Treatment of lower back pain

Back pain is just a symptom, an external manifestation of some 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 overloading of muscles and ligaments.Unfortunately, if the cause was only in the muscles, 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.

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

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

Lower right back pain 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 left shoulder blade area (or pain under the left shoulder blade) can be a consequence 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 shoulder blades occurs not only with spinal pathology and osteochondrosis, but also with diseases of the stomach (gastritis, ulcers, cancer, etc.) and often of the intestine.

Cholecystitis and cholelithiasis often cause back pain on the right and pain under the right shoulder blade.Gallbladder pathology often manifests itself as pain under the right rib.You need diagnostics.

Protrusionsdiscs, are more often incidental findings on MRI, whichcanproceed without any pain.Herniated disc– not such a common cause of severe back pain.However, the formation of a hernia, for example when lifting heavy objects, causes lumbar or thoracic low back pain (sharp back pain).If you have constant, painful back pain, the hernia detected by 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, to effectively treat back and lower back pain, you need:

1. Determine the cause of back pain (establish a diagnosis).
2. The cause of low back pain will be determined by a neurologist, an orthopedic traumatologist with expertise 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 suffer from back pain, it is important to ensure that the pain does not recur.To achieve this we offer various methods, including physical rehabilitation of the spine.

Lower back pain.Why does my lower back hurt?

Low back pain refers to pain located in the area between the 12th pair of ribs and the gluteal folds.Pain of this type is already a social problem.The fact is that the lower back is the most loaded part of the spine, which bears daily and hourly overloads.85% of people have experienced lower back pain at least once in their lives.What is the reason?

Pain in the lumbar regionit 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, which is accompanied by pain.This is a little different.

The following image shows a normal disk being damaged (see damaged disk in the image).This damage can accelerate the aging of the disc and cause it to lose its height (see "narrowing of the intervertebral space").Subsequently, aging begins to affect the bone tissue of the vertebrae themselves, and osteophytes grow (see “osteophytes” in the figure).

Previously, it was believed that osteochondrosis was associated with pain.Therefore, at that time there was an attempt to explain the cause of pain in the spine and lower back, especially with osteochondrosis.For this reason, the question of the failure of vertebroneurology even arose.In 1978, the first research laboratory on the problems of spinal osteochondrosis was created, studied the problem 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.

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 (not innervated).Pain caused by a herniated or protruding disc occurs when the hernial protrusion puts pressure on the innervated tissue.For example, upspinal columnor uprearyuyulongitudinalalrightparcelsto.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 (lumbago) 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.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 bony articular surfaces lose their protective cartilaginous layer.The joints of the spine begin to hurt.This pain feels like back pain.

Radiculitis

Radiculitis is an inflammation of the root.Radiculitis most often occurs when the root is damaged by a herniated disc or spinal joints.It's usually not so much back pain as pain in the leg, buttocks, and pain or numbness in the toes as well.

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

Back and lower back pain due to pathology of internal organs

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

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, you 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, salpingoophoritis, 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 hurts and hurts and at the same time there is pain in the lower abdomen, then the woman needs to be checked by a gynecologist.It is imperative to undergo a gynecological ultrasound to initially clarify the diagnosis.

Constant, nagging 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 appear as the tumor grows.In this case, pain often appears in the lower back and below the lower back.The pain under the lower back is in the sacral area.

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

Unfortunately, if you don't pay attention to aching pain or discomfort in your lower back, the next sign of cervical cancer may be uterine bleeding.This is the stage where the tumor begins to disintegrate, when there may already be metastases.Including in the spine, when there is already severe pain in the lower back.

Important takeaway:If your lower back hurts, it's not necessarily osteochondrosis or a herniated disc.And it never hurts to consult a gynecologist beforehand.After all, cervical erosion detected during examination is a precancerous condition.

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

Sharp lower back pain may be due to kidney disease

The lower back hurts a lot due to a 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, 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 painful signal (impulse) reaches the spinal column through the sensitive roots, activating the tissues.The soft tissues of the spine and the attachment points of the back muscles swell (become inflamed) reflexively.And my lower back starts to hurt.

Constant pain in the back and lower back due to dysfunctions and other diseases of the gastrointestinal tract

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

Stomach cancer associated with back pain

Treatment of the back for pain caused by pathology of the gastrointestinal tract will not bring any improvement.The cause must be treated.

Another possible cause of back pain is overloading the back

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

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

If such a flare-up occurs more than once a year, the cause should be investigated.To do this, it is not enough to consult a doctor and perform manipulations, take painkillers, massage and other procedures.

An exam is needed to determine the cause of such frequent flare-ups.

Soft tissue injury of the lower back

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

If you are worried 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 on a hernia of the right side of the lumbar spine.

Types of back pain

Pain, taking into account the duration, can be acute, chronic or have a transitory (passing) character.

