Pain in the lumbar spine and adjacent areas may disturb the patient at any time of day, standing, sitting, lying down or on-the-go, during exercise or at rest. So this symptom is not specific, ie it can meet in such a huge number of cases that require special attention in the first place from the patient: it is necessary to immediately consult a doctor.
To what doctor to address?
According to statistics, up to 25% of patients seek medical help 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 less people of retirement age and even fewer adolescents (by various estimates, from 8 to 40% in Russia).
Therapist, neurologist, rheumatologist
The first doctors, which will address the majority of patients with pain in the lower back, become a therapist and neurologist. But young people with trauma in the recent past increasingly turning to specialist.
And diagnostic and therapeutic tactics in these professionals differ. Often, the therapist directs the patient to the neurologist, the neurologist determines "your" diagnosis and prescribes treatment. Specialist often working "individually", and besides using 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 by promises of instant healing when performing techniques, not to resort to them again in case of failure or, worse, intensified against the background of such treatment of pain.
When conservative treatment, that is medication, you should understand that treatment for four weeks without result, a strong argument for the revision of the diagnosis, treatment to revmatologu, not to conduct repeated courses of therapy. There are often situations when a patient with complaints of pain in the lower back receives symptomatic (only pain) treatment of some formulaic scheme, without specifying the real cause of the pain.
Causes of lower back pain
The main causes of pain in the lumbar region is
- changes in the structures of the spine, usually age-related (degenerative), degenerative disc disease of the spine, a variety of herniated discs or inadequate work muscle complex. Such pain is called primary, that is directly associated with the spine;
- the pathological changes of organs located near the painful area, but directly to the spine are not related (e.g., diseases of internal organs, skin). This category of causes include joint inflammation, trauma, endocrine disorders (e.g. diabetes), - in short, everything that doesn't fit the "natural age-related changes" of the spine. Such pain is called secondary.
Inspection on appointment
Pain, feeling heavy mobility or increased painful muscle tension in the area between the lower ribs and the buttocks is denoted by the term "lyumbalgiya". If these symptoms include pain in the leg, this condition is called lyumbalgiya.
The most important is the sharpness of the pain, that is, the remoteness of its occurrence. Pain the prescription to 12 weeks (3 months) is called acute, longer than 12 weeks – chronic. Chronic pain syndrome may occur with exacerbations and periods of improvement.
Of fundamental importance is how pain is felt. Or feeling at a certain point, or distribution ("projection", "irradiation") is pain along the nerve in the thigh, buttock, knee, foot, or fuzzy, "blunt" pain. You need to understand that restricted movement in the spine in moments of pain, or movement unhindered (this may indicate the mechanical nature of the damage, such as fracture of the vertebra). At which moments there is pain? Does it occur under load, or at rest during a night's sleep? An affirmative answer to the last question is generally a "red flag" for the expert and makes you wonder about the diagnosis of inflammatory diseases of the spine in a patient (a little later). If the pain increases with movement of the head, walking, jumping, it probably is about the so-called projected pain, the cause of which is damage to nerve structures (most often sciatica).
Osteochondrosis, or spondilez – a condition in which there is compression and deformation of the vertebrae, with the advent of small bone surfaces, like spikes on the edges of the vertebrae. For a long time it was assumed spondilez the result of the natural course of the degenerative processes of aging. However, it was demonstrated that not only the age can be a cause of low back pain. Sedentary lifestyle, increased load on the lumbar spine during prolonged work at the computer or during prolonged driving (e.g., profession truck drivers) contribute to the emergence of osteoarthritis even in young people. Under the influence of all these factors, the intervertebral discs become thinner buffers, and the nerve roots that go from the spinal cord injured raised the marginal spikes of bone. The constant irritation of these roots and causes pain. In Latin the root is called the radix, so this inflammation is usually called radikulit.
The so-called 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 obezdvizhennost' i invalidizatsiyu patient. The patients in this group usually "go to last" and night pain, and morning stiffness in the back, and weakness, and growing decline of health. Unfortunately, from the appearances of the first symptoms of the disease before the correct diagnosis on average it takes about seven years. During this time, changes in the spine can become irreversible, and functional (locomotor) activity is low. The spine becomes fixed, changes shape, there is a hump. Found this pathology is not as common as low back pain, for example, but the cost of treatment and total disability of such patients is disproportionately higher.
