Back pain

Back pain is a common problem among middle-aged and older patients. It can be caused by an incorrect lifestyle, pathologies of the musculoskeletal system, diseases of the internal organs. A neurologist, orthopedist, nephrologist, and urologist can treat back pain, depending on its source. It is difficult for the patient to find out the cause of the unpleasant sensations and to choose the right doctor. Therefore, initially it is necessary to contact a therapist, who, depending on the symptoms, history and results of the studies carried out, will refer you to a limited specialist.

Classification

Back pain can be:

• Myofascial.
• Nociceptive
• Neuropathic.
• Psychogenic.

Myofascial painobserved during the formation of the calls. trigger points in the back muscles. Trigger points are pea-shaped knots that form when muscles are constantly tense (when they just can't relax). Also, when one segment of the muscle fiber is compressed, the others are stretched. This affects the mobility of the muscle fiber: it is limited. The fiber itself shortens, becomes tighter.

Trigger points arise from muscle overexertion. In addition, overexertion can occur not only due to excessive physical activity, but also due to prolonged stay in one position (for example, sitting in front of a computer). Also, trigger points often occur with osteochondrosis.

Another factor that contributes to the formation of trigger points is the excessive stimulation of sarcomeres (basic contractile units that are a complex of proteins). If there is excessive stimulation of the sarcomeres, they are constantly in a contracted state.

The presence of trigger points does not allow the muscle to fully relax. Begins to tire quickly even with minor loads, overexerts when moving and recovers very slowlyIts limited range of motion affects the entire fascial chain. Other muscles and even some joints also become less mobile.

Blood flow in the tissues surrounding the trigger point also suffers. Due to this, a lack of oxygen is observed in this area. Decomposition products build up, irritate the trigger point, and pain develops from this. In this case, the size of the muscle does not matter, it all depends on the degree of irritation of the point. Even the smallest muscle in the presence of trigger points can produce many unpleasant sensations.

A characteristic feature of myofascial pain is its reflex. This means that the pain is reflected in other parts of the body. They can occur in areas very distant from the trigger points. So, for example, pain may develop under the shoulder blades or in the lower back due to the presence of nodes in the abdominal muscles. Also, the lower back can hurt due to trigger points in the calf region or buttocks.

Myofascial pain is usually long-lasting and dull. Sometimes they occur only when you move, sometimes at rest. They can be different in strength: from mild discomfort to excruciating pain.

Nociceptive pain- the body's response to direct irritation of pain receptors (nociceptors). In the case of the back, these are receptors located in the paravertebral ligaments, muscles, tendons, as well as in the joint capsules of the intervertebral joints and the outer third of the fibrous ring of the intervertebral disc. The patient may experience pain with reflex muscle spasm, dystrophic or pathological processes in the facet joints. When moving, the pain intensifies.

Neuropathic paindevelop into pathological processes in the nervous system: damage to the nerves or roots of the peripheral nervous system, alteration of the central nervous system. Such pain can be seen with osteoporosis, spondylolisthesis, hernias, and spinal fractures. They are intensified by bending over, moving, straining, coughing, sneezing, and in most cases are delivered to the limb. Sometimes they are dull and achy, but more often they are sharp, crazy.

Psychogenic painThey occur due to a muscle spasm caused by emotional stress, chronic stress, or anxiety disorder.

In some cases, the varieties can be combined with each other. For example, myofascial sensations coexist with nociceptive ones.

Also, back pain is divided into 3 types:

• Acute (lasting less than 6 weeks).
• Subacute (6-12 weeks).
• Chronic (more than 3 months).

Acute / subacute painusually develops due to tissue damage (deep, superficial) due to cuts, wounds, inflammation. Therefore, the body warns us that something is wrong. The pain goes away after the tissues have completely healed.

Chronic painIt occurs due to diseases of organs and systems or emotional disorders. If present, a complete medical examination is necessary.

By location, the pain can be:

• Local.
• Reflected.
• Radiating.

Local pain develops directly at the site of the development of the pathological process. Reflected: if there are trigger points. Irradiant - with damage to internal organs, spreads along nerve fibers.

Why does my back hurt?

