Backache

Low back and neck pain are among the most common reasons to seek medical attention. Pain is often caused by problems with the musculoskeletal system - most obviously problems with the spine, which includes the bones of the spine (vertebrae), the discs, and the muscles and ligaments that support them. Sometimes back pain is caused by a medical condition that doesn't 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 health care payments, disability benefits, and missed work time.

The spine (vertebrae) is made up of vertebrae. Between the vertebrae are shock-absorbing discs. The disc has a tough outer layer of fibrocartilage tissue and a soft jelly-like interior 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 surface of the other vertebral body, forming a joint. The joints, and together with the entire spine, are stabilized by ligaments and muscles, namely:

• The two sternocleidomastoid muscles run on either side of the spine
• Two upright back muscles run the entire length of the spine behind it
• Many short vertebral muscles are 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, the spinal nerves exit, the function is to merge all the nerves in the body. The part of the spinal nerve near the spinal cord is called the root. Due to the specific location of the spinal nerve roots, they can be compressed (pinched) with trauma to the spine, which in turn leads to pain.

The lower spine (lumbar spine) at the top connects to the upper spine (thoracic spine) and below the pelvis through the sacrum. The lumbar spine is flexible enough to bend, twist and flex, providing strength when standing, walking, and lifting. So the lower back is involved in almost all kinds 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, diffuse, and back-impact pain.

Local painoccurs in a certain area of the lower back. This is the most common type of back pain. The causes are usually disc injury, arthritis, and less commonly, muscle strain. The pain may be constant and aching, or at a certain point it may be replaced by intermittent acute pain. Sudden pain can occur when trauma is the cause. Local pain may increase or decrease with change of position. Touching the lower back can be painful. Muscle spasms may occur.

PainIt is a pain in the lower back that radiates down the leg. The pain can be dull or sharp and intense. Usually, it affects only one side or back of the leg and can extend to the foot or just to the knee. Radiating pain is often 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 cause pain. When spinal nerve roots are compressed, pain can be accompanied by weakness in the leg muscles, tingling sensations, and even loss of sensation. In rare cases, loss of control of urination (incontinence) or loss of bowel control (fecal incontinence) occurs.

Pain is reflectedfelt somewhere other than the actual cause of the pain. For example, some people who have had a heart attack feel pain in their left arm. The pain reflected from the internal organs in the lower back is mainly deep and painful in nature, and it is difficult to pinpoint its exact location. As a rule, when moving, pain does not increase, on the contrary, pain is accompanied by disorders of the musculoskeletal system.

The reasons

In most cases, back pain is the result of diseases of the spine and surrounding joints, muscles, ligaments and roots of spinal nerves, as well as discs. Often, a specific cause cannot be identified. Any pain in the spine can lead to reflex contractions (spasms) of the muscles around the spine. The spasm can increase the pain. Stress can make low back pain worse, but the mechanism isn't clear.

Sometimes, back pain is caused by a disorder that does not affect the spine, such as cancer, gynecological conditions (such as premenstrual syndrome), kidney disease (such as kidney stones), urinary tract disease (such as urinary tract infection). infections of the kidney, bladder, and prostate) and gastrointestinal tract (eg, diverticulitis), as well as diseases of the large arteries located near the spine.

Common causes

Common causes of back pain include:

• Osteoarthritis
• Compression fracture spine
• A ruptured or herniated disc
• Spinal stenosis in the lumbar spine thắt
• Degenerative spine
• Injury to muscles and ligaments
• Fibromyalgia

Damagemay occur during normal activities (eg, heavy lifting, exercise, unexpected movements) or as a result of trauma, such as a fall or traffic accident. Usually, imaging studies don't show any specific damage, but doctors suspect that certain muscles and/or ligaments are affected.

Osteoarthritis(degenerative arthritis) causes wear and tear of cartilage between joint surfaces and the formation of bone spurs (bone-forming bone). The disease is partly the result of years of tissue wear and tear. With severe degeneration and loss of disc height, bone-forming substances within the disc lumen can compress the spinal nerve roots. All of these changes can lead to lower back pain as well as stiffness.

Compression (compression) spine fracture(vertebral fracture) usually occurs when bone density decreases due to osteoporosis, which usually develops with age. However, osteoporosis fractures tend to occur in the upper and middle back and are accompanied by pain in these areas 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 jelly-like soft central part. If the disc is under constant pressure from the upper and lower vertebrae (for example, when bending forward, especially when lifting heavy objects), its outer layer can rupture (tear), causing pain.

