Treating lower back pain

Lower back pain is simply a symptom, an external manifestation of a 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 overuse of muscles and ligaments.Unfortunately, if the cause were only in the muscles, it would be very easy to relieve the pain.For example, a massage that is supposed to bring relief.But a massage doesn't always help because it eliminates the cause of the pain.

Severe back pain can occur due to a herniated or bulging disc.If the herniated disc is on the right side, you may experience back pain on the right side, pain on the right side, or pain in the right leg (sciatica from a large herniated disc).If the hernia is left-sided, you may feel pain in your left back and may have pain on your left side. 

If the hernia is large and compresses the left lumbar root (Radiculitisleft), then lumbago can occur in the left leg and pain in the left leg can occur.A large inguinal hernia often leads to a postural disorder in the form of a curvature of the trunk with acute “torsion pain” when standing up and straightening is not possible (the so-called antalgic trunk position).

Back pain in the lower right area can be the result of problems with a hernia or with the right joints of the spine or pathology of the sacral area (right sacroiliac joint).

Pain in the left shoulder blade area (or pain under the left shoulder blade) can be either a result of a hernia or joint disease, or the result of heart problems.Such pain can be caused by angina and heart attack.Pain between the shoulder blades occurs not only with spinal pathologies and osteochondrosis, but also with diseases of the stomach (gastritis, ulcers, cancer, etc.) and often the intestines.

Cholecystitis and cholelithiasis most commonly cause right back pain and pain under the right shoulder blade.Gallbladder pathology is often manifested by pain under the right rib.Need a diagnosis.

ProjectionsHard drives, are more common incidental findings on MRIcancontinue completely pain-free.Herniated disc– not such a common cause of severe back pain.However, the formation of a hernia, for example when lifting heavy objects, can lead to lumbar or thoracic lumbago (stinging pain in the back).If you have constant back pain, it may be that the hernia found on the MRI has nothing to do with it at all.The reasons for such constant pain are often different. Diagnosis will help you figure it out.

Therefore, to effectively treat back and lower back pain, you must do the following:

1. Determine the cause of lower back pain (establish a diagnosis).
2. The cause of lower back pain is determined by a neurologist, an orthopedic traumatologist with knowledge in the field of vertebrology and vertebroneurology or a vertebrologist (vertebroneurologist).The diagnosis is made by clinical and hardware examination.
3. Treatment tactics for lower back pain depending on the diagnosed cause.
4. If you suffer from back pain, it is important to ensure that the pain does not return.To achieve this, we offer various methods, including physical rehabilitation of the spine.

Lower back pain.Why does my lower back hurt?

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

Pain in the lumbar regioncan have many reasons.The most common causes are osteochondrosis, herniated discs, radiculitis and pathologies 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 that is accompanied by pain.This is a little different.

The image below shows a normal hard drive getting corrupted (see damaged hard drive in the image).This damage can cause the intervertebral disc to age more quickly and lose height (see “Narrowing of the intervertebral space”).Next, the aging process begins to affect the bone tissue of the vertebrae themselves and osteophytes grow (see “Osteophytes” in the picture).

Until now, it was assumed that osteochondrosis was accompanied by pain.Therefore, at that time people tried to explain the cause of pain in the spine and especially in the lower back with osteochondrosis.For this reason, the question of the failure of vertebroneurology even arose.In 1978, the first research laboratory for the problems of spinal osteochondrosis was founded, which for more than 10 years studied the problem of osteochondrosis and proved that the cause of pain is not osteochondrosis, but joint pathology. 

Osteochondrosis is not accompanied by pain because the intervertebral disc has no nerve endings.Therefore, there is no pain with osteochondrosis.

Herniated disc

Herniated disc as a possible cause of pain.The picture above shows several herniated discs - a small herniated disc (bulging) and a large herniated disc.A herniated disc itself doesn't hurt.

The intervertebral disc has no nerve endings (not innervated).Pain from a herniated or bulging disc occurs when the bulging disc puts pressure on the innervated tissue.For example onSpineor furtherrearYuyualongWowbunchat.In the first case, radicular pain occurs – radiculitis (see below).In the second case, when the receptors of the posterior longitudinal ligament are irritated, back pain (lumbodynia) or acute pain - lumbago (lumbago) occurs.

A herniated disc can often be treated without surgery.

Spondyloarthrosis

Spondyloarthrosis is osteoarthritis of the joints of the spine.Osteoarthritis itself is characterized by a disease of the articular cartilage.In this case, the height of the cartilage decreases (degenerates, “dries out”) and the bone articular surfaces 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 root.Radiculitis most commonly occurs when the root is injured by a herniated or herniated disc of the spine.It's usually not so much lower back pain, but more pain in the leg, buttocks, and even pain or numbness in the toes.

