Back pain

Low back pain and neck pain are one of the most common reasons for seeking medical attention. Pain is usually caused by problems with the musculoskeletal system - these are most commonly caused by problems with the spine, including the spine bones (vertebrae), discs, and the muscles and ligaments that support them. Sometimes back pain is caused by a condition that does not affect the musculoskeletal system.

Low back pain is more common in older age groups, affecting more than half of people over 60 years of age. There are significant costs in terms of health care, disability benefits and lost time.

The spine consists of vertebrae. There are shock-absorbing discs between the vertebrae. The plates have a hard outer layer of fibrocartilaginous tissue and a soft, gelatinous inner material called a core. Each vertebra has two joints behind the discs. These joints are called facet joints. The joint surface of one vertebral body lies on the joint surfaces below the other, forming a joint. The joints and with them the whole spine are stabilized by ligaments and muscles, namely:

• Two iliopsoas muscles that run on both sides of the spine
• Two erect back muscles that run along the entire length of the spine behind it
• There are many short paravertebral muscles between the vertebrae

The spinal cord is located in the spinal canal. Throughout the entire length of the spinal cord, through the holes between the vertebrae on both sides, the spinal nerves exit, which is responsible for joining all the nerves in the body. It is called the spinal nerve root near the spinal cord. Due to the peculiarities of the position of the roots of the spinal nerves, they can be compressed with spinal injuries (compression), which leads to pain.

The upper spine at the top (lumbar spine) connects to the upper spine (chest spine) and below the pelvis through the sacrum. The lumbar spine is quite flexible, curves, twists and bends, and provides strength when standing, walking and lifting. Thus, the lower back is involved in almost all types of daily activities. Low back pain can interfere with various activities and impair quality of life.

Types of back pain

Common types of low back pain include localized, radiant, and recurrent pain.

Local painappears in certain areas of the lower back. This is the most common back pain. This is usually caused by plate injury, arthritis of the joint and, less commonly, muscle tension. The pain can be continuous and painful or can be replaced at a given moment by intermittent acute pain. Sudden pain can occur when trauma is the cause. Local pain may increase or decrease as the situation changes. Touching the lower back can be painful. Muscle cramps are possible.

Radiant painLow back pain spreads to the legs. The pain can be dull or sharp and intense. It typically affects only the side or back of the foot and may extend to the foot or just the knee. Radiating pain is usually a manifestation of spinal nerve root compression in disorders such as herniated disc, sciatica, osteoarthritis, or spinal stenosis. Coughing, sneezing, straining, or bending with straight legs can be painful. If the nerve root of the spinal cord is compressed, the pain can accompany weakness of the leg muscles, tingling, or even loss of sensation. In rare cases, loss of control of the urine (urinary incontinence) or loss of control of bowel movements (faecal incontinence) occurs.

Reflective painit can be felt in a different place from the actual cause of the pain. For example, some people with a heart attack feel pain in their left arm. The reflected pain of the internal organs of the lower back is predominantly deep and painful, and its exact localization is difficult to determine. As a general rule, pain does not increase with movement, unlike pain associated with musculoskeletal disorders.

The reasons

In most cases, back pain is a consequence of the spine and surrounding joints, muscles, ligaments and roots of the spinal nerves, and intervertebral discs. Often, no single specific cause can be identified. Any painful spinal disease can lead to a reflex contraction (spasm) of the muscles around the spine. Seizures can increase the pain. Stress may exacerbate lower back pain, but the mechanism is not 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 diseases (such as kidney and bladder infections), and the digestive system (such as diverticulitis). and diseases of the large arteries near the spine.

Common causes

Common causes of back pain include:

• Osteoarthritis
• Compression fractures of the spine
• Cracked or disc herniation
• Spinal stenosis in the lumbar spine
• Spondylolisthesis
• Damage to muscles and ligaments
• Fibromyalgia

Damagemay occur during normal activities (such as lifting heavy objects, exercising, unexpected movement) or as a result of injuries such as a fall or traffic accident. Imaging tests usually do not show any specific lesions, but doctors suspect that some muscles and / or ligaments are affected.

Osteoarthritis(degenerative arthritis) causes cartilage wear between joint surfaces and the formation of bone sheaths (osteophytes). This disease is partly the result of years of tissue wear. With severe degeneration and decreased plate height, osteophytes in the foramen can compress the roots of the spinal nerves. All of these changes can lead to back pain as well as stiffness.

Compression fractures of the spine (due to compression)(vertebral fractures) often occur when bone density decreases due to osteoporosis, which usually develops with age. However, fractures due to osteoporosis usually occur in the upper and middle back and are associated with pain in these regions rather than the lower spine.

Cracked or disc herniationmay cause back pain. The disc is represented by a dense outer layer and a soft, gel-like middle portion. If the disc is subjected to constant stress from the vertebrae above and below (e. g. , when bending forward, especially when lifting heavy objects), its outer layer may rupture (tear), causing pain.

