Back pain

Back pain is a common problem among middle-aged and older patients. It can be caused by an incorrect lifestyle, pathologies of the musculoskeletal system, diseases of internal organs. A neurologist, orthopedist, nephrologist and urologist can treat back pain, depending on its origin. It is difficult for the patient to figure out the cause of the unpleasant sensations himself and choose the right doctor. Therefore, it is initially necessary to contact a therapist, who, depending on the symptoms, history and results of the studies performed, will refer you to a narrow specialist.

Classification

Back pain can be:

• Myofascial.
• Nociceptive.
• Neuropathic.
• Psychogenic.

Myofascial painobserved during the formation of the so-called. trigger points in the muscles of the back. Trigger points are pea-like knots that form when muscles are constantly tense (when they simply cannot relax). Moreover, when one segment of the muscle fiber is compressed, the others are stretched. This affects the mobility of the muscle fiber: it is limited. The fiber itself is shortened, becomes tighter.

Trigger points arise from muscle overstrain. Moreover, overstrain can occur not only due to excessive physical activity, but also due to prolonged stay in one position (for example, sitting at a computer). Also, trigger points often occur with osteochondrosis.

Another factor that contributes to the formation of trigger points is excessive stimulation of sarcomeres (basic contractile units that are a complex of proteins). If there is excessive stimulation of the sarcomeres, they are constantly in a contracted state.

The presence of trigger points does not allow the muscle to fully relax. She begins to tire quickly even with minor loads, overexerts when moving and recovers very slowly. Its limited range of motion affects the entire fascial chain. Other muscles and even some joints also become less mobile.

Blood flow in the tissues surrounding the trigger point also suffers. Because of this, oxygen starvation is observed in this area. Decay products accumulate, irritate the trigger point, and pain develops because of this. In this case, the size of the muscle does not matter, it all depends on the degree of irritation of the point. Even the smallest muscle in the presence of trigger points in it can deliver a lot of unpleasant sensations.

A characteristic feature of myofascial pain is their reflection. This means that pain is reflected to other parts of the body. They can occur in areas very distant from the trigger points. So, for example, pain below the shoulder blades or in the lower back can develop due to the presence of nodes in the abdominal muscles. Also, the lower back can hurt due to trigger points in the calf region or in the buttocks.

Myofascial pains are usually long-lasting and dull. Sometimes they occur only when moving, sometimes at rest. They can be different in strength: from minor discomfort to unbearable pain.

Nociceptive pain- the body's response to direct irritation of pain receptors (nociceptors). In the case of the back, these are receptors located in the paravertebral ligaments, muscles, tendons, as well as in the articular capsules of the intervertebral joints and the outer third of the fibrous ring of the intervertebral disc. The patient may experience pain with reflex muscle spasm, dystrophic or pathological processes in the facet joints. When moving, the pain intensifies.

Neuropathic paindevelop in pathological processes in the nervous system: damage to the nerves or roots of the peripheral nervous system, disruption of the central nervous system. Such pain can be observed with osteoporosis, spondylolisthesis, hernias, and spinal fractures. They intensify when bending, moving, straining, coughing, sneezing, and in most cases they are given to the limb. Sometimes they are dull and aching, but more often they are sharp, shooting.

Psychogenic painoccur due to muscle spasm caused by emotional stress, chronic stress, or anxiety disorder.

In some cases, the varieties can be combined with each other. For example, myofascial sensations coexist with nociceptive ones.

Also, back pain is divided into 3 types:

• Acute (lasting less than 6 weeks).
• Subacute (6-12 weeks).
• Chronic (more than 3 months).

Acute / subacute painusually develops due to tissue damage (deep, superficial) due to cuts, wounds, inflammation. Thus, the body warns us that something is wrong. The pain goes away after the tissues are completely healed.

Chronic painoccurs due to diseases of organs and systems or emotional disorders. If present, a thorough medical examination is necessary.

By location, the pain can be:

• Local.
• Reflected.
• Irradiating.

Local pain develops directly at the site of the development of the pathological process. Reflected - if there are trigger points. Irradiating - with damage to internal organs, spreads along the nerve fibers.

Why does my back hurt?

