The pain in the lumbar spine and nearby areas can disturb the patient at any time of the day, in standing, sitting, lying down or in motion, during exercise or at rest. This symptom is not as specific, that is, if you can find in such a large amount of cases, which requires special attention especially on the part of the patient: you should immediately contact your doctor.
The doctor use?
According to the statistics, up to 25% of patients seek medical help is in relation with the occurrence of pain in the lumbar region. 8 in every 10 inhabitants of the globe have experienced sensations of pain in the back at least 1 time in their life. Being most of the times suffer from these symptoms person healthy age, a little less – the people of retirement age, and even fewer - teens (according to various sources, from 8 up to 40% in portugal).
The therapist, a neurologist, rheumatologist
The first doctors to return the majority of patients with pain in the lower back, become a therapist, and a neurologist. And here are the young people with an injury in the recent past, once more turning to an expert.
And diagnostic and therapeutic tactics that these professionals will vary. Many times the therapist guides the patient to a neurologist, the neurologist determines the "your" diagnosis and assign treatment. Specialist more time to work "individually", in addition to the use of non-steroidal anti-inflammatory drugs, applies the techniques of manual therapy and физиолечение. Important for the patient – does not lose in this situation, is not to engage with promises of a cure is when you run techniques, not to resort to it again, in case of failure or, what is worse, intensified in the midst of this pain treatment.
When the conservative treatment, or medicines, one must understand that the treatment for four weeks, without success - a few good arguments for the revision of the diagnosis, treatment revmatologu, and not for the realization of cycles of repeated therapy. There are situations in which a patient with complaints of pain in the lower back receives symptomatic (or is only a pain reliever) treatment of certain шаблонной scheme, without clarifying the true cause of this pain.
The causes of lower back pain
The main causes of pain in the lumbar region is
- the changes of the structures of the spinal column, usually of age (degenerative), osteocondrose of the spinal column, a variety of hernia of the intervertebral disc or inappropriate for the muscular work of the complex. Such pain called primary, or is, directly related with the column;
- the pathological changes of the organs that are side-by-side with the painful area, but directly to the column not related (for example, disease of the internal organs, skin). The same category of causes include inflammation of joints, injury, endocrine diseases (for example, diabetes), - in a word, everything that does not fit in the standard "natural change" vertebral column. Such pain, called secondary.
Inspection at the office of the doctor
The pain, the heavy feel of mobility or increase the painful tension in the muscles, on the stretch between the lower ribs and the buttocks taken the labelling term "lyumbalgiya". If the symptoms of join pain in the leg, this state is called lyumbalgiya.
In the first place, it is important acuity, pain, or whatever the age of your occurrence. The pain with up to 12 weeks (3 months) draw acute, longer than 12 weeks – chronic. Chronic pain that is caused can proceed with the conditions and periods of improvement.
Of fundamental importance, such as the pain felt. Or the feeling of being at a particular point, or disclosure ("projection", "иррадиация") pain along the course of the nerve in the thigh, ягодицу, knee, foot, or fuzzy, "stupid," the pain. The need to understand the limited movement in the spinal column, in moments of pain, or movement of construction (this may indicate a mechanical nature of damage, such as, for example, when переломе vertebra). In which moments you will receive the pain? Occurs when the load, at rest, during the night of sleep? In the affirmative the answer to the last question is "red flag" to the expert, and makes us think about the diagnosis of inflammatory disease of the spine near the patient (let us pause a little later). If the pain intensifies, when the movement of the head, to walk, to jump, the more likely it is about the so-called projection of pain, which is why the damage of structures of the nerve (usually the sciatic).
Osteocondrose of the vertebral column, or spondilez – a condition in which occurs the seal and the deformation of the vertebrae, with the appearance of small bony surfaces, similar to the thorns on the edges of the vertebrae. For a long time, it was considered spondilez the natural result of the current degenerative processes, aging of the body. However, conclusively, that not only the age may be the cause of a degenerative disc disease. Property lifestyle, the increase in the load on the lumbar spine during prolonged operation of the computer or during long periods of driving (for example, the profession of driver, truck driver) contribute to the occurrence of degenerative disc disease, even in younger people. Under the influence of all these factors, межпозвонковые units of buffers become thinner, and the roots of the nerves that leave the spinal cord травмируются выросшими краевыми of thorns and bones. The constant irritation of these nerve root and causing pain. In Latin; the spine called the radix, therefore, is the inflammation making call of radikulit.
The so-called inflammatory disease of the spine – the area of interest in rheumatology. These mysterious diseases can "burn" a few years ago, starting mainly at a young age, and it strikes mostly men, and выливаясь end up with the obezdvizhennost' i invalidizatsiyu of the patient. The patients in this group usually "suffer until the end" and night pain and morning stiffness in the back, and the weakness and the growing decline of health. Unfortunately, from occurrences of the first symptoms of the disease until the enactment of a correct diagnosis, on average, it takes about seven years. During this time, changes in the spine can become irreversible, and functional (двигательная) activity – low. The spine becomes fixed, changes shape, appears the hump. Meets this pathology is not as common as the osteocondrose, for example, but the cost of treatment and the time the total disability of such patients, and much cheaper above.
If, in addition to back pain, the patient talks about the inflammation of the joints (generally, this is of the knee joints, the joints of brushes, or to stop), pain in the buttocks, volatile chair with natural impurities, blurred vision or eye pain, it is also urgent reason to refer you to a specialist for the realization of a specific additional search and exclusion of diseases in a group of spondiloartritov (for example, seronegative ankylosing or Crohn's disease).
