Low back pain treatment

Low back pain is just a symptom, an external manifestation of some disease or pathology.Any pain has its cause.There are many causes of back pain.

Patients are often told that back pain is caused by overload of muscles and ligaments.Unfortunately, if the cause were just in the muscles, it would be very easy to alleviate the pain.For example, a massage that is supposed to bring relief.But massage doesn't always help because it eliminates the cause of the pain.

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

If the hernia is large and compresses the left lumbar root (radiculitison the left), low back pain may occur in the left leg and the pain may begin in the left leg.A large hernia often causes a violation of posture in the form of a distortion of the trunk with sharp “twisting” pain, when it is impossible to straighten up and straighten up (the so-called antalgic position of the trunk).

Back pain in the lower right corner may be the result of problems with a hernia or the right joints of the spine, or pathology of the sacral region (right iliosacral joint).

Pain in the left shoulder blade region (or pain under the left shoulder blade) may be a consequence of a hernia or joint pathology or heart problems.This pain can be caused by angina pectoris and heart attack.Pain between the shoulder blades occurs not only with pathology of the spine and osteochondrosis, but also with diseases of the stomach (gastritis, ulcers, cancer, etc.) and often the intestines.

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

Protrusionsdisks, are more often incidental findings on MRI, whichhe canproceed without any pain.Disc herniation– is not such a common cause of severe back pain.However, the formation of a hernia, for example, when lifting heavy objects, causes lumbar or thoracic low back pain (sharp pain in the back).In the case of constant back pain, the hernia found on the MRI may have nothing to do with it.The reasons for this constant pain are often different. Diagnosis will help you find out.

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

1. Determine the cause of low back pain (establish a diagnosis).
2. The cause of low back pain will be determined by a neurologist, an orthopedic traumatologist with skills in the field of vertebrology and vertebroneurology or a vertebrologist (vertebroneurologist).The diagnosis is established through clinical 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 reoccur.To achieve this, we offer several methods, including physical spinal rehabilitation.

Lower back pain.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 type is already a social problem.The fact is that the lumbar region is the most loaded part of the spine, which endures daily and hourly overloads.85% of people have felt pain in the lower back at least once in their lives.What is the reason?

Pain in the lower backcan have many reasons.The most common causes are osteochondrosis, herniated disc, radiculitis and pathology of the lumbar joints.

Osteochondrosis

Osteochondrosis–natural aging of spinal tissue.

It is generally accepted that osteochondrosis is a sign of spinal disease, accompanied by pain.This is a little different.

The image below shows that a normal disk has been damaged (see the damaged disk in the image).This damage can accelerate the aging of the disc and it loses its height (see “narrowing of the intervertebral space”).Then, aging begins to affect the bone tissue of the vertebrae themselves and osteophytes grow (see “osteophytes” in the image).

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, especially osteochondrosis.For this reason, the question of the failure of vertebroneurology even arose.In 1978, the first research laboratory for the problems of spinal osteochondrosis was created, which 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 does not have nerve endings.Therefore, there is no pain in osteochondrosis.

Disc herniation

Disc herniation as a possible cause of pain.The image above shows several herniated discs – a small herniated (protrusion) and a large herniated disc.A herniated disc itself doesn't hurt.

The disc has no nerve endings (it is not innervated).Pain caused by a herniated or protruded disc occurs when the herniated protrusion presses on the innervated tissue.For example, inspineor inrearyuyulongitudinalwowpackagesin.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 (lombodynia) or sharp pain - lumbago (lumbago) appears.

A herniated disc can often be treated without surgery.

Spondyloarthrosis

Spondyloarthrosis is osteoarthritis of the spinal joints.Osteoarthritis itself is characterized by a disease of the cartilage of the joints.In this case, the cartilage decreases in height (degenerates, “dries out”) and the bony articular surfaces lose their protective cartilaginous 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 injured by a herniated disc or spinal joints.It's usually not so much lower back pain, but rather pain in the legs, buttocks, and pain or numbness even in the toes.

Radiculitis is most effectively treated with root release.If it arose due to a herniated disc, it is necessary to reduce the hernia, which puts pressure on the root.

Back and lower back pain due to pathology of internal organs

Back pain is possible due to the pathology of internal organs.For example,low back pain in womenmay be a consequence of diseases of the pelvic organs.

Low back pain in women

Lower back pain in women can be caused by inflammatory diseases of the female genital organs.

If a woman feels pain in the pelvis and lower back, always remember about gynecology.Inflammatory diseases of the female genital organs are not uncommon.The cause may be inflammation of the appendages, inflammatory diseases of the vagina and vulva, salpingitis, salpingoophoritis, endometritis, bacterial vaginitis, etc.More often, these inflammatory diseases in women are caused by infections of the genital area, including sexually transmitted infections.

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

Constant, dull 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 appears in the lower back or sacral region, it may already be too late.

Many people think that tumors are accompanied by pain.This is wrong.In the early 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 itself when the tumor grows.In this case, the pain usually appears in the lower back and lower back.Pain below the lower back occurs in the sacrum region.

In the case of cancer, intense pain in the lower back is not bothersome at first.Instead, the lower back doesn't hurt, but hurts.This pain can be the first sign that will help a woman prevent critical tumor growth and make a correct diagnosis in a timely manner.If your lower back or sacrum constantly hurts, you should pay special attention to this so as not to miss a catastrophe.

Unfortunately, if you don't pay attention to pain or discomfort in your lower back, the next sign of cervical cancer could be uterine bleeding.This is the phase in which the tumor begins to disintegrate, when metastases may already occur.Including in the spine, when there is already severe pain in the lower back.

