The pain in the lumbar region of the vertebral column and the adjacent regions may disturb the patient at any time of the day, standing, sitting, lying down or on the road, during exertion or at rest. The symptom if this is not specific, it can be found in a large number of cases, which requires special attention in the first place by the patient: you must immediately consult a doctor.
Your doctor contact?
According to the statistics, up to 25% of patients seek treatment because of the onset of pain in the lumbar region. 8 from 10 people in the world have experienced the pain in the back, at least 1 time in his life. Being the most often suffer from these symptoms is a person of working age, a little less people of retirement age, and even less often in adolescents (according to various sources, from 8% to 40% in Russia).
The therapist, neurologist, rheumatologist
The first doctors, who will refer the most patients with pain in the lower back, become the therapist and the neurologist. And here are the young people with injuries in the recent past, in turn, more professional.
Diagnostic and therapeutic tactics of these different professionals. Often, the therapist leads the patient to a neurologist, a neurologist defines it as "your" diagnosis and determines the treatment. The specialist most often works "individually" and, beyond the use of anti-inflammatory medications non-steroidal anti-inflammatory, applies the methods of manual therapy and physiotherapy. The essential for the patient – do not get lost in this situation, do not get carried away by promises of instant cures during the execution of receptions, not to use him again in case of failure, or, worse, an imbalance on the merits of such treatment of pain.
When a conservative treatment, there are medication, it is important to understand that the treatment in a period of four weeks without result - a convincing argument for the revision of diagnosis, treatment revmatologu, not to conduct repeated courses of therapy. There are situations where a patient complaining of pain in the lower back receives symptomatic (this is just an anti-pain), the treatment of a model schema, without specifying the real cause of this pain.
The causes of back pain
The main causes of pain in the lumbar region is
- the changes of the structures of the spine, is usually age-related (they degenerative), osteochondrosis of the spine, of the variety of hernia of the intervertebral disc or the failure of muscular work complex. Such pain called primary, it is directly in relation with the vertebral column;
- the pathological changes of the organs, located in the vicinity of the painful area, but directly to the spine are not related (for example, diseases of the internal organs, skin). To this same category of causes include inflammation of the joints, injuries, endocrine disorders (e.g., diabetes), - in short, everything that does not fit into the image of a "natural ageing" of the spine. This pain, called secondary.
The inspection of your doctor
Pain, a heavy feeling of mobility or increase the painful tension of the muscles in the area between the lower ribs and the buttocks are represented by the term "lyumbalgiya". If these symptoms join pain in the leg, it is the state of the so-called lyumbalgiya.
In the first place important to the severity of the pain, it is the limitation of his / her appearance. The pain of the prescription for up to 12 weeks (3 months), called the acute, more than 12 weeks – chronic. Chronic pain syndrome may occur with exacerbations and periods of improvement.
It is essential that the pain is felt. It is a or a feeling at a certain point, or the distribution ("projection", "иррадиация") of the pain along the nerve in the thigh, the buttock, the knee, the foot, or " blurred, "stupid" of the pain. The need to understand the restricted movement in the spine in moments of pain, or of the circulation without obstacles (which may indicate the mechanical nature of the damage, for example, when the fracture of the vertebra). In moments of pain? Arises-does it load or at rest, during a night of sleep? An affirmative answer to this last question is generally a "red flag" for the specialist and the need to think about the diagnosis of the inflammatory disease of the spine in the patient (and we will stop a little later). If the pain increases with the movement of the head, walking, jumping, it probably is what we call the projection of the pain, the cause of which – the corruption of the neural structures (the most often – sciatica).
Osteochondrosis of the spine, or spondilez – state, which has seen the seal and the deformation of the vertebrae, with the appearance of small bony surfaces, similar to spines on the edges of the spine. It has long been regarded as spondilez the result of the natural flow of the degenerative processes of ageing of the body. However, has demonstrated that not only the age can be the cause of the degenerative disease of the disc. Fixed mode of life, the increase of the load on the lumbar spine for long term work at the computer or during extended use of the pipe (for example, the profession, the driver of a trucker) contribute to the onset of degenerative disc disease, even in young people. Under the influence of all these factors, the intervertebral discs-pads of the thinner and the nerve roots leave the spinal cord injured born краевыми spikes of bone. The constant irritation of these roots and causes pain. In latin, the radicle is called the radix, therefore, is an inflammation of the decision to appoint radikulit.
The so-called inflammatory disease of the spine – region-of-interest of rheumatologists. This mysterious disease can "fester" for several years, beginning mainly at a young age and mainly affecting men, and выливаясь finally in obezdvizhennost' i invalidizatsiyu of the patient. The patients in this group usually "suffer until the last" and night pain and morning stiffness in the back, and weakness, and led to a decrease in performance. Unfortunately, the apparitions of the first symptoms of the disease until a diagnosis on average, it takes about seven years. During this time, the change of the spinal column can become irreversible, and functional (motor), the activity is low. The spine is immobile, changes shape, appears to be the kicker. The meeting of this pathology is not so often that the osteochondrosis, for example, but the cost of treatment and the total duration of the inability of these patients is immeasurably higher.
If, in addition to pain in the back, the patient speaks of the inflammation of the joints (often it is on the joints of the knees, the joints of the brushes and / or stop), the pain in the butt, a stool with impurities, disturbances of vision or pain in the eyes, it is also an occasion of emergency to refer her to a specialist for a specific outfit of ancillary tests and exclusion of the disease from a group spondiloartritov (for example, seronegative ankylosing spondylitis or Crohn's disease).
