Pain in the lower back is only a symptom, an external manifestation of some disease or pathology.Every pain has its own 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 be caused by 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 (large herniated sciatica).If the hernia is on the left side, then you may feel pain in the back on the left side, and pain in the left side may bother you.
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 trunk with acute "twisting" pain, when it is impossible to stand up and stand up (the so-called antalgic position of the torso).
Lower right back pain can be a consequence of problems with hernia or right joints of the spine, or pathology of the sacral area (right iliosacral joint).
Pain in the area of the left scapula (or pain under the left scapula) can either be the result of a hernia or joint pathology, or as a result of heart problems.Such pain can be caused by angina pectoris 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 provoke back pain on the right side and pain under the right shoulder blade.Gallbladder pathology often manifests as pain under the right rib.Diagnostics required.
Bumpsdiscs, are more often incidental findings on MRI, whichI cancontinue without any pain.Disc herniation– is not such a common cause of severe back pain.Although, the formation of a hernia, for example, when lifting heavy objects, causes lumbago or thoracic lumbago (sharp pain in the back).In the case of persistent aching back pain, a hernia found on an MRI may have nothing to do with it.The reasons for such constant pain are often different. Diagnostics will help you figure it out.
Therefore, in order to effectively treat back and lower back pain, you need to:
- Determine the cause of lower back pain (make a diagnosis).
- The cause of pain in the lower back 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 made by clinical and hardware examination.
- Low back pain treatment tactics depending on the diagnosed cause.
- If you have lower back pain, it is important to ensure that the pain does not reoccur.To achieve this, we offer various methods, including physical rehabilitation of the spine.
Lower back pain.Why does my lower back hurt?
Lower back pain refers to pain that is localized in the area between the 12th pair of ribs and the gluteal folds.Pain of this kind is already a social problem.The fact is that the lower back is the most stressed part of the spine, which endures daily and hourly overloads.85% of people have experienced pain in the lumbar region at least once in their life.What is the reason?
Pain in the lumbar regionit can have many reasons.The most common causes are osteochondrosis, disc herniation, radiculitis and lumbar joint pathology.
Osteochondrosis
Osteochondrosis–natural aging of spinal tissue.
It is generally accepted that osteochondrosis is a sign of spinal disease, which is accompanied by pain.This is a little different.
The picture below shows that a normal disk becomes damaged (see damaged disk in the picture).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 vertebra itself, and osteophytes grow (see "osteophytes" in the picture).
Previously, it was believed that osteochondrosis was associated with pain.Therefore, at that time they tried to explain the cause of pain in the spine and lower back, especially osteochondrosis.For this reason, the question of the failure of vertebroneurology was even raised.In 1978, the first research laboratory for the problems of osteochondrosis of the spine was created, it 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 in osteochondrosis.
Disc herniation
Disc herniation as a possible cause of pain.The picture above shows several herniated discs - a small hernia (protrusion) and a large herniated disc.The herniated disc itself does not hurt.
The disc has no nerve endings (it is not innervated).Disc herniation or protrusion pain occurs when the herniated protrusion puts pressure on the innervated tissue.For example, onspineor onin the backyuyulongitudinalWowbundlesat.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 (lumbodia) or acute pain - lumbago (lumbago) appears.
A herniated disc can often be cured without surgery.
Spondyloarthrosis
Spondyloarthrosis is arthrosis of the joints of the spinal column.Arthrosis itself is characterized by joint cartilage disease.In this case, the cartilage decreases in height (degenerates, "dries up"), and the articular surfaces of the bones 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 roots.Radiculitis most often occurs when the root is injured by a herniated disc or spinal joints.It's usually not so much lower back pain as leg pain, buttock pain, and pain or numbness even in the toes.
Radiculitis is most effectively treated by loosening the roots.If it was 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 pathology of 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
Pain in the lower back 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 gynecology.Inflammatory diseases of the female genital organs are not uncommon.The cause can be appendicitis, inflammatory diseases of the vagina and vulva, salpingitis, salpingoophoritis, endometritis, bacterial vaginitis, etc.More often, such 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 pains in the lower abdomen, then the woman should be examined by a gynecologist.It is necessary to undergo a gynecological ultrasound in order to initially clarify the diagnosis.
Constant nagging pain in the lower back also occurs whenoncology in gynecology.
