Discomfort in the spine is the main reason why people seek medical help. Almost 80% of the adult population faces this problem. Back pain causes a significant level of disability and can be a problem that lasts from childhood into adulthood.
Dorsopathy affects almost every aspect of life. Sleep is interrupted and it becomes difficult to bend, reach or turn. Difficulties arise when driving, walking, lifting and exercising. If you have back pain, you should immediately consult a doctor. The specialist will study the medical history, collect the anamnesis and perform an examination. If any violation is detected, conservative or surgical treatment is prescribed.
Why does my spine hurt?
The cause of dorsopathy is muscle tension and spasm. Tension can be the result of hard physical work, awkward positions 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 undergoes degenerative changes. With age, pain often appears in the so-called "transition zone" between the flexible cervical vertebrae and the more rigid thoracic part of the spine.
- Thoracic – relates to the chest and relates to the ribs. In particular, older adults may experience compression fractures in this area as a result of bone loss.
- Lumbar – lower back. Younger patients are more prone to discogenic low back pain, while older patients are more likely to experience structural joint disorders.
- Sacral - the lowest part of the spine. It consists of a flat, triangular sacrum bone that connects to the hips and tailbone. Degeneration of this area usually occurs in elderly patients or after a fall.
Between the upper back and tailbone are 17 vertebral bodies, many joints, the sacrum and tailbone, as well as fibrous and muscular support structures, intervertebral discs, the spinal cord and 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 of which is separated by an intervertebral disc. Vertebrae are a series of small bones to which muscles are attached. Each vertebra consists of two parts: the anterior body, which protects the spinal cord and nerve roots, and the posterior arch, which houses the canal and also protects the spinal cord.
Back muscles are divided into three groups:
- intermediate - responsible for the movement of the ribs;
- internal – stabilize the spine, control 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 function as the main stabilizers of bony and ligamentous structures. Tensions of these muscles are possible in patients of different age groups.
There are other parts of the spine that must be considered when determining dorsopathy. These include ligaments and tendons, intervertebral discs and joints that provide stability and mobility.
Inflammatory disease, malignancy, pregnancy, trauma, osteoporosis, nerve root compression, radiculopathy, plexopathy, osteochondrosis, herniated disc, spinal stenosis, sacroiliac joint dysfunction, joint damage, and infection are all part of the difference. Differentiating the signs and symptoms of nociceptive (mechanical) pain from radiculopathy (neuropathic dorsopathy) is an important first step in establishing a diagnosis.
Degenerative pathologies
Degeneration includes endplate-related changes (sclerosis, defects, modal changes, and osteophytes) as well as disc changes (fibrosis, annular tears, desiccation, height loss, and mucinous annular degeneration).
Degenerative changes in the disc are already observed in a third of healthy people aged 21 to 40 years. The high prevalence of asymptomatic degeneration should be considered when evaluating spinal symptoms.
With age, the intervertebral disc becomes more fibrous and less elastic. Degenerative changes progress when the structural integrity of the posterior annulus fibrosus is compromised by overuse. This will eventually lead to the formation of tears in the annulus fibrosus. A herniation is defined as displacement of disc material (cartilage, nucleus, fragmented annulus and apophyseal bone) across the intervertebral disc space.
Rachiocampsis
The natural curves of the spine are important to ensure its strength, flexibility and ability to distribute the load evenly. There is a normal range of natural curves. Abnormal curves include lordosis, kyphosis, and scoliosis.
Abnormal lordosis
Lordosis, a spinal disorder, is defined as a severe inward curvature of the spine. Although this disease most often affects the lumbar spine, it can also develop in the cervical spine.
The normal range of lordosis is considered to be between 40 and 60 degrees. Changes in posture can lead to unsteadiness in walking and changes in the figure - the buttocks become more visible. Causes of abnormal lordosis: spondylolisthesis, osteoporosis and obesity.
Abnormal kyphosis
Kyphosis, a spinal disorder, is defined as an excessive curvature of the spine and can result in a forward lean. It most often affects the thoracic or thoracolumbar regions, but it can also occur in the cervical region.
The normal range of kyphosis is considered to be between 20 and 45 degrees. But when a structural abnormality results in the development of a kyphotic curve outside this normal range, the curvature becomes abnormal and problematic. It is manifested by rounding the shoulders and tilting the head forward.
