Backache

Low back pain and neck pain are among the most common reasons for seeking medical assistance. Pain is usually caused by problems with the musculoskeletal system-the most obvious are spinal problems, including the spine (vertebrae), intervertebral discs, and the muscles and ligaments that support them. Sometimes back pain is caused by diseases that do not affect the musculoskeletal system.

Low back pain is more common in the elderly, and more than half of people over 60 are affected. This can lead to huge costs in terms of health care payments, disability benefits, and missed work.

The spine (spine) is made up of vertebrae. There are shock-absorbing discs between the vertebrae. The intervertebral disc has a tough outer layer of fibrocartilage tissue and a soft jelly-like inner substance called the nucleus. Each vertebra has two joints behind the disc. These joints are called facet joints. The articular surface of one vertebral body is located on the articular surface of another vertebral body, forming a joint. The joints and the entire spine are stabilized by ligaments and muscles, namely:

• The two iliopsoas muscles on both sides of the spine
• Two erector spinae muscles running through the entire length of the back of the spine
• Many short paravertebral muscles are located between the vertebrae

The spinal cord is located in the spinal canal. Along the full length of the spinal cord, spinal nerves come out through the holes between the vertebrae on both sides, and their function is to connect all the nerves in the body. The part of the spinal nerve near the spinal cord is called the root. Due to the location of the spinal nerve roots, they may be compressed (compressed) due to spinal injuries, causing pain.

The lower spine (lumbar spine) at the top is connected to the upper spine (thoracic spine) and below the pelvis through the sacrum. The lumbar spine is flexible enough to bend, twist, and bend, and provide strength when standing, walking, and lifting. Therefore, the lower back participates in almost all types of daily activities. Low back pain can interfere with various activities and reduce the quality of life.

Types of back pain

Common types of low back pain include local pain, radiating pain, and reverberant pain.

Local painAppears in a certain area of the lower back. It is the most common type of back pain. The cause is usually intervertebral disc injury, joint arthritis, and less common muscle strain. Pain can be continuous and painful, or it can be replaced by intermittent acute pain at some point. When trauma is the cause, sudden pain may occur. Local pain will increase or decrease as the position changes. It may be painful to touch the lower back. Muscle cramps are possible.

Radiating painIt is low back pain spreading to the legs. The pain may be dull or severe. Usually, it only affects the sides or back of the legs, and can extend to the feet or knees. Radiating pain is usually a manifestation of spinal nerve root compression in diseases such as herniated disc, sciatica, osteoarthritis, or spinal stenosis. Coughing, sneezing, straining or bending your legs can be painful. When the spinal nerve root is compressed, the pain may be accompanied by weakness, tingling, or even loss of leg muscles. In rare cases, uncontrolled urination (urinary incontinence) or uncontrolled defecation (fecal incontinence) can occur.

Reflex painFeeling outside of the actual cause of the pain. For example, some people who have a heart attack experience pain in their left arm. The pain of lower back visceral reflex is mainly deep pain and pain in nature, and its precise location is difficult to determine. Generally, the pain does not increase during exercise compared to the pain associated with musculoskeletal diseases.

the reason

In most cases, back pain is the result of diseases of the spine and surrounding joints, muscles, ligaments and spinal nerve roots, and intervertebral discs. Often, a single specific cause cannot be determined. Any painful spinal disease causes reflexive contraction (spasm) of the muscles around the spine. Cramps may increase pain. Pressure can worsen low back pain, but the mechanism is not clear.

Sometimes back pain is caused by diseases that do not affect the spine, such as cancer, gynecological diseases (such as premenstrual syndrome), kidney diseases (such as kidney stones), urinary tract diseases (such as kidney, bladder infections, and prostate), and digestionTract (such as diverticulitis), and disease of the large arteries near the spine.

Common cause

Common causes of back pain include:

• Osteoarthritis
• Compression fracture of the spine
• Ruptured or herniated disc
• Lumbar spinal stenosis
• Spondylolisthesis
• Damage to muscles and ligaments
• Fibromyalgia

damageIt may occur during normal activities (for example, lifting heavy objects, exercising, unexpected sports) or due to injury (for example, a fall or a traffic accident). Normally, imaging studies will not show any specific lesions, but doctors suspect that certain muscles and/or ligaments are affected.

