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 the internal organs. A neurologist, orthopedist, nephrologist, and urologist can treat back pain, depending on its origin. It is difficult for the patient to understand the cause of the unpleasant sensations on his own and choose the right doctor. Therefore, it is initially necessary to contact a therapist, who, depending on the symptoms, history and results of the studies performed, will refer you to a narrow 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 muscles are constantly strained (when they simply can't relax). Also, 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 shortens, becomes tighter.
Trigger points result 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). Also, trigger points often occur with osteochondrosis.
Another contributing factor to trigger point formation is over-stimulation of sarcomeres (basic contractile units that 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 fully relax. He begins to tire quickly even with minor loads, strains excessively 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 surrounding the trigger point is also affected. Because of this, oxygen deficiency is observed in this area. Decomposition products accumulate, irritate the trigger point, and pain develops as a result. In this case, the size of the muscle does not matter, it all depends on the degree of irritation of the spot. Even the smallest muscle in the presence of trigger points in it can provide a lot of unpleasant sensations.
A feature of myofascial pain is their reflex. This means that the pain is reflected in other parts of the body. They can occur in areas very distant from the trigger points. So, for example, pain may develop under the shoulder blades or in the lower back due to the presence of knots in the abdominal muscles. Also, the lower back can hurt due to trigger points in the calf region or buttocks.
Myofascial pains are usually long-lasting and dull. Sometimes they occur only in motion, sometimes at rest. They can be different in strength: from mild 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 in the outer third of the fibrous ring of the intervertebral disc. The patient may experience pain with reflex muscle spasm, dystrophic or pathological processes in the facet joints. When moving, the pain intensifies.
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, straining, coughing, sneezing, and in most cases they are administered to the limb. Sometimes they are dull and sore, but more often they are sharp, shooting.
Psychogenic painoccur due to muscle spasms 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 ones.
Also, 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. Hence, the body warns us that something is wrong. The pain subsides after the tissues have completely healed.
Chronic painoccurs due to diseases of organs and systems or emotional disorders. If present, a thorough medical examination is required.
Depending on the location, the pain can be:
- Local.
- Reflection.
- Radiating.
Local pain develops directly at the site of the development of the pathological process. Reflex - if there are any trigger points. Irradiating - with damage to internal organs, it spreads along the nerve fibers.
Why does my back hurt?
Back pain can be caused by a variety of reasons, including:
- Curvature of the spine: scoliosis, kyphosis.
- Neurological diseases: herniated intervertebral discs, osteochondrosis, spondylosis, spondyloarthrosis.
- Endocrine disorders: osteoporosis.
- Diseases of the respiratory system: pleurisy.
- Kidney and urinary system disorders: urolithiasis, pyelonephritis, glomerulonephritis.
- Tumors.
Short-term pain (usually severe, burning) can be due to various reasons. These include:
- Injuries.
- Excessive 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.
- 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 great 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.
Back pain in rare cases can be of infectious origin. For example, sometimes my back hurts from 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, related to age, during or after menopause). In this case, hormonal spondylopathy (degenerative changes in the spine) occurs
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 needed. You need to lie on your back on a flat, hard surface (for example, the floor). This will help relieve spasms, relax muscles, and reduce pain.
When sinking on a flat surface, do not change the position of the back. Lying on your back, try rolling 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. Stay in this position for 10-15 minutes.
You also need to climb correctly: first roll onto your side. From this position, get on all fours. Then lean on something (if there is no support nearby, crawl towards it) and get up slowly. Only then do you carefully straighten your back.
To find out why your back hurts, don't put off a visit to the doctor. This will help avoid new attacks.
Diagnostics
You should definitely make an appointment with a therapist if back pain:
- appear during physical exertion, muscle tension;
- last more than 3 days;
- are repeated episodically.
It is necessary to visit a doctor immediately in the following cases:
- the back constantly hurts;
- to the pain are added an increase in body temperature, numbness of the limbs, lethargy of the limbs in the morning;
- in the supine position, the pain does not go away;
- the pains get worse during the night.
At the appointment, the doctor will collect anamnesis, examine the patient (assess the condition of the skin, position and symmetry of the body, gait, etc. ). Then he will assign the studies:
- general blood and urine analysis;
- X-ray;
- computed tomography;
- magnetic resonance.
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 can include:
- taking medications (anti-inflammatory, painkillers, restorative drugs);
- blockage (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, low-traumatic operations with a short rehabilitation period.
Back pain prevention
Simple preventative measures can help prevent back pain. It is necessary:
- Check your posture.
- Sleep on a bed with a firm mattress.
- Engaging in activities involving a long sitting position (driving, computer work), it is necessary to change posture from time to time, as well as organize breaks and warm-up.
- When you stand for a long time, lean on something.
- Don't wear high heels for more than 2 hours straight.
- 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 weights.
- Do not turn or bend over with sudden movements.
- Promptly treat urological and gynecological diseases.
Annual preventive visits to the therapist will also be helpful. Pathologies identified in the early stages can be eliminated without waiting for the development of complications.