Treatment of lower back pain

Lower 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 only in the muscles, then it would be very easy to relieve the pain.For example, a massage that should bring relief.But massage does not always help because it removes the cause of the pain.

Sharp back pain can occur due to a herniated disc or disc protrusion.If the disc herniation is right-sided, you may experience back pain on the right side, pain in the right side, or pain in the right leg (sciatica with a large hernia).If the hernia is left-sided, then you may feel pain in the back on the left, and may be bothered by pain in the left side. 

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

Back pain on the lower right can be the result of problems with a hernia or with the right joints of the spine, or pathology of the sacral area (right iliosacral joint).

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

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

Protrusionsdisks, are more often incidental findings on MRI, whichcanproceed without any pain at all.Disc herniation– not such a common cause of severe back pain.Although, the formation of a hernia, for example, when lifting heavy objects, does cause lumbar or thoracic lumbago (sharp pain in the back).In the case of constant aching back pain, the hernia found on the MRI may have nothing to do with it at all.The reasons for such constant pain are often different. Diagnostics will help you figure it out.

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

1. Determine the cause of lower back pain (establish a diagnosis).
2. The cause of lower 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 using 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 recur.To achieve this, we offer various methods, including physical rehabilitation of the spine.

Lower back pain.Why does my lower back hurt?

Low back pain refers to pain that is localized in the area between the 12th pair of ribs and the gluteal folds.Pain of this kind is already a social problem.The fact is that the lower back is the most loaded part of the spine, which withstands overloads daily and hourly.85% of people have experienced pain in the lumbar region at least once in their lives.What is the reason?

Pain in the lumbar regionmay 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 a disease of the spine, which is accompanied by pain.This is a little different.

The picture below shows that a normal disk gets damaged (see damaged disk in the picture).These damages can accelerate the aging of the disc and it loses its height (see “narrowing of the intervertebral space”).Next, aging begins to affect the bone tissue of the vertebrae itself, and osteophytes grow (see “osteophytes” in the picture).

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 in particular with 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, created, 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 has no nerve endings.Therefore, there is no pain with osteochondrosis.

Disc herniation

Disc herniation as a possible cause of pain.The picture above shows several disc herniations - a small herniation (protrusion) and a large disc herniation.A herniated disc itself does not hurt.

The disc has no nerve endings (not innervated).Pain from a disc herniation or protrusion occurs when the hernial protrusion puts pressure on the innervated tissue.For example, onspineor onrearyuyulongitudinalwowbundlesat.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 (lumbodynia) or acute pain - lumbago (lumbago) appears.

A herniated disc can often be treated without surgery.

Spondyloarthrosis

Spondyloarthrosis is arthrosis of the joints of the spine.Arthrosis 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 bone articular surfaces lose their protective cartilaginous layer.The joints of the spine begin to ache.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 as pain in the leg, buttock, and pain or numbness even in the toes.

Radiculitis is most effectively treated by releasing the root.If it arose due to a disc herniation, you need to reduce the hernia, which puts pressure on the root.

Pain in the back and lower back due to pathology of internal organs

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

Lower back pain in women

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

If a woman has pain in the pelvis and lower back, then you should 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, such inflammatory diseases in women are caused by infections of the genital area, including sexually transmitted infections.

If the lower back aches and hurts and at the same time there is pain in the lower abdomen, then the woman needs to be checked by a gynecologist.It is imperative to undergo a gynecological ultrasound to initially clarify the diagnosis.

Constant nagging pain in the lower back also occurs whenoncology in gynecology.

Cancer and lower back pain in women

Cancer doesn't hurt at first.When pain appears in the lower back or sacral area, it may already be too late.

Many people think that tumors are accompanied by pain.This is wrong.In the initial stages of tumor development, a person does not feel pain.The person feels practically healthy.For example, cervical cancer is asymptomatic in the genital organs.It begins to manifest itself when the tumor grows.In this case, pain often appears in the lower back and below the lower back.Pain below the lower back is in the sacrum area.