The pains are as follows:

• Local pain– pain exclusively in the lower back.
• Referred pain– when the pain occurs not only in the lower back, but for example in the buttock, in the pelvic area.Or pathology of internal organs causes pain in the lower back.In these cases we talk about referred pain.
• Radicular pain– differ 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, 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 a sharp pain in the lower back that can radiate into the leg.
• Myofascial pain– is the result of a reflex muscle spasm.The causes of myofascial pain can be diseases of the internal organs or damage to the spine itself.Muscle spasm significantly disrupts the biomechanics of human movement.Chronic muscle spasms can also cause lower back pain and cramps.

In what cases is it necessary to consult a doctor for low back pain and what to do?

• with acute (sharp) pain in the lumbar region;
• if back or lower back pain continues for more than 3 days;
• if back pain appeared after an injury;
• if the pain is localized simultaneously in the lower back, foot and lower leg;
• if pain in the lumbar region is combined with numbness of the thigh, buttocks, leg, foot, groin;
• if 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 pain in your back or lower back (sacrum) is constant, it gets worse in the morning

What to do if you suffer from back pain?

The causes of low back pain are varied, therefore 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 occurrence.

A visit to the doctor has 3 objectives:

1. Establish 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 lower back problems:

• osteochondrosis;
• osteoarthritis;
• spondylolisthesis;
• spondylosis;
• ankylosing spondylitis;
• spondyloarthropathy;
• muscle damage;
• ligament damage;
• herniated disc "Herniathe disc is treated without surgery in 98% of cases (worldwide statistics)";
• atherosclerosis of the abdominal aorta;
• malignant neoplasms of the spine;
• metastasis to the spinal column;
• urinary tract infections;
• spinal stenosis;
• biliary tract diseases;
• penetrating duodenal ulcer;
• pancreatitis;
• nephropathy;
• 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;
• abscess of the coccygeal epithelial duct;
• embolism of the arteries of the lower limbs;
• intermittent claudication;
• pseudo-intermittent claudication;
• obliteration of atherosclerosis of the vessels of the lower extremities;
• rheumatoid spondylitis;
• polymyalgia rheumatica;
• fibromyalgia
• depression;
• other.

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 a survey, anamnesis, 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 low back pain, laser therapy, etc. are effective.In acute and subacute periods, rest during drug therapy is important.Physiotherapy, massage, manual therapy which can aggravate the process are not indicated.In the acute period, not even traction is used: hardware, on inclined tables, on espaliers.

To more effectively treat low back pain, you need to understand its cause.For this purpose, the patient is further examined to clarify the diagnosis.The causes of pain in the lumbar region can be multiple.An indicative list of diseases accompanied by back pain 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 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 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, treatment of spondylosis is useless and often dangerous: it is unrealistic to remove bone growths in the spine and there is no need for it.The patient may encounter exotic diagnoses such as “muscle damage”, “muscle spasm”, “damage toligaments". Unfortunately, it is not always true to talk about muscle spasms as a cause of pain. Muscle spasm of the paravertebral muscles is a reflex act and, as a rule, accompanies most diseases, including those not related to the spine. Muscles are actively involved in the segmental reflex process and can respond to any irritation both in the spine and outside. The so-called "spasms" must be differentiated from reflex or projective pain in the lower back, which can be caused by pathologies of internal organs: organ diseasespelvic, retroperitoneal space, kidneys, pancreas and prostate glands, gynecological diseases of inflammatory or tumor origin, diseases of the aorta, hemorrhage in the retroperitoneal tissue and much more. Osteopathic techniques for working with secondary spasmodic paravertebral muscles can, on a reflex level, temporarily alleviate the condition. Manual therapy, osteopathic techniques, inclined table, massage, traction, physiotherapy, etc.For example, they do not help in case of prostatitis or adenomatosis. The so-called “therapeutic removal” The “muscle spasms” in this case are only the wishes of the manipulator.

Treatment of herniated and protruding discs 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?

The first thing to do– clarify how clinically significant this hernia is.The fact is that if you take 100 absolutely healthy people without low back pain and make an MRI diagnosis, it turns out that 80% of them have some kind of disc protrusion ("herniation"), which does not give 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.To clarify the causes of pain, a thorough anamnesis is collected, 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 to be operated on.Patients who need this operation are no more than 2%.

Neurosurgeons have prescribed absolute indications for surgical intervention, which are clearly defined.In most cases, the presence of a herniated disc is not a reason for emergency surgery.

There is a sufficient arsenal for the treatment of herniated and protruding discs, including traction, the formation of stable motor patterns in the back, methods of local and general drug therapy, physiotherapy, reflexology, etc.Calibrated treatment without surgery is often accompanied by regression of symptoms and the hernia (protrusion) may decrease over time.

When deciding on surgical intervention, it is necessary to take into account the relevant indicators for 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 tests. 

It should be especially noted that surgery is often associated with a number of complications, which after surgery must be dealt with many times more intensively than with pain relief before surgery.

Degenerative changes of the spine, such as osteochondrosis, spondyloarthrosis, spondylosis, etc., are treated based on the identification of the triggering factors 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 management of patients with low back pain, taking into account the possible range of their causes.