Low back and neck pain is one of the most common reasons for seeking medical help. The 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 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, affecting more than half of people over 60. This leads to significant costs in terms of health care payments, disability benefits and lost working time.
The spine (spine) is made up of vertebrae. There are cushioning discs between the vertebrae. The discs have a strong outer layer of fibro-cartilage tissue and a soft, jelly-like inner substance called the nucleus. Each vertebra has two joints behind the discs. These joints are called facets. 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, namely:
- Two iliopsoas muscles that move on either side of the spine
- Two erectile muscles in the back that run the entire length of the spine behind it
- Very 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 peculiarities of the position of the roots of the spinal nerves, they can be compressed (compression) with injuries to the spine, which leads to pain.
The lower spine (lumbar spine) in the upper part 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 when 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 painappears in a specific area of the lower back. This is the most common type of back pain. The cause is usually disc damage, arthritis of the joint and less frequent muscle strain. The pain may be prolonged and painful, or at some point it may be replaced by periodic sharp pain. Sudden pain can occur when trauma is the cause. Local pain may increase or decrease with a change in position. Touching the waist can be painful. Muscle spasms are possible.
Radiant painIs low back pain that spreads to the legs. The pain can be dull or sharp and intense. It usually affects only the side or back of the foot and can extend to the foot or just to the knee. Radiating pain is usually a manifestation of compression of the spinal nerve root in disorders such as disc herniation, sciatica, osteoarthritis or spinal stenosis. Coughing, sneezing, straining, or bending your legs upright can be painful. When the spinal nerve root is compressed, the pain may be accompanied by weakness in the leg muscles, numbness or even loss of sensation. In rare cases, there is a loss of control over urination (urinary incontinence) or loss of control over bowel movements (faecal incontinence).
Reflected painfelt in a place other than the actual cause of the pain. For example, some people with a heart attack experience pain in their left arm. The reflected pain from the internal organs in the lower back is mostly deep and painful in nature and its exact location is difficult to determine. As a rule, during movement the pain does not increase, unlike the pain accompanying disorders of the musculoskeletal system.
The 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 a specific cause cannot be identified. Any painful spinal disease can lead to reflex contraction (spasm) of the muscles around the spine. The spasm may increase the pain. Stress can worsen low 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 diseases (such as infections of the kidneys, bladder, and prostate). ) and the digestive tract (eg 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
- Torn or herniated disc
- Spinal stenosis in the lumbar spine
- Spondylolisthesis
- Damage to muscles and ligaments
- Fibromyalgia
Too badit can occur during normal activities (eg lifting heavy objects, exercising, unexpected movement) or as a result of an injury, such as a fall or a car accident. Imaging tests usually do not show any specific lesions, but doctors suspect that some muscles and / or ligaments are affected.
Osteoarthritis(degenerative arthritis) causes wear of the cartilage between the joint surfaces and the formation of bone spines (osteophytes). This disease is partly the result of many years of tissue wear. In severe degeneration and loss of disc height, the 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 back and are accompanied by pain in these regions rather than in the lower spine.
Torn or herniated discmay cause back pain. The disc is represented by a dense outer layer and a soft, jelly-like central part. If the disc is under constant stress from the vertebrae above and below (for example, when bending forward, especially when lifting heavy objects), its outer layer may rupture (tear), 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 down from the lower part of the spinal cord) into the lumbar region. This 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 displacement of the vertebra 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 vertebrae. If both sides of the vertebrae are affected, the vertebra may slide forward over the underlying vertebra. Spondylolisthesis can also occur in the elderly, but mainly as a result of degenerative disease. With the development of spondylolisthesis in adulthood, the risk of spinal stenosis in the lumbar region increases.
FibromyalgiaIs 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.
Studies
Tests are not usually prescribed, as most back pain is due to osteoarthritis, sprains or other minor musculoskeletal disorders and resolves within 6 weeks. Imaging tests are often needed if:
- another reason is suspected;
- there are warning signs;
- back pain continues.
An evaluation may also be ordered if there is no response to the initial treatment or if symptoms worsen or change.
X-rays of the lower back can only provide an image of the bones. Such images may reveal degenerative changes due to osteoarthritis, spinal fractures, spondylolisthesis, and ankylosing spondylitis. However, magnetic resonance imaging (MRI) or computed tomography (CT) can provide a clear image of the bones and, as is typical of MRI, show soft tissues (including discs and some nerves). MRI or CT scans are 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 the MRI results are ambiguous, it becomes necessary to perform myelography with CT. Rarely, if a malignancy or infection is suspected, a tissue sample (biopsy) should be taken for analysis. In some cases, electromyography and nerve conduction tests are performed to confirm the presence, location, and in some cases the duration and severity of spinal nerve root compression.
Prevention
People can reduce the risk of developing low back pain by taking the following measures:
- physical exercises;
- exercises to strengthen and stretch muscles;
- maintaining a normal body weight;
- maintaining proper posture;
- compliance with the recommendations for safe weight lifting.
The most effective way to prevent low back pain is through regular exercise. Aerobic exercises and special exercises for the development of 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 trunk 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 tilt and abdominal crunches. Stretching exercises include stretching by bending the knees to the chest. For 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 aggravates back pain should be stopped. The exercises should be repeated until you feel a slight (but not extreme) muscle fatigue. Breathing is essential during exercise. People with back pain should consult a doctor before training.
