Pain in the lumbar spine area and with adjacent areas may bother the patient at any time of day, standing, sitting, lying down or on the go, during physical exertion or at rest. This symptom is so specific, it means that you can meet in such a huge number of cases that requires special attention in the first place by the patient: it is necessary to immediately seek medical help.
To what doctors to go to?
According to statistics up to 25% of patients seek is in connection with the appearance of pain in the lumbar region. 8 out of 10 of the world's population experience pain in the back, at least, 1 once in your life. While most often suffer from these symptoms of a person in the working-age population, a little less often – people of retirement age, and even rarer - teenagers (according to various sources, from 8 to 40% in Russia).
Therapist, neurologist, ревматолог
The first doctors, to which they turn, the majority of patients with pain in the lower back, will be an internist and a neurologist. And here the young people with trauma in the recent past increasingly turning to the expert.
And the diagnostic and therapeutic tactics in these experts is different. Often the doctor sends the patient to a neurologist, the neurologist defines it as "your" diagnosis and prescribe treatment. Specialist often working "individually", and in addition to the use of non-steroidal anti-inflammatory drugs used method of manual therapy and физиолечение. What is the most important for the patient – not растеряться in this situation, do not get carried away with promises of instant healing when performing tricks, not to resort to them repeatedly in case of failure, or, what is worse, усилившейся on the background of such treatment of pain.
When treating conservatively, that means drugs, you need to remember that the treatment for four weeks without result - веский argument for the re-evaluation of the diagnosis, treatment to revmatologu, and not to carry out repeated courses of treatment. There are many situations where the patient complain of pain in the lower back gets symptomatic (this is just a painkiller) for the treatment of some шаблонной way, without clarification of the real causes of this pain.
Causes of pain in the lower back
The main causes of pain in the lumbar region – it is
- changes to the structure of the spine, as usual, age (are the same degenerative), osteochondrosis of the spine, a variety of hernia of the intervertebral discs or inadequate work muscle complex. These pains are called primary, it is directly associated with the spine;
- pathological changes in organs that are in the vicinity of the painful area, but directly to the spine are outside (for example, diseases of internal organs, skin). To the same category of causes include inflammation of the joints, injuries, endocrine disorders (eg, diabetes), - a word, everything that does not fit into the image of the "natural age-related changes" of the spine. These pains are called secondary.
Examination at the doctor's office
Pain, feeling of heavy mobility or increased painful muscle tension in the section between the lower ribs and the buttocks customary to refer to the term "lyumbalgiya". If to the above symptoms joins pain in the leg, this condition is called lyumbalgiya.
First of all it is important the sharpness of the pain, it is the age of its occurrence. Pain давностью up to 12 weeks (3 months) is referred to as acute, more than 12 weeks – chronic. Chronic painful can proceed with the aggravations and periods of improvement.
Of crucial importance is how the pain felt. Or the feeling that at some point, or spread ("projection", "иррадиация") pain in the course of the nerve, in the thigh, buttocks, knee joint, foot, or fuzzy, "dull" pain. It is necessary to understand, restricted movement in the spine, in the moments of emergence of pain, or the movement of the unbridled (this may indicate the mechanical nature of the damage, for example, at the turn of the vertebrae). In what moments to appear the pain? Arises, whether it is under load or at rest, during sleep? A positive answer to the last question at all is a "red flag" for specialists and makes you think about the diagnosis of inflammatory diseases of the spine in a patient (for them to focus on something later). If the pain gets worse when moving head, walking, jumping, it's most likely the so-called projection head, that the reason – damage to neural structures (the most commonly – sciatica).
Osteochondrosis of the spine, or spondilez – a condition in which the seal and the deformation of the vertebrae, with the advent of small bone surfaces, such as spines, on the edges of the vertebrae. Long been recognized spondilez the result of the natural flow of the degenerative processes of aging of the organism. However it is conclusively proven that not only age may be the cause of degenerative disc disease. Immobile lifestyle, increased the burden on the lumbar spine during prolonged work at the computer or in the longer run (for example, the profession of driver-дальнобойщика) contribute to the emergence of degenerative disc disease even in young people. Under the influence of all these factors of the intervertebral disc-bumpers are becoming thinner, and the nerve roots that go from the spinal cord травмируются выросшими council of krasnodar region to representatives of the thorns bones. The constant irritation of these roots and causes pain. In Latin корешок is called the radix, is an inflammation of the customary list radikulit.
The so-called inflammatory diseases of the spine – the area of interest ревматологов. These mysterious diseases can "smolder" for several years, начинаясь predominantly in young age and mainly affects men, and выливаясь finally in obezdvizhennost' i invalidizatsiyu of the patient. Patients this group usually "tolerated up to the last" and night pain and morning stiffness in the back, weakness and weakness, and persistent decreased performance. The large sad, that since the appearance of the first symptoms of the disease to determine the correct diagnosis on average it takes about seven years. During this time, changes in the spine may become irreversible, and functional (двигательная) activity – low. The spine becomes immobile, it changes shape, there arises a hump. Meets this pathology is not as often as osteochondrosis, for example, but the cost of treatment and the total period of incapacity of these patients immeasurably higher.
If in addition to the back pain patient says about inflammation of the joints (most often it is the knee joints, the joints of the feet or the feet), pain in the buttocks, unstable chair with unusual impurities, blurred vision or pain in the eyes, that is the reason, urgent and direct him to a specialist for the implementation of a specific additional examination and exclusion of diseases from the group of spondiloartritov (e.g. seronegative spondylitis or Crohn's disease).