Back pain can be caused by a variety of reasons, which include:

• Curvature of the spine: scoliosis, kyphosis.
• Neurological diseases: herniated intervertebral discs, osteochondrosis, spondylosis, spondyloarthrosis.
• Endocrine pathologies: osteoporosis.
• Respiratory system diseases: pleurisy.
• Pathologies of the kidneys and urinary system: urolithiasis, pyelonephritis, glomerulonephritis.
• Tumors.

Short-term pain (usually severe, burning) can be due to various reasons. These include:

• Injuries.
• Overexertion of muscles (due to a monotonous posture or the performance of the same type of repetitive movements).
• Hypothermia.

Pain caused by degenerative processes occurs with the following diseases:

• Osteochondrosis.
• Intervertebral hernia.
• Intervertebral disc protrusion.
• Spondylosis deformans.
• Degenerative scoliosis.
• Arthrosis.
• Spondylolisthesis (displacement of the vertebrae).
• Spondylolysis (non-union of the vertebral arch).
• Spinal stenosis.

Pain radiating to the spine can develop due to diseases:

• Heart and great vessels: myocardial infarction, angina pectoris, aortic aneurysm.
• Lungs: cancerous tumors, pleurisy.
• Esophagus.
• Gallbladder and biliary tract: acute and chronic cholecystitis.
• Kidney and urinary tract.
• Pancreas.

Back pain in rare cases can be of infectious origin. For example, sometimes my back hurts with the flu. Also, the infection can penetrate into the spine from nearby organs: urinary tract, kidneys.

Other reasons for the development of back pain may be changes in hormonal levels (for example, age-related, during or after menopause). In this case, hormonal spondylopathy occurs (degenerative changes in the spine)

Back hurts a lot: what to do?

If you have a severe attack of pain, be sure to see a doctor as soon as possible. However, if the sensations are so strong that any movement causes torment, first aid is needed. You need to lie on your back on a flat, hard surface (for example, the floor). This will help relieve spasms, relax muscles, and reduce pain.

Sinking on a flat surface, do not change the position of your back. Lying on your back, try to roll over onto your side. This will relieve the spine. When the pain subsides, roll back onto your back. It is recommended to put something under your feet, lifting them up. Lie in this position for 10-15 minutes.

You also need to climb correctly: first roll over on your side. From this position, get down on all fours. Then lean on something (if there is no support nearby - crawl to it) and slowly get up. Only then carefully straighten your back.

To find out why your back hurts badly, do not postpone a visit to the doctor. This will help avoid new attacks.

Diagnostics

You should definitely make an appointment with a therapist if back pain:

• appear during physical exertion, muscle tension;
• last more than 3 days;
• are episodically repeated.

It is necessary to visit a doctor immediately in the following cases:

• back hurts constantly;
• increased body temperature, numbness of the limbs, lethargy of the limbs in the morning are added to the pain;
• in the lying position, the pain does not go away;
• pains worse at night.

At the appointment, the doctor will take an anamnesis, examine the patient (assess the condition of the skin, the position and symmetry of the body, gait, etc. ). Then he will assign studies:

• general analysis of blood and urine;
• x-ray;
• computed tomography;
• magnetic resonance imaging.

If necessary, the therapist will refer the patient to a neurologist, orthopedist, urologist, gynecologist or nephrologist.

Back pain treatment

Back pain treatment is comprehensive and may include:

• taking medications (anti-inflammatory, painkillers, restorative drugs);
• blockade (long-term pain relief);
• physiotherapy procedures;
• physiotherapy exercises;
• massages;
• manual therapy.

If conservative methods do not give the desired result, surgical treatment is prescribed. Modern methods make it possible to carry out low-traumatic precise operations with a short rehabilitation period.

Prevention of back pain

Simple preventive measures can help prevent back pain. It is necessary:

• Monitor your posture.
• Sleep on a bed with a hard mattress.
• Engaging in activities that involve a long sitting position (driving, working at the computer), it is necessary to change posture from time to time, as well as organize breaks and warm up.
• When standing for a long time, lean on something.
• Don't wear high heels for more than 2 hours in a row.
• Spend time with moderate physical activity (swimming, fitness).
• Keep track of your weight - back pain can occur due to the presence of extra pounds.
• Try not to lift weights.
• Do not turn or bend over with sudden movements.
• Timely treat urological and gynecological diseases.

The preventive annual visits to the therapist will also be beneficial. Pathologies identified in the early stages can be eliminated without waiting for the development of complications.