There are disease, manifesting pain in the lower back and not affected vertebrate or nerve structures. One of these disease – myofascial pain caused. The patients (mostly young women) point to the long presence of posture problems or physical overload, preceding the development of headache. When врачебном inspection draws attention to the strong pain during pressure on specific points located near the spine. This condition reduces the patient's quality of life, but small changes in the muscle tissue (the local overvoltage) does not represent a risk to any of the nerve roots, or to the internal organs. Typically, the therapeutic effect is possible to achieve the target of a relaxed muscle, low doses of nsaids, the location of the introduction (bite) in "болевую point-steroidal anti-inflammatory medicine.
Examination
It is considered that if a patient with a complaint of pain in the lower part of the back does not have "alarm signals" (see below), the secondary, the examination he does not need, and the treatment can be carried out by a physiotherapist, without analysis, and even an x-ray. But, in practice, in almost any patient, such "signs" can be detected, and therefore, there is a need to donate blood, at least, in common (and better, and in the иммунологический), the analysis and carry out x-rays of the lumbar spine in two projections (preferably with the "seizure" of the pelvis).
- - Blood tests may reveal elevation of the sedimentation rate of erythrocytes (ESR), which indicates inflammation, perhaps immune source, or an infection. The increased level of white blood cells also says of an infection or inflammation, and expresses the anemia about the possible presence of a malignant process.
- - Examination of urine gives up when there is suspicion of kidney disease. The pain in the lumbar region, when this uses the recurring character, often spreading to the top, to the bottom ribs. If there are changes in the urine analysis pass through the ultrasound of the kidneys, and more tactics are discussed in detail with the therapist or urologist.
- - The radiograph is the cheapest of the suppliers of the surveys is the method of choice when the diagnostic finding in this case. In the x-ray you can see a violation of the structures of the vertebral column, signs of inflammation of the vertebral joints, for signs to determine the location of compression of the nerves. The "transparency" of the vertebrae in the x-ray will lead you on to thinking about osteoporosis (thinning) of the bone marrow of the skeleton. As you know, in the middle of the osteoporosis is more commonly found is the complication such as a fracture of the vertebra. If the fracture, unfortunately, has been carried out, it will also be seen in the x-ray. The ability of this method of research is huge, but if the pathology found, the need to clarify how serious the damage, you do not need if the patient intervention in the spine. To this already requires more accurate search послойное (ct). There are two types of tomography – computerized x-rays and magnetic resonance imaging.
- - Computed tomography (CT). Method of search that allows you to, literally, look at the inside of the spine. All of the bony structures, which are not visible when the conventional radiography, in the tomogram will be quite visible. If necessary, using the data and a special pc program, it is possible to reconstruct a 3D model from any interest to the structure.
- - Magnetic resonance imaging (MRI). Not x-ray method of research. Is different from a ct scan, that allows the doctor to more carefully assess the state of the "soft" structures of the vertebral column (in CT as well only visible bone items): the spinal cord, the nerve root. More details when the exam can be seen insects hernia, changes of the blood vessels and muscles. Usually is a specialist in magnetic resonance imaging remains the last word when the diagnosis the research and determination of future tactics.
Signs that you should pay attention
Side of pain in the back, that is, have no communication with остеохондрозом – disturbing symptom, forcing the more quickly as possible to begin the search for the core of a disease process that causes pain. Briefly in symptoms that may indicate a possible secondary (or is, not directly related to the column) the nature of the headache and require greater surveillance, as the doctor and the patient:
- quick sudden loss of body mass can occur tumour);
- infections of the kidneys and bladder (in this case, the pain can be a symptom of pyelonephritis);
- the gain of pain at rest or after a good night's sleep (this symptom is especially interested in rheumatology, as well as can be a sign of the evolution of the disease Ankylosing);
- the increase of the temperature of the body;
- changes in blood tests (increased blood clotting, detected when you run coagulogram, the increased level of white blood cells or the decrease of the hemoglobin, as well as the increase of ESR (erythrocyte sedimentation rate), general, analysis, improvement of the level of c reactive protein in the analysis);
- established the diagnosis of osteoporosis", or medicines that reduce the amount of calcium in the bones;
- above the age of 50 years (risk of development of osteoporosis in menopausal women) or less than 20 years, this applies especially to young people;
- the reference to the injury, regardless of their age (for example, falling from a height of over 2 metres, and the elderly, significant injury is already the fall of your own body);
- signs of severe neurological deviation (violation of the sensitivity of the skin, urinate or defecate normally, it indicates the profound defeat of the spinal cord);
- the inefficiency of the "routine" treatment for 4 weeks.
Maintain activity and mobility
It is a common mistake and the fulfillment of resting in bed when the acute back pain. The movement of this pathology of the musculoskeletal system is not easy, but it is necessary! In all cases, in addition to the compression radicular syndrome (this diagnostic is installed the neurologist), and finding, in the horizontal position, increases the cost of treatment and tightening the time limits for the recovery. Yes, and when radicular syndrome of the total time resting in bed should not be more than two days.
When inflammatory diseases of the spine and крестцово-iliac joints for physical activity – the primary tool for dealing with the coming disability. Remember, this group of diseases has, gradually, a character, and exercises, in order to maintain the flexibility and the development and strengthening muscular "corset" for the spine, can be considered as effective method of treatment, such as special therapy anti-inflammatory drugs, drugs of different groups, assigned to the experts.