Osteoarthritis(Degenerative arthritis) causes the cartilage between the articular surfaces to wear out and the formation of bone spurs (osteophytes). Part of the cause of this disease is years of tissue wear and tear. With the severe degeneration and loss of the height of the intervertebral disc, the osteophytes in the intervertebral foramen will compress the roots of the spinal nerves. All these changes can cause back pain and stiffness.

Compression fracture of the spine (due to compression)(Vertebral fracture) usually occurs when osteoporosis leads to a decrease in bone density, which usually progresses with age. However, fractures caused by osteoporosis often occur in the upper and middle back, and are accompanied by pain in these areas, rather than the lower spine.

Ruptured or herniated discCan cause back pain. The disc is represented by a dense outer layer and a soft jelly-like central part. If the intervertebral disc is subjected to constant pressure from the upper and lower vertebrae (for example, when bending forward, especially when lifting heavy objects), its outer layer can rupture (tear), causing pain.

Lumbar spinal stenosis-Narrowing of the lumbar spinal canal (passing through the center of the spine and containing the spinal cord and nerve bundles extending downward from the lower part of the spinal cord). This is a common cause of back pain in the elderly. People with spinal stenosis also have spinal stenosis in middle age. Spinal stenosis is caused by diseases such as osteoarthritis, spondylolisthesis, ankylosing spondylitis and Paget's disease.

Spinal stenosis can cause sciatica and back pain.

Spondylolisthesis-The vertebrae in the lower part of the spine are partially displaced. One type usually occurs during adolescence or adolescence (usually in athletes) and is caused by injuries to partial vertebral fractures. If both sides of the vertebrae are affected, the vertebrae can slide forward over the vertebrae below. Spondylolisthesis may also occur in the elderly, but it is mainly due to degenerative diseases. With the development of spondylolisthesis in adulthood, the risk of lumbar spinal stenosis increases.

FibromyalgiaIt is a common cause of pain and affects many parts of the body, including the lower back. This condition can cause chronic, diffuse pain in muscles and other soft tissues other than the lower back. Fibromyalgia is also characterized by sleep disturbance and fatigue.

survey

Since most back pain is caused by osteoarthritis, sprains, or other minor musculoskeletal diseases and resolves within 6 weeks, testing is usually not performed. If the following conditions occur, imaging examinations are usually required:

• Suspect other reasons;
• Has a warning sign;
• Back pain persists.

It can also be evaluated if there is no response to the initial treatment, or if the symptoms worsen or change.

X-rays of the lower back can only provide images of bones. Such images can detect degenerative changes caused by osteoarthritis, spinal compression fractures, spondylolisthesis, and ankylosing spondylitis. However, magnetic resonance imaging (MRI) or computer tomography (CT) can provide clear images of bones and, like MRI, show soft tissues (including intervertebral discs and some nerves). When doctors determine whether there are diseases that cause certain changes in bone structure and soft tissue diseases, they usually need an MRI or CT scan.

If compression of the spinal cord is suspected, MRI should be performed as soon as possible. In rare cases, when the MRI results are not clear, it is necessary to use CT for myelography. In rare cases, if a malignant tumor or infection is suspected, a tissue sample (biopsy) needs to be collected for analysis. In some cases, electromyography and examination are performed to study nerve conduction to confirm the presence, location, and in some cases the duration and severity of spinal nerve root compression.

prevention

People can reduce the risk of low back pain by taking the following measures:

• Physical Exercise;
• Exercise to strengthen and stretch muscles;
• Maintain a normal weight;
• Maintain the correct posture;
• Follow the recommendations for safe weightlifting.

The most effective way to prevent back pain is to exercise regularly. Aerobic exercises and special exercises that develop muscle strength and stretching are desirable.

Aerobic exercises, such as swimming and walking, can improve overall health and strengthen muscles.

