Recurrent low back pain can be associated with excessive stress on muscles, ligaments and tendons. However, in most cases, the appearance of this clinical symptom indicates the presence of serious pathological changes in the tissues of the spine and other parts of the musculoskeletal system.
The article explains why there is pain in the lower back, which doctor to go to for a full differential diagnosis, and what to do at home.
To understand the potential causes of this clinical syndrome, it is important to have an idea of how this part of the body, generally called the back, is located and works. The waist conditionally refers to the lumbar region. Thus, the back in our understanding is the back of the chest, waist and sacrum. The two shoulder bones involved in the formation of the shoulder joints with the help of acromial processes are adjacent to the chest.
As you can see, the spine has three parts, each with its own anatomical features:
- The chest region stabilizes the caustic arches using the costal-vertebral joints, there are additional processes in the vertebral bodies;
- The lumbar region consists of five massive vertebral bodies that carry the maximum cushioning load during various movements of the human body;
- sacrum - five vertebrae connected to one bone, responsible for the strengthening of the lower extremities with the formation of ilio-sacral joints.
Intervertebral discs are located between the vertebral bodies. They are not only between the sacral vertebrae. Inside the spine is the spinal cord, which is surrounded by rigid membranes. It is also divided into thoracic, lumbar and sacral segments. Each of them is responsible for the innervation of a certain part of the human body. For innervation from the spinal cord structures, the root-paired nerves pass through the lateral foraminal holes in the spinal cord. Branched radicular nerves form nerve plexuses. The great nerves are separated from them, for example, from the lumbosacral plexus to the sciatic, femoral, inguinal.
The mobility and elasticity of the human body is provided by the muscle frame. The paravertebral muscles also provide diffuse nutrition to the cartilage tissues of the intervertebral discs. Intervertebral discs do not have their own circulatory system. If the paravertebral muscles are damaged, the entire load falls on the last plates that separate the ring fibrosis from the vertebral body.
The stability of the position of the vertebral bodies is ensured by a complex mechanism. This includes:
- intervertebral joints - provide a certain mobility and stability of vertebral bodies relative to each other;
- longitudinal (long) and transverse (short) ligaments of the spine;
- intervertebral discs - provide equal height of the gaps between the vertebral bodies, compensate for the shock absorber load and protect the radicular nerves from compression.
In addition, the most important structural parts of the back and waist are the blood and lymphatic vessels. They provide tissue nourishment and removal of toxins and cell debris.
By understanding the structure and physiology of this part of the musculoskeletal system of the human body, you can move on to the potential causes of pain. At this time there is an important practical recommendation. If you have back pain in the lower back, we recommend that you seek emergency medical attention. It is best to treat pathologies of the musculoskeletal system (spine and joints) and the autonomic nervous system (spinal cord, radicular nerves and their branches) in hand therapy clinics.
Causes of low back pain
There are various causes of low back pain, both physiological factors and pathological changes in the tissues. First and foremost, you should always rule out the possibility of traumatic exposure:
- bruises on the soft tissues of the back after blows or falls;
- elongation of the spinal cord ligament and tendon apparatus (can occur with awkward movement, falling, abnormal weight lifting, etc. );
- cracks in the spinous processes and fractures of the vertebral bodies (young people leading an active lifestyle and older people suffering from osteoporosis are at risk);
- contusion of the spinal cord and the development of a hematoma in the hard membranes (this can lead to compression and a number of accompanying neurological manifestations).
Trauma can result in displacement of the vertebral body, rupture of the intervertebral disc, protrusion or subluxation of the joint between individual vertebrae. It is necessary to consult a traumatologist as soon as possible to eliminate the possibility of such negative consequences after injury. He will perform an X-ray examination and make an accurate diagnosis.
The second most common group of low back pain is degenerative dystrophic changes in the cartilage tissues of the musculoskeletal system:
- Osteochondrosis - a violation of the diffuse nutrition of the cartilage tissue of the intervertebral discs leads to dehydration of the ring fibrosis, the pulposus nucleus begins to lose its amortization ability;
- protrusion of the intervertebral disc - a decrease in height and an increase in the occupied area, there is compression pressure in the soft tissues and nerve branches around the spine;
- intervertebral hernia - rupture of the fibrous ring of the intervertebral disc and protrusion of part of the nuclear pulp;
- destruction of the cartilaginous synovial layer inside the intervertebral joints - deformed spondylarthrosis;
- deformation of ilio-sacral joints;
- coxarthrosis - deforming osteoarthritis of the hip joints.