The most effective way to treat radiculitis is to expose the root.If it arose due to a herniated disc, you need to reduce the herniated disc that is putting pressure on the root.

Pain in the back and lower back due to pathology of internal organs

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

Lower back pain in women

Lower 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 think about gynecology.Inflammatory diseases of the female genital organs are not uncommon.The cause can be inflammation of the appendages, 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 at the same time there is pain in the lower abdomen, the woman needs to be examined by a gynecologist.A gynecological ultrasound examination is absolutely necessary to initially clarify the diagnosis.

Constant, excruciating lower back pain also occurs whenOncology in gynecology.

Cancer and lower back pain in women

Cancer doesn't hurt at first.If pain occurs in the lower back or sacrum area, it may already be too late.

Many people think that tumors are associated with pain.That's 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 sexual organs.It begins to manifest itself as the tumor grows.In this case, pain often occurs in the lower back and below the lower back.Pain below the lower back occurs in the sacrum area.

When you have cancer, severe pain in your lower back doesn't bother you at first.Rather, the lower back does not hurt, but rather hurts.Such pain can be the first call that will help a woman prevent the 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 disaster.

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

Important NOTE:If your lower back hurts, it is not necessarily osteochondrosis or a herniated disc.And it never hurts to seek preventive advice from a gynecologist.After all, the erosion of the cervix found during the examination is a precancerous condition.

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

Acute back pain can be due to kidney disease

With a kidney disease such as pyelonephritis, the lower back hurts badly.

Pyelonephritis is an infectious disease that is usually caused by an 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 a long time in unwashed towels.

Inflammation activates pain receptors in the soft tissues of the pelvic organs.The pain signal (impulse) reaches the spine via the sensitive roots and activates its tissue.The soft tissues of the spine and the attachment points of the back muscles become reflexively swollen (inflamed).And my lower back starts to hurt.

Constant back and lower back pain due to functional disorders and other diseases of the gastrointestinal tract

The back usually hurts with intestinal cramps, flatulence, ulcers or ulcerative colitis, stomach ulcers and gastritis.

Stomach cancer is associated with back pain

Treatment of the back for pain caused by pathology of the gastrointestinal tract does not lead to improvement.The cause must 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 exacerbation.Overload often affects the lower back joints, lower back ligaments, tendons or muscles.In addition, the muscles in the lower back work actively under stress.So if you have pain in the spine in the lumbar region after training, it is not necessarily a disease.It could be a torn muscle.If this pain does not go away within 1-2 days, 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 the muscles and their attachments.Or – inflammation of the joint capsules.

If such an exacerbation occurs more than once a year, the cause of such exacerbations should be looked for.To do this, it is not enough just to see a doctor and carry out manipulations, take painkillers, do massages and other procedures.

To determine the cause of such frequent exacerbations, an examination is required.

Soft tissue injury to the lower back

Stabbing pain in the lower back when making awkward movements or lifting heavy objects is most likely a spinal injury.

If you are worried about pain on this side, for example, pain in the lower back on the right, then you should think about the pathology of the joint on the right side.Or about a right-sided inguinal hernia in the lumbar spine.

Types of lower back pain

Depending on its duration, the pain can be acute, chronic or (temporarily) transient in nature.

The pain is as follows:

• Local pain– Pain exclusively in the lower back.
• Referred pain– if pain occurs not only in the lower back, but, for example, in the buttocks and pelvic area.Or pathology of internal organs causes pain in the lower back.In such cases one speaks of 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 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 area 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 internal organs or damage to the spine itself.Muscle spasms significantly disrupt the biomechanics of human movements.Chronic muscle spasms can also cause aching and cramping pain in the lumbar spine.

In which cases should you see a doctor if you have back pain and what should you do?

• with sharp (acute) pain in the lumbar region;
• if back or lower back pain lasts more than 3 days;
• if back pain occurred after an injury;
• if the pain is localized in the lower back, foot and lower leg at the same time;
• if pain in the lumbar region is accompanied by numbness in the thigh, buttocks, leg, foot, groin;
• if pain in the lumbar region is accompanied by twitching (fasciculations) of the limb muscles;
• if the function of urination and defecation is impaired (urinary retention, incontinence, frequent urination or false urge to urinate);
• when the perineum is numb.
• If the pain in the back or lower back (sacrum) is constant, worse in the morning

What to do if you have lower back pain?

The causes of lower back pain are varied, so treatment of lower back pain should only be carried out after diagnosis and after the diagnosis has been made by a qualified doctor.Pain in the vertebral area requires a medical examination and clarification of the cause of its occurrence.

