Low's painindicates a disease or damage to the spinal column, nerve structures, soft tissues, internal organs, is observed with feverish states of various genesis.It is acute, stupid, constant, periodic, burning, shooting, bursting.Sometimes it is associated with physical activity, changes in the weather.Pathologies, manifested by lower back pain, are diagnosed on the basis of complaints, anamnesis, examination data and additional studies: radiography, MRI, CT.Before making a diagnosis, peace is necessary, sometimes it is permissible to use ointments, taking analgesics.
Why does the lower back hurt
Spinal diseases
A common cause of lower back pain is congenital anomalies and acquired diseases of the spinal column.The nature of the pain syndrome varies.Pain caused directly by the pathological process, often periodic, local, aching or pulling, are associated with weather, physical activity, stay in an uncomfortable position.
Due to the spasm of the muscles, lumbago (lateral) occurs-a sharp pain accompanied by restriction of movements.With many pathologies of the spine, lumboyshialgia is observed - aching, burning or firewood, radiating on the back of the thigh.Painful sensations are often found in the radicular syndrome.Can be detected in the following diseases of the spinal column:
- Degenerative pathologies: osteochondrosis, protrusion of the intervertebral disk, intervertebral hernia, spondylosis, spondylo arthrosis.
- Congenital anomalies: sacralization, lumbalization.
- Polyetiological conditions: spondylolis, spondylolist.
- Vascular diseases: Violations of spinal circulation.
- Other diseases: Foreness disease.
- Secondary lesions of nervous structures: lumbosacral radiculitis, lumbosacral plexitis, myelopathy of various genesis.
Curvature of the spine
Minor or moderate aching pains are noted for all types of curvature of the spinal column, which is associated with non -violeological redistribution of the load, overvoltage of the muscles and ligaments of the back.Soreness appears as a result of an uncomfortable body position, sleep on too hard or too soft bed.The symptom is accompanied by:
- lordosis;
- kyphosis;
- scoliosis;
- kyphoscoliosis;
- Flat back syndrome.
Osteoporosis
Pulling or aching painful sensations in the lumbar and thoracic spine for a long time are the only symptom of osteoporosis.The pain syndrome is expressly expressed, intensifies after the load, before changing weather conditions.The symptom is observed at the following varieties of osteoporosis:
- postmenopausal;
- Juvenile;
- idiopathic;
- senile.
Similar pains are detected in patients with secondary forms of pathology, due to genetic diseases, endocrine disorders, chronic intoxications, and taking some drugs.Secondary osteoporosis can also occur against the background of malabsorption syndrome, liver diseases, KHPN, rheumatoid arthritis, well.
Strengthening pain, increasing the duration of pain may be associated with the development of a pathological fracture.Other signs of trauma are often not expressed, so the fracture often remains undiagnosed.
Spinal injuries
The most common damage is the bruise of the spinal column.In mild cases, pathology is manifested by moderate lower back pain, intensifying during movements, local edema, and sometimes hematomas and hemorrhages.In severe bruises, neurological disorders are added to the listed symptoms.
The compression fracture of the lumbar spine occurs due to violent flexion of the body.It is characterized by sharp pain, holding breathing at the time of injury.Then, an increase in pain in case of corps turns is noted, soft tissue edema is detected.Palpation of the spinous process is painful.Other possible fractures include damage to arcs, transverse processes, spinous processes.
In addition, lower back pain is found in patients with traumatic spondylolistisis and subluxation of the vertebrae.Painful sensations are paroxysmal, resemble lumbago, complemented by a sense of severity and numbness of the lower extremities.
Injuries of soft tissues and kidneys
The injury of soft tissues is accompanied by insignificant or moderate rapidly subsiding local pain, small edema.Hemorrhages are possible.There is no blood in the urine.The kidney bruises are manifested by pain and insignificant short -term hematuria.In case of kidney injuries, the painful syndrome is intense, pain radiates to the lower abdomen, groin, and genitals.A hematoma is visible in the lumbar region.In severe cases, severe pain, prolonged macrohematuria are observed.The shock condition develops.
