Treatment of lower back pain

Pain in the lower back is just a symptom, an external manifestation of some 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 was only in the muscles, then it would be very easy to relieve the pain.For example, a massage that should bring relief.But massage does not always help because it removes the cause of the pain.

Sharp back pain can occur due to a herniated disc or disc protrusion.If the herniated disc is right-sided, you may experience right-sided back pain, right-sided pain, or right-leg pain (sciatica with large herniation).If the hernia is left-sided, you may feel pain in the back on the left, and may be bothered by pain on the left side. 

If the hernia is large and compresses the left lumbar root (radiculitisto the left), then a lumbago may occur in the left leg and pain may begin in the left leg.A large hernia often causes a violation of the posture in the form of a distortion of the torso with acute "twisting" pain when it is impossible to straighten up and straighten up (the so-called antalgic position of the torso).

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

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

Cholecystitis and cholelithiasis most often cause pain in the back on the right and pain under the right shoulder blade.Gallbladder pathology often presents as pain under the right rib.Need diagnostics.

Projectiondisks, are more often incidental findings on MRI, whichcancontinue with no pain at all.Disc herniation– not so common a cause of severe back pain.Although the formation of a hernia, for example, when lifting heavy objects, causes lumbar or thoracic lumbago (sharp pain in the back).In the case of constant aching back pain, the hernia found on the MRI may have nothing to do with it at all.The causes of such constant pain are often different. Diagnostics will help you find out.

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

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

Pain in the lower back.Why does my lower back hurt?

Low back pain refers to pain located in the area between the 12th pair of ribs and the gluteal folds.Pain of this nature is already a social problem.The fact is that the lower back is the most stressed part of the spine, which withstands overload daily and hourly.85% of people have experienced lower back pain at least once in their life.What is the reason?

Pain in the lower backcan have many reasons.The most common causes are osteochondrosis, disc herniation, radiculitis and pathology 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, which is accompanied by pain.This is a little different.

The picture below shows a normal disk being damaged (see damaged disk in the picture).These injuries can accelerate the aging of the disc and it loses its height (see "narrowing of the intervertebral space").Next, aging begins to affect the bone tissue in the vertebrae themselves, and osteophytes grow (see "osteophytes" in the picture).

Previously, it was believed that osteochondrosis was associated with pain.Therefore, at that time, they tried to explain the cause of pain in the spine and lower back, in particular with osteochondrosis.For this reason, the question of failure of vertebroneurology even arose.In 1978, created the first research laboratory for the problems of spinal osteochondrosis, studied the issue of osteochondrosis for more than 10 years and proved that the cause of pain is not osteochondrosis, but joint pathology. 

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

Disc herniation

Disc herniation as a possible cause of pain.The picture above shows several herniated discs - a small protrusion and a large herniated disc.A herniated disc itself does not hurt.

The disc has no nerve endings (not innervated).Pain from a herniated disc or protrusion occurs when the hernial protrusion puts pressure on the innervated tissue.For example onthe spineor onto the rearyuulongitudinalwowbundlesat.In the first case, radicular pain occurs - radiculitis (see below).In the second, when the receptors in the posterior longitudinal ligament are irritated, back pain (lumbodyny) or acute pain - lumbago (lumbago) occurs.

A herniated disc can often be treated without surgery.

Spondyloarthrosis

Spondyloarthrosis is osteoarthritis in the joints of the spine.Osteoarthritis itself is characterized by a disease of the cartilage of the joints.In this case, the cartilage decreases in height (degenerates, "dry out"), and bone-articular surfaces lose their protective cartilage layer.The joints in the spine begin to hurt.This pain feels like lower back pain.

Radiculitis

Radiculitis is an inflammation of the root.Radiculitis most often occurs when the root is damaged by a herniated disc or spinal joint.It is usually not so much pain in the lower back as pain in the leg, buttock and pain or numbness even in the toes.

Radiculitis is most effectively treated by releasing the root.If it's caused by a herniated disc, reduce the herniation, which puts 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.e.g.lower back pain in womencan be a consequence of diseases of the pelvic organs.

Pain in the lower back 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 must always remember gynaecology.Inflammatory diseases of the female genital organs are not uncommon.The cause can be inflammation of 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 in the genital area, including sexually transmitted infections.

If the lower back aches and hurts, and there is pain in the abdomen at the same time, then the woman must be checked by a gynecologist.It is imperative to undergo a gynecological ultrasound to initially clarify the diagnosis.

Constant nagging pain in the lower back also occurs whenoncology in gynecology.

Cancer and low back pain in women

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

Many people think that tumors are accompanied by pain.This is incorrect.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 genitals.It begins to manifest as the tumor grows.In this case, pain often occurs in the lower back and below the lower back.Pain below the lower back is in the sacrum area.

