Back pain

Back pain is a common problem among middle-aged and elderly patients. It can be caused by improper lifestyle, pathologies of the musculoskeletal system, diseases of the 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 discomfort himself and to choose the right doctor. Therefore, you should first contact a therapist who will refer you to a narrow professional depending on the symptoms, history, and results of the tests performed.

Classification

Back pain can be:

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

Myofascial painobserved during the formation oftrigger points in the back muscles. Triggering points are pea-like lumps that form when the muscles are constantly tense (when they simply cannot relax). Moreover, when one segment of muscle fiber is compressed, the others stretch. This affects muscle fiber mobility: limited. The fiber itself shortens, tightens.

Triggering points result from muscle overload. In addition, overload can be caused not only by excessive physical activity, but also by staying in one position for a long time (such as sitting next to a computer). Furthermore, trigger points often occur in osteochondrosis.

Another factor that contributes to the formation of trigger points is excessive stimulation of sarcomeres (essential contractile units that are a protein complex). If the sarcomers are over-stimulated, they are in a constant state of contraction.

The presence of trigger points does not allow for complete muscle relaxation. Even with low loads, it starts to get tired quickly, overloads while moving, and recovers very slowly. Its limited range of motion affects the entire fascia chain. Other muscles and even some joints are less mobile.

Blood flow in the tissues surrounding the trigger point also suffers. For this reason, oxygen starvation is observed in this area. Decomposition products accumulate, irritate the trigger point, causing pain. In this case, the size of the muscle doesn’t matter, it all depends on the degree of irritation at the point. Even the smallest muscle, in the presence of trigger points, can cause a lot of discomfort.

A characteristic feature of myofascial pain is their reflection. This means that the pain is also reflected in other parts of the body. They can occur in areas very far from the trigger points. Thus, for example, pain under the shoulder blades or in the lower back may be due to the presence of nodules in the abdominal muscles. The lower back can also hurt due to trigger points on the calf or buttocks.

Myofascial pain is usually long lasting and boring. Sometimes they only occur when moving, sometimes at rest. They can vary in intensity: 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 found in the paravertebral ligaments, muscles, tendons, as well as in the joint capsules of the intervertebral joints and in the outer third of the fibrous ring of the intervertebral disc. The patient may experience pain, dystrophic or pathological processes in the facial joints with reflex muscle cramps. When you move, the pain increases.

Neuropathic painthey develop in pathological processes of the nervous system: damage to the nerves or roots of the peripheral nervous system, disturbance of the central nervous system. Such pain is observed in osteoporosis, spondylolisthesis, hernias and spinal fractures. They increase in case of bending, movement, exertion, coughing, sneezing, and in most cases are given to the limb. Sometimes they are boring and sore, but more often they are sharp, shooting.

Psychogenic painthey occur due to muscle cramps caused by emotional stress, chronic stress, or anxiety disorder.

In some cases, the varieties can be combined with each other. For example, myofascial feelings coexist with nociceptives.

In addition, back pain is divided into 3 types:

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

Acute / subacute painit usually develops due to tissue damage (deep, superficial) as a result of cuts, wounds, inflammation. So the body warns us that something is wrong. The pain goes away after the tissues have completely healed.

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

In some places, the pain may be:

• Local.
• It is reflected.
• Irradiator.

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

Why does my back hurt?

Back pain can be caused by a variety of causes, including:

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

Short-term pain (usually severe, burning) can come from a variety of causes. These include:

• Injuries.
• Muscle overload (due to monotonous posture or performing 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 (movement of the vertebrae).
• Spondylolysis (non-fusion of the vertebral arch).
• Scoliosis.

Pain in the spine can be caused by diseases:

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

In rare cases, back pain can be of infectious origin. For example, sometimes my back hurts from the flu. The infection can enter the spine from nearby organs: urinary tract, kidneys.

Other causes of back pain may include changes in hormonal levels (such as age, during or after menopause). In this case, hormonal spondylopathy occurs (degenerative changes in the spine)

The back hurts a lot: what to do?

If you have a severe pain attack, be sure to see a doctor as soon as possible. However, if the feelings are so strong that any movement causes torment, first aid is needed. You should lie on your back on a smooth, hard surface (such as the floor). This helps relieve cramps, relax muscles and reduce pain.

Do not change the position of your back when descending on a flat surface. Lying on your back, try to roll over to your side. This makes the spine easier. When the pain subsides, roll back on your back. We recommend that you put something under your feet, lifting it up. Lie in this position for 10-15 minutes.

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

To find out why your back hurts badly, don’t delay your visit to the doctor. This will help you avoid new attacks.

Diagnostics

Be sure to make an appointment with a therapist if you have back pain:

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

See a doctor immediately in the following cases:

• the back constantly hurts;
• increase in body temperature, numbness of the limbs, lethargy of the limbs are added to the pain in the morning;
• in the supine position, the pain does not go away;
• at night his pain worsens.

At the meeting, the doctor collects the medical history, examines the patient (assesses the condition of the skin, body position and symmetry, gait, etc. ). He then orders 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, analgesic, restorative medications);
• 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 allow low-traumatic, precise surgeries to be performed with a short rehabilitation period.

Prevention of back pain

Simple preventative measures can help prevent back pain. Required:

• Pay attention to your posture.
• Sleep on a hard mattress bed.
• Participating in activities that require long sitting (driving, working with a computer) changes your posture from time to time, and you need to organize breaks and warm-ups.
• If you stand for a long time, rely on something.
• Do not 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 with sudden movements.
• Treat urological and gynecological diseases in a timely manner.

Therapist’s annual preventive visits will also be helpful. Pathologies identified at an early stage can be eliminated without waiting for complications to develop.