Spinal pain (back disease) is a common body language that indicates disorders in the body. There are almost as many causes as there are terms used to describe the symptoms.
Spinal discomfort is the main reason people seek medical help. Almost 80% of the adult population faces this problem. Back pain causes a significant degree of disability and can be a problem that continues from childhood into adulthood.
Back pain affects almost every aspect of life. Interrupted sleep and difficulty bending, reaching, or turning. Difficulties arise when driving, walking, lifting heavy objects and exercising. If you have pain in your spine, you should consult your doctor immediately. The specialist will study the patient's medical history, collect medical history and conduct an examination. If any violations are detected, conservative or surgical treatment is prescribed.
Why does my spine hurt?
The cause of back pain is muscle tension and spasm. Stress can be the result of heavy work, uncomfortable posture, and even poor posture.
Studying the anatomy of the spine can help understand the problem at a deeper level. Main parts of the spine:
- The cervix is a mobile segment that is subject to degenerative changes. With age, pain often occurs in what is called the "transition zone" between the flexible cervical vertebrae and the stiffer thoracic portion of the spine.
- Thoracic cage - connected to the chest and connected to the ribs. Older adults, in particular, may suffer compression fractures in this area due to bone loss.
- Lumbar – lower back. Younger patients are more likely to have discogenic low back pain, while older patients are more likely to have structural joint disorders.
- Sacrum – lowest part of the spine. It consists of a flat, triangular sacrum connected to the hip and coccyx. Degeneration in this area often occurs in older patients or after a fall.
Between the upper back and the coccyx are the 17 vertebral bodies, multiple joints, the sacrum and coccyx, as well as fibrous and muscular support structures, intervertebral discs, spinal cord, nerve roots and blood vessels. The spine is more than the sum of its parts, but here's what you need to know about those parts.
The spine usually consists of 33 vertebrae, each vertebra divided by an intervertebral disc. Vertebrae are a series of small bones to which muscles are attached. Each vertebra consists of two parts: the anterior arch, which protects the spinal cord and nerve roots, and the posterior arch, which contains the spinal canal and also protects the spinal cord.
The back muscles are divided into three groups:
- medial - responsible for the movement of the ribs;
- internal – stabilizes the spine, controls the movement and position of the spine;
- superficial - provides movement of the neck and upper limbs.
The muscles that support the spine are structured in layers. They act as primary stabilizers of bone and ligament structures. Tension of these muscles can occur in patients of different age groups.
There are other parts of the spine that need to be considered when determining back pathology. These include ligaments and tendons, discs and joints that provide stability and mobility.
Inflammatory diseases, malignant tumors, pregnancy, trauma, osteoporosis, nerve root compression, radiculopathy, plexus disease, osteonecrosis, disc herniation, spinal stenosis, functional disorderssacroiliac joint, facet joint injury, and infection are all part of the differential. Differentiating the signs and symptoms of nociceptive (mechanical) pain from radiculopathy (back radiculopathy) is an important first step in diagnosis.
Degenerative disease
Degeneration includes endplate-related changes (sclerosis, defects, modal changes, and osteophytes) as well as disc changes (fibrosis, annular tears, desiccation, loss of height, and degenerationannulus fibrosus).
Degenerative changes in the intervertebral disc have been observed in one-third of healthy people aged 21 to 40 years. The high rate of asymptomatic degeneration must be taken into account when evaluating spinal symptoms.
As you get older, the disc becomes more fibrous and less elastic. Degenerative changes progress when the structural integrity of the posterior annulus fibrosus is compromised by overload. This will eventually lead to the formation of cracks in the fiber ring. Herniation is defined as displacement of disc material (cartilage, nucleus, fragmented annular tissue, and apophyseal bone) outside the disc space.
Rachiocampis
The natural curves of the spine are important to ensure strength, flexibility and even load distribution. There is a normal range of natural curves. Abnormal curvatures include lordosis, kyphosis, and scoliosis.
Abnormal curvature
Lordosis, a spinal disorder, is defined as a severe inward curvature of the spine. Although this disease most commonly affects the lumbar spine, it can also develop in the cervical spine.
The normal range of curvature is considered to be between 40 and 60 degrees. Changes in posture can lead to an unsteady gait and changes in shape - the buttocks become more visible. Causes of abnormal curvature: spinal degeneration, osteoporosis and obesity.