A visit to the doctor has 3 goals:

1. Make the correct diagnosis.
2. Eliminate pain.
3. Formulate measures that will help maintain the patient's health so that the pain does not recur.

Possible causes of lower back pain

The following conditions may be the cause of your lower back pain complaints:

• osteochondrosis;
• Osteoarthritis;
• Spondylolisthesis;
• Spondylosis;
• Ankylosing spondylitis;
• Spondyloarthropathy;
• Muscle damage;
• Ligament damage;
• Herniated disc "herniaIntervertebral discs are treated without surgery in 98% of cases (world statistics)”;
• arteriosclerosis of the abdominal aorta;
• malignant neoplasms of the spine;
• Metastases to the spine;
• Urinary tract infections;
• stenosis of the spine;
• 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 the female genital organs;
• Endometriosis;
• Prostatitis;
• Prostate cancer;
• Epithelial coccyx abscess;
• Embolism of the arteries of the lower extremities;
• Intermittent claudication;
• Pseudo-intermittent claudication;
• obliterating atherosclerosis of the vessels of the lower extremities;
• rheumatoid spondylitis;
• Polymyalgia rheumatica;
• Fibromyalgia
• depression;
• other.

Treating lower back pain (back pain)

At the stage of initial treatment of lower back (back) pain, a primary diagnosis is made.This is done on the basis of a survey, anamnesis and neurological and orthopedic examinations.At this stage, medications may be prescribed to relieve pain, relieve tissue swelling, and general anti-inflammatory therapy.Reflexology, local medical effect, regional anesthesia, various injection methods for treating back pain, laser therapy, etc. are effective.In the acute and subacute phase, rest is important during drug therapy.Physiotherapy, massage, manual therapy, which can aggravate the process, are not indicated.In the acute phase, traction is also not used: hardware, on inclined boards, on a wall bars.

To treat back pain more effectively, you need to understand the cause.For this purpose, the patient is examined further to clarify the diagnosis.Pain in the lumbar region can have many causes.An exemplary list of diseases accompanied by lower back pain is presented 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, in inflammatory diseases of the spine (spondylitis, spondyloarthropathy, spondyloarthritis, myositis, ligamentitis, etc.), manual therapy, massage and physiotherapy are not indicated due to the ineffectiveness and risk of complications.It is necessary to identify the cause of the inflammation and treat it.

Spondylosis visible on radiographs can occur without clinical symptoms and often mask a more complex disease.Therefore, treatment of spondylosis is useless and often dangerous: it is not realistic nor necessary to remove bone growths in the spine.The patient may be diagnosed with exotic diagnoses such as “muscle damage”, “muscle spasm”, “ligament damage”.be confronted.Unfortunately, the statement that muscle cramps are a cause of pain is not always true.Muscle spasms of the paravertebral muscles are a reflex act and usually accompany most diseases, even those that are not related to the spine.The muscles are actively involved in the segmental reflex process and can respond to irritation both inside and outside the spine.The so-called “cramps” must be distinguished from reflected or projective pain in the lower back, which can be caused by pathologies 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, bleeding into the retroperitoneal tissue and much more.Osteopathic techniques for working with secondary spasmodic paravertebral muscles can temporarily relieve the condition at the reflex level.For example, manual therapy, osteopathic techniques, slant board, massage, traction, physiotherapy do not help with prostatitis or adenomatosis.So-called “therapeutic removal”.“Muscle spasms” in this case are just the desires of the manipulator.

Treatment of hernias and bulging discs in the lower back

An MRI often reveals a hernia or bulge, which is interpreted as the cause of lower back pain.The question immediately arises: remove the hernia or try to do without surgery?

The first thing to do– Clarify how clinically significant this hernia is.The fact is: if you take 100 perfectly healthy people with no lower back pain and do an MRI diagnosis, it turns out that 80% of them have some kind of slipped disc (“hernia”) that does not cause any symptoms.

A herniated disc is often an incidental finding that is 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 detailed anamnesis is taken, a neurological examination is carried out to determine neurological deficits, the function of the pelvic organs is clarified, etc.

It turns out that not all hernias and bulging discs require surgery.The number of patients requiring such an operation is no more than 2%.

Neurosurgeons have given absolute indications for surgery that 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 surgical intervention is often accompanied by a regression of symptoms, and the hernia (protrusion) can decrease over time.

When deciding on surgery, it is necessary to take into account the relative indicators of surgical treatment officially prescribed by neurosurgeons.Each individual 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 particularly noted that surgical intervention is often associated with a number of complications, which require treatment many times more intensively after the operation than to relieve pain before the operation.

The treatment of degenerative changes in the spine such as osteochondrosis, spondyloarthrosis, spondylosis, etc. is based on identifying the triggers 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 treating patients with low back pain, taking into account the possible range of its causes.