Special exercises to develop muscle strength and stretch the muscles of the abdominal wall, buttocks and back (deep trunk muscles) allow you to stabilize the spine and reduce the stretching of the discs and ligaments that absorb the spine to catch it.

Strength exercises include pelvic tilt and abdominal crunches. Stretching involves stretching by bending the knees to the chest. In some people, stretching exercises can increase back pain, so caution must be exercised. The basic rule is that any movement that causes or aggravates back pain must be stopped. The exercise should be repeated until slight (but not extreme) muscle fatigue is felt. Breathing is essential during exercise. People with back pain should consult a doctor before exercising.

Pelvic tilt Lie on your back with your knees bent, your heels on the floor, and your heels with weight. Press your back on the floor, tighten your hips (lift them about half an inch off the floor) and tighten your abdominal muscles. Keep this position and count to 10. Repeat 20 times.
Sit-ups Lie on the bed with knees bent and feet flat on the floor. Cross your arms across your chest. Tighten your abdominal muscles and slowly lift your shoulders about 10 inches off the ground, keeping your head straight (the chin should not touch the chest). Relax your abdominal muscles and slowly lower your shoulders. Do 3 sets, 10 reps in each set.
Extend the knee to the chest Take a supine position and straighten your body. Place the palms of your hands under one knee and press it against your chest. Keep this position and count to 10. Slowly lower your leg and repeat the exercise on the other leg. Do 10 exercises.

Exercise can also make it easier to maintain the weight you want. Exercise also helps maintain bone density. Therefore, exercise can reduce the risk of two diseases that can cause low back pain: obesity and osteoporosis.

The correct posture when standing and sitting can reduce back pressure. Laziness should be avoided. The height of the chair seat should be adjusted so that the feet are flat on the floor, the knees are slightly bent, and the lower back is close to the back of the chair. If the chair cannot provide support for your lower back, you can put a pillow under the chair. When sitting, it is recommended to place your feet on the floor instead of crossing your legs. People who are sick should not stand or sit for long periods of time. If you have to stand or sit for a long time, changing your posture frequently can reduce the pressure on your back.

treatment

If the specific cause can be determined, treat the disease. For example, antibiotics are used to treat prostate infections. However, there is no cure for pain caused by sprains or other diseases of the musculoskeletal system. However, this situation can be improved by general measures. Usually, such measures are also used when squeezing spinal nerve roots.

General measures for back pain

Possible measures include:

• Make changes to the event
• Taking painkillers
• Hot or cold compresses on the painful area
• Light exercise, if tolerable

For recent back pain, treatment begins with eliminating activities that strain the back and cause pain, such as lifting weights and bending the waist. Bed rest does not accelerate pain relief. Most professionals recommend light work. The bed rest necessary to relieve severe pain should not exceed 1 or 2 days. Prolonged bed rest will weaken the core muscles and increase stiffness, leading to worse back pain and slower recovery. Corsets and traction are ineffective. Traction will slow down the rate of healing.

Over-the-counter drugs or prescription non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. If non-steroidal anti-inflammatory drugs cannot adequately relieve pain, opioid analgesics are sometimes prescribed, but only for short-term use, because long-term use of opioid analgesics may be the opposite, increasing sensitivity to pain, causing side effects, andIncrease the risk of addiction and dependence.

Muscle relaxants can sometimes relieve muscle spasms, but their effectiveness is questionable. These drugs are not recommended for elderly patients who are more likely to have side effects such as drowsiness and disorientation. If the patient does not have obvious and palpable muscle cramps, the doctor will try not to prescribe muscle relaxants. If a muscle relaxant is prescribed, it should not be used for more than 72 hours. Doctors sometimes recommend taking it before going to bed.

Massage can temporarily relieve back pain. Some studies show that acupuncture has positive results; other studies contradict these findings. Chiropractors or other doctors (such as osteopaths) spinal massage, combined with exercise programs, can also relieve pain. However, manipulation of the spine increases the risk of additional injuries and should be avoided for people with inflammatory arthritis, neck problems that cause cervical spine instability, or a herniated disc.

