The pain in the lumbar spine and adjacent areas that may bother the patient in any moment of the day, standing, sitting, supine, or on the road, during physical exercise or in the privacy of. This symptom is not as subjective, i.e., it can happen in such a large number of cases, that need special attention, especially by the side of the patient: you should immediately consult your doctor.
What doctor to be treated?
According to the statistics, up to 25% of patients to seek medical help is in relation with the appearance of pain in the lumbar region. 8 out of 10 inhabitants of the planet have experienced back pain at least 1 time in his life. And more often suffering from these symptoms people of working age, a little bit at least – the people of retirement age, and even more rarely teenagers (according to various estimates, from 8% to 40% in Greece).
Pathologist, neurologist, ревматолог
The first of the doctors to whom I turn to most patients with pain in the lower part of the back, is a psychologist and a neurologist. And here are the young people with trauma in the recent past, often turn to the expert.
And the diagnostic and therapeutic tactics of these special vary. Often the therapist guides the patient to a neurologist, the neurologist determines "the" diagnosis and prescribes treatment. Specialist most often works in isolation', but in addition to the use of non-steroidal anti-inflammatory drugs, applying techniques of therapy and физиолечение. Important for the patient not get lost through this situation, not to get involved promises of instant healing in the execution of techniques, I don't resort to this again in the event of a failure or, even worse, усилившейся in the context of this treatment of pain.
During treatment with conservative treatment, i.e. medications, it should be understood that the treatment for four weeks without result - a powerful argument for the revision of the diagnosis, treatment revmatologu, and not to conduct new courses of treatment. There are situations, when the patient complains about pain in the lower part of the back gets symptomatic (i.e., only a painkiller), treatment with a standard system, without to clarify the real cause of this pain.
Causes of pain in the back
Main causes of pain in the lumbar region is
- changing the structures of the spine, usually, age (it is degenerative), osteochondrosis of the spine, a variety of disc herniation or insufficient working of the muscles of the band. Pain, as it is called elementary, that is directly associated with the spine?
- pathological changes of the organs which are located near the painful area, but directly on the spine are not related (e. g., disease of internal organs, skin). In the same category causes include inflammation of the joints, traumas, endocrine disorders (for example, diabetes), - in a word, anything that doesn't fit the image "of the natural age-related changes" of the spine. As pain is referred to as secondary.
Inspection at the doctor's office
Pain, burning severe mobility or increased painful muscle tension in the area between the bottom fins and buttocks is taken labeling of the term "lyumbalgiya". If these symptoms are related pain in the foot, this condition is called lyumbalgiya.
In the first place is a significant acidity of the pain, namely the recent appearance of the. The pain became to 12 weeks (3 months) is called acute, over 12 weeks – years. Chronic pain syndrome can occur with exacerbations and periods of improvement.
Of fundamental importance is how it feels pain. This or feeling to a specific point, or distribution ("view", "иррадиация") pain along the nerve in the thigh, the hip, the knee joint, the leg, or is confusing "stupid" with the pain. We need to understand, is limited movements in the spine in the moments of occurrence of the pain, or move беспрепятственные (this may indicate a mechanical description of damage, for example, fracture of the vertebrae). In which points appear the pain? Either it is caused when the load, or at rest, during the night of sleep? The affirmative answer to the last question, in fact it is a "red flag" for the professional and make him reflect on the diagnosis of inflammatory disease of the vertebral column of the patient (to stop them a little later). If the pain gets worse with head movement, walking, jumping, you are likely to this is the so-called проекционной pain, the reason – damage to the nerve structures (most often sciatica).
Osteochondrosis of the spine, or spondilez – a condition in which there is seal and deformation of the vertebrae, with the advent of small bone surfaces that look like thorns on the edges of the vertebrae. A long time had been assumed spondilez the result of the natural flow degenerative processes of the aging body. However, convincingly demonstrated that is not only age can cause degenerative disc disease. Stationary way of life, increased load on the lumbar spine during the long work on the computer or with prolonged driving (e. g., the profession of driver-trucker) contribute to degenerative disc disease even in young people. Under the influence of all these factors межпозвонковые trays-buffers to become thinner, and the nerve roots emanating from the spinal cord травмируются выросшими краевыми spikes bones. Continued irritation of these roots and causes pain. In Latin, the ridge called the radix, therefore, this inflammation it is customary to call radikulit.
So called inflammatory diseases of the spine – the area of interest to rheumatologists. This mysterious disease may "flare up" a few years ago, starting mostly at a young age and hitting primarily men, and выливаясь finally obezdvizhennost' i invalidizatsiyu of the patient. The patients of this group are usually "endure to the last" and night pain and morning stiffness in the back, and the weakness of the, and a growing reduction of profitability. The large, unfortunately, from the appearances of the first symptoms of the disease until the correct diagnosis, on average, he spends about seven years. In that time the changes in the spine may be irreversible, and functional (locomotor) activity is low. The spine becomes stable, it changes shape, appears a hump. Out this pathology is not so often, such as back pain, for example, but the cost of treatment and the total duration of disability of these patients is incomparably above.
If in addition back pain, the patient speaks of inflammation of the joints (usually the knee joints, joints of, or interruption), pain in the buttocks, unstable chair with unusual impurities, blurred vision or pain in the eyes, and that's why urgently need to refer you to a specialist for the conduct of specific additional research and the exclusion of the disease from the group spondiloartritov (for example, seronegative spondylitis, or Crohn's disease).