There are disease, manifested by pain in the lower back and completely which позвоночными or nerve structures. One of these disease – myofasial painful. Patients (more often these are young patients) point to an extended stay in an uncomfortable position, or physical overload, prevent the development of pain. When врачебном perspective draws attention to yourself is a sharp pain when надавливании on certain points located in the vicinity of the spine. This condition significantly reduces the quality of life of the patient, but small changes in the muscle tissue (the local tribe) does not constitute a danger even for the nerve roots, even for the internal organs. Usually, the therapeutic effect will be achieved with the help of determining muscle relaxation, low-dose non-steroidal anti-inflammatory drugs, local administration (injected) in the "болевую point" стероидного anti-inflammatory drugs.
It is widely known that if the patient complain of pain in the lower back does not have a "worrying sign" (about them it talks about this below), then further examination is not necessary, and the treatment can be made practical physician without examination, and even x-rays. But, as practice shows, practically at each patient as a "sign", can be discovered, and this means that there is a need to donate blood at least to the overall (and better – and still on the иммунологический) analysis, and complete chest x-rays of the lumbar spine in two planes (ideally – with the "grip" of the pelvic bones).
- - Blood tests may reveal an increase in the speed of red blood cell sedimentation rate (ESR), which is indicative of inflammation, perhaps of the immune origin, or infection. Increase the level of leukocytes also speaks about infection or inflammation, and the expressed anemia – about the possible availability of the cancer process.
- - Analysis of urine gives up when suspected kidney disease. Pain in the lumbar and wears a regular character, often "extending" up to the lower ribs. In the presence of changes in the analysis of urine to spend ULTRASOUND of the kidneys, and the other tactic is in detail discussed with a therapist or урологом.
- - Radiography – the most cheap of the instrumental examination, is the method of choice in the diagnostic section to provide the search in this case. On рентгенограмме you can see the violation of the structure of the spine, the symptoms of inflammation of the vertebral joints, the telltale sign to determine the place сдавления nerves. The "transparency" of the vertebra at the рентгенограмме will lead to the idea of osteoporosis (fragility) in the bone of the skeleton. As is known, on the background of osteoporosis the most commonly found such complications as fractures of the vertebrae. If there is a fracture, unfortunately, does not take place, it also will be seen on the рентгенограмме. The possibilities of this method of research are huge, but if pathology is found, it is necessary to clarify how serious the injury is necessary, whether the patient in the surgical intervention on the spine. To do this it is necessary a more accurate study – послойное (tomography). There are two types of tomography – computed x-ray and magnetic.
- - Computed tomography (CT). Survey method, which allows you to literally look into the spine. All of the bone structure, which are not visible in a normal x-ray, tomogram will be perfectly visible. If necessary with the help of obtained data and a special computer program it is possible to reconstruct a 3D model of any other patterns.
- - Magnetic resonance imaging (MRI). No-x-ray method of research. Differs from the computer tomography also allows the doctor to more carefully evaluate the condition of the "soft" structures of the spine (CT scan, well the only visible bone elements): the spinal cord, the nerve roots. Furthermore, in this survey it is evident позвоночные hernia, changes in the blood vessels and muscles. Usually it's to see a specialist for an MRI remains the last word in the diagnostic section to provide the search and determination of further tactics.
The symptoms to which you should pay attention to
Secondary pain in the back, then there have a connection with остеохондрозом – alarming symptom that as soon as possible to start looking for the main defective process that pain. Briefly we will focus on the symptoms that can point to possible secondary (i.e. not directly associated with the spine) the nature of the pain and require increased vigilance, as from a doctor, from the patient:
- rapid sudden loss body weight (can be suspected on the tumor);
- infections of the kidneys and the urinary bladder (in this case, the pain can be a symptom of pyelonephritis);
- increasing pain at rest or after a night's sleep (this symptom is especially interested in ревматологов, because it can be a sign of an emerging disease of ankylosing Spondylitis);
- increase in body temperature;
- changes in the blood (increased blood clotting, found in the performance of coagulogram, increased levels of white blood cells or decreased hemoglobin and increased ESR (sedimentation rate of red blood cells) in the overall analysis, increased levels of C-reactive protein in the analysis);
- set the diagnosis of "osteoporosis", or the use of drugs that are deductible the amount of calcium in the bones;
- age over 50 years (risk of osteoporosis in women in menopause) or less than 20 years, in particular young men;
- link to the injury, regardless of its limitations (e.g. fall from a height more than 2 meters, and for the elderly meaningful injury is already a fall from the height of his own body);
- symptoms of severe neurological deviations (violation of the sensitivity of the skin, urination or defecation usually indicative of deep damage to the spinal cord);
- the ineffectiveness of the "normal" treatment for a period of 4 weeks.
Maintain activity and mobility
A common mistake – compliance with bed rest during acute back pain. The movement in this pathology of the musculoskeletal system is not just need, and need! In all cases, in addition to компрессионного radicular syndrome (the diagnosis determined by a neurologist), location in horizontal position and increases the cost of the treatment and tightened the timing of a rebound. Yes, and when radicular syndrome of the total time of bed rest should not be more than two days.
In inflammatory diseases of the spine and sacroiliac joints of the physical activity – the basic means of struggle with progressing disabilities. Recall that the group of the disease is a slowly progressive character, and exercises aimed at maintaining flexibility and developing and strengthening the muscular "corset" of the spine, can be considered as an effective method of treatment, as well as special therapy anti-inflammatory drugs of different groups, the appointed experts.