Scoliosis
It is 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 adolescent scoliosis, diagnosed between the ages of 10 and 18. The remaining 20% are due to neuromuscular, congenital, degenerative and traumatic causes.
Developmental abnormalities
The symptom often appears with developmental defects and may be combined with neurological manifestations.
Dorsopathy is present with the following developmental anomalies:
- Separation - with small bone defects there is moderate discomfort in the lumbosacral region. After a while, radicular syndrome appears.
- Lumbarization, sacralization - root compression is accompanied by shooting or burning pain. Sensory disturbances or paresis may be added.
- Wedge-shaped vertebra - discomfort occurs when you exert stress and maintain a static position of the body for a long time. It is accompanied by chest deformation and poor posture.
Osteoporosis
It typically affects the thoracic and thoracolumbar spine and can cause debilitating pain. This disorder is caused by loss of bone mineral density, which leads to brittle bones.
Osteoporosis can cause vertebral compression fractures, loss of height, stooped posture and even humps. To prevent osteoporosis, it is necessary to ensure a balanced diet, quit smoking and alcohol abuse. An active lifestyle is also recommended.
INJURY
The severity of dorsopathy corresponds to the severity of the injury. As a rule, it is combined with signs of nerve tissue damage.
Traumatic causes of back pain:
- A bruise is the result of a direct blow or a fall on the back. Dorsopathy is local, moderate. It gradually goes away for 1-2 weeks.
- Displacement - occurs due to high energy impact. It is accompanied by severe pain in combination with disorders of sensitivity and motor activity. The general condition also suffers.
- Spondylolisthesis is a traumatic injury to the spine in the lumbar region. Dorsopathy radiates to the leg, there is a positive symptom of axial load.
- Compression fracture - occurs when you fall on your butt or jump from a height. At first the pain is sharp, then becomes intense and progresses with movement.
Pathological fractures that occur against the background of osteoporosis or tumors are manifested by minor discomfort, discomfort and painful pain. They remain unchanged for a long time.
Inflammatory and infectious diseases
Ankylosing spondylitis is associated with a feeling of stiffness and dull pain in the lumbar region. There is a characteristic circadian rhythm - symptoms appear at night and intensify in the morning. The intensity decreases after physical activity and water procedures. Dorsopathy increases at rest and decreases with movement. Over time, the mobility of the spine is limited and thoracic kyphosis is created.
Also, back pain occurs with tuberculosis. Deep local discomfort is characteristic of vertebral destruction. Dorsopathy increases with exercise and is accompanied by excessive skin sensitivity. With shooting and radiating pain, we are talking about compression of the nerve roots. The condition is fulfilled by the stiffness of the movement.
With osteomyelitis, intense dorsopathy is observed. The disease is diagnosed in childhood and adolescent patients. It is characterized by hematogenous nature. Discomfort increases with movement, so the patient remains in bed. Osteomyelitis is accompanied by fever, weakness and local swelling.
Arachnoiditis is manifested by pain that radiates to the area of innervation of the nerve roots. Symptoms become constant and resemble sciatica. They are accompanied by motor disturbances, sensory disturbances and loss of the ability to control the pelvic organs.
Tumors
Benign neoplasms have an insidious course or are associated with slowly progressive and few symptoms. Hemangiomas appear more often, which appear only in 10-15% of cases. The concern is painful, local. It improves at night and after physical activity. Spinal cord neoplasia is associated with radicular pain and impaired nerve conduction.
Spinal sarcomas in the primary stage of progression are manifested by moderate intermittent pain, which intensifies at night. It is accompanied by limitation of motor activity and radicular syndrome. The discomfort is localized in the internal organs, legs or arms (taking into account the level of the location of the tumor).
Other diseases
Discomfort in the spine is also observed with:
- Spinal epidural hemorrhage - similar to the signs of radiculitis, accompanied by a spinal conduction disorder.
- Calvet's disease - radiates to the legs, appears periodically, is mild. Decreases when lying down, increases during physical activity.
- Forestier's disease - located in the chest region, spreads to the lower back or neck. Symptoms are usually short-lived. It may be accompanied by pain in the elbow or shoulder joints. Spinal stiffness cannot be ruled out.