It is recommended to sleep on a medium firm mattress in a comfortable position. People lying on their backs should put a pillow under their knees. Patients sleeping on the side should use a pillow to keep their head in a neutral position (not bend the neck up or down). The patient should put a second pillow between the knees and bend the knees and hips slightly, if this can relieve the back pain. If the patient feels comfortable, they can still sleep on their stomachs.

Continue or start taking other precautions (correct posture, correct lifting technique). When doing this type of activity, most of the episodes of back pain disappear within a few days to 2 weeks. Regardless of the treatment method, 80% to 90% of these attacks will resolve within 6 weeks.

Treatment of chronic low back pain

Additional measures are needed to treat chronic low back pain. Aerobic exercise is appropriate, and weight loss is recommended if necessary. If analgesics are ineffective, other treatments should be prescribed.

Transcutaneous electrical nerve stimulation (TENS) is possible. The CHENS device generates a weak alternating current, causing a slight tingling sensation. This current can prevent some pain from the spinal cord to the brain. Electric current can be applied to the painful area multiple times a day, and the treatment course can range from 20 minutes to several hours, depending on the severity of the pain.

Sometimes corticosteroids and local anesthetics are regularly injected into the facet joints or epidural space of the spine-between the spine and the outer tissue that covers the spinal cord. Epidural injections may be more effective for sciatica, which is more due to a herniated disc than a stenosis of the lumbar spinal canal. However, they may not have long-term beneficial effects. They usually only last a few days or weeks. Their main purpose is to relieve pain so that you can relieve pain in the long term through exercise.

Back pain surgery

If a herniated disc causes persistent or chronic sciatica, weakness, loss of sensitivity, or fecal incontinence, surgical removal of the herniated disc (discectomy) and, in some cases, part of the vertebrae (laminectomy) may be required.

In severe spinal stenosis, most of the posterior vertebrae (laminas of the vertebral arch) may be removed to enlarge it (lumbarectomy). General anesthesia is usually required. The length of hospital stay is usually 4 to 5 days. The patient will be able to resume normal activities within 3-4 months. Full or complete recovery is observed in approximately two thirds of patients. For the remaining patients, this type of surgery can prevent the worsening of pain and other symptoms.

If the spine is unstable (which may be caused by a severe disc herniation, spondylolisthesis, or laminectomy for spinal stenosis), surgery can be performed to fuse the vertebrae (called lumbar arthrodesis). However, fusion limits mobility and may be accompanied by excessive mechanical stress on the rest of the spine and cause problems in the future.

Compression fracture of the spine

Compression fractures of the spine are common in women over 50 years of age. They can be treated conservatively without surgery, using braces, painkillers, and calcitonin nasal spray, which will not help the bones heal, but can reduce the pain.

If the pain cannot be adequately controlled, there are two surgical options:

• Vertebroplasty: Inject cement mortar into the fractured bone.
• Kyphoplasty: A balloon is inserted into the fractured bone to create space. Then fill the balloon with cement.

However, recent studies have shown that in the long run, the effectiveness of these surgical procedures does not exceed the effectiveness of non-surgical treatment options.

key point

• Low back pain is very common. It is usually caused by musculoskeletal diseases of the spine and factors such as fatigue, obesity and insufficient physical activity.
• Low back pain is rarely severe when you are young, and unless symptoms persist for several weeks, you usually do not need to be checked.
• Patients with warning signs or patients over 55 years of age should seek medical attention immediately.
• Strengthening the muscles of the abdominal wall and back through specific exercises can help prevent the most common type of low back pain.
• For back pain, the most common adequate treatment is to eliminate measures that cause mechanical effects on the back, take painkillers, and in some cases, apply cold or hot compresses.
• Prolonged bed rest and stretching exercises will slow down recovery.
• In severe cases, such as paresthesias and weakness in the legs, surgery may be required.
• Vertebral compression fractures can be treated conservatively (with braces, painkillers, and nasal sprays) or, in some cases, more aggressively treated with surgery.