Treatment of lower back pain

Lower back pain is just a symptom, an external manifestation of an illness or pathology.All pain has its cause.There are many causes of back pain.

Patients are often told that back pain is caused by overloading the muscles and ligaments.Unfortunately, if the cause was purely muscular, then it would be very easy to relieve the pain.For example, a massage which should 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 or protruded disc.If the herniated disc is on the right side, you may experience right-sided back pain, right-sided pain, or right leg pain (sciatica with a large herniation).If the hernia is on the left side, you may feel back pain on the left side and be bothered by left-sided pain. 

If the hernia is large and compresses the left lumbar root (radiculitisleft), lumbago may then 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 distortion of the torso with sharp "twisting" pain, when it is impossible to straighten and straighten (the so-called analgesic position of the torso).

Lower right back pain can be the result of hernia or straight joint problems in the spine, or pathology in the sacral area (right iliosacral joint).

Pain in the left shoulder blade (or pain under the left shoulder blade) can either be the result of a hernia or joint pathology, or the result of heart problems.Such pain can be caused by angina 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 cause pain in the right back and pain under the right shoulder blade.Gallbladder pathology often manifests itself as pain under the right rib.Need a diagnosis.

Projectionsdiscs, are most often incidental findings on MRI, whichcanproceed without any pain.Herniated disc– an uncommon cause of severe back pain.However, the formation of a hernia, for example when lifting heavy objects, causes lumbar or thoracic lumbago (severe 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 such constant pain are often different. Diagnostics will help you figure it out.

So, in order to effectively treat back and lower back pain, you must:

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 a clinical and physical examination.
3. Tactics for treating low back pain depending on the diagnosed cause.
4. If you suffer from lower back pain, it is important to ensure that the pain does not return.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 localized pain in the area between the 12th pair of ribs and the gluteal folds.Such pain is already a social problem.The fact is that the lower back is the most stressed part of the spine, which resists daily and hourly overloads.85% of people have felt pain in the lumbar region at least once in their life.What is the reason?

Pain in the lumbar regioncan have several 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 spinal disease accompanied by pain.It's a little different.

The image below shows that a normal disk is damaged (see 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 itself and osteophytes develop (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 in osteochondrosis.For this reason, the question of the failure of vertebroneurology even arose.In 1978, the first research laboratory on the problems of osteochondrosis of the spine, established, 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, osteochondrosis does not cause any pain.

Herniated disc

Herniated disc 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 does not hurt.

The disc has no (non-innervated) nerve endings.Pain caused by a herniated disc or disc protrusion occurs when the herniated protrusion puts pressure on the innervated tissue.For example, onspineor onbackYuyulongitudinalwowpackageshas.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 sharp pain - lumbago (lumbago) appears.

A herniated disc can often be treated without surgery.

Spondyloarthrosis

Spondyloarthrosis is osteoarthritis of the joints of the spine.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 bone joint surfaces lose their protective cartilaginous layer.The joints of 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 as it is leg pain, buttock pain, and pain or numbness even in the toes.

Radiculitis is treated most effectively by freeing the root.If this is due to a herniated disc, you need to reduce the herniation, 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 womencan 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, 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.Most often, these inflammatory diseases in women are caused by infections in 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 should be examined by a gynecologist.It is imperative to undergo a gynecological ultrasound to first clarify the diagnosis.

Constant shooting 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 region, it may already be too late.

Many people think that tumors come with pain.This is false.In the early stages of tumor development, a person does not feel any pain.The person feels practically healthy.For example, cervical cancer is asymptomatic in the genitals.This 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 located in the sacrum region.

In case of cancer, severe pain in the lower back may not bother you at first.On the contrary, 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 your lower back or sacrum constantly hurts, you need to pay special attention to it so as not to miss a disaster.

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

Important takeaway:If you have lower back pain, 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 a lot with kidney disease such as pyelonephritis.

Pyelonephritis is an infectious disease, most often caused by an ascending infection.It can be linked to both sexually transmitted infections and other types of household infections transmitted through swimming pools, bathrooms and personal hygiene items.For example, everything lives for a long time in unwashed towels.

Inflammation activates pain receptors in the soft tissues of the pelvic organs.The pain signal (impulse) reaches the spine through the sensitive roots, thereby activating its tissues.The soft tissues of the spine and the attachment points of the back muscles swell (inflame) reflexively.And my lower back is starting to hurt.

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

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

Stomach cancer associated with back pain

Back treatment for pain caused by pathology of the gastrointestinal tract will not bring improvement.The cause must 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.In addition, the lower back muscles actively work under load.Therefore, if you experience spinal pain in the lumbar region after exercise, it is not necessarily an illness.It could be a muscle rupture.If this pain does not go away within 1-2 days, then you should think about problems in the lumbar spine.Especially if this pain intensifies with movement.

The causes of this pain are often excessive inflammation of the muscles and their attachments.Or – inflammation of the joint capsules.

If such an exacerbation occurs more than once a year, you need to find out the cause.To do this, it is not enough to consult a doctor and carry out manipulations, take painkillers, massage 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 during awkward movements or when lifting something heavy is most likely a spinal injury.

