Back pain is a common problem among middle-aged and elderly patients. It can be caused by an incorrect lifestyle, pathologies of the musculoskeletal system, diseases of Organs internal organs. A neurologist, orthopedist, nephrologist and urologist can treat back pain, depending on its origin. It is difficult for the patient to discover alone the cause of the unpleasant sensations and to choose the right doctor. Therefore, it is necessary to initially contact a therapist who, depending on the symptoms, history and results of the studies carried out, will refer you to a restricted specialist.
Classification
Back pain can be:
- Myofascial.
- Nociceptive.
- Neuropathic.
- Psychogenic.
Myofascial painobserved during the formation of the calls. trigger points on the back muscles. Trigger points are pea-like knots that form when muscles are constantly tense (when they simply cannot relax). In addition, when one segment of the muscle fiber is compressed, the others are stretched. This affects the mobility of the muscle fiber: it is limited. The fiber itself is shortened, it becomes tighter.
Trigger points arise from muscle overvoltage. In addition, overvoltage can occur not only due to excessive physical activity, but also due to prolonged stay in one position (for example, sitting at a computer). In addition, trigger points often occur with osteochondrosis.
Another factor that contributes to the formation of trigger points is the excessive stimulation of sarcomeres (basic contractile units that are a protein complex). If the sarcomeres are over-stimulated, they are constantly in a contracted state.
The presence of trigger points does not allow the muscle to fully relax. She starts to tire quickly even with smaller loads, overdoes it when 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 in the tissues around the trigger point also suffers. Because of this, a lack of oxygen is observed in this area. Decomposition products accumulate, irritate the trigger point and pain develops because of it. In that case, the size of the muscle does not matter, it all depends on the degree of irritation of the point. Even the smallest muscle in the presence of trigger points can cause many unpleasant sensations.
A characteristic of myofascial pain is its reflex. This means that the pain is reflected in other parts of the body. They can occur in areas very far from the trigger points. Thus, for example, pain may develop below the shoulder blades or in the lower back due to the presence of nodules in the abdominal muscles. In addition, the lower back can hurt due to trigger points in the calf area or on the buttocks.
Myofascial pains are usually long-lasting and opaque. Sometimes they occur only in motion, sometimes at rest. They can be different in 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, they are receptors located in the paravertebral ligaments, muscles, tendons, as well as in the articular capsules of the intervertebral joints and in the external third of the fibrous ring of the intervertebral disc. The patient may experience pain with reflex muscle spasm, dystrophic or pathological processes in the joints. When you move, the pain intensifies.
Neuropathic paindevelop in pathological processes in the nervous system: damage to the nerves or roots of the peripheral nervous system, disturbance of the central nervous system. This pain can be seen with osteoporosis, spondylolisthesis, hernias and fractures of the spine. They intensify when bending, moving, stretching, coughing, sneezing and, in most cases, are administered to the limb. Sometimes they are dull and painful, but more often they are pointed, penetrating.
Psychogenic painthey occur due to muscle spasm caused by emotional stress, chronic stress or anxiety disorder.
In some cases, the 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 painit usually develops due to tissue damage (deep, superficial) due to cuts, wounds, inflammation. Thus, the body warns us that something is wrong. The pain goes away after the tissues are completely healed.
Chronic painit occurs due to organ and system diseases or emotional disorders. If present, a thorough medical examination is necessary.
By location, pain can be:
- Local.
- Reflected.
- Radiating.
Local pain develops directly at the site of the development of the pathological process. Reflected - if there are trigger points. Radiating - with damage to internal organs, it spreads along nerve fibers.
why does my back hurt?
Back pain can be caused by several reasons, including:
- Spine curvature: scoliosis, kyphosis.
- Neurological diseases: herniated intervertebral disc, osteochondrosis, spondylosis, spondyloarthrosis.
- Endocrine pathologies: osteoporosis.
- Respiratory system disorders: pleurisy.
- Pathologies of the kidneys and urinary system: urolithiasis, pyelonephritis, glomerulonephritis.
- Tumors.
Short-term pain (usually severe, burning) can be caused by several reasons. These include:
- Injuries.
- Excessive muscular effort (due to a 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.
- Arthrosis.
- Spondylolisthesis (displacement of vertebrae).
- Spondylolysis (non-union of the vertebral arch).
- Spinal stenosis.
Pain that radiates to the spine can develop due to illness:
- 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 of infectious origin. For example, sometimes my back hurts with the flu. In addition, the infection can penetrate the spine from nearby organs: urinary tract, kidneys.
Other reasons for the development of back pain may be changes in hormone levels (for example, age-related, during or after menopause). In this case, hormonal spondylopathy (degenerative changes in the spine) occurs
It hurts a lot in the back: what to do?
If you have a severe pain attack, see a doctor as soon as possible. However, if the sensations are so strong that any movement causes torment, first aid is necessary. You need to lie on your back on a flat, hard surface (for example, the floor). This will help to relieve spasms, relax muscles and reduce pain.
Sinking on a flat surface, do not change the position of your back. Lying on your back, try to roll to the side. This will lighten the spine. When the pain subsides, roll over onto your back. It is recommended to put something under your feet, lifting them up. Lie in this position for 10-15 minutes.
You also need to climb correctly: first turn sideways. From this position, stay on all fours. Then lean on something (if there is no support nearby - crawl over to it) and get up slowly. Only then carefully straighten your back.
To find out why your back hurts so much, don't postpone a visit to the doctor. This will help prevent further attacks.
Diagnosis
You should definitely make an appointment with a therapist if you have back pain:
- appear during physical effort, muscle tension;
- last more than 3 days;
- are repeated episodically.
It is necessary to consult a doctor immediately in the following cases:
- back ache constantly;
- an increase in body temperature, numbness of the limbs, lethargy of the limbs in the morning are added to the pain;
- in the supine position, the pain does not go away;
- the pains get worse at night.
In the consultation, the doctor will take the anamnesis, examine the patient (will assess the condition of the skin, body position and symmetry, gait, etc. ). Then he will assign studies:
- general analysis of blood and urine;
- X-ray;
- computed tomography;
- magnetic resonance image.
If necessary, the therapist will refer the patient to a neurologist, orthopedist, urologist, gynecologist or nephrologist.
Back pain treatment
Back pain treatment is comprehensive and may include:
- taking medications (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, non-traumatic operations with a short period of rehabilitation.
Back pain prevention
Simple preventive measures can help prevent back pain. It is necessary:
- Monitor your posture.
- Sleep on a bed with a hard mattress.
- For involvement in activities that involve a long sitting position (driving, working on the computer), it is necessary to change the posture from time to time, as well as to organize breaks and warm-up.
- When standing for a long time, lean on something.
- Do not wear high heels for more than 2 hours straight.
- Spend time with moderate physical activities (swimming, fitness).
- Track your weight - back pain may occur due to the presence of extra pounds.
- Try not to lift weights.
- Do not turn or bend with sudden movements.
- Treat urological and gynecological diseases in a timely manner.
Annual preventive visits to the therapist will also be beneficial. The pathologies identified in the early stages can be eliminated without waiting for complications to develop.