Pain in the lumbar and the surrounding areas can disturb the patient at any time of day, standing, sitting, lying down or on-the-go, during exercise or at rest. So, this symptom is not specific, meaning that it can fill such a huge number of cases that require special attention in the first place, where the patient: it is necessary to immediately consult a doctor.
To what doctor to address?
Statistics show that up to 25% of patients seek medical advice in connection with the occurrence of pain in the lumbar region. 8 out of 10 inhabitants of the world have experienced the pain back, at least 1 time in my life. Most often suffer from these symptoms people of working age, slightly fewer people of retirement age, and even less for young people (according to various estimates, 8 to 40% in Russia).
Therapist, neurologist, rheumatologist
The first doctors who treated the majority of patients with pain in the lower back, to become a therapist and a neurologist. But young, who is a trauma recently, more and more expert.
And diagnostic and therapeutic tactics of these professionals differ from each other. Often the therapist directs the patient to a neurologist, neurologist to determine the "own" diagnosis and prescribes treatment. Expert working with a number of "alone", and in addition to the using non-steroidal anti-inflammatory drugs, applied techniques of manual therapy and physiotherapy. The most important thing for patients – not to get lost in this situation, not to get carried away by promises of instant healing when you execute the techniques will not resort to them again if the fault or, worse, intensified against the background of such treatment of pain.
After conservative treatment, it is medication, you should understand that treatment for four weeks without result, a strong argument will be checked in the diagnosis, treatment revmatologu, not to make repeated courses of treatment. There are often situations, when the patient's complaints of pain in the lower back can get symptomatic (only pain) the treatment of some formulaic system, without specifying the actual cause of the pain.
Causes of lower back pain
The main causes of pain in the lumbar region is
- changes in the structure of the spine, usually age-related (degenerative), degenerative disc disease of the spine, a variety of herniated discs or insufficient working of the muscle complex. Such pain is called the primary, which is directly related to the spine;
- pathological changes in the organs located near the painful area, but directly into the spine are not related (e. g., diseases of internal organs, skin). This category causes include arthritis, trauma, endocrine disorders (eg. diabetes), - in short, everything that does not fit the "natural age-related changes" of the spine. Such pain is called secondary.
Inspection appointment
Pain, feeling heavy movement or increased painful muscle tension in the area between the lower ribs and the buttocks are marked with the term "lyumbalgiya". If these symptoms include pain in the foot, this condition is called lyumbalgiya.
The most important thing is the sharpness of the pain, which is the remoteness of its occurrence. Pain prescription 12 weeks (3 months) is called acute, for more than 12 weeks – chronic. Chronic pain syndrome can occur with exacerbations and periods of improvement.
Essential is how pain is felt. Or feeling at some point, or distribution ("projection", "irradiation") is pain along the nerve in the thigh, buttock, knee, leg, or fuzzy, "boring" pain. You need to understand that the limited mobility of the spine a moment of pain, or moving unhindered (this may indicate the mechanical nature of the damage, such as fracture of the vertebrae). With a moment's pain? It occurs under load or at rest during the night? An affirmative answer to the last question is usually a "red flag" for the expert and makes you wonder about the diagnosis of inflammatory diseases of the spine of the patient (a little later). If the pain increases with movement of the head, walking, jumping, it probably is about the so-called projected pain, the cause of which is injury to the nerve structures (most often the sciatic).
Osteochondrosis, or spondilez – a condition in which there is compression and deformation of the vertebrae, with the advent of small bone surface, such as spikes on the edges of the vertebrae. For a long time it was assumed, spondilez the result of the natural degenerative processes of aging. However, it was shown that not only age can be the cause of lower back pain. Lack of physical activity, increased load on the lumbar spine during prolonged work at a computer or prolonged driving (eg. professional truck drivers) will contribute to osteoarthritis even in young people. Under the influence of all these factors, the intervertebral discs become thinner bumpers, and the nerve roots that go to the spinal cord injured raised the marginal spikes of bone. The continued irritation of these roots and cause pain. The Latin root is called the radix, so this inflammation is usually called radikulit.
The so-called inflammatory diseases of the spine – the area of interest in rheumatology. These mysterious diseases can "smolder" for a few years, starting mainly in young age and mainly affects men, and the result in the end obezdvizhennost' I don't invalidizatsiyu patient. Patients in this group usually the "go to last" and night pain and morning stiffness in the back, and weakness, and the increasing decline in health. Unfortunately, the appearance of the first symptoms of the disease before the correct diagnosis on average it takes about seven years. During this period, changes in the spine can become irreversible, and functional (locomotor) activity is low. The spine becomes fix, change shape, is pink. I found this pathology is not as common as lower back pain, for example, but the cost of treatment and disability of such patients is disproportionately higher.
