Back pain is a common problem in middle-aged and older patients. It can be caused by an incorrect lifestyle, pathologies of the musculoskeletal system, diseases of internal organs. A neurologist, orthopedist, nephrologist, and urologist can treat back pain, depending on its origin. It is difficult for the patient to determine the cause of the unpleasant sensations for himself and to choose the right doctor. Therefore, it is first necessary to contact a therapist, who, depending on the symptoms, history and results of the studies carried out, will refer you to a narrow specialist.
Classification
Back pain can be:
- Myofascial.
- Harmful.
- Neuropathic.
- Psychogenic.
Myofascial painobserved during the formation of the so-called. trigger points in the back muscles. Trigger points are pea-shaped knots that form when muscles are constantly tense (when they just can't relax). In addition, when one segment of muscle fiber is compressed, the others are stretched. This affects the mobility of the muscle fiber: it is limited. The fiber itself is shortened, becomes tighter.
Trigger points come from muscle overload. In addition, overload can occur not only due to excessive physical activity, but also due to prolonged stay in one position (for example, sitting in front of a computer). Also, trigger points often occur with osteochondrosis.
Another factor that contributes to the formation of trigger points is the over-stimulation of sarcomeres (basic contractile units which are a complex of proteins). If there is excessive stimulation of the sarcomeres, they are constantly in a contracted state.
The presence of trigger points does not allow the muscle to relax completely. She begins to tire quickly even with minor loads, overexerts while moving, and recovers very slowly. Its limited range of motion affects the entire fascial chain. Other muscles and even some joints also become less mobile.
Blood flow to the tissues surrounding the trigger point also suffers. For this reason, oxygen deprivation is observed in this area. The decay products build up, irritate the trigger point, and pain develops because of it. In this case, the size of the muscle does not matter, it all depends on the degree of irritation of the tip. Even the smallest muscle in the presence of trigger points can provide a lot of unpleasant sensations.
A characteristic feature of myofascial pain is their reflection. This means that the pain is reflected in other parts of the body. They can occur in areas very far from the trigger points. So, for example, pain under the shoulder blades or lower back may develop due to the presence of knots in the abdominal muscles. Also, the lower back can hurt due to trigger points in the calf area or in the buttocks.
Myofascial pain is usually long lasting and dull. Sometimes they occur only when moving, sometimes when at rest. They can be of different strength: from minor discomfort to unbearable pain.
Nociceptive pain- the body's response to direct irritation of pain receptors (nociceptors). In the case of the back, these are receptors located in the paravertebral ligaments, muscles, tendons, as well as in the joint capsules of the intervertebral joints and the outer third of the fibrous ring of the intervertebral disc. The patient may experience pain accompanied by reflex muscle spasms, dystrophic or pathological processes in the facet joints. As you move, the pain intensifies.
Neuropathic paindevelop in pathological processes of the nervous system: damage to the nerves or roots of the peripheral nervous system, disruption of the central nervous system. Such pain can be observed with osteoporosis, spondylolisthesis, hernias and fractures of the spine. They are intensified by bending, moving, straining, coughing, sneezing and, in most cases, they are administered to the limb. Sometimes they are dull and sore, but more often they are crisp and tight.
Psychogenic painoccur due to muscle spasms caused by emotional stress, chronic stress, or anxiety disorder.
In some cases, varieties can be combined with each other. For example, myofascial sensations coexist with nociceptive sensations.
In addition, back pain is divided into 3 types:
- Acute (lasting less than 6 weeks).
- Subacute (6-12 weeks).
- Chronic (more than 3 months).
Acute / subacute painUsually develops due to tissue damage (deep, superficial) due to cuts, wounds, inflammation. So the body warns us that something is wrong. The pain goes away once the tissues are completely healed.
Chronic painoccurs due to diseases of organs and systems or emotional disturbances. If necessary, a thorough medical examination is necessary.
By location, the pain can be:
- Local.
- Reflected.
- Irradiating.
Local pain develops directly at the site of the development of the pathological process. Reflected - if there are any trigger points. Radiant - with damage to internal organs, spreads along nerve fibers.
Why is my back hurting?
Back pain can be caused by a variety of reasons, including:
- Curvature of the spine: scoliosis, kyphosis.
- Neurological diseases: herniation of the intervertebral discs, osteochondrosis, spondylosis, spondylarthrosis.
