Lower back pain treatment

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

Patients are often told that back pain is caused by overloading of muscles and ligaments.Unfortunately, if the cause is only in the muscles, it will be very easy to get rid of the pain.For example, massage is supposed to relieve pain.But massage does not always help because it removes the cause of pain.

Sharp back pain can occur due to disc herniation or disc bulging.If the disc herniation occurs on the right side, you may experience back pain on the right side, pain on the right side, or pain in the right leg (sciatica with large hernia).If the hernia occurs on the left side, then you may feel pain on the left side of your back, and may be bothered by pain on the left side. 

If the hernia is large and presses on the left lumbar root (sciaticaon the left), then back pain can occur in the left leg and the pain can start in the left leg.Large hernias often cause posture disorders in the form of trunk distortion with acute “twisting” pain, when it is impossible to straighten and straighten the body (the so-called antalgic position of the trunk).

Lower right back pain can be the result of a hernia or right spinal joint problem, or a disorder of the sacral area (right iliosacral joint).

Pain in the left shoulder blade area (or pain under the left shoulder blade) can be caused by a hernia or joint disorder, or due to heart problems.Such pain can be caused by angina pectoris and heart attack.Pain between the shoulder blades occurs not only in spinal pathologies and osteochondrosis, but also in diseases of the stomach (gastritis, ulcer, cancer, etc.) and often of the intestines.

Cholecystitis and cholelithiasis most often trigger pain in the right side of the back and pain under the right shoulder blade.Gallbladder pathology often manifests as pain under the right rib.Need diagnostics.

Bulgedisk, is more often an incidental finding on MRI, whichCancontinue without any pain at all.Disc herniation– not a common cause of severe back pain.In fact, the formation of a hernia, for example when lifting heavy objects, does cause back or thoracic pain (sharp pain in the back).In cases of persistent back pain, the hernia found on MRI may have nothing to do with it at all.The causes of persistent pain are often different. Diagnostics will help you find out.

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

1. Determine the cause of lower back pain (establish a diagnosis).
2. The cause of low back pain will be determined by a neurologist, orthopedic traumatologist who has expertise in vertebrology and vertebroneurology, or a spine specialist (vertebroneurologist).The diagnosis is confirmed by clinical and hardware examination.
3. Low back pain treatment tactics depend on the diagnosed cause.
4. If you have lower back pain, it is important to ensure that the pain does not return.To achieve this, we offer a variety of methods, including physical spinal rehabilitation.

Lower back pain.Why does my lower back hurt?

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

Pain in the lumbar areathere may be many reasons.The most common causes are osteochondrosis, herniated disc, radiculitis, and lumbar joint pathology.

Osteochondrosis

Osteochondrosis–natural aging of spinal tissue.

It is generally accepted that osteochondrosis is a sign of spinal disease accompanied by pain.This is a little different.

The image below shows that a normal disk is damaged (see damaged disk in the image).This damage can accelerate disc aging and loss of height (see “narrowing of the intervertebral space”).Next, aging begins to affect the bone tissue of the spine itself, and osteophytes grow (see “osteophytes” in the figure).

Previously, osteochondrosis was believed to be associated with pain.Therefore, at that time they tried to explain the causes of pain in the spine and lower back, especially in osteochondrosis.Therefore, the question arises about vertebroneurological failure.In 1978, the first research laboratory on the problem of osteochondrosis of the spine was created, studying the problem of osteochondrosis for more than 10 years and proving that the cause of pain is not osteochondrosis, but joint pathology. 

Osteochondrosis is painless because the discs have no nerve endings.Therefore, there is no pain with osteochondrosis.

Disc herniation

Disc herniation as a possible cause of pain.The image above shows multiple disc herniations – small herniations (bulges) and large disc herniations.A herniated disc itself is not painful.

Discs have no nerve endings (not innervated).Pain due to disc herniation or bulging occurs when the hernia protrusion puts pressure on the innervated tissue.For example onspineor activebehindcrabelongatedWowbundlein.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 spinal joints.Arthrosis itself is characterized by disease of the joint cartilage.In this case, the cartilage decreases in height (slumps, “dries out”), and the articular surfaces of the bones lose their protective layer of cartilage.The spinal joints start to hurt.This pain feels like lower back pain.

Radiculitis

Radiculitis is inflammation of the roots.Radiculitis most often occurs when the root is injured by a herniated disc or spinal joint.Usually it is not lower back pain but pain in the legs, buttocks, and pain or numbness even in the toes.

