Low back pain is a characteristic type of pain in the lumbosacral spine that occurs against the background of degenerative changes or injuries of the spinal column. The condition is accompanied by acute lower back pain and pronounced motor limitations. The diagnosis is established on the basis of the clinical picture, the results of spondylography, MRI or CT of the spine, blood tests and cerebrospinal fluid. Treatment is aimed at eliminating the causal factor, as well as pain reactions, inflammation, swelling and spinal movement disorders.
ICD 10
M54.5 Lower back pain
General information
Low back pain can be primary, as a result of age-related changes in the vertebral column, and secondary, a manifestation of another disease (lumbalization, hernia, subluxation of the vertebra, trauma, spinal osteochondrosis, etc.). Most often low back pain has a secondary character and develops against the background of another pathological process. It does not occur in children and adolescents, it is most often observed in young and middle-aged people (after 25 years), less often in the elderly. It quickly turns into a chronic form. Do not confuse pain with low back pain and sciatica, they are represented by different pathological processes.
The main reason for the appearance of low back pain in the lower back is fatigue and tension of the muscles of the lumbar region due to sudden movements, increased physical exertion. Low back pain occurs with destructive changes in the spine. In response to irritation of nerve endings and receptors located in the area of the fibrous ring of the intervertebral disc, reflex muscle spasm occurs, accompanied by pain. It is noticed that low back pain is more common among middle-aged men. Overheating of the lumbar tissues (during active work, sports) with further hypothermia can provoke the development of lumbar prostration; muscle overstrain; careless turns, sudden movements of the body; loss of the intervertebral disc; exacerbation of infectious processes. After exposure to a traumatic factor in the vertebral disc segment, there is a rupture of the fibrous ring, protrusion of the intervertebral disc, displacement of the pulpous nucleus, ligament tear.
Symptoms
Severe lower back pain is the main sign of low back pain. A painful attack appears at the moment of intense exertion or some time after the action of a predisposing factor (hypothermia, prolapse of the intervertebral disc). The pain is unbearable, paralyzing a person for a while; he freezes in a pose in which he was seized by an attack, sometimes patients fall. The pain can be shooting, pulsating, give to nearby tissues and organs. The lower back is “shackled”, that is, the muscles are sharply tense, sometimes the tension extends to the muscles of the buttocks, legs; the torso is slightly tilted forward. Flexion in the lower back is impossible (a symptom of the board). In bed, patients lie on their backs with their legs raised to their stomach, or on their stomach with a pillow. Patients sit down very carefully, leaning on their hands (a symptom of a tripod).
The patient is taken by surprise by a low back pain attack: he freezes in a certain position, is afraid to move and change the position of the body, because even a slight movement causes increased pain. The duration of an attack of lumbar lumbar can be different — from a few minutes to 1-2 hours or even a day. The intensity of pain can be so high that patients need urgent help from a neurologist or a vertebrologist.
Diagnostics
The clinical picture of low back pain is enough to make a correct diagnosis. In the patient’s anamnesis, osteochondrosis, intervertebral hernias, spinal column injuries and other pathologies of the musculoskeletal system are most often observed.
To obtain the most detailed information, MRI or CT of the spine, spondylography are prescribed, since these examination methods allow to establish pathological changes in bone and joint structures, identify osteophytes, determine the localization of the focus of inflammation. Lumbar puncture is used to take cerebrospinal fluid with its further study, sometimes this method of examination is used simultaneously with the introduction of painkillers, anti-inflammatory drugs directly into the focus of inflammation and pain. Myelography is also used – radiography of the spine, performed after lumbar puncture, with the introduction of contrast.
Laboratory research methods are prescribed in order to detect the presence of obvious signs of the inflammatory process in the blood test (increased white blood cell count, shift of the leukocyte formula).
Treatment
Low back pain treatment should be aimed at the cause of the disease — destructive changes in the joints of the spinal column. Specialists also pay attention to the symptoms of pathology: pain, inflammation, edema, movement restrictions. During an attack, analgesics, nonsteroidal anti-inflammatory drugs, antispasmodics, intradermal blockades are prescribed.
In the acute period of the disease, bed rest is prescribed. Active movements that can increase pain or provoke the appearance of new attacks of low back pain are prohibited. The bed place should be moderately hard, in no case should you sleep on a bed with sagging springs and an uneven, soft mattress. With the help of UV irradiation, therapeutic massage and other physiotherapy, it is possible to reduce the intensity of pain, eliminate signs of inflammation and reduce pathological manifestations. It is very important to take a responsible approach to all medical appointments, not to violate bed rest, not to reduce or increase the dosage of prescribed medications.
To improve blood flow and lymph circulation, patients are shown the use of the following procedures: acupuncture, amplipulstherapy, manual therapy, therapeutic gymnastics (exercise therapy), mud treatment, applications with therapeutic compositions on the lower back, classical relaxing massage, laser therapy, magnetotherapy. It is recommended to combine manual therapy with acupuncture and massage. Physiotherapy triggers regenerative processes, fights swelling of tissues, reduces pain and quickly restores efficiency.
Special gymnastic exercises are prescribed after the removal of acute pain and inflammation. Moderate physical exertion has a complex effect on the tissues of the lumbar spine and cartilaginous structures of the spine: strengthen the muscular framework that holds the vertebrae in their natural position and prevents the development of intervertebral hernias; activate metabolic processes in the joints of the spinal column; enhance the processes of self-healing and regeneration; increase the elasticity of ligaments and cartilage of the spine; expand the amplitude of movements; reduce the risk of recurrence of low back pain; improve the prognosis for osteochondrosis, intervertebral hernia; relieve muscle tension.
The most important therapeutic measure for low back pain is kyphosis of the lumbar spine. The patient should be laid on his back with his legs bent at right angles in the hip and knee joints, with the support of the lower leg on a stool covered with a blanket. In some cases, the position on the stomach, under which several pillows are placed, will be more physiological for the patient.
Patients with low back pain are recommended to rest at least several times a year at the sea, in a hot climate. Sea water and air contribute to the restoration of metabolism in the tissues of the spine, strengthen the elasticity of ligaments and joints, relieve pain.
Prognosis and prevention
With timely medical treatment, the prognosis for low back pain is favorable. But, if you do not follow medical recommendations, skip trips to doctors, do not take care of your health, then lumbar low back pain will appear more and more often. Sooner or later, there will be so-called root syndromes (radiculitis) and irreversible consequences that can cause disability and a decrease in the quality of life.
To prevent the appearance of low back pain, it is recommended to avoid hypothermia. After physical work or sports, you can not immediately go outside or dive into cool water. It is also necessary to avoid sharp turns of the trunk, so as not to accidentally provoke a displacement of the vertebrae.