Cancer and lower back pain in women
Cancer does not hurt at first.When the pain appears in the lower back or sacral area, it may already be too late.
Many people think that tumors are accompanied by pain.This is not right.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 itself when the tumor grows.In this case, the pain often occurs in the lower back and under the lower back.The pain below the lower back is in the area of the sacrum.
With cancer, severe pain in the lower back does not bother you at first.More precisely, the lower back does not hurt, it hurts.Such pain can be the first call that will help a woman to prevent the critical growth of a tumor and to make a correct diagnosis in time.If the lower back or sacrum constantly hurts, you should pay special attention to it so you don't miss a disaster.
Unfortunately, if you don't pay attention to lower back pain or discomfort, 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 the spine, when there is already severe pain in the lower back.
Important attachment:if your lower back hurts, it is not necessarily osteochondrosis or a herniated disc.And a preventive consultation with a gynecologist never hurts.After all, erosion of the cervix discovered during the examination is a precancerous condition.
Why does my back hurt because of urological or urogenital problems (inflammation)?
Acute pain in the lower back can be a consequence of kidney disease
The lower back hurts a lot with kidney disease such as pyelonephritis.
Pyelonephritis is an infectious disease, most often caused by an ascending infection.It can also be associated with sexually transmitted infections and other types of household infections that are transmitted through swimming pools, bathrooms and personal hygiene products.For example, he 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 swell reflexively (inflammation).And my lower back is starting to hurt.
Constant pain in the back and lower back due to dysfunction and other diseases of the gastrointestinal tract
With intestinal spasms, with flatulence, with ulcers or ulcerative colitis, with stomach ulcers and gastritis, the back usually hurts.
Stomach cancer linked to back pain
Treatment of back pain caused by pathology of the gastrointestinal tract will not bring improvement.The cause should be treated.
Another possible cause of lower back pain is back strain
Excessive strain 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.Moreover, the muscles in the lower back actively work under load.Therefore, if you have back pain in the lumbar region after exercise, it is not necessarily a disease.It could be a muscle rupture.If this pain does not disappear within 1-2 days, then you should think about problems with the lumbar spine.Especially if this pain increases with movement.
The causes of such pain are often overloaded inflammation of muscles and their connections.Or – inflammation of joint capsules.
If such aggravation occurs more than once a year, the cause of such exacerbations should be sought.To do this, it is not enough just to consult a doctor and perform manipulations, take painkillers, 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 lower back pain on the right side, then you should consider the pathology of the joint located on the right side.Or about the right hernia of the lumbar spine.
Types of lower back pain
Pain, depending on the duration, can be acute, chronic or (transient) of a transient nature.
The pains are as follows:
- Local pain– pain exclusively in the lower back.
- Reference pain- when the pain occurs not only in the lower back, but for example in the buttocks, in the pelvis area.Or, the pathology of internal organs causes pain in the lower back.In such cases, they talk about referred pain.
- Radicular pain- they differ in significant intensity, and are localized within the borders of the root innervation (from the spine to the periphery).The cause is an injury (stretching, compression, curvature, compression) of the nerve root of the spinal nerve.Mobility 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 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 aching and cramping low back pain.
In which cases should you consult a doctor for lower back pain and what should you do?
- with sharp (acute) pain in the lumbar region;
- if back or lower back pain lasts longer than 3 days;
- if back pain appeared after an injury;
- if the pain is simultaneously localized in the lower back, foot and lower leg;
- if pain in the lumbar region is combined with numbness in the thighs, buttocks, legs, feet, groin;
- if the pain in the lumbar region is accompanied by twitches (fasciculations) of the limb muscles;
- if the function of urination and defecation is disturbed (urine 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, it is worse in the morning
What to do if you have lower back pain?
The causes of pain in the lower back are different, therefore the treatment of low back pain should be carried out only after diagnosis and after diagnosis by a qualified doctor.Any pain in the area of the vertebrae requires a medical examination and clarification of the cause of its occurrence.
A visit to the doctor has 3 goals:
- Make the correct diagnosis.
- Take away the pain.
- Formulate measures to help maintain the patient's health so that the pain does not recur.
