Pain in the lumbar spine and the neighboring areas may disturb the patient at any time of the day, standing, sitting, lying down or on-the-go, during exercise or at rest. So, this symptoms are not specific, i.e. it can meet in such a large number of cases which require special attention in the first place from the patient: it is necessary to immediately consult a doctor.
What doctor to address?
According to the statistics, up to 25% of patients seek medical advice in connection with the occurrence of pain in the lumbar region. 8 out of 10 inhabitants of the globe have experienced pain in the back, at least 1 time in my life. Most often suffer from these symptoms of persons of working age, slightly fewer people of retirement age, and even fewer adolescents (by different estimates, from 8 to 40%, in Russia).
Therapist, neurologist, rheumatologist
The first doctors, who will refer the majority of patients with pain in the lower back, to become a therapist and neurologist. But, young people with trauma in the recent past more and more are turning to specialist.
And the diagnostic and therapeutic tactics in these professionals vary. Often, the therapist directs the patient to the neurologist, the neurologist determines the "" a diagnosis and prescribe treatment. Specialist often working "individual", despite the use of non-steroidal anti-inflammatory drugs, applied techniques of manual therapy and physiotherapy. The main thing for the patient – not to get lost in this situation, not to get carried away with the promises of instant healing when performing techniques, and not to resort to them again in case of failure or, even worse, will be further intensified against the background of such treatment of pain.
When conservative treatment, which is medication, you need to understand that the treatment for four weeks without result, a strong argument for revision of the diagnosis, treatment to revmatologu, and not to carry out repeated courses of therapy. There are often situations when the patient with complaints of pain in the lower part of the back gets symptomatic (pain), the treatment of some formulaic pattern, without specifying the real reason for the pain.
Causes of pain in the back
The main reasons for pain in the lumbar region is
- changes in the structures of the spine, usually age-related (degenerative), degenerative disc disease of the spine, various herniated discs or inadequate work of the muscle complex. Such pain is called primary, which is directly connected with the spine;
- the pathological changes of the organs are located in the vicinity of the painful area, but directly on the spine are not related (for example, diseases of the internal organs, skin). This category causes include joint inflammation, trauma, endocrine disorders (e.g., diabetes), - in short, everything that does not fit in the "natural age-related changes" of the spine. Such pain is called secondary.
Inspection on appointment
Pain, with feeling of heavy mobility or increased painful muscle tension in the area between the lower ribs and the buttocks is marked with the term "lyumbalgiya". If these symptoms include pain in the leg, this condition is called lyumbalgiya.
The most important thing is the sharpness of the pain, that is, the distance from its occurrence. Pain prescription for up to 12 weeks (3 months) is called acute, more than 12 weeks – chronic. Chronic pain syndrome may occur with exacerbations and periods of improvement.
Of fundamental importance is the way the pain feels. Or feeling in a particular moment, or distribution ("projection", "radiation") is pain along the nerve in the thigh, buttock, knee, leg or vague, "blunt" pain. You need to understand that restricted movement in the spine and in moments of pain, or the smooth movement (this may indicate the mechanical nature of the damage, such as fracture of the vertebra). In that moments there is pain? Does it happen under load, or at rest in the course of the night is for sleep? An affirmative answer to the last question is generally a "red flag" for an expert and makes you wonder about the diagnosis of inflammatory diseases of the spine in one patient (a little later). If the pain increases with movement of the head, walking, jumping, it is probably about t.n. designed pain, the cause of which is the damage of the nerve structures (mostly sciatica).
Osteochondrosis, or spondilez – a condition in which there is compression and deformation of the vertebrae, with the advent of the small surfaces of the bones, as the spikes and the edges of the vertebrae. For a long time, it is assumed spondilez a result of the natural course of the degenerative processes of aging. However, it was demonstrated that not only the age can be a reason for low pain in the back. Sedentary way of life, increased load on the lumbar spine during prolonged work at the computer or during a long ride (for example, the profession of the drivers of the trucks) contribute to the onset of osteoarthritis, even in young people. Under the influence of all these factors, the intervertebral discs become thinner buffers, and the nerve roots going from the spinal cord injured, and raised the marginal spikes of bone. The constant irritation of these roots and causes pain. In Latin the root is called the radix, and this inflammation is usually called radikulit.
T.o inflammatory diseases of the spine – the area of interests of rheumatology. These mysterious diseases can "smolder" for a few years, starting mainly in young age and mainly affecting men, and resulting in the end in the obezdvizhennost' I invalidizatsiyu the patient. Patients in this group usually the "go to last" and night pain, and morning stiffness of the back and weakness, and the growing decline of health. Unfortunately, from the appearance of the first symptoms of the disease before the correct diagnosis on average it takes about seven years. During this period, changes in the spine can become irreversible, and functional (locomotor) activity is at a low level. The spine becomes fixed, changes shape, there are hump. I found this pathology is not as common as low back pain, for example, but the cost of treatment and the complete inability of such patients is disproportionately higher.
If in addition to back pain, the patient talks about inflammation of the joints (most often it comes for the knee joints, the joints of the hands or the feet), pain in the buttocks, unstable chair with unusual impurities, impaired vision or pain in the eyes, this is also a reason to immediately send the specialist for the implementation of the specific additional examinations and exclusion of diseases from the group spondiloartritov (for example, seronegative spondylitis or crohn's disease).