Spinal stenosis in the lumbar spine- Narrowing of the spinal canal (which passes through the middle of the spine and includes the spinal cord and the nerve node extending down from the lower part of the spinal cord) in the lumbar region. A common cause of low back pain in the elderly. Spinal stenosis also develops in the Middle Ages in people whose spinal canal is narrow from birth. Spinal stenosis is caused by disorders such as osteoarthritis, spondylolisthesis, ankylosing spondylitis, and Paget's disease.

Spinal stenosis can also cause sciatica and back pain.

Spondylolisthesis- partial displacement of the vertebrae in the lower part of the spine. One type usually occurs in adolescence or adolescence (often in athletes) and causes an injury that breaks a portion of the vertebrae. If both sides of the vertebrae are affected, the vertebrae may slide forward on the vertebrae below. Spondylolisthesis can also occur in the elderly, but mainly due to degenerative disease. With the development of adult spondylolisthesis in the lumbar region, the risk of spinal stenosis increases.

FibromyalgiaIt is a common cause of pain that affects many parts of the body, including the lower back. This condition results in chronic diffuse pain in the muscles and soft tissues outside the lower back. Fibromyalgia is characterized by sleep disturbances and fatigue.

Surveys

Tests are usually not prescribed because most back pain is the result of osteoarthritis, sprains, or other minor musculoskeletal disorders and resolves within 6 weeks. Imaging tests are often required if:

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

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

An X-ray of the lower back can only give an image of the bones. Such images are able to detect degenerative changes caused by osteoarthritis, compression fractures of the spine, spondylolisthesis, and ankylosing spondylitis. However, magnetic resonance imaging (MRI) or computed tomography (CT) can provide a clear image of bones and display soft tissues (including plates and some nerves) in a manner typical of MRI. MRI or CT scan is usually needed when doctors detect the presence of abnormalities that lead to certain changes in bone structure, as well as diseases of the soft tissue.

If spinal cord compression is suspected, MRI is performed as soon as possible. In rare cases where MRI results are inconclusive, it becomes necessary to perform myelography with CT. Rarely, if a malignancy or infection is suspected, a tissue sample (biopsy) should be taken for analysis. In some cases, electromyography and studies are performed to study nerve conduction to confirm the presence and localization of the spinal nerve root, and in some cases, the duration and severity of compression.

Prophylaxis

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

• physical exercises;
• exercises to strengthen and stretch muscles;
• maintaining normal body weight;
• maintaining proper posture;
• adherence to recommendations for safe lifting of weights.

The most effective way to prevent low back pain is to exercise regularly. Special exercises to improve aerobic exercise as well as muscle strength and stretching are recommended.

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

Special exercises to develop muscle strength and stretch the abdominal wall, buttocks and back muscles (the deep muscles of the torso) allow you to stabilize your spine and reduce the elongation of discs and ligaments that absorb spine. keep them.

Strength building exercises include pelvic tilt and abdominal crunching. Stretching exercises include stretching by bending the knee to the chest. In some people, stretching exercises can lead to increased back pain, so care must be taken. The basic rule is that all practices that cause or aggravate back pain should be stopped. Exercises should be repeated until mild (but not extreme) muscle fatigue is felt. Breathing is essential during exercise. People with back pain should consult their doctor before training.

Pool leaning Stand in a supine position, knees bent, heels on the floor, load on the heels. Press your back against the floor, stretch your buttocks (lift them about half an inch from the floor), and stretch your abdominal muscles. Hold this position until 10. Repeat 20 times.	<3_img_rxx>
Lying crunch Lie down with your knees bent and flat legs on the floor. Fold your arms across your chest. Tighten your abdominal muscles, slowly lift your shoulders about 10 inches off the floor, keeping your head straight (your chin should not touch your chest). Relax your abdominal muscles, slowly lower your shoulders. Perform 3 sets of 10 repetitions.
He stretches his knee to his chest Take a supine position, straighten up. Place both palms under one knee and press to your chest. Hold the position until 10 p. m. Slowly lower your leg and repeat the exercise on the other leg. Do the exercise 10 times.

Exercise also makes it easier to maintain the desired body weight. Exercise also helps maintain bone density. Thus, exercise can reduce the risk of developing two diseases that can cause low back pain: obesity and osteoporosis.

Proper posture while standing and sitting will reduce stress on your back. Relaxation should be avoided. The height of the chair seats should be adjusted so that the legs are flat on the floor, the knees are slightly bent and the lower backrest is flush with the back of the chair. If the chair does not provide support for the lower back, a cushion can be placed underneath. In a sitting position, it is recommended to place your feet on the floor and not to cross your legs. Sick people should not stand or sit for long periods of time. If you have to stand or sit for a long time, frequent changes of position can reduce the strain on your back.

Treatment

If it is possible to determine a specific cause, the disease is treated. For example, antibiotics are used to treat a prostate infection. However, there is no cure for musculoskeletal pain or pain caused by other conditions. However, the situation can be improved by general measures. Typically, such measures are also used to constrict the spinal nerve root.

