The pain in the lumbar region of the spinal column and adjacent areas may disturb the patient at any time of the day, in position of standing, sitting, lying down, or in movement, during exercise or at rest. The symptom of this is not as specific, that is to say, which can be found in a number of cases, which requires special attention, in the first place on the part of the patient: you must immediately consult the doctor.
To what doctor to go to?
According to the statistics, up to 25% of patients seeking medical attention in relation to the onset of pain in the lumbar region. 8 out of every 10 people around the world have experienced the pain in the back, at least 1 time in life. And more often suffering from these symptoms of a person of working age, a little less – the people of the age of retirement and even fewer adolescents (according to various sources, from 8 to 40% in russia).
The therapist, the neurologist, the rheumatologist
The first doctors to address the majority of patients with pain in the lower back, become the therapist and the neurologist. And here is the young people with an injury in the recent past, often turn to a specialist.
And diagnosis, and treatment of the tactics of these professionals are different. Often the therapist directs the patient to nevrologu, neurologist defines "your" diagnosis and assign treatment. Specialist most often works "individually", and in addition to the use of non-steroidal anti-inflammatory means, applying the methods of manipulative therapy and fiziolechenie. The most important thing for the sick – not to get lost in this situation, do not get carried away by the promises of instant healing when you run techniques, not to resort to it again in case of failure or, what is worse, have become more important in the background of this treatment of pain.
In the treatment of the conservative, that is to say, the drugs, it should be understood that the treatment for four weeks without result - what I was missing by reviewing the diagnosis, the treatment to revmatologu, and not to repeat the courses of the therapy. There are frequent situations when the patient complains of pain in the lower part of the back receives symptomatic (that is to say, only a pain reliever), the treatment of a model scheme, without clarifying the true cause of this pain.
The causes of pain in the lower back
The main causes of pain in the lumbar region is
- changes in the structures of the spine, as a general rule, the age (degenerative), osteochondrosis of the spine, a variety of hernia of the intervertebral discs or inadequate, the muscle work of the complex. These pains are called primary, i.e., directly related to the spinal column;
- the pathological changes of the organs that are found near the painful area, but directly to the vertebral column, which does not relate (for example, diseases of the internal organs, the skin). To this same category of causes lead to inflammation of the joints, injuries, endocrine disorders (e.g. diabetes), - in a word, everything that does not fit the image of "natural changes of age" of the spine. These pains are called secondary.
The medical examination
The pain, the heavy feeling of movement or the increase of the painful muscle tension in the stretch between lower ribs and the buttocks is accepted to designate the term "lyumbalgiya". If to these symptoms are joined a pain in the leg, this is called lyumbalgiya.
In the first place, it is important to the acuteness of the pain, that is to say, the prescription of their appearance. The pain of the prescription before 12 weeks (3 months) is called acute, longer than 12 weeks – chronic. The syndrome of chronic pain may occur with acute episodes and periods of improvement.
It is of the utmost importance, as the pain that you feel. It is the feeling that at a certain point, or of the distribution ("projection", "the irradiacin") the pain of the march of nerve in the thigh, buttock, knee joint, foot, or confusing, "dull" the pain. It is necessary to understand the limited movement in the spine in the moments of appearance of pain, or uncontrolled movements (this could indicate that in the mechanics of the nature of the damage, for example, when the crisis of the vertebra). In the moments in which pain appears? Is under load or at rest, during a night of sleep? Affirmative the answer to the last question in general is the "red flag" to the specialist and to reflect on the diagnosis of the inflammatory disease of the spine in the patient (as they will concentrate a little later). If the pain intensifies to the movement of the head, walk, jump, probably of the so-called projection of the pain, the cause of which – the damage of the nerve structures (the most often – back pain).
The osteochondrosis of the spine, or spondilez – a condition in which is observed the seal and the deformation of the vertebrae, with the appearance of small bones of the surfaces similar to the spines of the edges of the vertebrae. It has long been considered spondilez the result of the natural history of the degenerative diseases of aging processes of the organism. However, convincingly, that not only the age may be the cause of the degenerative disc disease. Stationary lifestyle, the increase of the load on the lumbar spine during a long work at the computer for long hours of driving (for example, the profession of a driver of a truck) contribute to the degenerative disc disease, even for the young. Under the influence of all these factors, intervertebral discs m? s-buffer is thin, and the nerve roots that extend from the spinal cord, there are institutions provincial who have grown spines of the bones. The constant irritation of these roots and causes pain. In Latin, the loin is called the radix, which is the swelling are often referred to as radikulit.
The so-called inflammatory disease of the spine – the area of interest to rheumatologists. These mysterious diseases that can "decline" of several years, starting mainly at an early age, and that stick mostly men, and the shedding in the final in obezdvizhennost' i invalidizatsiyu of the sick. The patients of this group usually "suffering until the last, and the night of pain and stiffness in the back, and the weakness, and the increasing decline of work capacity. Unfortunately, the occurrence of the first symptoms of the disease before the correct diagnosis, on average, spends close to seven years. During this time, changes in the spine may be irreversible, and functional (motor) activity is low. The spinal column becomes stationary, changes the form, appears the hump. You will find this pathology is not as common as the osteochondrosis, for example, but the costs of treatment and the total time of the inability of these patients immensely superior.
If, in addition to pain in the lower back, the patient speaks of the inflammation of the joints (often the knees, the joints of brushes and feet, pain in the buttocks, unstable chair with unusual impurities, disturbances of vision or pain in the eyes, is also a matter of urgency to send you to a specialist for the specific test additional of the survey and the exclusion of the disease in a group of spondiloartritov (for example, seronegative spondylitis or Crohn's disease).
