Treatment of lower back pain

Pain in the lower back is only 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 the pain would be relieved very easily.For example, a massage that should bring relief.But massage does not always help because it removes the cause of the pain.

Acute 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-sided leg pain (large herniated sciatica).If the hernia is on the left side, then you may feel back pain on the left side and may be worried about pain on the left side. 

If the hernia is large and presses on the left lumbar root (radiculitison the left), then lumbago may appear in the left leg and pain may begin in the left leg.A large hernia often causes a violation of posture in the form of distortion of the torso with sharp "twisting" pain when it is impossible to stand up and stand 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 joints of the spine or pathology of the sacral area (right iliosacral joint).

Pain in the area of the left shoulder blade (or pain under the left shoulder blade) can be either 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 attack.Pain between the shoulder blades occurs not only with spinal pathology and osteochondrosis, but also with diseases of the stomach (gastritis, ulcer, cancer, etc.), and often also of the intestines.

Cholecystitis and cholelithiasis most often provoke pain in the back on the right and pain under the right shoulder blade.Gallbladder pathology often manifests itself as pain under the right rib.You need diagnostics.

Protrusionsdisks, are more often incidental MRI findings thatcancontinue without any pain.Disc herniation– a less common cause of severe back pain.However, herniation, for example when lifting heavy objects, causes lumbar or thoracic lumbago (sharp back pain).In the case of persistent back pain, the hernia detected on MRI may have nothing to do with it.The causes of such constant pain are often different. Diagnostics will help you understand.

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

1. Determine the cause of lower back pain (make 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 established by clinical and instrumental examination.
3. Low back pain treatment tactics depending on the diagnosed cause.
4. If you have lower back pain, it is important to make sure that the pain does not reoccur.To achieve this, we offer various methods, including physical rehabilitation of the spine.

Lower back pain.Why does my lower back hurt?

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

Lumbar painthere could be many reasons.The most common causes are osteochondrosis, disc herniation, radiculitis and lumbar joint pathology.

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 becoming corrupted (see the corrupted disk in the picture).These damages can accelerate the aging of the disc and its loss of height (see "narrowing of the intervertebral space").Aging then begins to affect the bone tissue of the vertebrae themselves and osteophytes grow (see "osteophytes" in the picture).

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

Osteochondrosis is not accompanied by pain, since the disc does not have nerve endings.Therefore, there is no pain in osteochondrosis.

Disc herniation

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

The disc has no nerve endings (it is not innervated).Disc herniation or protrusion pain occurs when the herniated protrusion puts pressure on the innervated tissue.For example onspineor onbehindyuulongitudinallywowbundlesat.In the first case, radicular pain occurs - radiculitis (see below).In the second, when the receptors of the posterior longitudinal ligament are irritated, back pain (lumbodynia) or acute pain - lumbago (lumbago) appears.

A herniated disc can often be treated without surgery.

Spondyloarthrosis

Spondyloarthrosis is arthrosis of the joints of the spine.Arthritis itself is characterized by disease of the joint cartilage.In this case, the cartilage decreases in height (degenerates, "withers"), and the bone joint surfaces lose their protective cartilage layer.The joints of the spine begin to hurt.This pain feels like lower back pain.

Radiculitis

Radiculitis is an inflammation of the root.Most often, radiculitis occurs when the root is injured by a herniated disc or spinal joints.It's usually not so much lower back pain as leg pain, buttock pain, and pain or numbness even in the toes.

Radiculitis is most effectively treated by releasing the root.If it is due to a herniated disc, you need to reduce the herniated disc that is putting 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.for example,lower back pain in womenit can be a consequence of diseases of the pelvic organs.

Lower back pain in women

Pain in the lower back 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 should always remember about gynecology.Inflammatory diseases of the female genital organs are not uncommon.The cause can be inflammation of the appendages, inflammatory diseases of the vagina and vulva, salpingitis, salpingo-oophoritis, endometritis, bacterial vaginitis, etc.More often, such inflammatory diseases in women are caused by infections of the genital area, including sexually transmitted infections.