With cancer, severe pain in the lower back does not bother you at first.Rather, the lower back does not hurt, but hurts.Such pain can be the first call that will help a woman prevent critical growth of the tumor and make a correct diagnosis in a timely manner.If the lower back or sacrum hurts constantly, you should pay special attention to this in order not to miss a disaster.

Unfortunately, if you are not aware of the aching pain or discomfort in the lower back, the next sign of cervical cancer may be uterine bleeding.This is the stage where the tumor begins to disintegrate, when there may already be metastases.Including in the spine, when there is already severe pain in the lower back.

Important takeaway:if your lower back hurts, it is not necessarily osteochondrosis or a herniated disc.And it never hurts to have a preventive consultation with a gynecologist.After all, cervical erosion discovered during the examination is a precancerous condition.

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

Acute lower back pain can be caused by kidney disease

The lower back hurts severely with a kidney disease like pyelonephritis.

Pyelonephritis is an infectious disease, which is most often caused by an increasing 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.Everything lives, for example, in unwashed towels for a long time.

Inflammation activates pain receptors in the soft tissue of the pelvic organs.The pain signal (impulse) reaches the spine through the sensitive roots and activates its tissues.The soft tissues of the spine and the attachment points of the back muscles reflexively swell (inflame).And my lower back is starting to hurt.

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

With intestinal spasms, with bloating, with ulcers or ulcerative colitis, with stomach ulcers and gastritis, the back usually hurts.

Stomach cancer associated with back pain

Treatment of the back for pain caused by pathology of the gastrointestinal tract will not provide improvement.The cause must be addressed.

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 aggravation.Overuse often affects the lower back joints, ligaments, tendons or muscles.In addition, the muscles in the lower back work actively under load.If you have pain in the spine in the lower back after training, it is therefore not necessarily a disease.It could be muscle spasms.If this pain does not disappear within 1-2 days, then 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 aggravation occurs more than once a year, you should look for the cause of such aggravations.To do this, it is not enough just to consult a doctor and perform manipulations, take painkillers, massage and other procedures.

An investigation is needed to determine the cause of such frequent exacerbations.

Soft tissue injury in the lower back

Sharp pain in the lower back when you move awkwardly or when you lift something heavy is most likely a spinal cord injury.

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

Types of lower back pain

The pain can, taking into account the duration, be acute, chronic or have a (transient) transistor character.

The pains are as follows:

• Local pain– pain exclusively in the lower back.
• Referred pain– when pain occurs not only in the lower back, but for example in the buttocks, in the pelvic area.Or pathology of the internal organs causes pain in the lower back.In such cases, they speak of referred pain.
• Radicular pain– differs in significant intensity and is localized within the boundaries of the innervation of the root (from the spine to the periphery).The cause is a violation (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 that can shoot (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 movement.Chronic muscle spasms can also cause aching and cramping lower back pain.

In which cases should you consult a doctor for lower back pain and what should you do?

• with sharp (acute) pain in the lower back;
• if back or lower back pain continues for more than 3 days;
• if back pain appeared after an injury;
• if the pain is localized simultaneously in the lower back, foot and lower leg;
• if pain in the lower back is combined with numbness in the thigh, buttock, leg, foot, groin;
• if pain in the lumbar region is accompanied by twitching (fasciculations) of the muscles of the limbs;
• if the function of urination and defecation is impaired (urinary retention, incontinence, frequent urination or false urge to urinate);
• if the perineum is numb.
• If the pain in the back or lower back (sacrum) is constant, worse in the morning

What should you do if you have lower back pain?

The causes of low back pain are different, therefore treatment of low back pain should only be carried out after diagnosis and after the diagnosis has been made by a qualified doctor.Any 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. Establish the correct diagnosis.
2. Eliminate pain.
3. Formulate measures to help maintain the patient's health so that the pain does not reoccur.

Possible causes of lower back pain

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

• osteochondrosis;
• osteoarthritis;
• spondylolisthesis;
• spondylosis;
• ankylosing spondylitis;
• spondyloarthropathy;
• muscle damage;
• ligament injuries;
• disc herniation "Herniadisc is treated without surgery in 98% of cases (world statistics)";
• atherosclerosis of the abdominal aorta;
• malignant neoplasms of the spine;
• metastases to the spine;
• urinary tract infections;
• spinal stenosis;
• bile duct diseases;
• penetrating duodenal ulcer;
• pancreatitis;
• kidney disease;
• dissect aneurysm of abdominal aorta;
• bleeding in the retroperitoneal tissue;
• inflammatory diseases of the female genital organs;
• oncological diseases of the female genital organs;
• endometriosis;
• prostatitis;
• prostate cancer;
• abscess of the epithelial coccygeal duct;
• embolism in the arteries of the lower extremities;
• intermittent claudication;
• pseudo claudication intermittents;
• eliminate atherosclerosis of the vessels of the lower extremities;
• rheumatoid spondylitis;
• polymyalgia rheumatica;
• fibromyalgia
• depression;
• other.