Abnormal kyphosis
Kyphosis, a spinal disorder, is defined as an excessive outward curvature of the spine that can lead to a forward tilt. Usually it affects the thoracic or lumbar region, but can also occur in the cervical region.
The normal range for kyphosis is considered to be between 20 and 45 degrees. But when a structural abnormality leads to the development of a kyphotic curve outside this normal range, the curvature becomes abnormal and problematic. Show it by rounding your shoulders and tilting your head forward.
Scoliosis
Defined as an abnormal lateral curvature of the spine. Scoliosis is a progressive structural disease. Lordosis and kyphosis are characterized by a backward or forward curvature of the spine. Scoliosis involves an abnormal sideways curvature of the spine.
The most common form of scoliosis is juvenile scoliosis, diagnosed between the ages of 10 and 18 years. The remaining 20% are due to neuromuscular, congenital, degenerative and traumatic causes.
Developmental abnormalities
This symptom often occurs with developmental defects and may be associated with neurological manifestations.
Back pathology presents with the following developmental anomalies:
- Separation – with small bony defects, moderate discomfort in the lumbosacral region. After a while, root syndrome occurs.
- Lumbago, decentralization - root compression is accompanied by soreness or burning pain. Sensory disorders or paralysis may be added.
- Wedge vertebrae - discomfort that occurs when stressed and maintaining a static body position for a long time. Accompanied by chest deformity and poor posture.
Osteoporosis
Usually affects the thoracic and lumbar spine and can cause debilitating pain. This disorder is caused by loss of bone mineral density, leading to brittle bones.
Osteoporosis can cause vertebral fractures, loss of height, stooped posture and even hunchback. To prevent osteoporosis, it is necessary to ensure a balanced diet, quit smoking and abuse alcohol. An active lifestyle is also encouraged.
Injury
The severity of the back condition corresponds to the severity of the injury. As a rule, it is associated with signs of damage to nervous tissue.
Causes of injury causing spinal pain:
- Bruises are the result of a direct blow or fall on the back. Back pain is localized and moderate. Gradually disappears after 1-2 weeks.
- Dislocation – occurs due to high energy impact. Accompanied by severe pain combined with disorders of sensitivity and motor activity. General condition is also affected.
- Spondylolisthesis is an injury to the lumbar spine. Back pathology spreads to the legs, with positive symptoms of axial load.
- Compression fracture - occurs when falling on the buttocks or jumping from a height. The pain is intense at first, then becomes intense and progresses with movement.
Pathological fractures that occur due to osteoporosis or tumors are manifested by mild discomfort, pain and persistence. They remain unchanged for a long time.
Inflammatory and infectious diseases
Ankylosing spondylitis is accompanied by a feeling of stiffness and dull pain in the lumbar region. There is a characteristic circadian rhythm - symptoms occur at night and intensify in the morning. Intensity decreases after physical activity and water procedures. Back pain increases with rest and decreases with movement. Over time, the mobility of the spine is limited and kyphosis forms.
In addition, pain in the spine occurs with tuberculosis. Profound local discomfort is characteristic of vertebral destruction. Back pain increases with exercise and is accompanied by excessive skin sensitivity. With aching and radiating pain, we are talking about nerve root compression. This condition is complemented by stiffness of movement.
With osteomyelitis, severe back pathology is noted. The disease is diagnosed in patients in childhood and adolescence. Characterized by hematopoietic properties. The discomfort increases with movement, so the patient remains in bed. Osteomyelitis is accompanied by fever, weakness, and local swelling.
Arachnoiditis is manifested by pain radiating to the innervation zone of the nerve root. Symptoms become constant and resemble sciatica. They are complemented by movement disorders, sensitivity disorders and loss of control of the pelvic organs.
Tumor
Benign tumors have hidden progression or are accompanied by slowly progressing and few symptoms. Most often, hemangiomas appear, appearing only in 10-15% of cases. The discomfort is aching, localized. Progresses at night and after physical activity. Spinal cord neoplasia is accompanied by nerve root pain and impaired nerve conduction.
Spinal sarcoma in its advanced stages is initially characterized by moderate episodic pain that gradually increases at night. Accompanied by limited motor activity and nerve root syndrome. Discomfort localized in internal organs, legs or arms (taking into account the extent of the location of the tumor).
Other diseases
Discomfort in the spine is also observed with:
- Spinal epidural hemorrhage - similar to signs of radiculitis, accompanied by spinal conduction disorders.