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

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

Cancer and low back pain in women

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

Many people think that tumors are accompanied by pain.this is wrong 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 genital organs.It begins to manifest when the tumor grows.In this case, the pain often appears in the lower back and below the waist.The pain under the lower back is in the area of the sacrum.

With cancer, severe pain in the lower back does not bother you at first.Rather, the lower back doesn't hurt, it hurts.Such pain can be the first call that will help a woman prevent the critical growth of the tumor and make a correct diagnosis in a timely manner.If the lower back or sacrum hurts constantly, you need to pay special attention to it so you don't miss an accident.

Unfortunately, if you do not pay attention to the pain or discomfort in the lower back, the next sign of cervical cancer can be bleeding from the uterus.This is the stage in which the tumor begins to disintegrate, when metastases can already occur.Including in the spine, when there is already severe pain in the lower back.

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

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

Acute lower back pain may be due to kidney disease

The lower back hurts a lot with kidney disease such as pyelonephritis.

Pyelonephritis is an infectious disease that is most often caused by an ascending infection.It can be associated with both sexually transmitted infections and other types of household infections transmitted through swimming pools, baths and personal hygiene items.For example, everything lives in unwashed towels for a long time.

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

Constant pain in the back and lower back 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 back pain caused by pathology of the gastrointestinal tract will not lead to improvement.The cause must be treated.

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 exacerbation.Overuse often affects the lower back joints, lower back ligaments, tendons or muscles.In addition, the muscles of the lower back work actively under load.Therefore, if you have pain in the spine in the lumbar region after training, it is not necessarily a disease.It could be a muscle tear.If this pain does not disappear within 1-2 days, then you should think about problems with the lumbar spine.Especially if this pain is aggravated by movement.

The causes of such pain are often overloaded inflammations of the muscles and their attachments.Or – inflammation of the joint capsules.

If such an exacerbation occurs more than once a year, you should look for the cause of such exacerbations.To do this, it is not enough just to consult a doctor and perform manipulations, take painkillers, massages and other procedures.

An examination is necessary to determine the cause of such frequent exacerbations.

Trauma to the soft tissues of the lower back

Sharp pain in the lower back when moving awkwardly or when lifting something heavy is most likely a spinal injury.

If you are concerned about pain on this 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 for a right-sided hernia of the lumbar spine.

Types of lower back pain

Pain, given the duration, can be acute, chronic or have a (transient) transient nature.

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 also in the buttock, in the pelvic region.Or the pathology of the internal organs causes pain in the lower back.In such cases it is referred to as transferred pain.
• Radicular pain– differ in significant intensity and are localized in the borders of the innervation of the root (from the spine to the periphery).The reason is a violation (stretching, compression, curvature, compression) of the nerve root of the spinal nerve.Movement or even coughing increases the pain due to the so-calledimpulse to cough.This is severe pain in the lower back that can shoot (radiate) down the leg.
• Myofascial pain– is the result of a reflex muscle spasm.The causes of myofascial pain can be diseases of the internal organs or damage to the spine itself.Muscle spasm significantly disrupts the biomechanics of human movements.Chronic muscle spasms can also cause pain and spasms in the lumbar region.

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

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

What to do if you have lower back pain?

The causes of low back pain are different, therefore the 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 spinal area requires a medical examination and clarification of the cause of its occurrence.

A visit to a doctor has 3 purposes:

1. Establish the correct diagnosis.
2. Eliminate the pain.
3. Formulate measures that will help maintain the patient's health so that the pain does not recur.

