Back pain is a common problem among middle-aged and elderly patients. It can be caused by improper lifestyle, pathologies of the musculoskeletal system, diseases of the internal organs. A neurologist, orthopedist, nephrologist and urologist can treat back pain, depending on their origin. It is difficult for the patient to understand the cause of the unpleasant sensations and to choose the right doctor. That is why it is first necessary to contact a therapist who, depending on the symptoms, history and results of the tests, 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. The trigger points are similar to peas, which are formed when the muscles are constantly tense (when they simply cannot relax). In addition, when one segment of the muscle fiber is compressed, the others stretch. This affects the mobility of the muscle fiber: it is limited. The fiber itself shortens, becomes tighter.
Trigger points arise from muscle strain. Moreover, overexertion can occur not only due to excessive physical activity, but also due to prolonged stay in one position (for example, sitting at a computer). Also, trigger points often occur in osteochondrosis.
Another factor that contributes to the formation of trigger points is the excessive 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 relax completely. She begins to get tired quickly even with small loads, overexertion 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 to the tissues around the surrounding point also suffers. Therefore, oxygen starvation is observed in this area. Decomposition products accumulate, irritate the trigger point and therefore develop 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 in it can deliver many unpleasant sensations.
A characteristic feature of myofascial pain is their reflection. This means that the pain affects other parts of the body. They can occur in areas very far from the trigger points. For example, pain may develop under the shoulder blades or in the lower back due to the presence of nodules in the abdominal muscles. Also, the lower back may hurt due to trigger points in the calf area or in the buttocks.
Myofascial pain is usually long-lasting and dull. Sometimes they appear only when moving, 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 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, disorders of the central nervous system. Such pain can be observed in osteoporosis, spondylolisthesis, hernias and spinal fractures. They are intensified by bending, moving, straining, coughing, sneezing and in most cases are given to the limb. Sometimes they are dull and painful, but more often they are sharp, shooting.
Psychogenic painoccur 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.
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 painusually develops due to tissue damage (deep, superficial) due to cuts, wounds, inflammation. In this way, the body warns us that something is wrong. The pain disappears after the tissues are completely healed.
Chronic painoccurs due to diseases of organs and systems or emotional disorders. If present, a thorough medical examination is required.
By location, the pain can be:
- Local.
- Reflected.
- Irradiating.
Local pain develops directly at the site of development of the pathological process. Reflected - if there are trigger points. Irradiating - with damage to internal organs, spreads along nerve fibers.
Why does my back hurt?
Back pain can be caused by a variety of reasons, which include:
- Curvature of the spine: scoliosis, kyphosis.
- Neurological diseases: intervertebral disc herniation, osteochondrosis, spondylosis, spondyloarthritis.
- Endocrine pathologies: osteoporosis.
- Respiratory system diseases: 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. They include:
- Injuries.
- Muscle strain (due to monotonous posture or performing the same type of repetitive movements).
- Hypothermia.
Pain caused by degenerative processes occurs in the following diseases:
- Osteochondrosis.
- Intervertebral hernia.
- Protrusion of the intervertebral disc.
- Spondylolisthesis.
- Degenerative scoliosis.
- Osteoarthritis.
- Spondylolisthesis (vertebral displacement).
- Spondylolysis (nonunion of the spinal 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.
- The esophagus.
- Gallbladder and bile ducts: 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. Also, 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 occurs (degenerative changes in the spine)
My back hurts a lot: what to do?
If you have a severe attack of pain, be sure to see a doctor as soon as possible. However, if the sensations are so strong that any movement causes torture, first aid is needed. You should lie on your back on a flat, hard surface (such as the floor). This will help relieve spasms, relax muscles and reduce pain.
When sinking on a flat surface, do not change the position of your back. Lie on your back, try to roll over on your side. This will relieve the spine. When the pain subsides, roll over on your back. It is advisable to place something under your feet by lifting them. Lie in this position for 10-15 minutes.
You also need to climb properly: roll over to the side first. From this position, get on all fours. Then lean on something (if there is no support nearby - crawl to it) and slowly get up. Only then carefully straighten your back.
To find out why your back hurts so much, do not delay a visit to the doctor. This will help avoid new attacks.
Diagnosis
You should definitely make an appointment with a therapist if you have back pain:
- appear during exercise, muscle tension;
- last more than 3 days;
- are repeated sporadically.
You should see a doctor immediately in the following cases:
- the back hurts constantly;
- fever, tingling in the limbs, lethargy of the limbs in the morning are added to the pain;
- lying down the pain does not disappear;
- pain worse at night.
During the meeting the doctor will collect the anamnesis, will examine the patient (assess the condition of the skin, the position and symmetry of the body, gait, etc. ). He will then commission studies:
- general analysis of blood and urine;
- X-rays;
- CT;
- magnetic resonance.
If necessary, the therapist will refer the patient to a neurologist, orthopedist, urologist, gynecologist or nephrologist.
Treatment of back pain
The treatment of back pain is comprehensive and may include:
- taking medication (anti-inflammatory, analgesic, restorative drugs);
- 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 allow the performance of low-trauma precision operations with a short rehabilitation period.
Prevention of back pain
Simple preventative measures can help prevent back pain. It's necessary:
- Watch your posture.
- Sleep on a bed with a firm mattress.
- When engaging in activities that involve long sitting (driving, working in front of a computer), it is necessary to change posture from time to time, as well as to organize breaks and warm-ups.
- When you stand for a long time, lean on something.
- Do not wear high heels for more than 2 hours in a row.
- 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 with sudden movements.
- Treat urological and gynecological diseases in time.
Preventive annual visits to the therapist will also be helpful. Pathologies identified in the early stages can be eliminated without waiting for complications to develop.