Pain in the lumbar spine and adjacent areas may be bothering the patient at any time of day, standing, sitting, lying down or on-the-go, during exercise or at rest. So, this is a symptom, not specific, which means that it can meet in such a large number of cases which require special attention in the first instance from the patient: it is necessary to consult a doctor immediately.
What doctor to address?
According to statistics, up to 25% of patients seek medical help in connection with the occurrence of pain in the lumbar region. 8 of 10 people in the world have experienced back pain at least 1 time in my life. Most often suffer from these symptoms of persons working age, slightly fewer people of retirement age and fewer young people (according to various estimates, from 8% to 40% in Russia).
Therapist, neurologist, rheumatologist
The first doctors, which will address the majority of patients with pain in the lower back, becomes a therapist and neurologist. But young people with trauma in the recent past increasingly turning to the specialist.
And diagnostic and therapeutic tactics in these experts differ. Often, the therapist directs the patient to the neurologist, the neurologist determines, "your", the diagnosis and prescribed treatment. Specialist often working "individually", and furthermore, using nonsteroidal anti-inflammatory drugs, which used techniques of manual therapy and physiotherapy. The main thing for the patient – does not lose in this situation, that they do not get carried away by the promises of instant healing by applying the techniques, not to resort to them again, in the event of a breakdown or, worse, intensified against the background of such treatment of pain.
When conservative treatment that is a cure, you need to understand that treatment for four weeks without result, there is a strong argument for the revision of the diagnosis, treatment, to revmatologu, not to conduct repeated courses of therapy. There are often situations when a patient with complaints of pain in the lower back receives symptomatic (pain) treatment of certain formulaic schemes, not to explain, the real cause of the pain.
Causes of pain in the low back
The main causes of pain in the lumbar region is
- changes in the structures of the spine, usually age-related (degenerative), degenerative disc disease of the spine, various herniated discs or improperly working muscle complex. Such pain is called primary, which is directly connected with the spine;
- the pathological changes in organs, which are located in the vicinity of the painful area, but directly on the spine are not related (e.g., diseases of internal organs, skin). This category causes include inflammation of joints, injury, endocrine diseases (e.g. diabetes), - in short, everything that does not match the "natural age-related changes" of the spine. Such pain is called secondary.
Inspection on appointment
Pain, feel heavy duty mobility of greater than or painful muscle tension in the area between the lower ribs and the buttocks is denoted by the term "lyumbalgiya". If these symptoms include pain in the toes, this condition is called lyumbalgiya.
The most important is the sharpness of the pain, that is, the distance from its occurrence. Pain prescription for 12 weeks (3 months) is called acute, more than 12 weeks – chronic. Syndrome chronic pain may occur with exacerbations and periods of improvement.
Of fundamental importance is, how it is to feel pain. Or feeling at a certain point, or distribution ("projection", "radiation") is pain along the nerve in the thighs, buttocks, knees, foot, or fuzzy, "blunt" pain. You need to understand that there is limited motion in the spine, in moments of pain, or freedom of movement (this may indicate the mechanical nature of the injury, such as fracture of the vertebrae). In which moments is the pain? Does not occur under load, or at rest at night to sleep? An affirmative answer to the last question, which is on the "red flag" for the referee and makes you wonder about the diagnosis of inflammatory diseases of the spine in a patient (a little later). If pain increases when moving the head, walking, jumping, it probably is about the so-called projected pain, the cause of which is damage to nerve structures (most often sciatica).
Osteochondrosis, or spondilez – state in which the compression and deformation of the vertebrae, with the advent of the small bone area, as are the spikes at the edges of the vertebrae. For a long time it was assumed, spondilez the result of the natural course of degenerative aging processes. However, it has been proven that not only is the age can be a cause for pain in the low back. Sedentary lifestyle, increased load on the lumbar spine during prolonged work at the computer or for prolonged driving (e.g., the profession of truck drivers) contribute to the formation of osteoarthritis even in young people. Under the influence of all these factors, the intervertebral discs become thinner reserves, and the nerve roots that go from the spinal cord of the injured raised the marginal spikes of bone. The constant irritation of these roots and causes pain. In Latin the root is called the radix, so that this inflammation is usually called the radikulit.
The so-called inflammatory diseases of the spine – the area of interests of rheumatology. These mysterious diseases can "smolder" for a few years, starting mainly in the young age and it affects men, and is the result at the end of the obezdvizhennost' i invalidizatsiyu the patient. Patients in this group usually the "go to last" and night pain, and morning stiffness in the back, weakness, and a still greater decline in health. Unfortunately, from the appearances of the first symptoms of the disease before the correct diagnosis on average it takes about seven years. In the meantime, changes in the spine can become irreversible and functional (locomotor) activity is low. The spine becomes limited, to change the shape, is shunting. Found this pathology is not as common as low back pain, for example, but the cost of treatment and total disability of such patients is disproportionately higher.
If in addition to the back pain patient talks about inflammation of the joints (most often we are talking about the knee joints, the joints of the hands or the feet), pain in the buttocks, unstable chair with unusual impurities, impaired vision or pain in the eyes, this is also the reason that it is immediately sent to a specialist for the implementation of the specific additional examinations and exclusion of diseases from the group of spondiloartritov (e.g., seronegative spondylitis or crohn's disease).
