Low back pain treatment

Low back pain is just a symptom, an external manifestation of some 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 overloading muscles and ligaments.Unfortunately, if the cause were only in the muscles, it would be very easy to relieve the pain.For example, a massage that should provide relief.But massage does not always help because it eliminates the cause of the pain.

Acute back pain can occur due to a herniated disc or bulging disc.If the herniated disc is on the right side, you may experience right-sided back pain, right-sided pain, or right leg pain (sciatica with a large herniation).If the hernia is on the left side, you may feel pain in your back on the left side and be bothered by pain on the left side. 

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

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

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

Cholecystitis and cholelithiasis most often cause pain in the right back and pain under the right shoulder blade.Gallbladder pathology often manifests itself as pain under the right rib.Needs diagnosis.

Bumpsdiscs, are more often incidental findings on MRI, whichcanproceed without any pain.herniated disc– is not such a common cause of severe back pain.Although, the formation of a hernia, for example, when lifting heavy objects, does cause lumbar or thoracic lumbago (acute pain in the back).In the case of constant back pain, the hernia detected on the MRI may have nothing to do with it.The reasons for such constant pain are usually different. Diagnostics will help you figure it out.

Therefore, to effectively treat back and lumbar pain, it is necessary:

1. Determine the cause of low back pain (establish a diagnosis).
2. The cause of low back pain will be determined by a neurologist, an orthopedic traumatologist with skills in the field of vertebrology and vertebroneurology, or a vertebrologist (vertebroneurologist).The diagnosis is established by clinical and hardware examination.
3. Treatment tactics for low back pain depending on the diagnosed cause.
4. If you have lower back pain, it is important to make sure the pain does not return.To achieve this, we offer several methods, including physical rehabilitation of the spine.

Lumbar pain.Why does my lower back hurt?

Low back pain refers to pain that is located in the area between the twelfth pair of ribs and the gluteal folds.Pain of this type is already a social problem.The fact is that the lumbar area is the most loaded part of the spine, which supports daily and hourly overloads.85% of people have experienced pain in the lower back region at least once in their lives.What is the reason?

Pain in the lumbar region.It can have many reasons.The most common causes are osteochondrosis, herniated disc, radiculitis and pathology of the lumbar joints.

osteochondrosis

osteochondrosis–natural aging of spinal tissue.

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

The following image shows a normal disk becoming corrupted (see the corrupted disk in the image).These damages can accelerate the aging of the disc and it loses its height (see “narrowing of the intervertebral space”).Then, aging begins to affect the bone tissue of the vertebrae and osteophytes grow (see “osteophytes” in the image).

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

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

herniated disc

Herniated disc 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 (it is not innervated).Pain from a herniated or bulging disc occurs when the protrusion of the hernia puts pressure on the innervated tissue.For example, inbackboneor inrearyuyulongitudinalWowpackagesin.In the first case, radicular pain occurs - radiculitis (see below).In the second, when the receptors of the posterior longitudinal ligament are irritated, back pain (lumbodynia) or acute pain appears - lumbago (lumbago).

A herniated disc can often be treated without surgery.

spondyloarthrosis

Spondylarthrosis is osteoarthritis of the joints of the spine.Osteoarthritis itself is characterized by a disease of the cartilage of the joints.In this case, the cartilage decreases in height (degenerates, “dries out”) and the articular surfaces of the bone lose their protective cartilage layer.The joints of the spine begin to hurt.This pain feels like lower back pain.

radiculitis

Radiculitis is an inflammation of the root.Radiculitis most commonly occurs when the root is injured by a herniated disc or spinal joints.Usually, it is not so much lower back pain as pain in the leg, buttock, and pain or numbness even in the toes.

Radiculitis is most effectively treated by freeing the root.If it arose due to a herniated disc, it is necessary to reduce the herniation, which puts pressure on the root.

Pain in the back and lumbar area due to pathology of internal organs.

Back pain is possible due to pathology of internal organs.For example,lower back pain in womenIt may be a consequence of diseases of the pelvic organs.

Low back pain in women.

Low 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, she should always remember about gynecology.Inflammatory diseases of the female genital organs are not uncommon.The cause may be inflammation of the appendages, inflammatory diseases of the vagina and vulva, salpingitis, salpingo-oophoritis, endometritis, bacterial vaginitis, etc.More often, these 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 the woman should be examined by a gynecologist.It is imperative to undergo a gynecological ultrasound to initially clarify the diagnosis.

Constant, persistent pain in the lower back also occurs whenoncology in gynecology.

Cancer and low back pain in women

Cancer doesn't hurt at first.When pain appears in the lumbar or sacral area, it may already be too late.

Many people think that tumors are accompanied by pain.This is wrong.In the initial stages of tumor development, a person does not feel pain.The person feels practically healthy.For example, cervical cancer is asymptomatic in the genital organs.It begins to manifest when the tumor grows.In this case, the pain usually appears in the lower back and below the lower back.The pain under the lower back is located in the sacral area.

