Back pain

Low back pain and neck pain are one of the most common reasons for seeking medical care. Pain is usually caused by problems in the musculoskeletal system - more pronounced with problems in the spine, including the spinal bones (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, affecting more than half of people over 60 years of age. This leads to significant costs in terms of health care payments, disability benefits and lost working hours.

The spine (vertebral column) is made up of vertebrae. There are shock-absorbing discs between the vertebrae. Discs have a hard outer layer of fibrocartilaginous 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 meet the articular surfaces of the other beneath it, forming a joint. The joints, and with them the entire spine, are stabilized by ligaments and muscles, namely:

• Two iliopsoas muscles that run on either side of the spine
• Two erector muscles of the back 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, exit 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 spinal nerve roots, they can be compressed (compressed) with spinal injuries, which leads to pain.

The lower part of the spine (lumbar spine) at the top 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 to stand, walk, and lift. Thus, the lower back is involved in almost all types of daily activities. Low back pain can interfere with many activities and worsen quality of life.

Types of Back Pain

Common types of low back pain include localized, radiating, and rebounding pain.

local painappears in a certain area of the lower back. It is the most common type of back pain. The cause is usually a disc injury, joint arthritis, and, less commonly, a muscle strain. The pain can be continuous and painful, or at some point it can be replaced by intermittent sharp pain. Sudden pain can appear when trauma is the cause. Local pain may increase or decrease with changing position. Touching your lower back can be painful. Muscle spasms are possible.

radiating painIt is the lower back pain that spreads to the leg. The pain can be dull or sharp and intense. It usually affects only the side or back of the leg and may extend to the foot or just the knee. Radiated pain is usually a manifestation of spinal nerve root compression in disorders such as herniated disc, sciatica, osteoarthritis, or spinal stenosis. Coughing, sneezing, straining or bending your legs straight can be painful. When the root of a spinal nerve is compressed, pain may be accompanied by weakness in the leg muscles, a tingling sensation, or even loss of sensation. In rare cases, there is loss of control over urination (urinary incontinence) or loss of control of bowel movements (faecal incontinence).

reflected painfelt in a place other than the true cause of the pain. For example, some people with a heart attack experience pain in their left arm. The pain reflected in Organs internal organs of the lower back is predominantly deep and painful in nature, and its exact location is difficult to determine. As a rule, with movement, the pain does not increase, unlike the pain that accompanies 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 spinal nerve roots, as well as the intervertebral discs. Often a single specific cause cannot be identified. Any painful spinal disease can cause reflex contraction (spasm) of the muscles around the spine. Spasm can increase pain. Stress can make lower back pain worse, but the mechanism isn't clear.

Sometimes back pain is caused by a disorder that doesn't affect the spine, such as cancer, gynecological conditions (such as premenstrual syndrome), kidney disease (such as kidney stones), urinary tract disease (such as kidney infections, bladder and prostate) and 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
• Spine compression fractures
• A ruptured or herniated disc
• Spinal stenosis in the lumbar spine
• Spondylolisthesis
• Damage to muscles and ligaments
• Fibromyalgia

Damageit can occur during normal activities (eg lifting heavy objects, exercising, unexpected movements) or as a result of an injury such as a fall or traffic accident. Normally, imaging studies do not show any specific damage, 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 bony spines (osteophytes). This disease is in part the result of years of wear and tear on the fabric. With severe degeneration and loss of disc height, osteophytes in the foramen can compress the spinal nerve roots. All of these changes can cause lower back pain and stiffness.

Spine compression fractures (due to compression)(vertebral fractures) usually 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 of the back and are accompanied by pain in these regions rather than in the lower spine.

A ruptured or herniated disccan cause back pain. The disc is represented by a dense outer layer and a soft, gelatinous central part. If the disc is under constant tension from the vertebrae above and below (for example, when leaning 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 runs through the center of the spine and contains the spinal cord and the bundle of nerves that extends down from the bottom of the spinal cord) in the lower back. It is a common cause of low back pain in elderly people. Spinal stenosis also develops in middle age in people whose spinal canal is narrow from birth. Spinal stenosis is caused by diseases 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 at the bottom of the spine. One type usually occurs during adolescence or adolescence (usually in athletes) and is caused by an injury that fractures part of the vertebrae. 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 mostly as a result of degenerative disease. With the development of spondylolisthesis in adulthood, the risk of spinal stenosis in the lower back increases.

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 the muscles and other soft tissue outside of the lower back. Fibromyalgia is also characterized by sleep disturbances and fatigue.

researches

Tests are generally not prescribed because most back pain is caused by osteoarthritis, sprains, or other minor musculoskeletal disorders and resolves within 6 weeks. Image tests are often needed if:

• another reason is suspected;
• there are warning signs;
• back pain persists.

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 provide only an image of the bones. These images can detect degenerative changes due to osteoarthritis, spinal compression fractures, spondylolisthesis, and ankylosing spondylitis. However, magnetic resonance imaging (MRI) or computed tomography (CT) can provide a sharp image of the bones and, as is typical with MRI, show soft tissue (including discs and some nerves). An MRI or CT scan is often needed when doctors determine the presence of disorders that lead to 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 ambiguous, CT myelography is necessary. Rarely, if a malignant tumor or infection is suspected, a tissue sample (biopsy) needs to be collected for analysis. In some cases, electromyography and tests to study nerve conduction are performed to confirm the presence, location, and, in some cases, the duration and severity of spinal nerve root compression.

Prophylaxis

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

• physical exercises;
• exercises to strengthen and stretch muscles;
• maintain a normal body weight;
• maintain correct posture;
• compliance with the recommendations for safe lifting of weights.

The most effective way to prevent lower back pain is through regular exercise. Aerobic exercise and special exercises for the development of muscle strength and stretching are advised.