- Calvet disease - spreads to the legs, occurs periodically, mild symptoms. Decreases when lying down, increases with physical activity.
- Forestier's disease - localized in the chest area, spreading to the lower back or neck. Symptoms are usually short-lived. May be accompanied by pain in the elbow or shoulder joints. Spinal stiffness cannot be ruled out.
Back pain sometimes occurs with mental disorders. In this case, the clinical picture is unusual - it does not correspond to the symptoms of possible diseases.
Causes of back pain by location
Chronic upper back disease affects 15 to 19% of people worldwide. Postmenopausal women are at higher risk, possibly due to osteoporosis and vertebral fractures.
Occupational activities also lead to back pain. People who have to maintain a fixed body position for long periods of time, such as dentists or salespeople, are more likely to experience this problem than others. Office workers experience upper back discomfort due to poor working environment.
Back pain can occur at many different points in the spine. The localization indicates the cause of discomfort and greatly aids in diagnosis.
Pain on the right side
The cause is excessive body weight, slipped disc or myositis. On the right side of the back, discomfort also appears with hunchback.
Among the somatic pathologies there are salpingitis, oophoritis, nephritis, cholecystitis. Appendicitis and the presence of stones in the organs of the urinary system also require attention.
Pain on the left side
The left back pain is caused by splenitis (spleenitis), urinary stones, ovarian inflammation, duodenitis, and root compression. Unpleasant sensations above the lower back indicate inflammation of the serous membranes of the lungs, bronchial damage, ischemia and intercostal neuralgia.
Pain in the lumbar region
The lumbar region is more often than other regions subject to the development of pathological processes from the spine. This is due to the fact that it bears a huge load. When nerve roots are damaged, inflammation develops. Protruding hernias and osteonecrosis may also occur.
Less often, the cause is a combination of prostatitis and urethritis, violation of bone tissue structure, decreased density, lumbar sciatica, arthritis, spinal tuberculosis. Discomfort in the lower back in most cases is chronic.
Pain in the right lower back
Back disease occurs when:
- myositis;
- tuberculosis;
- scoliosis;
- osteomyelitis;
- spondylitis.
May indicate the presence of a tumor. Talk about radiculitis. Indicates liver dysfunction.
Pain in the left lumbar region
Localized discomfort occurs mainly after physical activity. The condition returns to normal after rest. If the discomfort does not subside with rest, then we are talking about scoliosis, osteoarthritis, spinal infections and circulatory disorders.
Nerves are compressed
In most cases, the sciatic nerve is compressed (sciatica). At the same time, its myelin sheath is not damaged. Usually it develops against the background of osteoarthritis. Accompanied by acute, severe symptoms spreading to the lower back, sacrum and lower limbs.
Spinal nerve roots are also compressed during nerve root compression. The cause is due to disc herniation or reduced space between vertebrae. Feeling of "superficial" discomfort, which increases significantly when exercising, sneezing, coughing.
Intervertebral hernia
It is characterized by extrusion (protrusion) of the nucleus into the intervertebral canal. In most cases, it develops against the background of osteoarthritis. The central portion of the extruded core compresses the spinal cord. Even a light load can lead to progression of the pathological process. Back pain is sharp and acute, radiating down the legs or arms.
Pain in the shoulder blade
Based on the nature of the back pathology, a presumptive diagnosis can be determined:
- dull, develops – stomach ulcers;
- acute, aggravated by movement – intercostal neuralgia;
- hand numbness, pressure changes, dizziness – osteonecrosis;
- radiates below the clavicle - aggravates angina.
Pain along the spine and in the back
Develops due to nerve endings being compressed on the curved base of the spine. If the symptoms are not clearly expressed, we can talk about the phenomenon of protrusion. Increased symptoms suggest osteochondrosis, myositis, or fractures.
Severe discomfort along the spine indicates worn or thinned discs. May indicate spondylitis. The pain is constant and sharp.
Pain below the waist
Most often they occur with osteoarthritis of the spine and osteoarthritis. Less common in diseases of the female genital area (oophoritis, cervicitis, endometritis, etc. ). They can appear during pregnancy, during menstruation, when suffering from appendicitis or ulcerative colitis. In men, indicates diseases of the bladder or prostate.
Diagnose
First, a physical examination is performed to identify signs that further testing is needed. The medical examination includes the following procedures:
- Examine your back and posture to identify anatomical abnormalities.