Spine and spinal cord infections
Osteomyelitis of the spine can be hematogenous, post -traumatic, contact, postoperative.The acute form of the disease is manifested by rapidly increasing lower back pain, combined with chills, fever, intoxication syndrome, and a deterioration in general condition.The pain twitching, bursting, so intense that they prevent any movements, force the patient to freeze in bed.In chronic osteomyelitis, manifestations are smoothed out, a fistulous course with purulent separated is formed.
Tuberculosis of the spinal column develops gradually.At first, periodic deep pains are observed, enhanced after the load, the increased sensitivity of the skin in the projection of the affected vertebrae.The stiffness of the gait is formed.Against the background of significant destruction of bone structures, the nature of the pain changes, since it is caused by the compression of the nerve roots.The pain becomes burning, radiate to the legs, complemented by paresthesia, numbness.
In patients with spinal epidural abscess, the pain is severe, deep, poured, combined with chills, hyperthermia, muscle tension.Taping on the spinous processes of the vertebrae is painful.With the progression of pathology, rooster syndrome occurs, then paresis, disorders of the pelvic organs develop.
Local inflammatory processes
Purulent processes in surface tissues and near -soil fiber are accompanied by intense lower back pain.Possible causes of pain syndrome are boils, carbunks and paranephritis.
In the first two cases, the abscess is formed in the skin, looks like a limited, sharply painful seal with a diameter of 1 cm of crimson or crimson-blue shade with one or more rods in the center.The pain intensifies quickly, becomes twitching, pulsating, losing sleep.General hyperthermia, insignificant or moderate violation of the general state are noted.
With paranephritis, a pronounced fever occurs at first.The pain syndrome develops after 2-3 days.The pains are very intense, can be given to the stomach or hypochondrium, intensify when walking, movements, deep breathing.In some forms of paranephritis due to pain, the patient takes a forced position.The lumbar muscles are tense.Edema, local hyperemia, hyperthermia are detected.The condition is serious.
Infectious diseases
Diffuse aching pain in the lower back, causing a desire to change the position of the body, are characteristic of acute infections, accompanied by an increase in temperature and intoxication syndrome.In most cases, they are due to myositis, often combined with pain in the muscles of the limbs.Observed with influenza, tonsillitis, acute respiratory viral infections.Sometimes pain is provoked by kidney damage.The infectious diseases accompanied by pain in the lower back area include:
- hemorrhagic fever;
- Japanese mosquito encephalitis;
- Ebola fever;
- foot and mouth disease;
- severe form of coronavirus infection;
- Generalized forms of bacterial, fungal, viral infections.
In a number of patients, the lower back pain is observed with a cytokine storm - an inflammatory reaction that develops against the background of severe infectious diseases.Epidemiological myalgia is accompanied by intense paroxysmal pains up to 10 minutes, which appear not only in the lower back, but also in other parts of the back, in the area of the abdominal wall, chest, limbs.Repeated with an interval of 30-60 minutes.Combined with rhinitis, conjunctivitis, severe hyperthermia.
Other muscle lesions
The aching pain in the muscles of the lumbar region is determined after intense physical exertion - the performance of strength exercises for the muscles of the back, a long stay in a forced position with a tense lower back.Myalgia subsides at rest, intensifies during movements, weakens after warming, neat warm -up, disappears after a few days.
Myosites develop not only with infectious diseases, but also after hypothermia or overload, against the background of exogenous intoxication, metabolic disorders.Accompanied by long -term aching pain.There are also special forms of myositis:
- specific infectious myositis for syphilis and tuberculosis;
- idiopathic, juvenile dermatomyositis and polymiositis;
- Polymiositis and dermatomyositis for oncological pathologies, systemic diseases of the connective tissue.
Chronic diffuse pains in the whole body, including the lower back, are observed with fibromyalgia.They are combined with sleep disturbances, asthenia, neurotic disorders.
Other diseases
In addition to the listed pathologies of the lower back, they can bother with such conditions as:
- Tumor of the spine, spinal cord: sarcoma, hemangioma, metastases, intramedullary and extragraul neoplasms of the spinal cord.