If in addition to the back pain patient talks about inflammation of the joints (most often we are talking about the knee joints, the joints of the hands or 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 him to a specialist for implementation of specific additional examination and exclusion of diseases from the group spondiloartritov (e.g., seronegative spondylitis or Crohn's disease).
There are diseases manifested by pain in the lower back completely untouched vertebrates or the neural structures. One such disease – myofascial pain syndrome. Patients (mostly young patients), indicate that spending long periods in an awkward position or physical overload, preceded the development of pain. When doctors drew the attention of a sharp pain when pressure on certain points located near the spine. This condition significantly reduces the patient's quality of life, but minor changes in the muscle tissue (the local strain) is not a danger to the nerve roots or to the internal organs. Typically, the therapeutic effect can be achieved by using the purpose of muscle relaxants, low-dose nonsteroidal anti-inflammatory drugs, local injection (injection) in the "pain point" steroid anti-inflammatory drug.
It is considered that if a patient with complaints of pain in the lower back has no "red flags" (discussed below), then additional testing it is not needed, and treatment can be carried out by the physician without tests and even x-rays. But, as practice shows, almost every patient these "signs" can be detected, and hence there is a need to donate blood for at least common (and better – more on immunological) analysis, and perform x-rays of the lumbar spine in two projections (ideally with the "capture" of the pelvis).
- - Blood tests can detect the 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 – about the possible presence of cancer.
- - Urinalysis for rent with suspected kidney disease. Pain in the lumbar region is periodic in nature, often "spreading" up to the lower ribs. If there are changes in the urine analysis performed renal ultrasound, and tactics is discussed in detail with a therapist or urologist.
- - X-ray – the cheapest of instrumental examinations, is the method of choice in diagnostic finding in this case. On the radiograph you can see the violation of the structures of the spine, signs of inflammation of the vertebral joints, on circumstantial evidence to determine the location of compression of the nerves. "Transparency" of the vertebrae on radiographs will lead to the thought of osteoporosis (fragility) bone of the skeleton. As you know, on the background of osteoporosis, the most common complications such as fracture of a vertebra. If the fracture is, alas, taken place, it will also be seen on the radiograph. The possibilities of this method of research is huge, but if pathology is found, one must ask how serious the damage is, not whether the patient needs surgical intervention on the spine. This has required a more precise study – level (CT). There are two types of tomography – computed x-ray and magnetic resonance.
- - Computed tomography (CT). Survey method that allows you to literally look inside of the spine. All the bone structure, which are not visible on x-ray, tomogram will be perfectly visible. If necessary, using the obtained data and a special computer program can reconstruct a 3D model of any 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 for a specialist in MRI remains the last word in diagnostic search and definition of further tactics.
Signs that you should pay attention
Secondary back pain that is not related to the low back pain is an alarming symptom, forcing to start a search of the primary pathological process causing the pain. Briefly the symptoms which may indicate possible secondary (i.e. not directly related to the spine) character of pain and require increased vigilance, as from the doctor and the patient:
- quick 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 of developing Bechterew's disease);
- the increase in body temperature;
- changes in blood tests (increased blood clotting, discovered when you run coagulogram, increased level of leukocytes or drop in hemoglobin and increased ESR (erythrocyte sedimentation rate) in the overall 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, especially for boys;
- link to the injury, regardless of its limitations (for example, a drop of more than 2 meters, and for older people a significant injury is falling from height of own body);
- signs of serious neurological abnormalities (impaired skin sensitivity, urination or bowel movement is usually an indication that deep lesions of the spinal cord);
- the ineffectiveness of the "routine" treatment for 4 weeks.
To maintain activity and mobility
A common mistake is to comply with bed rest for acute back pain. The movement in this pathology of locomotor apparatus not only necessary, but essential! In all cases, except for the compression radicular syndrome (the diagnosis will be established neurologist), being in a horizontal position increases the cost of treatment and prolongs the time of recovery. And when radicular syndrome, 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 of combating the upcoming disabilities. Recall that this group of diseases is gradually progressive in nature, and exercises aimed at maintaining flexibility and developing and strengthening the muscular "corset" of the spine can be considered as effective a treatment method as special therapy anti-inflammatory drugs of different groups, appointed by the specialists.