Important conclusion: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 detected during examination is a precancerous condition.

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

Acute low back pain may be caused by kidney disease

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

Pyelonephritis is an infectious disease, usually caused by an ascending 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.For example, everything stays on dirty 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 reflexively swell (inflame).And my lower back starts to hurt.

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

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

Stomach cancer linked to back pain

Treatment of back pain caused by gastrointestinal tract pathology will not provide improvement.The cause needs to be treated.

Another possible cause of low back pain is back overload.

Excessive load on the lower back is a common cause of back pain or its exacerbation.Overload usually affects the lumbar joints, lumbar ligaments, tendons or muscles.In addition, the muscles of the lower back work actively under load.Therefore, if you feel back pain in the lower back after exercise, it is not necessarily an illness.It could be a muscle tear.If this pain does not go away within 1-2 days, you should think about problems with the lumbar spine.Especially if this pain intensifies with movement.

The causes of this pain are often overloaded inflammation of the muscles and their insertions.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 to consult a doctor and carry out manipulations, take painkillers, massages and other procedures.

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

Soft tissue injury of the lower back

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

If you are worried 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 about a hernia on the right side of the lumbar spine.

Types of low back pain

Pain, taking into account duration, can be acute, chronic or have a transient (transient) character.

The pains are as follows:

• Local pain– pain exclusively in the lower back.
• Referred pain– when the pain occurs not only in the lower back, but for example in the buttocks, in the pelvic region.Or the pathology of internal organs causes pain in the lower back.In these cases they talk about referred pain.
• Radicular pain– differ in significant intensity and are located within the limits of root innervation (from the spinal column 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 pain due to so-calledcough impulse.It is intense pain in the lower back that can reach (radiate) to 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 spasm significantly disrupts the biomechanics of human movements.Chronic muscle spasms can also cause painful, cramping lower back pain.

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

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

What to do if you have low back pain?

The causes of low back pain are varied, therefore treatment of low back pain should be carried out only after diagnosis and after the diagnosis has been made by a qualified doctor.Any pain in the vertebral region requires a medical examination and clarification of the cause of its occurrence.

A visit to the doctor has 3 objectives:

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

Possible causes of low back pain

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

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

Treatment of low back pain (back pain)

At the stage of initial treatment for pain in the lumbar region (back), a primary diagnosis is established.This is done based on research, medical history, neurological and orthopedic exams.At this stage, medications may 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.In the acute and subacute periods, rest is important during drug therapy.Physiotherapy, massage, manual therapy, which can aggravate the process, are not indicated.In the acute period, traction is also not used: fittings, on inclined boards, on wall bars.

To treat lower back pain most effectively, you need to understand the cause.To this end, the patient is subsequently examined to clarify the diagnosis.There can be many causes of lower back pain.An indicative list of diseases accompanied by lower back pain is listed 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 not indicated for this disease.For example, for inflammatory diseases of the spine (spondylitis, spondyloarthropathy, spondyloarthritis, myositis, ligamentitis, etc.), manual therapy, massage and physiotherapy are not indicated due to ineffectiveness and the risk of complications.It is necessary to identify the cause of the inflammation and treat it.

Spondylosis visible on x-rays can occur without clinical symptoms and often mask a more complex disease.Therefore, treating spondylosis is useless and often dangerous: it is unrealistic to remove bone growths from the spine and there is no need.The patient may encounter exotic diagnoses such as “muscle damage”, “muscle spasm”, “ligament damage”.Unfortunately, talking about muscle spasms as a 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 respond to any irritation both in the spine and outside it.The so-called “spasms” must be differentiated from reflected or projective pain in the lumbar region, which can be caused by pathologies of internal organs: diseases of the pelvic organs, retroperitoneal space, kidneys, pancreas and prostate, gynecological diseases of inflammatory or tumoral origin, diseases of the aorta, hemorrhage in the retroperitoneal tissue and much more.Osteopathic techniques to work with secondary spasmodic paraspinal muscles can, on a reflex level, temporarily alleviate the condition.Manual therapy, osteopathic techniques, inclined board, massage, traction, physiotherapy, for example, do not help with prostatitis or adenomatosis.The so-called “therapeutic removal”.“Muscle spasms” in this case are just the desires of the manipulator.

Treatment of herniated and protruding discs in the lower back

Often, an MRI scan reveals a hernia or protrusion, which is interpreted as the cause of lower back pain.The question immediately arises: remove the hernia or try to survive 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 lower back pain, and carry out an MRI diagnosis, it turns out that 80% of them have some kind of disc protrusion (“hernia”), which has no symptoms.

Often times, a herniated disc can be an accidental finding, which is 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 pain, a complete medical history is taken, a neurological examination is performed to identify neurological deficits, the functioning of the pelvic organs is clarified, etc.

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

Neurosurgeons have prescribed absolute indications for surgery, which are clearly defined.Most of the time, 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, the formation of stable motor patterns in the back, methods of local and general drug therapy, physiotherapy, reflexology, etc.Calibrated treatment without surgical intervention is often accompanied by regression of symptoms, and the hernia (protrusion) may decrease over time.

When making a decision about surgery, the indicators related to surgical treatment, officially prescribed by neurosurgeons, must be taken into account.Each specific case is considered separately, taking into account clinical symptoms, medical history, anamnesis, neurological and orthopedic examinations, results of hardware and laboratory examinations. 

It should be especially noted that surgical intervention is often associated with a number of complications, which after surgery must often be treated more intensively than to relieve pain before surgery.

Degenerative changes in the spine, such as osteochondrosis, spondyloarthrosis, spondylosis, etc., are treated based on identifying 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 its causes.