Back pain

Low back pain and neck pain are one of the most common reasons to seek medical attention. The pain is usually caused by problems with the musculoskeletal system, most pronounced with problems in the spine, including the bones of the spine (vertebrae), the 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 the age of 60. It leads to significant costs in terms of health care payments, disability benefits, and lost work hours.

The spine (vertebral column) is made up of vertebrae. There are shock absorbing discs between the vertebrae. Discs have a tough 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 lie on the articular surfaces of the other below it, forming a joint. The joints, and with them the entire spine, are stabilized by ligaments and muscles, namely:

• Two muscles of the iliopsoas that run on either side of the spine
• Two erector back muscles that run along the entire spine from behind
• 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, come out the spinal nerves, whose function is to unite all the nerves of 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 of the spine, resulting in pain.

The lower 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 when standing, walking, and lifting. Therefore, the lower back is involved in almost all types of daily activities. Low back pain can interfere with various activities and worsen quality of life.

Types of back pain

Common types of low back pain include localized, radiating, and repercussion 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, arthritis of the joint, and, less commonly, a muscle strain. The pain can be continuous and painful, or at a certain 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 a change in position. Touching the lower back can be painful. Muscle spasms are possible.

Radiating painIt is a low back pain that extends to the leg. The pain can be dull or sharp and intense. It usually affects only the side or back of the leg and can spread to the foot or only to the knee. Radiated pain is usually a manifestation of spinal nerve root compression in conditions such as herniated disc, sciatica, osteoarthritis, or spinal stenosis. Coughing, sneezing, straining, or bending over with your legs stretched out can be painful. When a spinal nerve root is compressed, pain can be accompanied by weakness in the leg muscles, a tingling sensation, or even loss of sensation. In rare cases, loss of control of urination (urinary incontinence) or loss of control of bowel movements (fecal incontinence) occurs.

Reflected painFelt in a place other than the actual cause of the pain. For example, some people with a heart attack have pain in the left arm. Reflected pain from internal organs in the lower back is predominantly deep and painful in nature, and its exact location is difficult to determine. As a general 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 results from diseases of the spine and the surrounding joints, muscles, ligaments, and roots of the spinal nerves, as well as the intervertebral discs. Often times, no single specific cause can be identified. Any painful spinal disease can cause a reflex contraction (spasm) of the muscles that surround the spine. The spasm can increase pain. Stress can make low back pain worse, 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 PMS), kidney disease (such as kidney stones), urinary tract disease (such as infections of the kidneys, bladder ). and prostate) and the digestive tract (for example, diverticulitis), as well as diseases of the great arteries located near the spine.

Common causes

Common causes of back pain include the following:

• Osteoarthritis
• Compression fractures of the spine
• A ruptured or herniated disc
• Spinal stenosis in the lumbar spine.
• Spondylolisthesis
• Damage to muscles and ligaments.
• Fibromyalgia

HurtIt can occur during normal activities (for example, lifting heavy objects, exercising, unexpected movements) or as a result of an injury, such as a fall or a traffic accident. Imaging studies usually do not show any specific injury, 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 in part the result of years of tissue wear and tear. With severe degeneration and loss of disc height, osteophytes in the foramen can compress the spinal nerve roots. All of these changes can lead to low back pain and 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 tend to occur in the upper and middle back and are associated with pain in these regions rather than the lower spine.

A ruptured or herniated discit can cause back pain. The disk 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 bending forward, especially when lifting heavy objects), its outer layer can rupture (tear) and cause 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 downward from the lower part of the spinal cord) in the lumbar region. It is a common cause of low back pain in older people. 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 and 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 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 mainly as a result of a degenerative disease. With the development of spondylolisthesis in adulthood, the risk of spinal stenosis in the lumbar region increases.

FibromyalgiaIt is a common cause of pain that affects many parts of the body, including the lower back. This condition results in diffuse chronic pain in the muscles and other soft tissues outside of the lower back. Fibromyalgia is also characterized by sleep disturbances and fatigue.

Polls

The tests are generally not prescribed because most back pain is due to osteoarthritis, sprains, or other minor musculoskeletal disorders and resolve within 6 weeks. Imaging tests are often needed if:

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

An evaluation may also be requested if there is no response to initial treatment or if symptoms worsen or change.

X-rays of the lower back can only provide a picture 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 clear image of the bones and, as is typical for MRI, show soft tissue (including discs and some nerves). An MRI or CT scan is usually needed when doctors determine the presence of disorders that cause some changes in the structure of the bones, as well as soft tissue diseases.

If spinal cord compression is suspected, an MRI is done as soon as possible. In rare cases, when MRI results are ambiguous, CT myelography is necessary. In rare cases, if a malignant tumor or infection is suspected, a tissue sample (biopsy) needs to be taken for analysis. In some cases, electromyography and nerve conduction examinations 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 a correct posture;
• compliance with the recommendations for the safe lifting of weights.