There are diseases that manifest with pain in the lower part of the back and not affected the vertebrate or nerve structures. One of those disease – myofascial pain syndrome. The patients (most of them are youth of the patient) indicate prolonged in an uncomfortable posture or physical overload, which preceded the development of pain. When you query the inspection, attention is called to the acute pain when they are pressed on certain points located near the spine. This condition reduces considerably the patient's quality of life, but a slight change in the muscle tissue (local overvoltage) does not represent any risk to the nerve roots, or to the internal organs. Typically, the therapeutic effect can be achieved through the allocation of a muscle relaxant, the low-dose nonsteroidal anti-inflammatory drugs, local administration (injection) "hit the nail" steroid anti-inflammatory medication.
The survey
It is believed that if a patient with complaints of pain in the lower part of the back does not have "warning signs" (see below), additional in the area of the survey that you do not need, and the treatment can be carried out by the therapist, without proof, and even x-ray. But, as practice shows, almost anyone who's sick of these "marks" can be detected and, therefore, there is the need of donating blood, as a minimum, in general (and better–, and in the immunological analysis and to perform an x-ray of the lumbar spine in two projections (ideally with the "capture" of the bones of the pelvis).
- - The analysis of blood can determine if the increase of the sedimentation rate of erythrocytes (esr), which indicates inflammation, it is possible immune origin, or of the infection. Increase the level of white blood cells it also speaks of the infection or inflammation, and expressed in terms of the anemia on the possible existence of the process.
- - Analysis of urine gives up when it is suspected of the disease of the kidneys. The pain in the lumbar area when this perpetuate, often "extending upward from the bottom of the edges. When there are changes in the urine analysis performed ultrasound of the kidneys, and the tactic is discussed in detail with your doctor or urologist.
- - X-ray – the cheapest of the instruments of the surveys, is the method of choice in the diagnosis of the search in this case. X-ray can see the violation of the structures of the spine, the signs of inflammation of the vertebrates of the joints, for indirect reasons to determine the place of the sdavleniya of the nerves. "Transparency" of the vertebrae in the x-ray to guide you in thinking about osteoporosis (fragility) bone marrow of the skeleton. As is known, on the background of osteoporosis occurs with greater frequency this complication such as fracture of a vertebra. If the fracture, unfortunately, took place, this was also seen in the x-ray. The ability of this method of research are enormous, but if the pathology is found, it is necessary to specify how severe is the damage, not the patient needs the intervention of the spinal column. To do this, since it requires more accurate research – posloynoe (computed tomography) scan. There are two types of computer tomography x-ray and magnetic resonance imaging mri.
- - Computed tomography (ct). The method of the survey, which allows you to literally see the inside of the spine. All of the bone structure, which are not visible with an x-ray, tomogram will be very visible. If it is necessary, with the help of the data, and in particular a computer program can reconstruct a 3D model of any interest of the structure.
- - Magnetic resonance imaging (mri). Not an x-ray method of research. It is different from the computed tomography scan also the fact that it enables a doctor carefully and evaluate the state of the "soft" structures of the spine (in the tc are well visible only bone of the items): the spinal cord, roots. More in detail when the survey is seen vertebrates of the hernia, the changes in the blood vessels and muscles. It is usually by a specialist in the magnetic resonance imaging is the last word in the diagnosis of the search and the determination of further tactics.
Symptoms you should pay attention
Side back pain, that is to say, do not have a relationship with the osteochondrosis is a disturbing symptom, it is ensured that as soon as possible to start the main quest pathological process that is causing the pain. Synopsis we will focus on the symptoms that may indicate a possible secondary (i.e., are not directly related to the spine) the nature of the pain and require more vigilance, both the doctor and the patient:
- rapid sudden weight loss body (can arise the suspicion of a tumor);
- infections of the kidneys and of the bladder (in this case, the pain can be a symptom of a pyelonephritis);
- the amplification of the pain at rest or after a night of sleep (this particular symptom, rheumatologists, as well as can be a sign of the evolution of the illness behtereva);
- the increase of the temperature of the body;
- changes in blood tests (increase of the coagulability of the blood is located when you run coagulogram, increased levels of leukocytes or the fall of the hemoglobin, as well as the increase of esr (erythrocyte sedimentation rate), in general, the analysis, the increase in the level Of c-reactive protein in the analysis);
- established the diagnosis of "osteoporosis", or medicines that reduce the amount of calcium in the bones;
- the age of over 50 years of age (the risk of osteoporosis in women at the change of life) or under 20 years of age, and particularly young people;
- the reference to the injury, regardless of its limitations (for example, falling from a height of over 2 metres, and for the people of age significant the injury is already a fall from the height of their own body);
- the signs of serious neurological disorders (violation of the sensitivity of the skin, urinating or defecating normally reflect a profound defeat of the spinal cord);
- the ineffectiveness of the "routine" treatment for 4 weeks.
To maintain the activity and the movement
A common mistake – the compliance of the bed so when the acute back pain. The movement to the east of the pathology of the locomotor apparatus is not simply necessary, and it is necessary! In all cases, in addition to compression radicular syndrome (this diagnosis will be a neurologist), the position in a horizontal position increases the cost of the treatment and tightened the time limits of recovery. Yes, and when radicular syndrome of the total time of bed linen and so should not be more than two days.
The inflammatory diseases of the spine and of the sacroiliac joints, the physical activity is the main tool of struggle against incoming disability. Let's remember that this group of diseases has gradually progressive in nature, and exercises to maintain flexibility and the development and strengthening muscular "corset" of the spine, can be considered the same effective method of treatment, as the special therapy with nsaids different groups that are assigned to the specialists.