In the case of cancer, severe pain in the lower back does not bother you at first.Rather, the lower back does not hurt, but hurts.This pain can be the first call that will help a woman prevent critical growth of the tumor and make the correct diagnosis in a timely manner.If the lower back or sacrum hurts constantly, you should pay special attention to it so as not to miss a catastrophe.

Unfortunately, if pain or discomfort in the lower back is not paid attention to, the next sign of cervical cancer may be uterine bleeding.This is the stage in which the tumor begins to disintegrate, when metastases may already occur.Even in the spine, when there is already intense pain in the lumbar area.

Important conclusion:If your lower back hurts, it is not necessarily osteochondrosis or herniated disc.And it never hurts to have a preventive consultation with a gynecologist.After all, cervical erosion detected during examination is a precancerous condition.

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

Acute low back pain may be due to kidney disease

The lower back hurts a lot with kidney disease such as pyelonephritis.

Pyelonephritis is an infectious disease, most often caused by ascending infection.It can be related to both sexually transmitted infections and other types of household infections transmitted through swimming pools, baths, and personal hygiene items.For example, everything lives for a long time on dirty towels.

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

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

With intestinal spasms, with bloating, with ulcers or ulcerative colitis, with stomach ulcers and gastritis, the back often hurts.

Stomach cancer associated with back pain

Back treatment for pain caused by gastrointestinal tract pathology will not improve.It is necessary to treat the cause.

Another possible cause of low back pain is back overload.

Excessive load on the lower back is a common cause of back pain or its exacerbation.Overload often affects the lower back joints, ligaments, tendons or lower back muscles.In addition, the muscles of the lower back work actively under load.Therefore, if you have pain in the lumbar spine after exercise, it is not necessarily a disease.It could be a muscle tear.If this pain does not go away within 1 or 2 days, then you should think about problems with the lumbar spine.Especially if this pain intensifies with movement.

The causes of this pain are usually excessive inflammation of the muscles and their insertions.O – inflammation of the joint capsules.

If such exacerbation occurs more than once a year, the cause of said exacerbations should be sought.To do this, it is not enough to consult a doctor and carry out manipulations, take painkillers, massages and other procedures.

An examination is necessary to determine the cause of such frequent exacerbations.

Soft tissue injury of the lower back.

Sharp pain in your lower back when moving awkwardly or lifting something heavy is probably a spinal injury.

If you are worried about pain on that side, for example, pain in the right lower back, then you should think about the pathology of the joint located on the right.Or about a hernia of the lumbar spine on the right side.

Types of low back pain

The pain, taking into account the duration, can be acute, chronic or have a transistorized (temporary) nature.

The pains are the following:

• local pain– pain exclusively in the lumbar area.
• Referred pain– when the pain occurs not only in the lower back, but also, for example, in the buttocks, in the pelvic area.Or pathology of internal organs causes pain in the lower back.In such cases we speak of referred pain.
• root pain– differ in significant intensity and are located within the limits of root innervation (from the column to the periphery).The cause is a violation (stretching, compression, curvature, compression) of the nerve root of the spinal nerve.Mobility or even coughing increases pain due to the so-calledcough impulse.This is intense pain in the lower back that can shoot (radiate) down the leg.
• myofascial pain– is the result of a reflex muscle spasm.The causes of myofascial pain can be diseases of internal organs or damage to the spine itself.Muscle spasm significantly alters the biomechanics of human movements.Chronic muscle spasms can also cause lower back pain and cramps.

In which cases should you consult a doctor for low back pain and what to do?

• with acute (acute) pain in the lumbar region;
• if pain in the back or lower back continues for more than 3 days;
• if back pain appeared after an injury;
• if the pain is located simultaneously in the lower back, foot and leg;
• if pain in the lower back is combined with numbness in the thigh, buttocks, leg, foot or groin;
• if pain in the lumbar region is accompanied by spasms (fasciculations) of the muscles of the extremities;
• if the function of urination and defecation is impaired (urine retention, incontinence, frequent urination or false urge to urinate);
• if the perineum is numb.
• If the pain in the back or lumbar area (sacrum) is constant, worse in the morning

What to do if you have lower back pain?

The causes of low back pain are varied, so treatment of low back pain should be carried out only after diagnosis and after the diagnosis has been made by a qualified doctor.Any pain in the spinal area requires a medical examination and clarification of the cause of its appearance.

A visit to the doctor has 3 objectives:

1. Establish the correct diagnosis.
2. Eliminate pain.
3. Formulate measures that will help maintain the patient's health so that the pain does not occur again.

Possible causes of low back pain.