If you are concerned about pain on this side, for example lower back pain on the right, then you should think about the pathology of the joint located on the right.Or about a right herniation of the lumbar spine.

Types of lower back pain

The pain, given its duration, can be acute, chronic or have a (transient) transistorized nature.

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 the internal organs causes pain in the lower back.In such cases, we speak of referred pain.
• Radicular pain– differ in their significant intensity, and are localized within the limits of the innervation of the root (from the spine towards the periphery).The cause is a violation (stretching, squeezing, curvature, compression) of the nerve root of the spinal nerve.Mobility or even coughing increases the pain due to the so-calledcoughing impulse.This is severe pain in the lower back that may spread (radiate) down the leg.
• Myofascial pain– is the result of a reflex muscle spasm.The causes of myofascial pain can be diseases of the internal organs or damage to the spine itself.Muscle spasms significantly disrupt the biomechanics of human movements.Chronic muscle spasms can also cause aching, cramping lower back pain.

When should you consult a doctor for lower back pain and what should you do?

• with sharp (acute) pain in the lumbar region;
• 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 lower leg;
• if pain in the lumbar region is associated with numbness in the thigh, buttock, leg, foot, groin;
• if the pain in the lumbar region is accompanied by contractions (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 lower back pain are varied, which is why treatment of lower back pain should only be carried out after diagnosis and after the diagnosis has been made by a qualified doctor.Any pain at the vertebral level requires a medical examination and clarification of the cause of its appearance.

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 conditions may be causing your complaints of lower back pain:

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

Treatment of lower back pain (back pain)

At the stage of initial treatment of pain in the lower back (back), a primary diagnosis is established.This is done on the basis of an investigation, medical history, neurological and orthopedic examinations.At this point, medications may be prescribed to reduce pain, relieve tissue swelling, and general anti-inflammatory treatment.Reflexology, local medicinal effects, regional anesthesia, various injection methods to treat lower back pain, laser therapy, etc.are effective.In acute and subacute periods, rest is important during drug treatment.Physiotherapy, massage, manual therapy, which can aggravate the process, are not indicated.In acute periods, traction is also not used: hardware, on inclined boards, on wall bars.

To treat lower back pain more effectively, you need to understand the cause.For this purpose, the patient is examined in more detail to clarify the diagnosis.The causes of pain in the lumbar region can be multiple.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 (spondyloarthritis, spondyloarthropathy, spondyloarthritis, myositis, ligamentitis, etc.), manual therapies, massages and physiotherapy are not indicated due to their 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 osteoarthritis is unnecessary and often dangerous: it is unrealistic to remove bony growths from the spine, and it is not necessary.The patient may be faced with exotic diagnoses such as "muscle damage", "muscle spasms",“ligamentous injuries”.Unfortunately, talking about muscle spasms as the cause of pain is not always true.Muscle spasms of the paraspinal muscles are a reflex act and usually accompany 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 in and outside the spine.The so-called "spasms" should be differentiated from reflected or referred pain in the lower back, which can be caused by pathology of the internal organs: diseases of the pelvic organs, retroperitoneal space, kidneys, pancreas and prostate, gynecological diseases of inflammatory or tumor origin, diseases of the aorta, hemorrhage in the retroperitoneal tissue, and much more.Osteopathic techniques for working with secondary spasmodic paravertebral muscles can, at the reflex level, temporarily relieve the disease.Manual therapy, osteopathic techniques, inclined board, massage, traction, physiotherapy, for example, will not help with prostatitis or adenomatosis.This is called “therapeutic elimination.”“Muscle spasms” in this case are just the desires of the manipulator.

Treatment of herniated and protruded discs in the lower back

Often, an MRI reveals a hernia or protrusion, interpreted as the cause of lower back pain.The question immediately arises: remove the hernia or try to get out of it without surgery?

First thing to do– clarify the clinical importance of this hernia.The fact is that if you take 100 completely healthy people without lower back pain and conduct an MRI diagnostic, it turns out that 80% of them have some kind of disc protrusion ("herniation"), which does not give any symptoms.

Often, a herniated disc can be an accidental discovery, 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 history is taken, a neurological examination is carried out to identify neurological deficits, the functioning of the pelvic organs is clarified, etc.

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

Neurosurgeons have prescribed absolute, clearly defined surgical indications.Most often, the presence of a herniated disc does not warrant emergency surgery.

There is a sufficient arsenal for the treatment of herniated and protruded discs, including traction, the formation of stable motor patterns in the back, methods of local and general drug therapy, physiotherapy, reflexology, etc.Calibrated treatment without surgery is often accompanied by regression of symptoms and the hernia (protrusion) may diminish over time.

When making a decision about surgical intervention, one should take into account the indicators relating to surgical treatment, which are officially prescribed by neurosurgeons.Each specific case is examined separately, taking into account clinical symptoms, medical history, anamnesis, neurological and orthopedic examinations, hardware results and laboratory examinations. 

It is especially worth noting that surgical intervention is often associated with a number of complications, which after surgery must be treated several times more intensively than for pain relief before surgery.

Degenerative changes in the spine, such as osteochondrosis, spondyloarthrosis, spondylosis, etc., are treated based on the identification of 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 suffering from low back pain, taking into account the possible range of its causes.