Treatment of lower back pain (back pain)

At the stage of initial treatment with pain in the lower back (back), a primary diagnosis is established.This is done on the basis of mapping, medical history, neurological and orthopedic examinations.At this stage, medication can be prescribed to reduce pain, relieve tissue swelling and general anti-inflammatory treatment.Reflexology, local medicinal effects, regional anaesthesia, various injection methods for treating low back pain, laser therapy etc. are effective.During the acute and subacute periods, rest is important during drug treatment.Physiotherapy, massage, manual therapy, which can aggravate the process, are not indicated.In the acute period, traction is also not used: hardware, on inclined boards, on a wall bar.

To more effectively treat lower back pain, you need to understand the cause.For this purpose, the patient is further examined to clarify the diagnosis.There can be many causes of pain in the lower back.An indicative list of diseases that are accompanied by lower back pain is given above.Each of them has its own treatment protocol with a list of the most effective approaches, medications and procedures.The protocols also contain data on methods that are 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 ineffectiveness and risk of complications.It is necessary to identify the cause of inflammation and treat it.

Spondylosis visible on radiographs can occur without clinical symptoms and often masks a more complex disease.Therefore, treatment of spondylosis is useless and often dangerous: it is not realistic to remove bone growth in the spine, and there is no need for it.The patient may come across exotic diagnoses such as "muscle injury", "muscle spasm", "ligament damage".Unfortunately, it is not always true to talk about muscle spasms as the cause of pain.Muscle spasms of the paravertebral muscles are a reflex action and usually accompany most diseases, including those not related to the spine.The muscles are actively involved in the segmental reflex process and can respond to any irritation both inside the spine and outside it.The so-called "spasms" must be differentiated from reflected or projective pain in the lower back, which can be caused by pathology of internal organs: diseases of the pelvic organs, retroperitoneal space, kidneys, pancreas and prostate glands, gynecological diseases of inflammatory or tumor origin, diseases of the aorta and more tissue in the aorta, hemorperitoneum.Osteopathic techniques for working with secondary spastic paravertebral muscles can temporarily alleviate the condition at the reflex level.Manual therapy, osteopathic techniques, incline board, massage, traction, physiotherapy will not help prostatitis or adenomatosis, for example."Therapeutic removal" so called."muscle spasms" in this case are only the wishes of the manipulator.

Treatment of hernias and protrusions of discs in the lower back

Often, an MRI reveals a hernia or protrusion, which is interpreted as the cause of low back pain.The question immediately arises: remove the hernia or try to do without surgery?

First thing to do– clarify how clinically significant this hernia is.The fact is that if you take 100 absolutely healthy people without low back pain and do an MRI diagnosis, it turns out that 80% of them have some kind of disc protrusion ("herniated") that does not cause any symptoms.

Often, a herniated disc can be an accidental finding, often attributed to another cause of pain.

At the same time, practice shows that not all hernias are clinically significant.In order to clarify the causes of pain, a thorough medical history is taken, a neurological examination is carried out to identify neurological deficits, the function of the pelvic organs etc. is clarified.

It turns out that not all disc herniations and protrusions need to be operated on.Patients who require such an operation are no more than 2%.

Neurosurgeons have prescribed absolute indications for surgery which are clearly defined.More often than not, the presence of a herniated disc is not a reason for emergency surgery.

There is a sufficient arsenal for the treatment of herniated discs and protrusions, including traction, formation of stable motor patterns in the back, methods of local and general drug treatment, physiotherapy, reflexology, etc. Calibrated treatment without surgical intervention is often accompanied by a regression of symptoms, and the hernia (protrusion) may decrease over time.

When making a decision on surgery, one must take into account the relative indicators of surgical treatment, which are officially prescribed by neurosurgeons.Each specific case is treated separately, taking into account clinical symptoms, medical history, anamnesis, neurological and orthopedic examinations, results of hardware and laboratory examinations. 

It should be noted in particular that surgical intervention is often associated with a number of complications, which must be dealt with many times more intensively after the operation than relieving pain before the operation.

Degenerative changes in the spine, such as osteochondrosis, spondyloarthrosis, spondylosis, etc., are treated based on the identification of 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 the management of patients with low back pain, taking into account the possible range of their causes.