Possible causes of lower back pain

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

• osteochondrosis;
• osteoarthritis;
• spondylolisthesis;
• spondylosis;
• ankylosing spondylitis;
• spondyloarthropathy;
• muscle damage;
• ligament damage;
• disc herniation "Herniathe disc is treated without surgery in 98% of cases (world statistics)";
• atherosclerosis of the abdominal aorta;
• malignant neoplasms of the spine;
• metastases in the spine;
• urinary tract infections;
• spinal stenosis;
• biliary tract diseases;
• penetrating duodenal ulcer;
• pancreatitis;
• kidney disease;
• dissecting aneurysm of the abdominal aorta;
• hemorrhage 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 canal;
• embolism of the arteries of the lower extremities;
• intermittent limp;
• pseudointermittent claudication;
• obliterating atherosclerosis of the vessels of the lower extremities;
• rheumatoid spondylitis;
• polymyalgia rheumatica;
• fibromyalgia
• depression;
• another.

Treatment of low 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 a survey, history, neurological and orthopedic examinations.At this stage, drugs can be prescribed to reduce pain, relieve tissue swelling and general anti-inflammatory therapy.Reflexology, local medicinal effects, regional anesthesia, various injection methods for the treatment of low back pain, laser therapy, etc. are effective.In the acute and subacute periods, rest is important during drug therapy.Physiotherapy, massage, manual therapy, which can worsen the process, are not indicated.In the acute period, traction is also not used: hardware, on inclined boards, on a wall.

To treat lower back pain more effectively, 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 lumbar region.Above is a sample list of diseases that are accompanied by pain in the lower back.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 in this disease.For example, with 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 find out the cause of the inflammation and treat it.

Spondylosis visible on radiographs can appear without clinical symptoms and often masks a more complex disease.Therefore, the treatment of spondylosis is useless and often dangerous: it is not realistic to remove bone growths in the spine and there is no need.The patient may be faced with exotic diagnoses such as "muscle damage", "muscle spasm", "ligament damage".Unfortunately, talking about muscle spasms as the cause of pain is not always true.Muscle spasm of the paravertebral muscles is a reflex act and, as a rule, accompanies most diseases, including those not related to the spine.Muscles are actively involved in the segmental reflex process and can react to any irritation both inside and outside the spine.So-called "spasms" must be distinguished 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 gland, gynecological diseases of inflammatory or tumor origin, diseases of the aorta, hemorrhage in the retroperitoneal tissue and many others.Osteopathic techniques for working with secondary spasmed paravertebral muscles can, on a reflex level, relieve the condition temporarily.Manual therapy, osteopathic techniques, tilting board, massage, traction, physiotherapy, for example, will not help with prostatitis or adenomatosis."Therapeutic removal" so-called"muscle spasms" in this case are simply the desires of the manipulator.

Treatment of hernias and protrusions of discs in the lower back

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

The first thing you should do– clarify how clinically significant this hernia is.The fact is that if you take 100 absolutely healthy people without low back pain and perform MRI diagnostics, it turns out that 80% of them have some kind of disc protrusion ("herniation") that does not give any symptoms.

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

At the same time, practice shows that not all hernias are clinically significant.To clarify the causes of the pain, a thorough history is taken, a neurological examination is performed to establish a neurological deficit, the functioning of the pelvic organs is clarified, etc.

It turns out that not all herniated discs and disc protrusions need surgery.Patients who need such an operation are no more than 2%.

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

There is a sufficient arsenal for the treatment of disc herniations and protrusions, including traction, formation of stable movement patterns of the back, methods of local and general drug therapy, physical therapy, reflexology, etc.Calibrated treatment without surgical intervention is often accompanied by regression of symptoms and the hernia (bulging) may decrease over time.

When deciding on surgery, the relative indications for surgical treatment that are officially prescribed by neurosurgeons should be taken into account.Each specific case is considered separately, taking into account clinical symptoms, anamnesis, anamnesis, neurological and orthopedic examinations, results of apparatus and laboratory tests. 

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

Degenerative changes in the spine, such as osteochondrosis, spondyloarthrosis, spondylosis, etc., are treated based on the identification of the causes of the pain syndrome. 

Massage and manual therapy are quite effective methods of treatment if there are indications for their use.Over the past three decades, the Institute has developed optimal treatment protocols for patients with low back pain, taking into account the possible range of their causes.