Dorsopathy sometimes occurs with mental disorders. In this case, the clinical picture is unusual - it does not fit into the symptoms of possible diseases.
Causes of back pain by location
Chronic upper back dorsopathy affects 15 to 19% of people worldwide. Postmenopausal women are at greater risk, possibly because of osteoporosis and vertebral compression fractures.
Occupational activities also lead to back pain. Those who have to maintain a static body position for long periods of time, such as dentists or salespeople, are more likely to encounter this problem than others. Office workers experience upper back discomfort due to poor workplace ergonomics.
Dorsopathy can occur at different points of the spine. The localization area indicates the cause of the disturbance and greatly facilitates the diagnosis.
Pain in the right side
The cause is excess body weight, slipped disc or myositis. On the right side of the back, discomfort also appears with kyphosis.
Among the somatic pathologies are salpingitis, inflammation of the ovaries, nephritis, cholecystitis. Appendicitis and the presence of stones in the organs of the urinary system should also be emphasized.
Pain in the left side
The back on the left hurts due to splenitis (inflammation of the spleen), urolithiasis, oophoritis, duodenitis, tight roots. Discomfort over the lower back indicates 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 others subject to the development of pathological processes from the spine. This is due to the fact that it carries a colossal load. When nerve roots are damaged, an inflammatory process develops. Hernial extension and osteochondrosis are also possible.
Less often, the cause is a combination of prostatitis and urethritis, a violation of the structure of bone tissue, a decrease in density, lumbar sciatica, arthritis, tuberculosis of the spine. Discomfort in the lower back in most cases is chronic.
Pain in the lower back on the right
Dorsopathy occurs when:
- myositis;
- tuberculosis;
- scoliosis;
- osteomyelitis;
- spondylitis.
It may indicate the presence of a neoplasia. Speaking of radiculitis. Indicates liver dysfunction.
Pain in the left lumbar region
Discomfort is mainly localized after physical activity. The condition returns to normal after rest. If the discomfort does not subside with rest, then it is a matter of scoliosis, osteochondrosis, spinal infections and blood circulation disorders.
Crushed nerve
In the vast majority of cases, the sciatic nerve is compressed (sciatica). At the same time, its myelin sheath is not damaged. It most often develops against the background of osteochondrosis. Accompanied by acute, severe symptoms radiating to the lower back, sacrum and lower extremities.
Spinal nerve roots are also compressed during compression radiculopathy. The cause is disc herniation or the reduction of the distance between the vertebrae. "Superficial" discomfort is felt, which is significantly intensified during exercise, sneezing, coughing.
Intervertebral hernia
It is characterized by the protrusion (exit) of the nucleus into the intervertebral canal. In most cases, it develops against the background of osteochondrosis. The central part of the extruded core compresses the spinal cord. Even a light load leads to the progression of the pathological process. Dorsopathy is sharp and acute, radiating to the leg or arm.
Pain in the shoulder blades
Based on the nature of dorsopathy, a presumptive diagnosis can be determined:
- dull, growing - stomach ulcer;
- acute, worsening with movement - intercostal neuralgia;
- numbness of the hands, changes in pressure, dizziness - osteochondrosis;
- radiates below the clavicle - exacerbation of angina pectoris.
Pain along the spine and back
It develops due to pinched nerve endings against the background of the curvature of the spine. If the symptoms are not clearly expressed, we can talk about prolongation. Increased symptoms indicate osteochondrosis, myositis or fracture.
Severe discomfort along the spine indicates wear or thinning of the intervertebral discs. It may indicate spondyloarthritis. The pain is constant and sharp.
Pain below the waist
Most often they occur with spondyloarthrosis and osteochondrosis. Less observed in diseases of the female genital area (oophoritis, cervicitis, endometritis, etc. ). They can appear during pregnancy, during menstruation, with appendicitis, ulcerative colitis. In men, indicate bladder or prostate disease.
Diagnosing
First, a physical examination is performed to identify signs that indicate the need for further testing. The medical examination includes the following procedures:
- Examination of the back and posture to identify anatomical abnormalities.
- Palpation/percussion of the spine - assessment of the condition of the spine and painful areas.
- Neurological examination - assessment of reflexes, spinal sensation and gait characteristics. For patients suspected of having radiculopathy, the neurological examination should focus on the L5 and S1 nerve roots.
