. Corsets and traction are ineffective. Traction can slow healing.
Nonsteroidal anti-inflammatory drugs sold over-the-counter or by prescription can relieve pain and reduce inflammation. Opioid analgesics are sometimes prescribed if NSAIDs do not provide sufficient pain relief, but should only be used for a short time, as long-term use of opioid analgesics may, conversely, increase pain sensitivity, cause side effects, and increase the risk of addiction.
Muscle relaxants can sometimes relieve muscle cramps, but their effectiveness is questionable. These drugs 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 cramps. If muscle relaxants are prescribed, they should not be used for more than 72 hours. Doctors sometimes recommend taking it just before bed.
Massage can provide some temporary relief from lower back pain. Some studies have shown positive results in acupuncture, while others have contradicted these findings. Spinal manipulation by a chiropractor or other physician (such as an osteopath), combined with an exercise program, can also relieve pain. However, manipulation of the spine can increase the risk of additional injuries and should be avoided in people with inflammatory arthritis, neck problems that cause cervical instability, or disc herniations.
It is recommended to sleep in a comfortable position on a medium firm mattress. People who sleep on their backs should have a pillow below their knees. Patients sleeping on their side should use a pillow that allows them to keep their head in a neutral position (without bending the neck up or down). Patients should place a second pillow between the knees, with the knees and hips slightly bent, if this relieves lower back pain. Patients can still sleep on their stomachs if they feel comfortable.
Continue or start with other preventative measures (proper posture, proper weight lifting technique). When performing such events, attacks of back pain usually disappear in a period of a few days to 2 weeks. Regardless of treatment, 80 to 90% of these attacks go away within 6 weeks.
Treatment of chronic low back pain
Additional measures are needed to treat chronic low back pain. Aerobic exercise is recommended, and weight loss is recommended if necessary. If analgesics are ineffective, other treatments should be prescribed.
Transcutaneous electroneurostimulation (TENS) is possible. CHENS devices generate weak alternating current that causes slight tingling. This current can block the transmission of some sensations of pain 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 is from 20 minutes to several hours, depending on the severity of the pain.
Sometimes corticosteroids with a local anesthetic are occasionally injected into the facet 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 due to a herniated disc rather 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 you can exercise for long-term pain relief.
Back pain surgery
In cases where a herniated disc leads to permanent 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 the spine (laminectomy).
In severe spinal stenosis, a large part of the posterior vertebrae (lamellae of the vertebral arch) can be removed to expand (lumbar laminectomy). General anesthesia is usually required. The length of hospital stay is usually 4 to 5 days. Patients will be able to return to normal activities in 3-4 months. Adequate or complete recovery 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 may be due to a severe disc herniation, spondylolisthesis, or laminectomy due to spinal stenosis), vertebral fusion surgery (called lumbar vertebral arthrodesis) may be performed. However, fusion limits mobility, can be accompanied by excessive mechanical stress on the rest of the spine and create problems in the future.
Compression fractures of the spine
Compression fractures of the spine are quite common in women older than 50 years. They can be treated conservatively without surgery, using a painkiller and possibly a calcitonin nasal spray, which will not help bone healing, but can reduce pain.
If sufficient pain control cannot be achieved, two surgical options are available:
- Vertebroplasty: injection of cement mortar into a broken bone.
- Kyphoplasty: Insertion of a balloon into a broken bone to create space. The balloon is then filled with cement.
However, recent studies have shown that the long-term effectiveness of these surgical procedures does not exceed the effectiveness of non-surgical treatment options.
Key points
- Low back pain is common. It is usually caused by musculoskeletal disorders of the spine and factors such as fatigue, obesity and insufficient physical activity.
- Low back pain is rarely severe at a young age, and testing is usually unnecessary unless symptoms persist for many weeks.
- Patients with warning signs or patients older than 55 should see a doctor immediately.
- Strengthening the muscles of the abdominal wall and back with specific exercises helps prevent the most common types of low back pain.
- In the case of back pain, treatment is usually sufficient by excluding measures that lead to mechanical effects on the back, taking painkillers and, in some cases, applying a cold or warm compress.
- Prolonged bed rest and stretching can slow recovery.
- In severe cases, such as abnormal sensations and leg weakness, surgery may be needed.
- Compression fractures of the spine can be treated conservatively (with locks, painkillers and nasal spray) or, in some cases, more aggressively with surgery.