Spinal stenosis in the lumbar spine thắtSpinal stenosis (running through the center of the spine and containing the spinal cord and the bundle of nerves that extend down from the lower part of the spinal cord) in the lumbar region. It is a common cause of low back pain in older adults. Spinal stenosis also develops in middle age in people who have had spinal stenosis since birth. Spinal stenosis is caused by disorders such as osteoarthritis, spondylitis, ankylosing spondylitis, and Paget's disease.

Spinal stenosis can cause sciatica as well as back pain.

Degenerative spine- displacement of part of the vertebrae in the lower part of the spine. One type usually occurs in adolescence or young adulthood (common 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 vertebra below. Osteoarthritis can also occur in the elderly, but is mainly due to 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 affecting many parts of the body, including the lower back. This condition leads to chronic radiating pain in the muscles and other soft tissues outside of the lower back. Fibromyalgia is also characterized by sleep disturbances and fatigue.

Survey

Tests are not usually prescribed because most back pain is caused by osteoarthritis, sprains, or other mild musculoskeletal disorders and resolves on its own within 6 weeks. Imaging tests are often needed if:

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

Evaluation may also be ordered if there is no response to initial treatment, or if symptoms worsen or change.

X-rays of the lower back can only provide images of the bones. Such images can detect degenerative changes caused by osteoarthritis, spinal compression fractures, spondylolisthesis, and ankylosing spondylitis. However, magnetic resonance imaging (MRI) or computed tomography (CT) can provide clear images of the bones and, as is typical with MRIs, show soft tissue (including discs and some nerves). meridians). An MRI or CT scan is often needed when doctors determine the presence of disorders that lead to certain changes in the structure of 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 the MRI results are not clear, a CT myelogram should be performed. Rarely, if malignancy or infection is suspected, a tissue sample (biopsy) should be taken for analysis. In some cases, electromyography and examination to study nerve conduction are performed to confirm the presence, localization, and in some cases, duration and severity of root compression. spinal nerves.

Preventive

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

• physical exercises;
• exercises to strengthen and stretch muscles;
• maintain normal body weight;
• maintain correct posture;
• Follow the recommendations for safe weight lifting.

The most effective way to prevent low back pain is to exercise regularly. Aerobic exercises and special exercises are recommended to develop strength and stretch.

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

Special exercises to develop muscle strength and stretch the muscles of the abdominal wall, buttocks and back (deep muscles of the trunk), allowing you to stabilize the spine and reduce the stretching of the column-absorbing discslife and ligaments. keep them.

Strength exercises include pelvic tilts and crunches. Stretching exercises include stretching by bending the knees to the chest. In some people, stretching exercises can lead to increased back pain, so extreme caution is required. The basic rule is that any exercise that causes or worsens back pain must be stopped. Exercises should be repeated until mild (but not too severe) muscle fatigue is felt. Breathing is essential during exercise. People with back pain should consult their doctor before exercising.

Pelvic tilt Perform a supine position with knees bent, heels on the floor, load on heels. Press your back into the floor, tense your glutes (lift about half an inch off the floor) and stretch your abs. Hold this pose for a count of 10. Repeat 20 times.
Lying crunches Lie down while sleeping, knees bent and feet flat on the floor. Cross your arms in front of your chest. Squeezing your abs, slowly lift your shoulders off the floor about 10 inches, keeping your head straight (chin should not touch your chest). Relax your abs and slowly lower your shoulders down. Do 3 sets of 10 times.
Stretch your knees to your chest Take a supine position, with your back straight. Place your palms under one knee and press into your chest. Hold the position 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. As a result, 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 strain on the back. Avoid slipping your hands. The chair should be adjusted in height so that the feet are flat on the floor, the knees are slightly bent, and the backrest fits snugly against the back of the chair. If the chair does not support the lower back, you can place a pillow under it. In a sitting position, feet should be on the floor, not crossed. Sick people should not stand or sit for long periods of time. If you have to stand or sit for long periods of time, changing positions regularly can reduce strain on your back.

Treatment

If a specific cause can be identified, the disease is treated. For example, antibiotics are used to treat prostate infections. However, there is no cure for pain caused by sprains in the musculoskeletal system, or pain caused by other diseases. However, the situation can be improved through general measures. Often, such measures are also used when compressing spinal nerve roots.