There are diseases manifested by pain in the lower part of the back completely intact vertebrates or the neural structures. One such disease – myofascial pain syndrome. The patients (mostly young patients), indicate that spending long periods in an awkward position, or physical overload, preceded the development of pain. When doctors have attracted the attention of a sharp pain when pressure on certain points located in the vicinity of the spine. This condition significantly reduces the patient's quality of life, but small changes in the muscle tissue (the local strain) is not a danger to the nerve roots or of the internal organs. Usually, the therapeutic effect can be achieved with the use of the intended use of muscle relaxants, low-dose nonsteroidal anti-inflammatory drugs, local injection (injection) in the "pain point" steroid anti-inflammatory drugs.
Examination
It is considered that if a patient with complaints of pain in the lower part of the back there will be no "red flags" (discussed below), and then further testing it is not necessary, and the treatment can be carried out by a physician without tests, and even x-rays. But, as practice shows, almost every patient these "signs" can be detected, and therefore, it is necessary to donate the blood at least a common (and better – more of the immune) analysis, and perform x-rays of the lumbar spine in two projections (ideally with the "capture" of the pelvis).
- - Blood tests may reveal an increase of the erythrocyte sedimentation rate (ESR), which indicates inflammation, probably immune in origin, or infection. Increasing the level of leukocytes, also suggests infection or inflammation, and severe anemia – for possible presence of cancer.
- - Urinalysis for rent with suspected kidney disease. Pain in the lumbar region is periodic in nature, it is often "spread" to the lower ribs. If there are changes in the urine analysis performed renal ultrasound, and tactics are discussed in detail with the help of a therapist or urologist.
- - X-ray – the cheapest of instrumental examinations, is the method of choice in the diagnosis of the finding in this case. On the radiograph one can see a violation of the structures of the spine, signs of inflammation of the vertebral joints, of the circumstantial evidence to determine the location of compression of the nerves. The "transparency" of the vertebrae on the radiographs will lead to the thought of osteoporosis (instability) of the bones of the skeleton. As you know, on the background of osteoporosis, the most common complications such as fracture of the vertebra. If the fracture is, unfortunately, happens, it will also be seen on the radiograph. The possibilities of this method of research is huge, but if pathology is discovered, we must ask ourselves how serious the damage is, not whether the patient is in need of surgical intervention of the spine. This is necessary with a more precise study – level (CT). There are two types of tomography – computed x-ray and magnetic resonance imaging.
- - Computed tomography (CT). The research method that allows you to literally look at the inside of the spine. All the bone structure, which are not visible on x-ray, tomogram will be perfectly visible. If necessary, with use of the obtained data and a special computer program can reconstruct a 3D model of each structure.
- - Magnetic resonance imaging (MRI). No x-ray method of research. Different from CT that allows the doctor to more closely assess the condition of the soft structures of the spine (visible on CT only bone elements): the spinal cord, roots. More details when the survey is seen vertebral hernias, vascular changes and muscle. Usually it is a specialist in the MFA remains the last word in the diagnostic search and definition of further tactics.
Signs that you need to pay attention
Secondary back pain which is not associated with low back pain is an alarming symptom, forcing you to start a search of the primary pathological process causing the pain. A summary of the symptoms that indicate possible secondary (i.e. not directly associated with the spine) character of pain and require increased vigilance, as well as from the doctor and the patient:
- the rapid and sudden loss of body weight (may be a suspected tumor);
- infection of the kidneys and bladder (in this case, the pain can be a symptom of pyelonephritis);
- increased pain at rest or after a night's sleep (this symptom is especially interested in rheumatology, as it can be a sign for the development of Bechterew's disease);
- the increase of temperature of the body;
- changes in blood tests (increase of clotting of the blood, discovered when you run coagulogram, increased level of leukocytes or a drop in hemoglobin and increased ESR (erythrocyte sedimentation rate) in a comprehensive analysis, increased levels of C-reactive protein analysis);
- diagnosis "osteoporosis", or taking medicines that reduce the amount of calcium in the bones;
- age over 50 years (risk of osteoporosis in women in menopause) or less than 20 years, particularly for boys;
- link to the injury, regardless of its limitations (for example, a drop of more than 2 meters, as well as for older people a significant injury is falling from height of own body);
- signs of serious neurological abnormalities (decreased sensitivity of the skin, urination or a bowel movement is usually an indication that the deep lesions of the spinal cord);
- the ineffectiveness of the "routine" treatment for 4 weeks.
For the maintenance of the activity and mobility
A common mistake is to comply with bed rest for acute back pain. The movement in this pathology of the locomotor apparatus not only necessary, but essential! In all cases, except for the compression radicular syndrome (the diagnosis will be established neurologist), who, in a horizontal position increases the cost of treatment and prolongs the time of recovery. And when radicular syndrome, the total time in bed should not be more than two days.
In inflammatory diseases of the spine and sacroiliac joints physical activity is the primary means to combat the upcoming obstacles in the development. Let us recall that this group of diseases is gradually progressive in nature, as well as exercises aimed at maintaining flexibility and developing and strengthening the muscular "corset" of the spine can be considered as an effective treatment method as a separate therapy anti-inflammatory medications for a variety of groups, appointed by the specialists.