Pain in the lumbar spine, as well as the neighbouring areas may disturb the patient at any time of the day, standing, sitting, lying down or on-the-go, during exercise, or the other. So this phenomenon is not unique, i.e., can meet such a huge number of cases that require special attention in the first place, the patient: you need to consult a doctor immediately.
What's the doctor's address?
According to the statistics, up to the patients to 25% seek medical help in the relationship formation, pain in the lumbar region. 8 out of 10 live in the world experience pain in the back, at least 1 time in my life. Most often suffer from these symptoms, the persons of working age, slightly fewer people of retirement age, but less in adolescents (to various estimates, from 8 to 40% - Russia).
Therapist, neurologist, rheumatologist
The first doctors, which address the majority of patients the pain in the lower back, the therapist and neurologist. But the young people trauma in the recent past increasingly turned to the professionals.
Diagnostic and therapeutic tactics these professionals are different. Often, the therapist directs the patient to the neurologist, the neurologist determines to "the" diagnosis and prescribes the treatment. Professionals often work "individually", and the non-steroidal anti-inflammatory drugs, applied techniques of manual therapy, physiotherapy. The main thing is that the patient that you are not lost in this situation, not to get carried away by the promises of instant cure, when you execute the techniques, you don't have to use them again in case of failing, or worse, increased against the background of such treatment of pain.
If the conservative treatment, medication treatment, you must understand that the treatment for four weeks without result, a strong argument for review of the diagnosis, the treatment, to revmatologu not to conduct repeated courses of therapy. Often there are situations when the patient's complaint of pain in the lower back get symptomatic (pain) in the treatment of some conventional system without specifying the real cause of the pain.
Causes of lower back pain
The main causes of pain in the lumbar region
- changes in the structures of the spine, usually age-related (degenerative), degenerative disc disease of the spine, the different herniated disks, or inadequate work muscle complex. Such pain is called primary, that are directly related to, the spine;
- the pathological changes of bodies near the painful area, but directly to the spine not related (e.g., diseases of the internal organs, the skin). This is the category of the causes include arthritis, trauma, endocrine diseases (e.g. diabetes), - in short, everything that does not fit the "natural age-related changes" of the spine. Such pain is called secondary.
Control the meeting
The pain, feeling heavy mobility or increased painful muscle tension in the region of the lower ribs, the bottom marker is the phrase, "lyumbalgiya". If these symptoms include pain in the feet, this condition is called lyumbalgiya.
The most important thing is the sharpness, the pain, the remote its occurrence. Pain in the prescription, 12 weeks (3 months) is called acute, longer than 12 weeks – chronic. The chronic pain syndrome may also occur exacerbation and periods of improvement.
It is essential that pain I felt. Or feel at a certain point, or of a licence ("projection", "radiation") is pain along the nerve in the thighs, buttocks, knees, feet, or fluffy, "blunt" pain. You have to understand that the limited movement of the spine in moments of pain, or the movement is unhindered (this may indicate the mechanical nature of the injury as a fracture of the vertebra). Where a moment's pain? Doesn't occur under load, or during a night? If you have answered yes to the last question is usually a "red flag" to the experts, whether the diagnosis of inflammatory diseases of the spine of the patient, (a little later). If the pain increases with movement of the head, walking, jumping, probably the so-called expected pain, which is caused by the damage to nerve structures (often sciatica).
Osteochondrosis, or spondilez – a condition in which there is no compression, deformation of the vertebrae, with the advent of the bone surfaces than the spikes, the media, the vertebrae. For a long time it was assumed spondilez the result of the natural degenerative processes of aging. However, it has been proven that it's not just the age, because the lower back pain. Sedentary lifestyle, the increased load on the lumbar spine during prolonged work at the computer or prolonged driving (e.g., professional truck drivers) contribute to the appearance of osteoarthritis young people. Under the influence of these factors, the intervertebral discs will be thinner, buffer, the nerve roots to the spinal cord injury raised the marginal spines on the bone. The constant irritation of these roots, the pain. The Latin root is called the radix, so that the inflammation is usually called radikulit.
The so-called inflammatory diseases of the spine – the area of interests of rheumatologists. This mysterious disease "more seriously" for a few years, starting with mainly young age mainly affected the men, which at the end of the obezdvizhennost I invalidizatsiyu patients. The patients in this group usually "go last" night pain, morning stiffness in the back, weakness, decreases the health. Unfortunately, the appearance of the first symptoms of the disease before the correct diagnosis, on average, approximately seven years ago. During this time, changes in the spine can become irreversible, and functional (locomotor) activity is low. The spine will be fixed, a shape-shifter, there's a bump. I found this pathology is not as common as lower back pain, for example, but the cost of treatment and the total disability in such patients is disproportionately higher.
If in addition to the back pain patient talks about the inflammation of the joints (most often we are talking about the knee joints, the joints of the hands or the feet), pain in the ass, unstable chair unusual impurities, decreased vision, or pain in the eyes, that's a reason to immediately send him to a specialist for the implementation of further advanced studies, and the exclusion of diseases, the group spondiloartritov (e.g., the negative spondylitis, or crohn's disease).
