Back pain is a common problem in middle-aged and elderly patients. It can be caused by an incorrect lifestyle, pathologies of the musculoskeletal system, diseases of the internal organs. A neurologist, orthopedist, nephrologist, and urologist can treat back pain depending on where it comes from. It is difficult for the patient to find out the cause of the unpleasant sensations on their own and choose the right doctor. Therefore, it is first necessary to contact a therapist who, depending on the symptoms, medical history and results of the studies carried out, will refer you to a close specialist.
classification
Back pain can be:
- Myofascial.
- Nociceptive.
- Neuropathic.
- Psychogenic.
Myofascial painobserved during the formation of the so-called. Trigger points in the back muscles. Trigger points are pea-like knots that form when the muscles are constantly tense (when they just can't relax). When one segment of the muscle fiber is compressed, the others are stretched beyond that. This affects the mobility of the muscle fiber: it is limited. The fiber itself is shortened, becomes narrower.
Trigger points arise 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 at the computer). Trigger points are also common in osteochondrosis.
Another factor that contributes to the formation of trigger points is excessive stimulation of sarcomeres (basic contractile units, which are a complex of proteins). When the sarcomeres are overly stimulated, they are constantly in a contracted state.
The presence of trigger points does not allow the muscle to relax completely. It begins to tire quickly even with low loads, overstrains itself when moving and recovers very slowly. Its limited range of motion affects the entire fascia chain. Other muscles, and even some joints, also become less flexible.
Blood flow in the tissues surrounding the trigger point also suffers. For this reason, a lack of oxygen is observed in this area. Decay products accumulate, irritate the trigger point and this creates pain. In this 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 a lot of unpleasant sensations.
A distinctive feature of myofascial pain is its reflection. This means that the pain is affecting other parts of the body. They can occur in areas that are very far from the trigger points. For example, there may be pain under the shoulder blades or lower back due to the presence of lumps in the abdominal muscles. The lower back can also hurt due to trigger points in the calf area or in the buttocks.
Myofascial pain is usually long-lasting and dull. Sometimes they only appear in motion, sometimes at rest. Their strength can vary: from mild discomfort to unbearable pain.
Nociceptive pain- the body's response to direct stimulation of pain receptors (nociceptors). In the case of the back, these are receptors located in the paravertebral ligaments, muscles, tendons and in the joint capsules of the intervertebral joints and the outer third of the fiber ring of the intervertebral disc. The patient may experience pain with reflex muscle spasms, dystrophic or pathological processes in the facet joints. The pain increases when moving.
Neuropathic paindevelop in pathological processes in 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 spinal fractures. They intensify when bending, moving, overexerting, coughing, sneezing and in most cases are released to the extremity. Sometimes they are boring and painful, but more often they are sharp and shooting.
Psychogenic painoccur due to muscle spasms caused by emotional stress, chronic stress, or anxiety disorders.
In some cases, the varieties can be combined with each other. For example, myofascial sensations coexist with nociceptive sensations.
Back pain is also divided into 3 types:
- Acute (less than 6 weeks).
- Subacute (6-12 weeks).
- Chronic (more than 3 months).
Acute / sub-acute painusually develops due to tissue damage (deep, superficial) due to cuts, wounds, inflammation. This is how the body warns us that something is wrong. The pain will go away after the tissue is completely healed.
Chronic painoccurs due to diseases of the organs and systems or emotional disorders. If available, a thorough medical examination is required.
According to location, the pain can be:
- Local.
- Reflects.
- Irradiate.
Local pains arise directly at the place of development of the pathological process. Reflects - when there are trigger points. Irradiation - with damage to the internal organs, spreads along the nerve fibers.
Why does my back hurt?
Back pain can be caused for a number of reasons, including:
- Curvature of the spine: scoliosis, kyphosis.
- Neurological diseases: herniated disc, osteochondrosis, spondylosis, spondyloarthrosis.
- Endocrine pathologies: osteoporosis.
- Respiratory disorders: pleurisy.
- Pathologies of the kidneys and urinary system: urolithiasis, pyelonephritis, glomerulonephritis.
- Tumors.
Short-term pain (usually severe, burning) can be for a number of reasons. These include:
- Injuries.
- Overuse of muscles (due to repetitive posture or performing the same type of repetitive movement).
- Hypothermia.
Pain caused by degenerative processes occurs with the following diseases:
- Osteochondrosis.
- Intervertebral hernia.
- Disc protrusion.
- Spondylosis deformans.
- Degenerative scoliosis.
- Arthrosis.
- Spondylolisthesis (displacement of the vertebrae).
- Spondylolysis (non-union of the vertebral arch).
- Spinal stenosis.
Pain radiating to the spine can develop due to diseases:
- Heart and large vessels: myocardial infarction, angina pectoris, aortic aneurysm.
- Lungs: cancerous tumors, pleurisy.
- Esophagus.
- Gallbladder and biliary tract: acute and chronic cholecystitis.
- Kidneys and urinary tract.
- Pancreas.
In rare cases, back pain can be of infectious origin. For example, sometimes my back hurts with the flu. The infection can also enter the spine from nearby organs: urinary tract, kidneys.
Other reasons for developing back pain could be changes in hormone levels (e. g. 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 attack of pain, see a doctor as soon as possible. However, if the sensations are so strong that any movement causes agony, first aid is needed. You need to lie on your back on a flat, hard surface (such as the floor). This helps relieve cramps, relax muscles, and relieve pain.
If you are sinking on a flat surface, do not change the position of your back. Try to lie on your back and roll over on your side. This relieves the spine. When the pain subsides, roll back onto your back. It is recommended that you put something under your feet and lift them up. Lie in this position for 10-15 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 over there) and slowly get up. Only then do you carefully straighten your back.
Don't postpone a visit to the doctor to find out why your back is sore badly. This helps avoid new attacks.
diagnosis
You should definitely make an appointment with a therapist if you experience back pain:
- appear with physical exertion, muscle tension;
- last longer than 3 days;
- are repeated episodically.
A doctor must be consulted immediately in the following cases:
- the back hurts constantly;
- A rise in body temperature, numbness of the limbs, and lethargy of the limbs in the morning all contribute to the pain.
- the pain does not go away in the supine position;
- Pain worse at night.
At the appointment, the doctor will collect an anamnesis, examine the patient (assess the condition of the skin, the position and symmetry of the body, the gait, etc. ). Then he will assign studies:
- general analysis of blood and urine;
- Roentgen;
- 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 can include:
- Taking medication (anti-inflammatory, pain reliever, restorative);
- Blockade (long-term pain relief);
- physiotherapy procedures;
- Physical therapy exercises;
- Massages;
- manual therapy.
If conservative methods do not give the desired result, surgical treatment is prescribed. Modern methods make it possible to carry out traumatically precise operations with a short rehabilitation period.
Back pain prevention
Simple preventive measures can help prevent back pain. It is necessary:
- Monitor your posture.
- Sleep on a bed with a firm mattress.
- For activities that involve a long sitting position (driving, working on the computer), it is necessary to change your posture from time to time, to organize breaks and to warm up.
- If you stand for a long time, lean on something.
- Do not wear high heels for more than 2 hours in a row.
- Spend time doing moderate physical activity (swimming, fitness).
- Keep an eye on your weight - back pain can occur due to the presence of extra pounds.
- Try not to lift weights.
- Do not twist or bend with sudden movements.
- Timely treatment of urological and gynecological diseases.
The preventive annual visits to the therapist are also beneficial. Pathologies identified in the early stages can be eliminated without waiting for complications to develop.