With cancer, severe pain in the lower back does not bother you at first.Rather, the lower back does not hurt, but aches.Such pain can be the first call that will help a woman prevent critical growth of the tumor and make a correct diagnosis in a timely manner.If the lower back or sacrum hurts constantly, you should pay special attention to this so as not to miss a catastrophe.

Unfortunately, if you do not pay attention to the aching pain or discomfort in the lower back, the next sign of cervical cancer may be uterine bleeding.This is the stage at which the tumor begins to disintegrate, when there may already be metastases.Including in the spine, when there is already severe pain in the lower back.

Important takeaway: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 (inflammations)?

Acute lower back pain may be due to kidney disease

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

Pyelonephritis is an infectious disease, most often caused by an ascending infection.It may 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 lives in unwashed 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 swell (inflame) reflexively.And my lower back starts to hurt.

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

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

Stomach cancer associated with back pain

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

Another possible cause of lower back pain is back overload

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

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

An examination is needed to determine the cause of such frequent exacerbations.

Soft tissue injury of the lower back

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

If you are concerned about pain on that 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 right-sided hernia of the lumbar spine.

Types of lower back pain

The pain, taking into account the duration, can be acute, chronic, or have a (passing) transistor character.

The pains are as follows:

• Local pain– pain exclusively in the lower back.
• Referred pain– when pain occurs not only in the lower back, but for example in the buttock, in the pelvic area.Or, pathology of the internal organs causes pain in the lower back.In such cases they talk about referred pain.
• Radicular pain– differ in significant intensity, and are localized within the boundaries of the innervation of the root (from the spine 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 the pain due to the so-calledcough impulse.This is severe pain in the lower back that can shoot (radiate) into 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 aching and cramping lumbar pain.

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

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

What to do if you have lower 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 area 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 pain.
3. Formulate measures that will help maintain the patient’s health so that the pain does not recur.

Possible causes of lower back pain

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

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

Treatment of lower back pain (back pain)

At the stage of initial treatment with pain in the lower back (back), a primary diagnosis is established.This is done based on a survey, medical history, neurological and orthopedic examinations.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 treating low back pain, laser therapy, etc. are effective. 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: hardware, on inclined boards, on a wall bars.

To more effectively treat low back pain, you need to understand the cause.For this purpose, the patient is further examined to clarify the diagnosis.There can be many causes of pain in the lumbar region.An indicative list of diseases that are 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 inflammation and treat it.

Spondylosis visible on radiographs can occur without clinical symptoms and often mask a more complex disease.Therefore, treating spondylosis is useless and often dangerous: it is not realistic to remove bone growths in the spine, and there is no need.The patient may encounter exotic diagnoses such as “muscle damage”, “muscle spasm”, “ligament damage”.Unfortunately, talk 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.The 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 lower back, which can be caused by pathology of internal organs: diseases of the pelvic organs, retroperitoneal space, kidneys, pancreas and prostate glands, gynecological diseases of inflammatory or tumor origin, diseases of the aorta, hemorrhage into the retroperitoneal tissue, and much more. Osteopathic techniques for working with secondary spasmodic paravertebralmuscles can, at a reflex level, temporarily alleviate the condition.Manual therapy, osteopathic techniques, inclined board, massage, traction, physiotherapy, for example, will not help with prostatitis or adenomatosis.“Therapeutic removal” so-called.“muscle spasms” in this case are just the desires of the manipulator.

Treatment of hernias and protrusions of discs in the lower back

Often, an MRI 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 cope 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 does not give any symptoms.

Often, a disc herniation 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 thorough 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 hernias and protrusions of discs need to be operated on.Patients who require such an operation are no more than 2%.

Neurosurgeons have prescribed absolute indications for surgery, which are clearly defined.More often than not, the presence of a disc herniation is not a reason for emergency surgery.

There is a sufficient arsenal for the treatment of disc herniations 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, one must take into account the relative indicators for surgical treatment, which are officially prescribed by neurosurgeons.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 have to be dealt with many times more intensely 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 methods of treatment 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 their causes.