There are diseases, manifested by pain in the lower back and not затронутыми позвоночными or neural structures. One of these disease – myofascial pain syndrome. The patients (usually young patient) show prolonged exposure to an awkward posture or physical overload, previous development of pain. During the medical examination of a remarkably acute pain when pressure is applied to specific points near the spine. This situation significantly reduces the quality of life of the patient, but small changes in the muscle tissue (the local over-voltage) is not a threat to the nerve roots, nor for the internal organs. Usually the therapeutic effect can be achieved with the help of the use of muscle relaxants, low doses of non-steroidal anti-inflammatory drugs, for topical administration (injection) at "a pressure point" - steroidal anti-inflammatory drug.
It is considered that if the patient complains of pain in the lower back has not been "worrying signs" (for the provided instructions below), additional examination is not needed and treatment can be carried therapist without an examination and x-ray. But, as practice shows, almost every patient such "signs" can be discovered, and, therefore, there is a need to give blood for at least a common (and better – even and on how the immune) analysis, and to perform an x-ray of lumbar spine in two projections (in the ideal case – the "seizure" of the bones of the pelvis).
- - Blood tests may reveal an increase in the speed of sedimentation of red blood cells (ESR), which indicates inflammation, may be of immunological origin, or infections. Elevated levels of white blood cells is also talking about infection or inflammation, and in severe anaemia – on the possible existence of the volume of the process.
- - Analysis of urine dumps if you suspect that the kidney disease. Back pain, when this brings the periodic character, often "spreading" the top to the bottom fins. If there are changes in the analysis of urine is carried out the ULTRASOUND of the kidneys, and the further tactic was discussed with the therapist or specialization.
- - X – ray- the cheapest of the instrumental investigations, is the method of choice for the diagnosis of the search in this case. In an x-ray can be considered as a violation of the structures of the spine, the signs of inflammation of the vertebral joints, in accordance with the telltale signs determine the location of compression of the nerve. "Transparency" of the vertebrae on an x-ray will lead to thoughts about osteoporosis (brittle) of the skeleton. As is well known, in the context of osteoporosis is the most common complication is like a fracture of the vertebrae. If the fracture, unfortunately, took place, also, it will be seen on x-ray. The possibilities of this method of research is huge, but if it was pathology, it should be clarified how severe is the damage, is not needed if the patient to a rapid intervention in the spine. For this, further research is needed – послойное (mri). There are two types of tomography ct scan, x-ray and mri.
- - Computed tomography (CT). The method of research that allows literally a look inside of the spine. All bony structures, which are not visible in normal x-ray, tomogram will be visible. If it is necessary, with the use of the findings and a special computer program can reconstruct a 3D model of any additional structures.
- - Magnetic resonance imaging (MRI). Not x-ray method of research. Differs from the computed tomography, also, a fact that allows the doctor more carefully to assess the condition of "soft" structures of the spine (CT is well visible only to bone) of the spinal cord, the roots. More detail on this research it seems vertebrate hernia, the changes of the blood vessels and muscles. Usually is an expert in MAGNETIC resonance imaging remains the last word when the diagnostic finding and the determination of further tactics.
The signs that you need to pay attention
Secondary back pain, so you don't have to do with остеохондрозом – alarming symptom, заставляющий as soon as possible to begin the search of the basic pathological process, causing pain. Brief stop the symptoms that may be suggestive of a possible secondary (i.e. not directly associated with the spine) the pain and require increased vigilance from both the doctor and the patient:
- quick sudden loss of body weight (can occur suspicion of a tumor);
- infections of the kidneys and the urinary bladder (in this case, the pain can be a symptom of pyelonephritis);
- growth of pain at rest or after a night of sleep (this symptom is especially interested in rheumatologists, as it can be a sign of occurrence of bechterew's disease);
- an increase in the temperature of the body?
- changes in blood glucose (increased coagulability of the blood, which is detected during the execution of coagulogram, elevated levels of white blood cells or drop of hemoglobin, and increased ESR (erythrocyte sedimentation rate) in the overall analysis, elevated levels of c-reactive protein in the analysis)?
- placed a diagnosis of "osteoporosis", or taking medicines, to reduce the amount of calcium in the bones?
- age over 50 years of age (the risk of developing osteoporosis in menopausal women) or less than 20 years, this is especially true for young people?
- reference to the trauma, regardless of the old (for example, falling from a height of over 2 meters, and for the elderly, significant damage is already falling from the height of the body);
- signs of severe neurological anomalies (violation of sensitivity of skin, urination or defecation, usually indicates a deep defeat of the spinal cord);
- ineffectiveness "standard" treatment for 4 weeks.
Storage activity and mobility
A common mistake – compliance with bed rest during acute back pain. Move with this pathology of the musculoskeletal system is not just necessary and needed! In all cases, except for compression radicular syndrome (this diagnosis will install the neurologist), being in a horizontal position increases the cost of treatment and tightening the recovery time. Yes, and when radicular syndrome total time of bed rest should not be more than two days.
In inflammatory diseases of the spine and крестцово-iliac joint physical activity – a key instrument for the fight of next disabilities. Remember, the defined group of diseases has been gradually progressing in nature, and exercise, with the aim of maintaining flexibility, and the development and strengthening of the muscles, "corset" of the spine, can be considered the same effective therapy as a specific therapy with anti-inflammatory drugs of different groups, назначаемая from the experts.