If in addition to the back pain patient talks about inflammation of the joints (most often we talk about the knee joints, the joints of the hands or the feet), pain in the buttocks, unstable chair unusual impurities, decreased vision, or pain in the eyes, this is also the reason immediately send him to the expert implementation of specific additional studies, and exclusion of diseases from the group of spondiloartritov (e. g., seronegative ankylosing spondylitis or Crohn's disease).
There are diseases manifested by pain in the lower back completely intact vertebrate or nerve structures. One such disease – myofascial pain syndrome. Patients (mostly young patients), show that spend long periods of time in a bad position or physical overload, preceded the development of pain. When the doctor drew a sharp pain when pressure on certain points located near the spine. This mode significantly reduces the patient's quality of life, but small changes in the muscle tissue (the local database) is not a danger to the nerve roots or the internal organs. Typically, the therapeutic effect can be achieved by using the purpose of muscle relaxants, low-dose-steroidal anti-inflammatory drugs, local injection (injection) "pain point" steroid anti-inflammatory drug.
Research
It is considered that if the patient complaints of pain in the lower back there is no "red flags" (discussed below), then additional testing it is not needed, and processing can be carried out without medical tests and even x-rays. But, as practice shows, almost every patient these "signs" can be detected, and thus it is necessary to donate blood at least the most common (and better – more immunological) analysis, and perform x-rays of the lumbar spine in two projections (preferably "capture" of the pelvis).
- - Blood tests can detect that the increase in erythrocyte sedimentation rate (ESR), which indicates inflammation, probably immune in origin, or infection. Increasing the level of white blood cells also suggests infection or inflammation, and severe anemia – the possible presence of cancer.
- - Urine for rent with suspected kidney disease. Pain in the lumbar region is regular in nature, often "spread" up to the lower ribs. If there are changes in the urine analysis performed renal ultrasound, and tactics is discussed in detail with a therapist or urologist.
- - X-ray – the cheapest of instrumental studies, is the method of choice for the diagnostic finding in this case. X-rays can be seen as a violation of the structure of the spine, signs of inflammation of the spine joints, circumstantial evidence to determine the location of compression of the nerves. The "transparency" of the vertebrae x-rays leads to the idea of osteoporosis (fragility) bone of the skeleton. As you know, in the background osteoporosis, the most common complications, such as fracture of the vertebrae. If the fracture is, unfortunately, taken place, it is also seen on the radiograph. The possibilities of this method of research is huge, but if the disease is found, it must be asked how serious the damage is, not whether the patient needs surgical intervention of the spine. This has required a more detailed research level (CT). There are two types of ct scans – computed tomography x-ray and magnetic resonance imaging.
- - Computed tomography (CT). Survey-a method, which allows you to literally look inside the spine. All the bone that are not visible on x-ray, tomogram is completely visible. If necessary, using the received data and a special computer program can be used to reconstruct the 3D model of any structure.
- - Magnetic resonance imaging (MRI). No x-ray research method. Different CT that allows the doctor to better assess the condition of the soft structures of the spine (visible on CT only bone elements): the spinal roots. More details when the research is seen in the spine hernias, vascular changes and muscle. Usually it is a specialized MRI is still the last word diagnostic in the search and definition of further tactics.
Signs that you should pay attention to
Secondary back pain, which is not related to low back pain is an alarming symptom, forcing the start of the search the primary pathological process causing the pain. Briefly in symptoms, which may indicate possible secondary (i.e. not directly related to the spine), the nature of pain and require vigilance, as 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 symptom is especially interested in rheumatology, because it can be a sign of developing bechterew's disease);
- increase in body temperature;
- changes in blood tests (blood clots, out when you run coagulogram, increased number of white blood cells or decreased hemoglobin and increased ESR (erythrocyte sedimentation rate) in the general analysis, an elevated C-reactive protein analysis);
- the diagnosis of "osteoporosis", or take medications that reduce the amount of calcium in the bones;
- age over 50 years (osteoporosis in women in menopause) or less than 20 years, especially for boys;
- link damage, regardless of its limitations (for example, dropped more than 2 meters, and the elderly, significant injury is falling from height of own body);
- signs of severe neurological abnormalities (reduced skin sensitivity, urination or bowel movement is usually a sign that deep lesions of the spinal cord);
- the ineffectiveness of the "routine" treatment for 4 weeks.
Maintain activity and mobility
A common mistake is to comply with bed rest for acute back pain. The movement of this pathology of the musculoskeletal system are not only necessary, but essential! In all cases, with the exception of compression radicular syndrome (a diagnosis based on neurologist), is in a horizontal position increases the cost of treatment and prolongs the time of recovery. And when radicular syndrome, total time in bed should not be more than two days.
Inflammatory diseases of the spine and sacroiliac joints exercise is the primary way to prevent future injuries. Remember that this group of diseases is gradually progressive in nature, and exercises, the purpose of which is to maintain flexibility and to develop and strengthen the muscular "corset" of the spine can be considered as effective form of treatment as the specific treatment with anti-inflammatory drugs of different groups, to nominate experts.