Back pain treatment

Back pain is only a symptom, an external manifestation of any disease or pathology.Every 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 the pain.

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

If the hernia is large and compresses the left medial root (radiculitison the left), then a lumbago can occur in the left leg and the pain can start in the left leg.A large hernia often causes a violation of posture in the form of a distortion of the torso with acute "twisting" pain, when it is impossible to straighten and straighten (the so-called antalgic position of the torso).

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

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

Cholecystitis and cholelithiasis most often provoke pain in the back on the right and pain under the right shoulder.Gallbladder pathology often manifests as pain under the right rib.Diagnosis is needed.

Extensionsdiscs, are more often incidental findings on MRI, whichcanproceed without any pain at all.Disc herniation– not such a common cause of severe back pain.Although, the formation of a hernia, for example, when lifting heavy objects, causes lumbar or thoracic lumbago (sharp pain in the back).In the case of persistent back pain, the hernia found on the MRI may have nothing to do with it.The reasons for such constant pain are often different. Diagnostics will help you understand.

Therefore, to effectively treat back and back pain, you should:

1. Determine the cause of back pain (make a diagnosis).
2. The cause of 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 using 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 that the pain does not recur.To achieve this, we offer various methods, including physical rehabilitation of the spine.

Pain in the lower back.Why does my lower back hurt?

Low back pain refers to pain that is located in the area between the 12th pair of ribs and the gluteal folds.Pains of this type are already a social problem.The fact is that the lower back is the most loaded part of the spine, which endures overloads every day and every hour.85% of people have experienced pain in the lumbar region at least once in their life.What is the reason?

Pain in the lumbar regionthere could be many reasons.The most common causes are osteochondrosis, disc herniation, radiculitis and lumbar joint pathology.

Osteochondrosis

Osteochondrosis-natural aging of the spinal cord.

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

The figure below shows a normal disc being damaged (see the damaged disc in the picture).These injuries 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 themselves, and osteophytes grow (see "osteophytes" in the picture).

Previously, it was believed that osteochondrosis was accompanied by pain.Therefore, at that time they tried to explain the cause of pain in the back and lower back, especially with osteochondrosis.For this reason, the issue of the failure of vertebroneurology was also raised.In 1978, the first research laboratory for the problems of spinal osteochondrosis was established, which studied the issue of osteochondrosis for more than 10 years and proved that the cause of pain is not osteochondrosis, but joint pathology. 

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

Disc herniation

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

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

A herniated disc can often be treated without surgery.

Spondyloarthrosis

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

Radiculitis

Radiculitis is an inflammation of the root.Radiculitis most often occurs when the root is injured by a herniated disc or spinal joint.It is usually not so much lower back pain as pain in the legs, buttocks and pain or numbness in the toes as well.

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

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

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

Lower back pain in women

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 about gynecology.Inflammatory diseases of the female genital organs are not uncommon.The cause can be inflammation of the appendages, inflammatory diseases of the vagina and vulva, salpingitis, salpingophoritis, endometritis, bacterial vaginitis, etc.Most often, such inflammatory diseases in women are caused by infections of the genital area, including sexually transmitted infections.

If the lower back aches and hurts and at the same time there is pain in the lower abdomen, then the woman should be checked by a gynecologist.It is necessary to undergo a gynecological ultrasound to first clarify the diagnosis.

Constant nagging pain in the lower back also occurs whenoncology in gynecology.

Cancer and back pain in women

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

Many people think that tumors are associated with 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 genitals.It begins to appear when the tumor grows.In this case, the pain often appears in the lower back and lower back.The pain under the lower back is in the sacrum area.

With cancer, severe pain in the lower back does not bother you at first.On the contrary, the lower back does not hurt, but it hurts.Such pain can be the first call that will help a woman prevent the critical growth of the tumor and make an accurate diagnosis at the right time.If the lower back or sacrum constantly hurts, you should pay special attention to this so that you don't miss a disaster.

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

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

Why does my back hurt because of urological or urogenital problems (inflammations)?

Acute back pain may be due to kidney disease

The lower back hurts a lot with a kidney disease like pyelonephritis.

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

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 swell (inflame).And my lower back hurts.

Constant pain in the back and back 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 usually hurts.

Stomach cancer linked to back pain

Back treatment for pain caused by pathology of the gastrointestinal tract will not provide improvement.The cause must be treated.

Another possible cause of back pain is back strain

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

The causes of such pains are often excessive inflammation of muscles and their attachments.Or – inflammation of joint capsules.

If such aggravation occurs more than once a year, you should look for the cause of such irritations.To do this, it is not enough just to consult a doctor and perform manipulations, take sedatives, massages and other procedures.

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

Soft tissue injury of the lower back

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

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

Types of back pain

Pain, taking into account the duration, can be acute, chronic or have a transient character.