There are of the disease, which is manifested by pain in the lower back and is not affected by the vertebrates or the neural structures. One of these diseases – the syndrome of the myofascial pain. The patients (most often these are the youth of the patient) indicate extended in an awkward position or physical overload have preceded the development of the pain. When a medical inspection, remarkable a sharp pain to pressure on certain points located near the spine. Such a condition significantly reduces the quality of life of the patient, but little change in the muscle tissue (a local power surge) does not present a risk or the nerve roots, or to the internal organs. Usually, the therapeutic effect is impossible to achieve with the help of the destination is a muscle relaxant, low doses of nonsteroidal anti-inflammatory drugs, local administration (injection) in the "painful point-of-steroid anti-inflammatory drugs.
The survey
It is believed that if the patient complains of pain in the lower back does not have "worrisome signs" (see below), in the appendix of the review, it does not need, and the treatment can be carried out by the therapist, without analysis, and even the x-ray. But, as practice shows, almost no matter how sick of these "signs" can be detected, and therefore, it is necessary to give blood at least (and even better still, and immunological) analysis and to perform an x-ray of the lumbar spine in two projections (ideally with the "crisis" of the bones of the pelvis).
- - Blood tests can reveal the increase of the sedimentation speed (vs), which are evidence of inflammation, may be an immune-mediated disease and / or infection. The increase in the level of leukocytes also said infection or inflammation, anemia – of the possible availability of the tumor process.
- - The analysis of urine is distributed at the suspicion of a disease of the kidneys. The pain in the lumbar region, this carrier is of intermittent nature, often extending up towards the lower ribs. If you make changes in the urinalysis, an ULTRASOUND of the kidney, and the continuation of the tactic in detail with the therapist or by the urologist.
- - X-ray – the most inexpensive survey tools, it is the method of choice when the diagnosis of the research in this case. On the x-rays, you can see the breach of the structures of the spine, the signs of inflammation of the vertebral joints, of the functions of the indirect definition of the place of the compression of the nerves. The "transparency" of the vertebrae on x-rays lead to the idea of osteoporosis (fragility) of the bony skeleton. As we know, at the bottom of the osteoporosis is the more common type is a complication such as a fracture of a vertebra. If the fracture is, unfortunately, took place, it will be also visible on x-rays. The possibilities of this method of research is huge, but if the disease is found, it is necessary to specify the severity of damage, if the patient does not need of the intervention on the spine. To do this, you need a more specific research послойное (computed tomography). There are two types of computer tomography x-ray and magnetic resonance imaging.
- - Enhanced computed tomography (CT). Survey method, which allows you to literally look inside of the spine. All of the structures underlying bones that are not visible in the conventional x-ray, tomogram will be perfectly visible. If necessary, with the help of the data received and computerised, we can reconstruct a 3D model of all the interesting corners of the structure.
- - Magnetic resonance imaging (MRI). No x-ray is a method of research. Different from the ct scan as it allows the physician to more carefully evaluate the status of "soft" structures of the spine (CT visible only the bony elements): the spinal cord, the roots. More detail during this survey we see the vertebrate of the hernia, the changes in the vessels and muscles. Usually, it is a specialist of MRI remains the last word in the event of diagnosis of the research and the definition of the continuation of the tactic.
The signs that should attract the attention
Side of the pain in the back, it is not to have communication with the low back pain – a symptom that alarming, forcing it to start as soon as possible to the research of the pathological process of the base, causing the pain. Let us dwell briefly on the symptoms that may indicate a possible secondary (which is not directly related to the spine) the nature of the pain and require increased vigilance, as the doctor and the patient:
- rapid the sudden loss of the mass of the body (may-be suspicious about the tumor);
- infections of the kidneys and of the bladder (in this case, the pain can be a symptom of pyelonephritis);
- the intensification of the pain at rest or after a night of sleep (this symptom is particularly interested in the american college of rheumatology, so that may be a sign of the evolution of Ankylosing spondylitis);
- increase in body temperature;
- changes in blood tests (increase of the coagulability of the blood, detected during the performance of coagulogram, improve the level of white blood cells or decreased hemoglobin, as well as the increase of the esr (sedimentation rate) in the general analysis, to improve the level of c-reactive protein in the analysis);
- established a diagnosis of osteoporosis", or taking medication, reducing the amount of calcium in the bones;
- the age of over 50 years of age (the risk of osteoporosis in women in menopause) or under 20 years of age, in particular young people;
- the reference to a trauma, regardless of its prescription (for example, fall from a height of over 2 metres and for the elderly, significant trauma is already a fall from a height of your own body);
- signs of severe neurologic abnormalities (disorders of the sensitivity of the skin, urination or defecation usually shows a great defeat of the spinal cord);
- the inefficiency "routine" treatment for 4 weeks.
Maintain activity and mobility
A common mistake is to adhere to the bed rest for acute low back pain. Movement when this pathology musculo-skeletal is not simple and it takes! In all cases, with the exception of compression radicular syndrome (diagnosis installs a neurologist), the presence in a horizontal position increases the cost of treatment and tightens the time of recovery. Yes, and in the radicular syndrome in general the time of bed rest should not be more than two days.
Inflammatory diseases of the spine and sacroiliac joints of the physical activity – the main tool of struggle from a disability. Remember, the group of the disease is gradually progressive in nature, and exercises to maintain flexibility and the development and strengthening muscular "corset" of the spine, can be considered as the same effective treatment as a special treatment anti-inflammatory drugs of different groups identified by specialists.