Radiculitis is most effectively treated by removing the roots.If it appears due to a disc herniation, the hernia must be reduced, which puts pressure on the root.

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

Back pain may occur due to pathology of internal organs.For example,lower back pain in womenmay be the result of disease of the pelvic organs.

Lower back pain in women

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

If a woman experiences 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 causes can be inflammation of the appendages, inflammatory diseases of the vagina and vulva, salpingitis, salpingoophoritis, endometritis, bacterial vaginitis, etc.More often, inflammatory diseases in women are caused by infections of the genital area, including sexually transmitted infections.

If the lower back feels sore and sore and pain occurs in the lower abdomen, then the woman needs to see a gynecologist.It is very important to undergo a gynecological ultrasound to clarify the diagnosis.

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

Cancer and low back pain in women

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

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

In cancer sufferers, severe lower back pain does not bother you at first.On the other hand, the lower back does not hurt, but is sore.Such pain can be the first call that will help a woman prevent critical tumor growth and make the correct diagnosis in a timely manner.If your lower back or sacrum constantly hurts, you should pay special attention so as not to miss the disaster.

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

Important takeaways:if your lower back hurts, it's not necessarily osteochondrosis or a herniated disc.And there's no harm in having a preventive consultation with a gynecologist.However, cervical erosion detected during examination is a precancerous condition.

Why does my back hurt due to urological or genitourinary problems (inflammation)?

Acute lower back pain may be caused by kidney disease

The lower back hurts a lot due to kidney diseases such as pyelonephritis.

Pyelonephritis is an infectious disease most often caused by ascending infection.It may be associated with sexually transmitted infections and other types of household infections transmitted through swimming pools, bathrooms, and personal hygiene items.For example, things live for a long time on unwashed towels.

Inflammation activates pain receptors in the soft tissues of the pelvic organs.Pain signals (impulses) reach 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 started to hurt.

Persistent back and lower back pain due to dysfunction and other gastrointestinal diseases

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

Stomach cancer is associated with back pain

Treatment of back pain resulting from gastrointestinal pathology will not provide improvement.The cause needs to be treated.

Another possible cause of lower back pain is excessive back load

Excessive stress 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 muscles in the lower back work actively under load.Therefore, if you feel pain in the spine in the lumbar area after exercising, it is not necessarily a disease.It could be that the muscle has ruptured.If this pain does not go away within 1-2 days, then you should think about problems with the lumbar spine.Especially if the pain gets worse with movement.

The cause of such pain is often excessive muscle inflammation and adhesions.Or – inflammation of the joint capsule.

If such exacerbations occur more than once a year, you should look for the cause of the exacerbation.To do this, it is not enough just to consult a doctor and carry out manipulations, take painkillers, massage and other procedures.

An examination is needed to find out the cause of these frequent exacerbations.

Soft tissue injury to 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 lumbar spine hernia.

Types of lower back pain

The pain, taking into account its duration, can be acute, chronic, or transistor (passing).

The pain is 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 buttocks, in the pelvic area.Alternatively, pathology of 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 limits of root innervation (from the spine to the periphery).The cause is a violation (stretching, compression, curvature, compression) of the nerve roots of the spinal cord.Mobility or even coughing increases the pain due to the so-calledurge to cough.This is severe pain in the lower back that can radiate to the legs.
• Myofascial pain– is the result of a reflex muscle spasm.The cause of myofascial pain can be diseases of the internal organs, or damage to the spine itself.Muscle spasms significantly disrupt the biomechanics of human movement.Chronic muscle spasms can also cause low back pain and cramps.

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 persists for more than 3 days;
• if back pain appears after injury;
• if the pain is localized simultaneously in the lower back, feet and lower legs;
• if pain in the lumbar region is accompanied by numbness in the thighs, buttocks, legs, feet, 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 pain in the back or lower back (sacrum) persists, it gets worse in the morning

What to do if you have lower back pain?

The causes of low back pain vary, therefore treatment of low back pain should be carried out only after diagnosis and after the diagnosis has been confirmed by a qualified doctor.Any pain in the spinal area requires a medical examination and clarification of the cause of its occurrence.