There are some diseases, indicating the pain in the lower back, completely intact vertebrates or the neural structures. One such disease – myofascial pain syndrome. Patients (especially young patients), indicate that the expenditure for a long time in an uncomfortable situation, or physical overload, preceded the development of the pain. When the doctors drew attention to a sharp pain when the pressure on the certain points located close to the spine. This condition significantly reduces the patient's quality of life, but small changes in the muscle tissue (the local tribe) are not dangerous to the nerve roots, or internal organs. In general, the therapeutic effect can be achieved by using the goal of muscle relaxants, low-dose steroid anti-inflammatory drugs, local injection (injection) the "pain" steroidal anti-inflammatory drug.
It is considered that if a patient's complaint of pain in the lower back part of the "red flags" (below), then further investigation is not necessary, the treatment the doctor studies without x-rays. But the practice shows, almost every patient these "signs" can be detected, therefore, it is necessary that blood least common (right – immunological) analysis, and perform the x-rays of the lumbar spine in two projections (ideally, the "capture" of the pool).
- The blood test can detect the increase of the erythrocyte sedimentation rate (ESR), which indicates inflammation, probably immune in origin, or infection. Increases the level of white blood cells indicate infection or inflammation, severe anemia – the possible presence of the cancer.
- - Urinalysis for rent with suspected kidney disease. Pain in the lumbar region, the periodic nature, it is often "spread" up to the lower ribs. If there is a change in the urine analysis, renal ultrasound, and tactics are discussed in detail in the therapist, or urologist.
- - X-ray – the cheapest of the instrument tests, the method is a diagnostic finding in this case. The x-rays we can see the violation, the structures, the spine, the signs of inflammation of the spinal joints, the use of indirect evidence to determine the location of the compression of the nerves. "Transparency" of the vertebrae x-rays leads to the thought that osteoporosis (brittle) the bones in your skeleton. As you know, in the background osteoporosis, the most common complications, such as fracture of the vertebrae. If the fracture, unfortunately, happened, this, too, I saw the x-rays. The possibilities that this method of research is huge, but if pathology is found, one must ask how serious the injury, not the patient's surgical intervention of the spine. It's necessary for the accurate study level (CT). Two types of tomography – computed x-ray magnetic resonance imaging.
- - Computed tomography (CT). Survey method, which allows you to literally look into the spine. The bone structure, which is not visible on x-ray, tomography test is perfectly visible. If necessary, the received data is a special computer program can reconstruct a 3d model of any structure.
- - Magnetic resonance imaging (MRI). No x-ray method of research. Other the CT scan, which allows the doctor to better assess the condition of the soft structures of the spine (visible on the CT scan, just bone elements): the spinal cord, roots. More details when the survey can be seen, spinal hernias, vascular changes, and the muscle. Usually a specialist MRI remains the last word in the diagnostic search for definition of further tactics.
Signs that you need to pay attention
Secondary back pain which is not related to the low back pain alarm symptoms, forcing you to start your search is the primary pathological process causing the pain. In short, the symptoms, which may suggest possible secondary (i.e. not directly related to the spine) character of the pain requires increased vigilance, as the doctor to the patient:
- rapid, sudden loss of body weight (may be a suspected tumor);
- the infection of the kidney, urinary bladder (in this case, the pain can be a symptom of pyelonephritis);
- pain in the rest or sleep after (this phenomenon is especially interested in rheumatology as a sign of developing Bechterew's disease);
- the increase in body temperature;
- changes in blood tests (increased blood clotting, discovered, if you are running coagulogram, increased white blood cells or a drop in hemoglobin, increased ESR (erythrocyte sedimentation rate) in the overall analysis, increased C-reactive protein-analysis);
- diagnosis "osteoporosis", or taking medications, which reduce the calcium in the bones;
- age more than 50 years (risk of osteoporosis in women in menopause) or less than 20 years, especially the boys;
- link to the damage, regardless of the restrictions (for example, a drop of more than 2 metres, the older people a significant damage decrease the height of your own body);
- signs of severe neurological abnormalities (impaired skin sensitivity, urination or bowel movement is usually a sign that deep lesions of the spinal cord);
- the ineffectiveness of the "routine" treatment for 4 weeks.
Maintain activity and mobility
A common mistake is to comply with bed rest for acute back pain. The movement in the pathology of musculoskeletal apparatus not only necessary, but essential! In all cases, except for the compression radiculáriszt syndrome (the diagnosis is established, a neurologist) to a horizontal position increases the treatment costs and prolong the healing time. When radiculáriszt syndrome, total time spent in bed should not be more than two days.
The inflammatory diseases of the spine, sacroiliac joints physical activity is a primary tool in the fight for the upcoming live. Recall that this group of diseases is gradually progressive in nature, and the exercises are designed, flexibility in maintaining, developing and strengthening the muscular "corset" for the spine is considered to be an effective treatment method, as a special therapy anti-inflammatory drugs, the different groups of designated professionals.