There are diseases, which is manifested by pain in the lower back fully intact vertebrate or nerve structures. One such disease – myofascial pain syndrome. Patients (especially young patients), show that spending a long period in an awkward position, or physical overload, before the development of pain. When doctors drew attention to a sharp pain when pressure on certain points located on the spine. This condition significantly reduces the patient's quality of life, but minor changes in the muscle tissue (the local strain), there is no risk to the nerve roots or the internal organs. Typically, the therapeutic effect can be achieved with the help of the purpose of muscle relaxants, low-dose nonsteroidal anti-inflammatory medications, local injection (injection) in the "pain points" steroid anti-inflammatory medication.
Review
It is considered that, if a patient with complaints of pain in the lower part of the back does not have "red flag" (described below), then additional testing is not necessary, and treatment may be performed by a doctor without the tests and x-rays. But, as practice shows, almost every patient these "signs" can be detected, and it is therefore necessary to donate blood for the least common (and better – more on immunological) analysis, and perform x-rays of the lumbar spine in two projections (ideally with the "capture" of the pelvis).
- - Blood tests can detect the increase in the erythrocyte sedimentation rate (EFF), which indicates inflammation, probably immune in origin, or infection. Increase the level of leukocytes also suggests infection or inflammation, and severe anemia – on the possible presence of cancer.
- - Urinalysis for rent with suspected kidney disease. Pain in the lumbar region is periodic in nature, often "spreading" to the lower ribs. If there are changes in the urine analysis performed ultrasound of the kidney, and tactics is discussed in detail with a therapist or urologist.
- - X-ray – the cheapest of instrumental investigations, is the method of choice in the diagnostic findings in this case. On the radiograph you can see the violation of the structures of the spine, signs of inflammation of the vertebrae, on circumstantial evidence, to determine the location of compression of the nerves. The "transparency" of the vertebrae on the radiographs will lead to the thought, and osteoporosis (brittleness) of bones of the skeleton. As you know, is in the background osteoporosis, the most common complications, such as fracture of a vertebra. If the fracture is, unfortunately, taken place, it will also be seen on the radiograph. Options for this method of research is huge, but if pathology is found, we must ask how serious the damage is, not whether the patient needs surgical intervention on the spine. It is necessary a more accurate study of the level of (CT). There are two types of tomography – computed x-ray and magnetic resonance imaging.
- - Computed tomography (CT). Survey method, which allows you to literally look inside of the spine. All of the bone structure, which are not visible on x-ray, tomogram will be completely visible. If necessary, with the use of derived data and a special computer program can reconstruct a 3D model of any structure.
- - Magnetic resonance imaging (MRI). Not x-ray method of research. Different from the CT scan that allows the doctor to more accurately assess the status of the soft structures of the spine (visible on CT only bone elements): the spinal cord, roots. More details in the survey it is evident vertebral hernias, vascular changes and muscle. Usually it comes to specialist for MRI is still the last word in diagnostic search and definition of further tactics.
Signs that you should pay attention
Secondary back pain that is not related to the low back pain is an alarming symptom, forcing them to start a search of the primary pathological process that causes pain. In short the symptoms that may indicate possible secondary (i.e., not directly associated with the spine) character of pain and the need for greater vigilance, than between the doctor and the patient:
- rapid sudden weight loss (may be a suspected tumor);
- infection of the kidneys and bladder (in this case, the pain can be a symptom of pyelonephritis);
- increased pain at rest or after a night's sleep (this issue is especially interested in rheumatology, as it can be a sign for the development of Bechterew disease);
- the increase in body temperature;
- changes in blood tests (increased blood clotting, discovered when you run a coagulogram, the increased level of leukocytes or drop in hb levels and greater ESA (erythrocyte sedimentation rate) is a general analysis, increased levels of C-reactive protein analysis);
- the diagnosis of "osteoporosis", or taking medications, which can reduce the amount of calcium in the bones;
- age over 50 years (risk of osteoporosis in women in menopause) or with less than 20 years, particularly for boys;
- link to the injury, regardless of its limitations (for example, fall more than 2 metres, and for older people important injury is fall from height of one's own body);
- signs of serious neurological abnormalities (impaired sensitivity of the skin, urination or bowel movement is usually an indication that deep lesions of the spinal cord);
- invalidity of the "routine" treatment for 4 weeks.
To maintain the activities and mobility
A common mistake is to comply with bed rest for acute back pain. The movement in this pathology of the locomotor apparatus not only necessary, but essential! In all cases, except for the compression radicular syndrome, the diagnosis will be established neurologist), is in a horizontal position increases the cost of treatment and prolongs the recovery time. And when radicular syndrome, total time in bed must not be more than two days.
In inflammatory diseases of the spine and the sacroiliac joints physical activity is a primary means to fight against the upcoming special needs. Recall that this group of diseases, which is gradually progressive in nature, and exercises aimed at maintaining flexibility and developing and strengthening the muscular "corset" of the spine can be considered as a successful method of therapy as specific therapy anti-inflammatory drugs of different groups, which are called experts.