General remedies for back pain

Measures may include:

• Change activities
• Take painkillers
• Apply heat or cold to the painful area
• Light exercise, if possible

For recent episodes of back pain, treatment begins by eliminating activities that strain the back and cause pain, such as lifting weights and bending. Bed rest doesn't provide quick relief, and most experts recommend light work. Bed rest, necessary to relieve severe pain, should not last more than 1 or 2 days. Too much bed rest weakens core muscles and increases stiffness, leading to worse back pain and slower recovery. Bras and traction are not effective. Traction can slow wound healing.

Over-the-counter or non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Opioid analgesics are sometimes prescribed if NSAIDs do not provide adequate pain relief, but they should only be used for short periods of time, as long-term use of opioid analgesics may increase susceptibility to painpain, side effects, and an increased risk of addiction and dependence.

Muscle relaxants can sometimes relieve muscle spasms, but their effectiveness is questionable. These drugs 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 contractions. If muscle relaxants are prescribed, they should not be used for more than 72 hours. Doctors sometimes recommend taking them right before bed.

Massage can provide temporary relief from back pain. Several studies have shown positive results in acupuncture; Other studies contradict these findings. Chiropractic manipulation by a chiropractor or other doctor (such as an osteopathic physician), combined with an exercise program, can also reduce pain. However, spinal manipulation can increase the risk of further injury and should be avoided in people with arthritis, neck problems that cause neck instability, or herniated discs.

You should sleep in a comfortable position on a mattress of moderate firmness. People who sleep on their backs should put a pillow under their knees. Patients lying on their side should use a pillow so that the head is kept in a neutral position (do not bend 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. The patient can still sleep on their stomach if they feel comfortable.

Continue or start taking other precautions (correct posture, correct weight lifting technique). When performing such events, the back pain virtually disappeared within a period of a few days to 2 weeks. Regardless of the 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. Do aerobic exercise and lose weight if necessary. If pain relievers are not effective, other treatments should be indicated.

Possible transcutaneous electrical nerve stimulation (TENS). The CHENS device generates 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. An electric current can be applied to the painful area several times a day, lasting from 20 minutes to several hours, depending on the severity of the pain.

Sometimes a local anesthetic corticosteroid is 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 caused by a herniated disc than for lumbar spinal stenosis. However, they may not have long-term effects. They usually last only a few days or weeks. Their main purpose 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 sensitivity, or bowel incontinence, surgical removal of the disc protrusion (discectomy) may be necessary. ) and in some cases, part of the vertebra (laminectomy).

In cases of severe spinal stenosis, a large portion of the posterior vertebra (the plates of the vertebral arch) may be removed to widen it (lumbar spondylectomy). Usually requires general anesthesia. The hospital stay is usually 4 to 5 days. Patients should be able to return to normal activities in 3-4 months. Full or complete recovery is observed in about two thirds of patients. For the remaining patients, such surgery can stop pain and the worsening of other symptoms.

If the spine is unstable (perhaps due to a severe herniated disc, spondylolisthesis, or spondylolisthesis), surgery may be performed to fuse the vertebrae (called vertebrae). lumbar spine). However, fusion limits mobility, which can be accompanied by excessive mechanical stress on the rest of the spine and cause future problems.

Compression fracture spine

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

If adequate pain control is not possible, there are two surgical options:

• Vertebral reconstruction: injecting cement mortar into the broken bone.
• Kyphoplasty: Insert the ball into the broken 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 approaches does not outweigh the effectiveness of nonsurgical options.

Main attractions

• Low back pain is common. It is usually due to 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 usually doesn't need testing unless symptoms persist for weeks.
• Patients with warning signs or patients over 55 years of age should see a doctor immediately.
• Strengthen the muscles in the abdominal wall and back with specific exercises that help prevent the most common types of low back pain.
• For back pain, usually, adequate treatment is to exclude mechanical measures on the back, take pain relievers, and in some cases, apply cold or warm compresses.
• Rest and stretching in bed can slow recovery.
• In severe cases, such as abnormal sensations and weakness in the legs, surgery may be required.
• Compression fractures can be treated conservatively (with splints, pain relievers, and nasal sprays) or, in some cases, more aggressive with surgery.