Back pain can be caused by a variety of reasons, including:

• Curvature of the spine: scoliosis, kyphosis.
• Neurological diseases: herniated intervertebral discs, osteochondrosis, spondylosis, spondyloarthrosis.
• Endocrine pathologies: osteoporosis.
• Diseases of the respiratory system: pleurisy.
• Pathologies of the kidneys and urinary system: urolithiasis, pyelonephritis, glomerulonephritis.
• Tumors

Short-term pain (usually severe, burning) can be due to a number of reasons. These include:

• Injuries
• Overexertion of the muscles (due to monotonous posture or performing the same type of repetitive movements).
• Hypothermia.

Pain caused by degenerative processes occurs with the following diseases:

• Osteochondrosis.
• Intervertebral hernia.
• Bulging of the intervertebral disc.
• Deforming spondylosis.
• Degenerative scoliosis.
• Osteoarthritis
• Spondylolisthesis (displacement of the vertebrae).
• Spondylolysis (pseudoarthrosis of the vertebral arch).
• Spinal stenosis

Pain radiating to the spine can develop due to diseases:

• Heart and great vessels: myocardial infarction, angina pectoris, aortic aneurysm.
• Lungs: cancerous tumors, pleurisy.
• Esophagus.
• Gallbladder and bile ducts: acute and chronic cholecystitis.
• Kidney and urinary tract.
• Pancreas.

Back pain in rare cases can be infectious in origin. For example, sometimes my back hurts from the flu. Also, the infection can penetrate the spine from nearby organs: urinary tract, kidneys.

Other reasons for the development of back pain can be changes in hormone levels (for example, related to age, during or after menopause). In this case, hormonal spondylopathy (degenerative changes in the spine) occurs.

The back hurts a lot: what to do?

If you have a severe pain attack, be sure to see a doctor as soon as possible. However, if the sensations are so strong that any movement causes torment, first aid is needed. You should lie on your back on a flat, hard surface (for example, the floor). This will help relieve spasms, relax muscles, and reduce pain.

Sinking onto a flat surface, do not change the position of your back. Lying on your back, try to roll onto your side. This will relieve the spine. When the pain subsides, roll back onto your back. It is recommended to put something under the feet, lifting them. Lie in this position for 10-15 minutes.

You must also climb correctly: first turn on your side. From this position, get on all fours. Then, lean on something (if there is no support nearby, crawl towards it) and get up slowly. Only then do you carefully straighten your back.

To find out why your back hurts so much, don't put off your doctor's visit. This will help prevent further attacks.

Diagnostics

You should definitely make an appointment with a therapist if your back pain:

• appear during physical exertion, muscle tension;
• last more than 3 days;
• they repeat episodically.

It is necessary to visit a doctor immediately in the following cases:

• the back hurts constantly;
• an increase in body temperature, numbness of the extremities, lethargy of the extremities in the morning add to the pain;
• in the supine position, the pain does not go away;
• pains worse at night.

At the appointment, the doctor will collect the anamnesis, examine the patient (assess the condition of the skin, the position and symmetry of the body, gait, etc. ). Then you will assign studies:

• general analysis of blood and urine;
• bone scan;
• computed tomography;
• magnetic resonance imaging.

If necessary, the therapist will refer the patient to a neurologist, orthopedist, urologist, gynecologist, or nephrologist.

Back pain treatment

Treatment of back pain is comprehensive and may include:

• taking medications (anti-inflammatory, analgesic, restorative drugs);
• blockage (long-term pain relief);
• physiotherapy procedures;
• physical therapy exercises;
• massages
• manual therapy.

If conservative methods do not give the desired result, surgical treatment is prescribed. Modern methods allow for low-traumatic precise operations with a short rehabilitation period.

Back pain prevention

Simple preventive measures can help prevent back pain. It is necessary:

• Check your posture.
• Sleep on a bed with a hard mattress.
• When participating in activities that involve a prolonged sitting position (driving, working at the computer), it is necessary to change posture from time to time, as well as organize breaks and warm-up.
• When you are on your feet for a long time, lean on something.
• Don't wear high heels for more than 2 hours straight.
• Spend time doing moderate physical activity (swimming, fitness).
• Keep track of your weight - Back pain can occur due to extra pounds.
• Try not to lift weights.
• Do not roll over or bend over with sudden movements.
• Treat urological and gynecological diseases promptly.

Annual preventive visits to the therapist will also be beneficial. Pathologies identified in the early stages can be eliminated without waiting for the development of complications.