Patients with a psychological disorder contributing to back pain may have accompanying physical signs, also known as Waddell's signs. These include the patient's hyperresponsiveness on physical examination, superficial tenderness, and unexplained neurologic deficits (eg, sensory loss, sudden weakness, or strange movements on motor examination). The presence of multiple Waddell signs indicates a psychological component of dorsopathy.
Spinal pain treatment
In cases of dorsopathy, the treatment must be carried out by a doctor. The specialist refers the patient for examination and, based on the results obtained, prescribes effective therapy.
Additional therapeutic measures should be used with caution and after consultation with a doctor. Any type of medication comes with potential risks and side effects, so self-medication is not acceptable.
Help before diagnosis
Basic home remedies that can be effective in combating mild to severe pain caused by muscle tension include:
- Short rest period. Many episodes of low back pain can be relieved by eliminating physical activity. It is not recommended to rest for more than 2-3 days, as prolonged inactivity hinders healing.
- Change in activity. It is recommended to stay active, but avoid activities and body positions that aggravate dorsopathy. For example, if sitting for a long time in a car or at a desk increases discomfort, then you should do a warm-up every 20 minutes.
- Exposure to heat or cold. A heating pad or a warm bath relaxes tense muscles and improves blood flow, reducing discomfort. If your lower back hurts due to inflammation, you can use ice or cold compresses to reduce swelling.
The most common over-the-counter medications for dorsopathy are ibuprofen, naproxen, and acetaminophen. Medicines relieve inflammation and reduce discomfort in the lower back.
Conservative therapy
Oral drug therapy:
- Analgesics. Patients are prescribed drugs from the anilide group, such as paracetamol. Provides a long-lasting analgesic effect. They have a synergistic effect with NSAIDs and are used in combination to improve pain relief without increasing toxicity.
- Non-steroidal anti-inflammatory drugs. They have analgesic properties. In higher doses they have an anti-inflammatory effect.
- Muscle relaxants. They act centrally, influencing the activity of muscle stretch reflexes. The combination of an NSAID and a muscle relaxant provides significant relief from dorsopathy. The main side effects are drowsiness, headache, dizziness and dry mouth.
- Neuropathic pain relievers. Tricyclic antidepressants relieve chronic pain. Low doses may be sufficient to control symptoms. They do not work immediately and may need to be continued for several weeks before symptoms are seen to improve. It plays a potential role when distress is mediated by peripheral and central mechanisms.
Local or regional anesthesia, given by injection, is part of the treatment regimen for some patients with back pain. The injection site can be an area of local injury or a myofascial trigger point (painful muscle area).
Epidural corticosteroid injections are used for radicular pain that does not respond to less invasive treatments. It is used to alleviate the condition of intervertebral hernias, spinal stenosis and radiculopathy. Reduces dorsopathy and quickly restores sensory functions.
Surgery
A small percentage of people with back pain require surgery to improve their condition. Indications for surgery vary depending on the patient's characteristics and include:
- severe radicular symptoms, especially in the presence of progressive neurological motor deficits;
- radicular symptoms that are not suitable for conservative treatment.
The choice of surgical intervention is determined by the characteristics of the spinal cord injury. The operation is more effective when the clinical picture of patients is dominated by manifestations of nerve compression. The most common problem is inadequate nerve decompression. Associated diseases including hip arthritis, osteoporosis and cardiovascular disease.
Surgery for patients with radicular pain due to a herniated disc primarily involves decompression. Protruding, extruded or isolated disc material is removed. The nerve root is examined and released.
Preventing
Complications are determined mainly on the basis of etiology. They are divided into physical and social. The first includes chronic pain, deformity, neurological effects with motor or sensory deficits, bowel or bladder damage. In social terms, complications are usually measured by disability and decreased performance.
Patients of all ages should:
- eliminate bad habits;
- to live an active lifestyle;
- strengthening the protective functions of the body;
- lift heavy objects correctly;
- undergo preventive examinations with a doctor.
It is important not to slouch and keep your back straight. The place to sleep and work must be organized correctly. It is recommended to perform light gymnastic exercises every day after waking up. You should also balance your diet by enriching your diet with foods with sufficient vitamins and minerals. It is recommended to take a contrast shower in the morning.