- Endocrine pathologies: osteoporosis.
- Diseases of the respiratory system: pleurisy.
- Pathologies of the kidneys and urinary system: urolithiasis, pyelonephritis, glomerulonephritis.
- Tumors.
Short-term pain (usually severe, burning) can be due to a variety of reasons. These include:
- Injuries.
- Muscle strain (due to monotonous posture or performing the same type of repetitive movements).
- Hypothermia.
Pain caused by degenerative processes occurs with the following diseases:
- Osteochondrosis.
- Intervertebral hernia.
- Protrusion of the intervertebral disc.
- Deforming spondylosis.
- Degenerative scoliosis.
- Osteoarthritis.
- Spondylolisthesis (displacement of the vertebrae).
- Spondylolysis (non-union of the vertebral arch).
- Spinal stenosis.
Pain radiating to the spine may develop due to diseases:
- Heart and large vessels: myocardial infarction, angina pectoris, aortic aneurysm.
- Lungs: cancerous tumors, pleurisy.
- Esophagus.
- Gallbladder and bile ducts: acute and chronic cholecystitis.
- Kidney and urinary tract.
- Pancreas.
Back pain in rare cases can be infectious in origin. For example, I sometimes have back pain from the flu. In addition, the infection can enter the spine from nearby organs: urinary tract, kidneys.
Other reasons for developing back pain may be changes in hormonal levels (eg, age-related, during or after menopause). In this case, hormonal spondylopathy occurs (degenerative changes in the spine)
The back hurts a lot: what to do?
If you have a severe pain attack, be sure to see a doctor as soon as possible. However, if the sensations are so strong that any movement causes torment, first aid is required. You should lie on your back on a hard, level surface (for example, the floor). This will help relieve spasms, relax muscles, and reduce pain.
While sinking on a flat surface, do not change the position of your back. Lying on your back, try to roll onto your side. This will relieve the spine. When the pain subsides, roll onto your back. It is recommended to put something under your feet, lifting them up. Lie down in this position for 10 to 15 minutes.
You also need to climb properly: roll on your side first. From this position, get on all fours. Then lean on something (if there is no support nearby - crawl on it) and slowly get up. Only then carefully straighten your back.
To find out why your back is hurting, don't put off a doctor's visit. This will help to avoid further attacks.
Diagnostic
You absolutely must make an appointment with a therapist in case of back pain:
- appear during physical exertion, muscle tension;
- last more than 3 days;
- are repeated episodically.
It is necessary to immediately consult a doctor in the following cases:
- the back constantly hurts;
- an increase in body temperature, numbness of the limbs, lethargy of the limbs in the morning add to the pain;
- when lying down, the pain does not go away;
- worse pains at night.
During the appointment, the doctor will collect the anamnesis, examine the patient (assess the condition of the skin, the position and symmetry of the body, gait, etc. ) Then he will assign studies:
- general analysis of blood and urine;
- radiography;
- computed tomography;
- Magnetic resonance imaging.
If necessary, the therapist will refer the patient to a neurologist, orthopedist, urologist, gynecologist or nephrologist.
Back pain treatment
Treatment for back pain is comprehensive and may include:
- take medication (anti-inflammatory, analgesic, restorative);
- blockade (long-term pain relief);
- physiotherapy procedures;
- physiotherapy exercises;
- massages;
- manual therapy.
If conservative methods do not give the desired result, surgical treatment is prescribed. Modern methods make it possible to perform precise, little traumatic operations with a short period of rehabilitation.
Prevention of back pain
Simple preventive measures can help prevent back pain. It is necessary:
- Watch your posture.
- Sleep on a bed with a hard mattress.
- Engaging in activities that involve a long sitting position (driving, working at the computer), it is necessary to change posture from time to time, as well as to organize breaks and warm-ups.
- When standing for a long time, lean on something.
- Do not wear high heels for more than 2 hours at a time.
- Spend time with moderate physical activity (swimming, fitness).
- Keep track of your weight - back pain can occur due to the presence of extra pounds.
- Try not to lift any weight.
- Do not turn around or bend over with sudden movements.
- Timely treat urological and gynecological diseases.
Annual preventive visits to the therapist will also be beneficial. Pathologies identified in the early stages can be eliminated without waiting for the development of complications.