- Palpation/percussion of the spine - evaluates the condition of the spine and painful areas.
- Neurological examination - evaluates reflexes, spinal sensitivity and gait characteristics. For patients with suspected radiculopathy, neurological examination should focus on the L5 and S1 nerve roots.
Patients with psychological disorders contributing to back pain may have accompanying physical signs, also known as Waddell signs. These include patient hyperresponsiveness on physical examination, superficial pain, and unexplained neurological signs (eg, loss of sensation, sudden weakness, or jerky movements on motor examination). The presence of multiple Waddell signs suggests a psychological component to the back pathology.
Treatment of spinal pain
In case of back problems, treatment must be performed by a doctor. The specialist refers the patient for examination and, based on the results obtained, prescribes effective treatment.
Complementary treatments should be used with caution and after consulting your doctor. Any medication has risks and possible side effects, so self-medication is unacceptable.
Help before diagnosis
Basic home remedies that can be effective in combating mild to severe pain from muscle strain include:
- Short rest period. Many low back pain can be relieved by eliminating physical activity. You should not rest for more than 2-3 days because prolonged inactivity will hinder the wound healing process.
- Changes in operations. You should stay active but avoid activities and body positions that make back disease worse. For example, if sitting for long periods in the car or sitting at a desk makes you more uncomfortable, you should warm up every 20 minutes.
- Exposure to heat or cold. Applying heat or taking a warm bath helps relax tense muscles and improve blood flow, reducing discomfort. If your lower back hurts due to inflammation, you can apply ice or a cold compress to reduce swelling.
The most common over-the-counter medications to treat back conditions are ibuprofen, naproxen, and acetaminophen. The medication reduces inflammation and eases lower back discomfort.
Conservation therapy
Treatment with oral medications:
- Analgesic. The patient is prescribed drugs from the anilide group, such as paracetamol. Provides long-lasting pain relief. They have a synergistic effect with NSAIDs and are used in combination to enhance pain relief without increasing toxicity.
- Nonsteroidal anti-inflammatory drugs. They have pain-relieving properties. At higher doses, they have anti-inflammatory effects.
- Muscle relaxants. They work centrally, affecting the activity of muscle stretch reflexes. The combination of NSAIDs and muscle relaxants significantly reduces back pain. The main side effects are drowsiness, headache, dizziness and dry mouth.
- Neuropathic pain relievers. Tricyclic antidepressants relieve chronic pain. Low doses may be enough to control symptoms. They do not have an immediate effect and may need to be continued for several weeks before symptoms improve. Plays a potential role as discomfort is mediated by both peripheral and central mechanisms.
Local or regional anesthesia by injection is part of the treatment regimen for some patients with back pain. The injection site can be a locally injured area or a myofascial trigger point (painful muscle area).
Epidural corticosteroid injections are used for radicular pain that does not respond to less invasive treatments. Used to alleviate intervertebral herniation, spinal stenosis, and radiculopathy. Reduce back pathology and quickly restore sensory function.
Surgery
A small percentage of people with back pain need surgery to improve their condition. Indications for surgery vary depending on patient characteristics and include:
- severe nerve root symptoms, especially when there is progressive neuromotor impairment;
- Root symptoms are not amenable to conservative treatment.
The choice of surgical intervention is determined by the characteristics of the spinal injury. Surgery is most effective when the patient's clinical picture is dominated by symptoms of nerve compression. The most common problem is incomplete nerve decompression. Related diseases include hip arthritis, osteoporosis and cardiovascular disease.
Surgery for patients with radicular pain due to disc herniation primarily involves decompression. Protruding, extruded or isolated disc material will be removed. The nerve root is examined and released.
Prevent
Complications are largely determined based on cause. They are divided into physical and social. The first type includes chronic pain, disfigurement, neurological effects with motor or sensory impairment, and bowel or bladder damage. Socially, complications are often measured in terms of disability and reduced performance.
Patients of all ages should:
- eliminate bad habits;
- live an active lifestyle;
- strengthens the body's protective functions;
- Lift heavy objects properly;
- undergo preventive examinations with your doctor.
It is important not to slouch and keep your back straight. Sleeping and working places must be properly organized. You should do light exercises every day after waking up. You should also balance your diet by enriching it with foods that have enough vitamins and minerals. It is recommended to take a contrast shower in the morning.