Possible causes of lower back pain
The cause of your complaints about pain in the lower back can be the following diseases:
- osteochondrosis;
- osteoarthritis;
- spondylolisthesis;
- spondylosis;
- 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 spinal column;
- spinal metastases;
- urinary tract infections;
- spinal stenosis;
- diseases of the biliary tract;
- penetrating duodenal ulcer;
- pancreatitis;
- kidney disease;
- dissecting aneurysm of the abdominal aorta;
- bleeding into the retroperitoneal tissue;
- inflammatory diseases of the female genital organs;
- oncological diseases of female genital organs;
- endometriosis;
- prostatitis;
- prostate cancer;
- epithelial coccygeal duct abscess;
- embolism of the arteries of the lower extremities;
- intermittent claudication;
- pseudo-intermittent claudication;
- obliterating atherosclerosis of blood vessels of the lower extremities;
- rheumatoid spondylitis;
- polymyalgia rheumatica;
- fibromyalgia
- depression;
- the rest.
Treatment of lower back pain (back pain)
In the phase of initial treatment of pain in the lower back (back), a primary diagnosis is made.This is done on the basis of a survey, medical history, neurological and orthopedic examinations.At this stage, medications can be prescribed to reduce pain, relieve tissue swelling, and general anti-inflammatory therapy.Reflexology, local medicinal effects, regional anesthesia, various methods of injections for the treatment of lower back pain, laser therapy, etc. are effective.In the acute and subacute period, 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: shackles, on inclined plates, on wall bars.
To treat lower back pain more effectively, you need to understand the cause.For this purpose, the patient is additionally examined to clarify the diagnosis.The causes of pain in the lumbar region can be different.An indicative list of diseases that are accompanied by pain in the lower back is listed above.Each of them has its own treatment protocol with a list of the most effective approaches, drugs and procedures.The protocols also contain data on methods that are not indicated for this disease.For example, in inflammatory diseases of the spine (spondylitis, spondyloarthropathy, spondylarthrosis, myositis, ligamentitis, etc.) manual therapy, massage and physiotherapy are not indicated due to ineffectiveness and risk of complications.It is necessary to determine the cause of the inflammation and treat it.
Spondylosis visible on X-rays can appear 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 bony 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 inside the spine and outside it.It is necessary to distinguish the so-called"spasms" from reflected or projective pain in the lower back, which can be caused by pathology of internal organs: diseases of the pelvic organs, retroperitoneal space, kidneys, pancreas and prostate, gynecological diseases of inflammatory or tumor origin, diseases of the aorta, hemorrhoids and retroperitoneum.Osteopathic techniques for working with secondary spasmodic paravertebral muscles can, on a reflex level, temporarily relieve the condition.Manual therapy, osteopathic techniques, inclined plank, massage, traction, physiotherapy, for example, will not help with prostatitis or adenomatosis."Therapeutic removal" of the so-called"muscle spasms" in this case are just the wishes of the manipulator.
Treatment of hernias and disc protrusions in the lower back
Often, an MRI reveals a hernia or protrusion, which is interpreted as the cause of lower 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 lower back pain and perform an MRI diagnosis, it turns out that 80% of them have some kind of disc protrusion ("herniation"), which does not cause any symptoms.
Often, a herniated disc can be an incidental finding, often attributed to another cause of pain.
At the same time, practice shows that not all hernias are clinically significant.In order to clarify the causes of pain, a detailed history is taken, a neurological examination is performed to determine neurological deficits, the functioning of the pelvic organs is clarified, etc.
It has been shown that it is not necessary to operate on all disc herniations and protrusions.The number of patients who need this type of surgery is 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, formation of stable motor patterns in the back, methods of local and general drug therapy, physiotherapy, reflexology, etc.Calibrated treatment without surgical intervention is often accompanied by a regression of symptoms, and the hernia (protrusion) can decrease over time.
When making a decision about surgical intervention, one must take into account the relative indicators for surgical treatment, which are officially prescribed by neurosurgeons.Each specific case is considered separately, taking into account clinical symptoms, anamnesis, 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 series of complications, which need to be dealt with many times more intensively after the operation than for pain relief before the operation.
Degenerative changes on the spine, such as osteochondrosis, spondyloarthrosis, spondylosis, etc., are treated based on the identification of the trigger of the pain syndrome.
Massage and manual therapy are quite effective methods of treatment 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 their causes.