Tilt the pelvis Take a lying position with bent knees, heels on the floor, load the heels. Press your back to the floor, tense your glutes (lift them about half an inch from the floor) and tense your abdominal muscles. Hold this position for counting 10. Repeat 20 times. |
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False crunches Lie down in your sleep with your knees bent and your feet on the floor. Fold your arms across your chest. Tighten your abdominal muscles, slowly lift your shoulders about 10 inches off the floor, keeping your head straight (your chin should not touch your chest). Relax the abdominal muscles, slowly lower the shoulders. Do 3 sets of 10 repetitions. |
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He stretches his knees to his chest Take a lying position, stand up. Place both palms under one knee and press it to your chest. Hold the counting position 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 the desired body weight. Exercise also helps maintain bone density. In this way, exercise can reduce the risk of developing two conditions that can cause low back pain: obesity and osteoporosis.
Proper posture when standing up and sitting reduces back stress. Staining should be avoided. The seat of the chair should be adjustable in height so that the feet are flat on the floor, the knees are slightly bent and the lower back is firmly attached to the back of the chair. If the chair does not provide support for the lower back, a cushion can be placed under it. In a sitting position, it is recommended that you place your feet on the floor, not cross your legs. People who are ill should not stand or sit for long periods of time. If you have to stand or sit for a long time, frequent changes in position 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 through common measures. Typically, such measures are also used to squeeze the spinal nerve root.
General measures for back pain
Possible measures include:
- Making changes in activities
- Taking painkillers
- Apply heat or cold to the painful area
- Light exercise, if tolerated
For more recent back pain, treatment begins by removing activities that strain the back and cause pain, such as lifting weights and bending. Bed rest does not speed up pain relief and most professionals recommend doing light work. Bed rest, necessary to relieve severe pain, should not last more than 1 or 2 days. Prolonged bed rest weakens core muscles and increases stiffness, leading to worse back pain and slower recovery. Corsets and grip are ineffective. Traction can slow healing.
Nonsteroidal anti-inflammatory drugs (NSAIDs) without a prescription or without a prescription can relieve pain and reduce inflammation. Opioid analgesics are sometimes prescribed if NSAIDs do not provide sufficient pain relief, but they should only be used for a short time, as long-term use of opioid analgesics may, in turn, increase sensitivity to pain, cause side effects and increasethe risk of addiction and dependence.
Muscle relaxants can sometimes relieve muscle spasms, but their effectiveness is questionable. These drugs are not recommended for older 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 spasms. If muscle relaxants are prescribed, they should not be used for more than 72 hours. Doctors sometimes recommend that you take them just before bed.
Massage can provide some temporary relief from lower back pain. Some studies have shown positive results in acupuncture; others contradict these findings. Spinal manipulation by chiropractors or other doctors (such as osteopathic doctors) combined with an exercise program can also relieve pain. However, manipulation of the spine can increase the risk of further 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 under their knees. Patients who sleep on their side should use a pillow that allows their head to be held in a neutral position (without bending the neck or down). Patients should place a second pillow between the knees, with the knees and hips slightly bent, if this relieves the pain in the lower back. Patients can still sleep on their stomachs if they feel comfortable.
Continue or start taking other preventative measures (proper posture, proper weight lifting technique). When such events occur, attacks of back pain usually disappear in a period of several 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 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 varies from 20 minutes to several hours, depending on the severity of the pain.
Sometimes corticosteroids with a local anesthetic are periodically injected into the facet joint of the spine or into the epidural space between the spine and the outer layer of tissue covering the spinal cord. Epidural injections may be more effective in sciatica, due more to a herniated disc than to a lumbar spinal 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.
Surgery for back pain
In cases where a herniated disc results in persistent or chronic sciatica, weakness, loss of sensation, or fecal and urinary incontinence, surgical removal of the protruding part of the disc (discectomy) and in some cases part of the vertebrae (laminectomy) may be necessary.
In severe spinal stenosis, much of the posterior vertebra (lamellae of the spine) 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 after 3-4 months. Adequate or complete recovery is seen in about two-thirds of patients. For other patients, such surgery may prevent pain and worsening of other symptoms.
If the spine is unstable (which may be the result of a severe disc herniation, spondylolisthesis, or laminectomy for spinal stenosis), a spinal fusion operation (called lumbar arthrodesis) may be performed. However, fusion restricts mobility, can be accompanied by excessive mechanical stress on the rest of the spine and can create problems in the future.
Compression fractures of the spine
Compression fractures of the spine are quite common in women over 50 years. They can be treated conservatively without surgery, with braces, painkillers and possibly calcitonin nasal spray, which will not help strengthen bones, but can reduce pain.
If sufficient pain control cannot be achieved, two surgical options are offered:
- Vertebroplasty: injection of cement screed into a broken bone.
- Kyphoplasty: Inserting a balloon into a broken bone to create space. The balloon is then filled with cement.
Recent studies, however, show that in the long run, the 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 lack of 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 over the age of 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 to exclude measures leading to mechanical effects on the back, to take painkillers and in some cases to apply a cold or warm compress.
- Prolonged bed rest and stretching can slow recovery.
- In severe cases, such as unusual sensations and weakness in the legs, surgery may be needed.
- Compression fractures of the vertebrae can be treated conservatively (with braces, painkillers and nasal spray) or, in some cases, more aggressively with surgery.