The pains are as follows:

• Local pain– pain exclusively in the lower back.
• Referred pain- when the pain appears not only in the lower back, but for example in the buttocks, in the pelvic area.Or, the pathology of the internal organs causes pain in the lower back.In such cases they talk about referred pain.
• Radicular pain– vary in significant intensity, and are localized within the boundaries of the innervation of the root (from the spine to the periphery).The cause is a violation (stretching, compression, bending, compression) of the nerve root of the spinal nerve.Movement or even coughing increases the pain due to the so-calledcough impulse.This is severe 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 disrupts the biomechanics of human movements.Chronic muscle spasms can also cause lower back pain and cramping.

In which cases should you consult a doctor about lower back pain and what to do?

• with sharp pains (acute) 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, leg and foot;
• if the pain in the lumbar region is combined with numbness in the thighs, buttocks, legs, feet, hips;
• if the pain in the lumbar region is accompanied by contractions (fasciculations) of the muscles of the limbs;
• if the function of urination and defecation is impaired (urinary retention, incontinence, frequent urination or false urge to urinate);
• if the perineum is numb.
• If the pain in the back or lower back (sacrum) is constant, worse in the morning

What should you do if you have lower back pain?

The causes of low back pain are varied, therefore the 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 vertebral area requires a medical examination and clarification of the cause of its occurrence.

A visit to the doctor has 3 objectives:

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

Possible causes of back pain

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

• osteochondrosis;
• osteoarthritis;
• spondylolisthesis;
• spondilosis;
• ankylosing spondylitis;
• spondyloarthropathy;
• muscle damage;
• ligament damage;
• disc herniation "Herniadisc 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;
• kidney disease;
• dissecting aneurysm of the abdominal aorta;
• hemorrhage in the 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;
• pseudo-intermittent claudication;
• the disappearance of atherosclerosis of the vessels of the lower extremities;
• rheumatoid spondylitis;
• polymyalgia rheumatica;
• fibromyalgia
• DEPRESSION;
• others.

Treatment of back pain (back pain)

At the stage of initial treatment with pain in the lower back (back), a primary diagnosis is established.This is done on the basis of the 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 medicinal effects, regional anesthesia, various injection methods for the treatment of lower back pain, laser therapy, etc.In acute and subacute periods, rest is important during drug therapy.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, on wall bars.

To treat lower back pain most effectively, you need to understand the cause.For this purpose, the patient is further examined to clarify the diagnosis.There can be many causes of pain in the lumbar region.An indicative list of diseases that are associated with pain in the lower back is listed above.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, for inflammatory diseases of the spine (spondylitis, spondyloarthropathy, spondyloarthritis, myositis, ligamentitis, etc.), manual therapy, massage and physiotherapy are not indicated due to ineffectiveness and the risk of complications.It is necessary to identify 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: it is not realistic to remove bone growths in the spine and there is no need.The patient may encounter exotic diagnoses such as "muscle damage", "muscle spasm","ligament damage".Unfortunately, talking about muscle spasms as the 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 are actively involved in the segmental reflex process and can respond to any irritation both on the back and outside it.So-called "spasms" must be differentiated from reflected or projecting pain in the lower back, which can be caused by the pathology of internal organs: diseases of the pelvic organs, retroperitoneal space, kidneys, pancreas and prostate glands, gynecological diseases of inflammatory or tumor origin, diseases of the aorta, hemorrhage more in the retro tissue.Osteopathic techniques to work with spasmodic secondary paravertebral muscles, on a reflex level, can temporarily relieve the condition.Manual therapy, osteopathic techniques, incline plank, massage, traction, physiotherapy, for example, will not help with prostatitis or adenomatosis.The so-called "therapeutic removal"."muscle spasms" in this case are only the desires of the manipulator.

Treatment of herniated and prolapsed discs in the lower back

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

First thing to do– clarify how clinically significant this hernia is.The fact is that if you take 100 absolutely healthy people without pain in the lower back and make an MRI diagnosis, it turns out that 80% of them have some kind of disc protrusion ("hernia"), which does not give any symptoms.

Often, a herniated disc can be an accidental finding, 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 the pain, a complete 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 disc herniations and protrusions need to be operated on.Patients who require 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, the formation of stable motor patterns in the back, local and general drug therapy methods, physiotherapy, reflexology, etc.Calibrated treatment without surgical intervention is often accompanied by regression of symptoms and the hernia (protrusion) may decrease over time.

When a decision is made for surgery, the relative indications for surgical treatment, which are officially prescribed by neurosurgeons, should be taken into account.Each specific case is examined separately, taking into account clinical symptoms, medical history, anamnesis, neurological and orthopedic examinations, results of hardware and laboratory examinations. 

In particular, it should be noted that surgical intervention is often associated with a number of complications, which must be treated many times more intensively after the operation than to relieve the pain before the operation.

Degenerative changes in 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 very effective treatment methods 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, taking into account the possible range of causes.