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

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

Strengthening exercises include pelvic and abdominal tilts. Stretching exercises include stretching by bending your knees at chest level. In some people, stretching exercises can lead to increased back pain, so be careful. The basic rule of thumb 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 essential during exercise. People with back pain should consult a doctor before exercising.

pelvic tilts

Position yourself on your back with your knees bent, heels on the floor and the load on your heels. Press your back to the floor, tense your buttocks (raise about half an inch off the floor), and tense your abdominal muscles. Hold this position and count to 10. Repeat 20 times.

lying crunches

Lie down to sleep with your knees bent and your feet flat on the floor. Cross your arms over your chest. Contract 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 your abdominal muscles, slowly lower your shoulders. Do 3 sets of 10 reps.

Knee-to-chest stretches

Place yourself in the supine position and straighten up. Place both palms under one knee and press it against your chest. Hold the position and count to 10. Slowly lower your leg and repeat the exercise with the other leg. Do the exercise 10 times.

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

Proper posture while standing and sitting reduces back stress. Curvature must be avoided. Chair seats should be adjusted in height so that your feet are flat on the floor, your knees slightly bent and your lower back snug against the back of 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 crossing your legs. Sick people should not be standing or sitting for long periods. If you have to stand or sit for a long time, frequent changes in position can reduce back strain.

Treatment

If a specific cause can be determined, the disease is treated. For example, antibiotics are used to treat a prostate infection. However, there is no cure for sprain pain in the musculoskeletal system or for pain caused by other conditions. However, the situation can be improved through general measures. Typically, these measurements are also used when squeezing the spinal nerve root.

General measures for back pain

Possible measures include:

• Making changes to activities
• taking painkillers
• Apply heat or cold to the painful area
• Light exercise, if tolerated

For newer back pain, treatment begins with eliminating activities that strain the back and cause pain, such as lifting weights and bending over. Bed rest does not speed pain relief, and most practitioners recommend light work. Bed rest, necessary to relieve severe pain, should last no longer than 1 or 2 days. Prolonged bed rest weakens core muscles and increases stiffness, causing back pain and slower recovery. Corsets and traction are ineffective. Traction can delay healing.

Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Opioid analgesics are sometimes prescribed if NSAIDs do not provide enough pain relief, but they should only be used for a short period of time, as long-term use of opioid analgesics can, on the other hand, increase pain sensitivity, cause side effects and increase the risk of addiction and dependence.

Muscle relaxants can sometimes relieve muscle spasms, but their effectiveness is questionable. These medications 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 longer than 72 hours. Doctors sometimes recommend taking them before bed.

Massage can provide some temporary relief from lower back pain. Some studies have shown positive results in acupuncture, others contradict these findings. Spine manipulation by chiropractors or other physicians (such as osteopaths), combined with an exercise program, can also relieve pain. However, spinal manipulation can increase the risk of further injury and should be avoided in individuals with inflammatory arthritis, neck problems that cause cervical instability, or herniated disc.

Sleeping in a comfortable position on a medium firm mattress is recommended. 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 them to keep their head in a neutral position (without bending the neck up or down). Patients should place a second pillow between their 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 taking other preventative measures (correct posture, proper weight lifting technique). When performing such events, back pain attacks usually resolve within several days to 2 weeks. Regardless of treatment, 80 to 90% of these attacks resolve within 6 weeks.

Chronic low back pain treatment

Additional measures are needed to treat chronic low back pain. Aerobic exercise is advisable and weight loss is recommended if necessary. If pain relievers 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 intensity of the pain.

Corticosteroids with a local anesthetic are sometimes injected periodically 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 for sciatica, which is due more to a herniated disc than to lumbar spinal stenosis. However, they may not have long-term beneficial effects. They usually only last a few days or weeks. Its main goal is to relieve pain so that you can exercise for long term pain relief.

Back Pain Surgery

In cases where a herniated disc leads to persistent 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 vertebra (laminectomy ).

In severe spinal stenosis, a large part of the posterior vertebra (spinal arch lamellae) can be removed to expand it (lumbar laminectomy). General anesthesia is usually required. The length of 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, this surgery can prevent pain and the worsening of other symptoms.

If the spine is unstable (which can result from a severe herniated disc, spondylolisthesis, or laminectomy for spinal stenosis), surgery can be performed to fuse the vertebrae (called arthrodesis of the lumbar vertebrae). However, fusion restricts mobility, can be accompanied by excessive mechanical stress on the rest of the spine, and cause problems in the future.

Spine compression fractures

Compression fractures of the spine are quite common in women over 50 years of age. They can be treated conservatively, without surgery, with braces, analgesics, and possibly calcitonin nasal spray, which does not help bone consolidation but can reduce pain.

If sufficient pain control cannot be achieved, two surgical options are available:

• Vertebroplasty: injection of cement mortar into fractured bone.
• Kyphoplasty: Inserting a balloon into a fractured bone to create space. The balloon is then filled with cement.

However, recent studies have shown that, in the long term, the effectiveness of these surgical procedures does not outweigh 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 often unnecessary unless symptoms persist for many weeks.
• Patients with warning signs or patients over 55 years of age should see a physician immediately.
• Strengthening your abdominal wall and back muscles with specific exercises helps prevent the most common types of low back pain.
• For back pain, in most cases, sufficient treatment is to exclude measures that cause mechanical effects on the back, take pain relievers and, in some cases, apply cold or hot compresses.
• Prolonged bed rest and stretching can delay recovery.
• In severe cases, such as abnormal sensations and weakness in the legs, surgery may be necessary.
• Compression fractures of the vertebrae can be treated conservatively (with braces, analgesics and nasal spray) or, in some cases, more aggressively with surgery.