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

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

Special exercises for the development of muscular strength and stretching of the muscles of the abdominal wall, buttocks and back (deep muscles of the trunk), allow to stabilize the spine and reduce the stretching of the discs that absorb the spine and the ligaments that maintain it.

Strength-building exercises include abdominal and pelvic tilts. Stretching exercises include stretching by bending the knees toward the chest. In some people, stretching exercises can lead to increased back pain, so caution should be exercised. The basic rule of thumb is that any exercise that causes or worsens back pain should be stopped. The 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 Take a supine position with your knees bent, your heels on the floor, and the load on your heels. Press your back against the floor, tense your glutes (lift them about half an inch off the floor), and tense your abdominal muscles. Hold this position for a count of 10. Repeat 20 times.
Lying abs Lie on your stomach with your knees bent and your feet flat on the floor. Fold your arms over your chest. Tighten your abdominal muscles, slowly lift your shoulders about 10 inches off the ground, keeping your head straight (chin should not touch chest). Relax your abdominal muscles, slowly lower your shoulders. Do 3 sets of 10 reps.
Stretch with your knees to your chest Take a supine position, straighten. Place both palms under one knee and press it against your chest. Hold for a count of 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. Therefore, exercise can reduce the risk of developing two conditions that can cause low back pain: obesity and osteoporosis.

Correct posture when standing and sitting reduces stress on your back. Stooping should be avoided. Chair seats should be adjusted in height so feet are flat on the floor, knees slightly bent, and lower back is snug against the back of the chair. If the chair does not provide lower back support, a pillow can be placed underneath. In a sitting position, it is recommended to put your feet on the floor, not cross your legs. Sick people should not stand or sit for long periods. If you have to stand or sit for a long time, frequent changes in position can reduce the strain on your back.

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 musculoskeletal sprain pain or pain caused by other conditions. However, the situation can be improved with general measures. Usually these measures are also used when squeezing the spinal nerve root.

General measures for back pain.

Possible measures include:

• Make changes to activities
• Take analgesics
• Applying heat or cold to the painful area
• Light exercise, if tolerated

For more recent back pain, treatment begins by eliminating activities that strain the back and cause pain, such as lifting weights and bending over. Bed rest does not accelerate pain relief, and most professionals recommend 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 traction are ineffective. Traction can slow healing.

Over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Opioid pain relievers are sometimes prescribed if NSAIDs do not provide enough pain relief, but they should only be used for a short period, as long-term use of opioid pain relievers may, on the contrary, 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 more than 72 hours. Sometimes doctors recommend taking them just before bed.

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

Sleeping in a comfortable position on a medium firm mattress is recommended. Back sleepers should have a pillow under their knees. Side sleepers should use a pillow that allows the head to be held in a neutral position (without bending the neck up or down). Patients should place a second pillow between the 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 carrying out such events, back pain attacks mainly disappear in the period of several days to 2 weeks. Regardless of treatment, 80 to 90% of these attacks resolve 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 pain relievers are ineffective, other treatments should be prescribed.

Transcutaneous electrostimulation (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 that covers the spinal cord. Epidural injections may be more effective for sciatica, which is due more to a herniated disc than lumbar spinal stenosis. However, they may not have beneficial long-term effects. They usually last only 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 causes persistent or chronic sciatica, weakness, loss of sensation, or fecal and urinary incontinence, it may be necessary to surgically remove the bulging 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 (lamellae of the vertebral arch) can be removed for expansion (lumbar laminectomy). General anesthesia is usually needed. The length of stay in the hospital is usually 4 to 5 days. Patients will be able to return to their normal activities in 3-4 months. Adequate or complete recovery is seen in approximately two-thirds of patients. For the rest of patients, this surgery can prevent pain and worsening of other symptoms.

If the spine is unstable (which can result from a severe herniated disc, spondylolisthesis, or laminectomy for spinal stenosis), surgery may be done to fuse the vertebrae (called an 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.

Compression fractures of the spine

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

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

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

However, recent studies have shown that, in the long term, the efficacy of these surgical procedures does not outweigh the efficacy 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 generally not necessary unless symptoms persist for many weeks.
• Patients with warning signs or patients over 55 years of age 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.
• For back pain, most of the time, sufficient treatment consists of excluding measures that cause mechanical effects on the back, taking pain relievers and, in some cases, applying a cold or warm compress.
• Prolonged bed rest and stretching can slow recovery.
• In severe cases, such as abnormal sensations and weakness in the legs, surgery may be required.
• Compression fractures of the vertebrae can be treated conservatively (with braces, pain relievers, and nasal sprays) or, in some cases, more aggressively with surgery.