The following diseases may be the cause of your lower back pain:

• osteochondrosis;
• osteoarthritis;
• spondylolisthesis;
• spondylosis;
• ankylosing spondyloarthritis;
• spondyloarthropathy;
• muscle damage;
• ligament damage;
• herniated disc "herniaThe disc is treated without surgery in 98% of cases (world statistics)";
• atherosclerosis of the abdominal aorta;
• malignant neoplasms of the spine;
• spinal metastases;
• urinary tract infections;
• spinal stenosis;
• biliary tract diseases;
• penetrating duodenal ulcer;
• pancreatitis;
• nephropathy;
• dissecting aneurysm of the abdominal aorta;
• hemorrhage in retroperitoneal tissue;
• Inflammatory diseases of the female genital organs.;
• oncological diseases of the female genital organs.;
• endometriosis;
• prostatitis;
• prostate cancer;
• epithelial coccygeal duct abscess;
• embolism of the arteries of the lower extremities;
• intermittent claudication;
• pseudointermittent claudication;
• clear atherosclerosis of the vessels of the lower extremities;
• rheumatoid spondylitis;
• polymyalgia rheumatica;
• fibromyalgia
• depression;
• other.

Treatment of low back pain (back pain)

At the stage of initial treatment of pain in the lumbar (back) area, a primary diagnosis is established.This is done based on a survey, medical history, neurological and orthopedic examinations.At this stage, medications may be prescribed to reduce pain, relieve tissue inflammation, and general anti-inflammatory therapy.Reflexology, local medicinal effects, regional anesthesia, various injection methods for the treatment of low back pain, laser therapy, etc. are effective.In the acute and subacute periods, rest is important during drug treatment.Physiotherapy, massages, and manual therapy are not indicated, as they can aggravate the process.In the acute period, traction is also not used: hardware, inclined boards, trellises.

To more effectively treat low back pain, you need to understand the cause.To do this, the patient is further examined to clarify the diagnosis.There can be many causes of pain in the lower back region.Listed above is an indicative list of diseases that are accompanied by lower 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 not indicated for this disease.For example, in inflammatory diseases of the spine (spondylitis, spondyloarthropathy, spondyloarthritis, myositis, ligamentitis, etc.), manual therapy, massage and physiotherapy are not indicated due to their ineffectiveness and the risk of complications.It is necessary to identify the cause of the inflammation and treat it.

Spondylosis visible on x-rays can occur without clinical symptoms and often masks a more complex disease.Therefore, treating spondylosis is useless and often dangerous: removing bone growths from the spine is unrealistic and unnecessary.The patient may encounter exotic diagnoses such as "muscle damage", "muscle spasm", "ligament damage".Unfortunately,Talking about muscle spasms as a cause of pain is not always true.Muscle spasm of the paravertebral muscles is a reflex act and, as a rule, accompanies most diseases, including those not related to the spine.The muscles actively participate in the segmental reflex process and can respond to any irritation both in the spine and outside it.The so-called "spasms" must be differentiated from reflected or projective pain in the lower back, which can be caused by pathology of the internal organs: diseases of the pelvic organs, retroperitoneal space, kidneys, pancreas and prostate, gynecological diseases of inflammatory or tumor origin, diseases of the aorta, hemorrhages in the retroperitoneal tissue and much more.Osteopathic techniques to work with secondary spasmodic paravertebral muscles can, on a reflex level, temporarily alleviate the condition.Manual therapy, osteopathic techniques, incline board, massage, traction, physiotherapy, for example, will not help with prostatitis or adenomatosis.The so-called “therapeutic elimination”."Muscle spasms" in this case are just the wishes of the manipulator.

Treatment of herniated and protruded discs in the lumbar area.

Often, an MRI scan 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 do without surgery?

The first thing you should do– clarify how clinically significant this hernia is.The fact is that if you take 100 absolutely healthy people without lower back pain and perform an MRI diagnosis on them, it turns out that 80% of them have some type of disc protrusion ("herniation"), which does not present any symptoms.

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

At the same time, practice shows that not all hernias are clinically significant.To clarify the causes of pain, a thorough medical history is taken, a neurological examination is performed to identify neurological deficits, the functioning of the pelvic organs is clarified, etc.

It turns out that not all herniated and bulging discs need surgery.Patients requiring such an operation do not represent more than 2%.

Neurosurgeons have prescribed absolute indications for surgery, which are clearly defined.Most of the time, 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, the formation of stable motor patterns in the back, methods of local and general drug therapy, physiotherapy, reflexology, etc.Calibrated treatment without surgical intervention is usually accompanied by a regression of symptoms and the hernia (protrusion) may decrease over time.

When making a decision about surgery, it is necessary to take into account the indicators relating to surgical treatment, which are officially prescribed by neurosurgeons.Each specific case is considered separately, taking into account clinical symptoms, medical history, anamnesis, neurological and orthopedic examinations, results of hardware and laboratory examinations. 

It should be especially noted that surgical intervention is often associated with a number of complications, which after surgery must be treated much more intensively than pain relief before surgery.

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

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