Sometimes the causes of back pain in the lumbar region are damage to the tissues of the spinal cord, radicular nerves, plexuses and major nerves (sciatic, femoral, inguinal). Tunnel syndromes, plexitis, radiculitis, etc. Do not rule out the possibility of development. Lumbago (back pain) can often be diagnosed only during a special examination.
Of course, it covers the X-ray image of the spine, ilio-sacral joints. MRI examination is required to detect degenerative dystrophic diseases of the spine and joints.
If you have low back pain, it is advisable to consult a vertebrologist or neurologist. If you have an injury the day before, consult a traumatologist. Local therapists often do not have enough professional skills to make an accurate diagnosis and prescribe effective treatment.
Severe back pain - what to do?
The first thing to do if you have back pain is to stop doing any physical activity on it. The cause of the pain may be damage to the muscles, ligaments or tendons. Fibromyalgia syndrome often occurs in young people who lead an active lifestyle. This is a pathology associated with the process of disrupting the transmission of nerve impulses to myocytes. As a result, some cells receive an impulse to prematurely contract or relax, others with a delay. A chaotic muscle contraction occurs. This causes a fairly severe pain syndrome.
Second, the pain may be caused by excessive strain on the lumbar muscles in order to compensate for the protrusion of the intervertebral disc. In this case, it is extremely dangerous to stop the spasm of muscle fibers. There are cases when a patient with a disc protrusion develops a fairly large intervertebral hernia after taking muscle carriers.
Severe low back pain in the lumbar region may be a clinical symptom of sciatica or lumbago development. Therefore, it is not worth diagnosing and treating independently. You need to provide yourself with comfort, try to relax tense muscles without the use of pharmacological drugs. See a neurologist or vertebrologist as soon as possible. During the initial examination, these specialists will be able to diagnose and provide the necessary assistance to eliminate severe pain syndrome.
Never take painkillers before seeing your doctor. This will make it difficult to make an accurate diagnosis. The use of external analgesics (ointments, plasters, compresses) is not recommended. In the first 3 days after the exacerbation of osteochondrosis, any warming, including visits to the bath and sauna, is contraindicated.
Treatment of low back pain
After the differential diagnosis, treatment should be started if you have low back pain. The fact is that pain syndrome is not an independent disease. It is impossible to treat pain effectively and safely without a therapeutic effect on the underlying pathology. Pain always indicates changes in the tissues. Therefore, it is important to detect these pathological changes and eliminate them if possible. Only this way of getting rid of pain syndrome is considered effective and safe.
For example, low back pain in the lumbar region is triggered by a decrease in the height of the intervertebral disc (protrusion) against the background of long-term osteochondrosis. During the manual examination, an experienced vertebrologist will find in this case the excessive tension of the muscle fiber, a decrease in the height of the intervertebral space.
In this case, you can use the procedure of manual spinal pull to provide first aid. After 2-3 sessions, the patient feels pain relief and restores natural mobility. But it is impossible to stop at this stage. If you do not receive rehabilitation treatment, the pain may return after a few months.
Further treatment of low back pain is recommended using the following exposure methods:
- massage to increase the elasticity and permeability of all soft tissues of the back and waist;
- osteopathy - to accelerate the microcirculation of blood and lymphatic fluid, it ensures complete trophism of all tissues and begins to regenerate;
- reflexology - affects the biologically active points in the human body, stimulates the process of regeneration of damaged tissues by activating the secret resources of the human body;
- physiotherapy - to improve metabolic processes at the cellular level, to accelerate recovery;
- Therapeutic gymnastics and kinesiotherapy to increase muscle tone and begin the process of nourishing the cartilaginous tissues of the intervertebral discs;
- Laser surgery to restore and activate cell regeneration processes.
Please note that the course of treatment is always seriously developed individually, taking into account all the features of the patient's state of health. Also includes your doctor's recommendations for lifestyle changes. For example, if you do not change your physical activity regimen and continue to lead a sedentary lifestyle, no, even the most effective treatment will help to restore the spine.
If you have low back pain, seek a manual therapy clinic before treatment and go there for the advice of a vertebrologist or neurologist.