- Kidney disease: pyelonephritis, glomerulonephritis, urolithiasis, kidney heart attack, renal vein thrombosis, kidney cyst, kidney cancer, purulent processes.
- Hereditary diseases: hereditary cerebellar ataxia Pierre-Marie.
- Exogenous intoxications: abuse of phenylpropanolamine.
- Pathologies of the heart and blood vessels: endocarditis Leffler, aneurysm of the abdominal aorta.
- Emergency conditions: hemotransfusion shock.
For diseases of the pelvis, the irradiation of pain in the lower back is sometimes noted.The appearance of a symptom is possible with a number of female diseases, prostate cancer, projection, sigmoid.
Diagnostics
Primary diagnostics is carried out by an orthopedic traumatologist.In the presence of neurological symptoms of the patient, the neurologist examines.The doctor interviews the patient, performs an objective examination.According to the testimony, consultations of a surgeon, rheumatologist, urologist, and other specialists are appointed.The diagnostic program may include:
- Neurological examination.In the process of research, the specialist evaluates reflexes, muscle strength, coordination of movements, deep and superficial sensitivity.
- X -ray.On the radiographs of the lumbar department, fractures, a decrease in the height of the intervertebral discs, other degenerative changes, volumetric formations, signs of inflammatory processes, and spondylolisthesis are visible.If necessary, standard radiographs are complemented by functional studies.
- Other neuroimaging methods.To clarify the data of radiography, CT and MRI are used.During computed tomography, the structure of solid structures is studied in detail, the state of the ligaments and intervertebral discs is examined on the MRI.To exclude stenosis, myelography is performed.
- Functional research.The condition of muscles and nervous conductivity is evaluated using electromyography, electroneorography, and studies of caused potentials.
- Laboratory tests.To confirm the infectious nature of the disease, the determination of the pathogen makes blood tests and microbiological examination.To detect neuroinfections, serological reactions are used.
According to the testimony, an ultrasound of the kidneys, prostates, the pelvic organs, urine tests, abdominal aorta, other studies, and other studies are performed.
Line pain treatment
Help at the prehospital stage
With traumatic damage to the spine, it is necessary to lay the patient on the shield and immediately deliver to the medical institution.In case of non -human pain, it is necessary to reduce the load on the back, optimize the position of the body during work and rest.Acute pain syndrome is an indication for consulting a neurologist.
Prior to the expert examination, a single intake of analgesics is possible.In lumbago, lumbar -ilgia caused by previously diagnosed degenerative diseases of the spine, the use of warming and painkillers of local acts is allowed.If there is a suspicion of the presence of an infectious process, local funds are not shown.
Conservative therapy
The basis of treatment is physiotherapeutic measures and drug therapy.The patient is prescribed a protective regime.Apply the following methods:
- NSAID.Effective in acute and chronic muscles and spine.Used in the form of tablets, local products.
- Neurotropic vitamins.Patients are introduced by B vitamins, which enhance the effect of drugs of other groups, help reduce pain.
- Local anesthetics.With stubborn and acute pains, therapeutic blockades with anesthetics are performed.To improve the result of treatment, painkillers are combined with glucocorticosteroids.
- Physoalization.Apply ultrasound, magnetotherapy, percutaneous electrical stimulation, laser therapy, drug electrophoresis.It is possible to prescribe massage, manual therapy, acupuncture.
Surgical treatment
Given the features of the pathology, the following surgical interventions are carried out:
- Instability: inter -core spondylodesis, transpedicular fixation, fixation with plates.
- Tumors, osteoporosis, osteomyelitis, tuberculosis: sequestralctomy, vertebroplasty, kyphoplasty, corporate.
- Intervertebral hernias: discoctomy, microdiscectomy, nucleoplasty.
- Putting the spinal canal: laminectomy, facetectomy, disk punctuation decompression.
In the postoperative period, analgesics, antibiotics are prescribed.Rehabilitation measures include exercise therapy, massage, physiotherapy.