General measures for back pain

Possible measures are:

• Changing activities
• Taking painkillers
• Applying hot or cold to the painful area
• Easy exercise if tolerable

In the case of further back pain, treatment begins with the elimination of back-straining and painful activities such as weight lifting and bending. Bed rest does not speed up pain relief, and most professionals recommend doing light work. Bed rest needed to relieve severe pain can last up to 1 or 2 days. Prolonged bed rest weakens the central muscles and increases stiffness, which aggravates back pain and heals more slowly. Corset and grip are ineffective. Adhesion can slow healing.

Over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Opioid analgesics are sometimes prescribed when NSAIDs do not provide adequate analgesia, but should only be used for a short time because long-term use of opioid analgesics can increase pain sensitivity, cause side effects, and increase the risk of addiction and dependence.

Muscle relaxants can sometimes relieve muscle cramps, but their effectiveness is questionable. These medications are not recommended for elderly 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 cramps. If muscle relaxants are prescribed, they should not be used for more than 72 hours. Doctors sometimes recommend taking them just before bed.

Massage can provide temporary relief against lower back pain. Some studies have shown positive results in acupuncture, while others have contradicted these findings. Manipulation of the spine by chiropractors or other doctors (such as osteopathic doctors) in combination with an exercise program can also relieve pain. However, spinal manipulation may increase the risk of further injuries and should be avoided in individuals with inflammatory arthritis, neck problems, cervical instability, or disc herniation.

It is recommended to sleep in a comfortable position on a medium hard mattress. People sleeping on their backs should have pillows under their knees. Patients who sleep on their side use a pillow that allows their head to be kept in a neutral position (without bending the neck up or down). Patients should place a second pillow between the knees, knees and hips slightly bent if this relieves lower back pain. Patients can still sleep on their stomachs if they feel well.

Continue or start other preventive measures (correct posture, proper weight lifting technique). During the execution of such events, seizures of back pain disappear from several days to 2 weeks. Regardless of treatment, 80-90% of these seizures resolve within 6 weeks.

Treatment of chronic low back pain

Further measures are needed to treat chronic low back pain. Aerobic exercise is recommended and weight loss is recommended if needed. If analgesics are ineffective, other treatments should be prescribed.

Transcutaneous electron neurostimulation (TENS) is possible. CHENS devices generate weak AC power, which causes slight tingling. This current can prevent some pain sensations from passing from the spinal cord to the brain. The current can be applied to the painful area several times a day, with the duration of the session ranging from 20 minutes to several hours, depending on the severity of the pain.

Sometimes corticosteroids with a local anesthetic are injected periodically into the facetary joint of the spine or the epidural space - between the spine and the outer layer of tissue covering the spinal cord. Epidural injections may be more effective in sciatica, which is due to the herniated disc rather than the narrowing of the lumbar spine. However, they may not have long-term benefits. They usually only last for a few days or weeks. Their main goal is to relieve pain so that you can exercise for long-term pain relief.

Back pain surgery

In cases where the herniated disc leads to persistent or chronic sciatica, weakness, loss of sensitivity, or fecal and urinary incontinence, surgical removal of the protruding part of the disc (discectomy) and in some cases a part of the vertebrae may be necessary. (laminectomy).

In severe spinal stenosis, most of the posterior vertebrae (lamellae of the vertebral arch) can be removed to expand it (lumbar laminectomy). General anesthesia is usually required. The length of the hospital stay is usually 4-5 days. Patients can return to normal activities after 3-4 months. Adequate or complete recovery is observed in approximately two-thirds of patients. In the rest of patients, such surgery can prevent pain and worsening of other symptoms.

If the spine is unstable (which can be the result of laminectomy in the case of severe herniated disc, spondylolisthesis, or spinal stenosis), surgery can be performed to join the vertebrae (called arthrodesis of the lumbar vertebrae). However, fusion limits mobility, excessive mechanical stress can accompany the rest of the spine, and cause problems in the future.

Compression fractures of the spine

Compression fractures of the spine are quite common in women over 50 years of age. They can be treated conservatively without surgery, with stiffeners, painkillers, and possibly calcitonin nasal spray, which do not help bones heal but can reduce pain.

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

• Vertebroplasty: injection of cement mortar into broken bone.
• Kyphoplasty: Place a balloon in a broken bone to make room. The balloon is then filled with cement.

However, recent studies have shown that in the long run, the effectiveness of these surgical procedures does not exceed the effectiveness of non-surgical treatment options.

Highlights

• Low back pain is common. It is usually caused by musculoskeletal disorders of the spine and by factors such as fatigue, obesity, and insufficient physical activity.
• Low back pain is rarely severe at a young age, and studies are usually unnecessary unless the symptoms persist for many weeks.
• Patients with warning signs or patients over the age of 55 should see a doctor immediately.
• Strengthening the abdominal wall and back muscles with special exercises will help prevent the most common types of low back pain.
• In the case of back pain, treatment is usually sufficient to rule out measures that cause mechanical effects on the back, to take painkillers, and in some cases to apply a cold or warm compress.
• Prolonged bed rest and stretching can slow healing.
• In severe cases, such as abnormal feelings and weakness in the legs, surgery may be needed.
• Compression fractures of the vertebrae can be treated conservatively (with stiffeners, analgesics, and nasal sprays) or, in some cases, more aggressively with surgery.