A visit to the doctor has 3 purposes:

1. Establish the correct diagnosis.
2. Relieves pain.
3. Formulate actions 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 lower back pain:

• osteochondrosis;
• osteoarthritis;
• spondylolisthesis;
• spondylosis;
• ankylosing spondylitis;
• spondyloarthropathy;
• muscle damage;
• ligament damage;
• disc herniation "herniadiscs are treated without surgery in 98% of cases (world statistics)";
• abdominal aortic atherosclerosis;
• malignant neoplasm of the spine;
• metastases to the spine;
• urinary tract infection;
• spinal stenosis;
• bile duct disease;
• penetrate the duodenal ulcer;
• pancreatitis;
• kidney disease;
• dissecting abdominal aortic aneurysms;
• bleeding into the retroperitoneal tissue;
• inflammatory diseases of the female genital organs;
• oncological diseases of the female genital organs;
• endometriosis;
• prostatitis;
• prostate cancer;
• abscess in the epithelial coccygeal canal;
• lower extremity arterial embolism;
• intermittent claudication;
• pseudo-intermittent claudication;
• obliterating atherosclerosis of the vessels of the lower extremities;
• rheumatoid spondylitis;
• polymyalgia rheumatism;
• fibromyalgia
• depression;
• other.

Treatment of low back pain (low back pain)

At the initial stage of treatment of pain in the lower back (back), the primary diagnosis is established.This is done based on surveys, 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 drug effects, regional anesthesia, various injection methods for treating low back pain, laser therapy, etc. are effective.In the acute and subacute period, 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 wall bars.

To more effectively treat low back pain, you need to understand its causes.For this purpose, the patient is further examined to clarify the diagnosis.There are many causes of pain in the lumbar area.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 protocol also contains data on methods that are 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 their ineffectiveness and risk of complications.It is important to identify the cause of inflammation and treat it.

Spondylosis seen on radiographs can occur without clinical symptoms and often masks a more complex disease.Therefore, treating spondylosis is pointless and often dangerous: it is unrealistic to remove bone growths in the spine, and it is not necessary.Patients may face exotic diagnoses such as “muscle damage”, “muscle spasm”, “ligament damage”.Unfortunately, talk about muscle spasms as the cause of pain is not always true.Muscle spasm of the paravertebral muscles is a reflex action and, as a rule, accompanies most diseases, including those not related to the spine.The muscles are actively involved in segmental reflex processes and can respond to any irritation both in the spine and outside it.The so-called “convulsions” should 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 gland, gynecological diseases of inflammatory or tumor origin, diseases of the aorta, hemorrhage into the retroperitoneal tissue, and much more.Osteopathic techniques for treating secondary spasmodic paravertebral muscles, at a reflex level, can temporarily relieve the condition.Manual therapy, osteopathic techniques, tilt boards, massage, traction, physiotherapy, for example, will not help with prostatitis or adenomatosis.“Therapeutic removal” is called.“muscle spasm” in this case is just the desire of the manipulator.

Treatment of hernias and disc bulges in the lower back

Often, an MRI shows a hernia or bulge, which is interpreted as the cause of lower back pain.The question immediately arises: remove the hernia or try to deal with it 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 MRI diagnostics, it turns out that 80% of them have some kind of disc protrusion (“hernia”), which does not give any symptoms.

Often, disc herniations occur accidentally, which is often associated with other causes of pain.

At the same time, practice shows that not all hernias are clinically significant.To clarify the cause of pain, a thorough medical history is taken, a neurological examination is performed to identify neurological deficits, the function of the pelvic organs is clarified, etc.

It turns out that not all hernias and disc bulges need surgery.Patients requiring such an operation are no more than 2%.

Neurosurgeons have established absolute indications for surgery, which are clearly defined.Often, 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 a stable motor pattern in the back, local and general methods of drug therapy, physiotherapy, reflexology, etc.Calibrated treatment without surgical intervention is often accompanied by regression of symptoms, and the hernia (bulge) may decrease over time.

When making a decision about surgery, one should take into account the relative indicators for surgical treatment, which are officially determined by the neurosurgeon.Each specific case is considered separately, taking into account clinical symptoms, medical history, anamnesis, neurological and orthopedic examination, 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 treated many times more intensively than eliminating pain before surgery.

Degenerative changes in the spine, such as osteochondrosis, spondyloarthrosis, spondylosis, etc., are treated based on identifying the trigger of the pain syndrome. 

Massage and manual therapy are quite effective treatment methods 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 various possible causes.