Lumbalia: symptoms and treatment

The lumbar spine of a person experiences a huge load every day, associated with the upright. Even more exacerbates its wrong way of life of modern people: low physical activity, excessive body weight, regular psychoemotional stresses and irrational nutrition. All these factors contribute to the development of morphological changes in the lower back, which manifest themselves primarily pain syndrome. Subacute or chronic pain in the lumbar region and received the name "lumbulgia" (from the Latin words "lumbus" - the lower back and "algos" - pain). The reasons for the appearance of lumbulgia, the symptoms that this syndrome manifests, as well as the diagnostic approach and the principles of treatment, we will talk about in this article.

Causes and mechanisms of development

Diseases and conditions, because of which lumbulgia occurs, can be divided into 2 large groups - vertebrogenic (that is, associated with the spine) and non-embryogenic (with the spine unrelated).

Vertebrogenic factors that can cause back pain are:

• scoliosis (lateral curvature of the spine);
• osteochondrosis;
• spondylosis (degenerative changes in the vertebrae);
• protrusion of the intervertebral disc;
• herniated intervertebral disc;
• arthrosis of intervertebral articulations;
• musculo-fascial syndrome;
• stenosis of the spinal canal;
• non-infectious inflammatory diseases of the spinal column, in particular, Bekhterev's disease;
• instability of the lumbar spine.

With these diseases, the structures of the damaged musculoskeletal system can be compressed by spinal nerves with the corresponding clinical symptoms.

Nonvertebrogenic lumbulgias can be caused by diseases that are absolutely irrelevant to the spine, namely:

• osteoporosis;
• traumatic injuries of the spine;
• kidney diseases (pyelonephritis, urolithiasis, hematomas of traumatic nature);
• bowel diseases;
• diseases of the reproductive system of men and women (uterine fibroids, ovarian cysts, endometriosis and others);
• cardiovascular diseases;
• benign and malignant neoplasms (both primary and metastatic);
• inflammatory processes of the abdominal cavity organs, small pelvis, muscles;
• Infectious diseases, in particular herpes zoster.

Often, lumbalia accompanies a woman during pregnancy. It arises in the case of weakness of the muscles of the back and is caused by pressure on the lumbar region of the mother by a growing fetus.

Lumbalia: symptoms

Pain in the lower back is so pronounced that it is hard for a person to straighten.

Occurrence of a painful syndrome in the loin is often preceded by:

• static overstrain (prolonged sitting, standing or being in another uncomfortable position);
• supercooling;
• excessive physical stress (in particular, lifting of weights);
• prolonged walking, especially with flat feet;
• contusion of the lower limb;
• wearing small shoes.

The pain after these kinds of effects can occur immediately, and sometimes from the moment the patient commits the action initiating the lumbalgia, before the onset of unpleasant sensations in the back, 2-3 days pass.

As is clear from the name of the syndrome, the main clinical manifestation of it is back pain. As a rule, it is more pronounced only on one side and sharply increases after active movements in the lumbar region spine (tilt), or with prolonged stay in the same position: sitting or standing.

The patient tends to accept the position of the body, relieving the pain: lying in bed on a sick or healthy side (depending on the clinical situation).

Bending over, a person with lumblagia is very difficult to straighten up: in order to perform this action, he puts his hand on the spine, creating as it were a lever.

Pain syndrome is often expressed so much that it is difficult for a patient to walk and perform previously usual household activities: wash, stand by the stove, preparing food, ironing clothes with iron.

The patient is constantly experiencing fatigue in the lower back and therefore seeks a frequent change of position: about the table with arms outstretched, it will move to the edge of the seat, then it will press against the back of the chair with its entire back.

It is difficult to lean forward, and with the progression of the disease, the volume of movements decreases, and the pain becomes constant, intense, aggravated by sudden movements, coughing, sneezing, laughter.

In the absence of treatment, the pathological process progresses: the pain extends to the region of the sacrum, the buttock and the lower extremity. Perhaps a reflex violation of the functions of internal organs.

In the affected area of ​​the patient, his associates or a doctor discern no less painful muscular tightening, palpation which causes intense local pain and pain reflected, at a point remote from the injury site. The patient even jerks in pain. This is the so-called symptom of muscle tension. It makes it possible to distinguish lumbalia from other diseases of the spine with similar clinical manifestations.

A number of patients have a positive Lasega symptom. This is one of the symptoms of tension, manifested by increased pain in the lumbar region and along the sciatic nerve, if the doctor raises the straight leg of the patient lying on the back. When bending the leg in the knee joint, the patient feels relief, as the pain disappears.

If the cause of lumblagia is a herniated intervertebral disc, in addition to back pain, the patient may complain of a feeling of cold in the legs, numbness of them, and the doctor will detect lethargy of tendon reflexes on the lower limbs, as well as motor disorders.

Principles of diagnostics

Important information about the causes and nature of the disease the doctor finds out by evaluating the results of additional survey methods.

The doctor will suspect lumblagia at the stage of collecting complaints and data of an anamnesis of life and illness of the patient. An objective examination of the patient, in particular, an examination of the neurological status, will convince the specialist of the fidelity of his guess. To find out which disease triggered the development of low back pain, the doctor will appoint the patient additional survey methods, among which the leading role belongs to the methods of visualization:

• radiography of the lumbar or lumbosacral spine;
• computed tomography;
• magnetic resonance imaging.

On the roentgenogram, there are gross changes in the structure of the spine: the presence of traumatic injuries, narrowing of intervertebral fissures and bone growth around them, osteoporosis.

More informative than roentgenography is computed tomography. This study allows you to get a clear layered image of the spine and surrounding tissues and identify such diseases as stenosis (constriction) of the vertebral canal, disc herniation, as well as neoplasm.

The most informative method for diagnosing this group of diseases is magnetic resonance imaging, or MRI. It allows to reliably diagnose changes in the spine and surrounding organs: muscles, vessels and nerves.

Also, diagnostic methods such as electromyography (EMG) and electroneuromyography (ENMG) can be used. With their help, it is easy to detect violations of the transmission of the nerve impulse along the muscles and nerve fibers.

To detect neoplasms and a focus of infection, a patient may be assigned a scintigraphy. This method of investigation is based on the different absorption of the radionuclide introduced into the body by a healthy and pathologically altered tissue.

If there is a suspicion of compression (jamming) of the nerve root, thermography will confirm or disprove it. With the help of special infrared sensors, the temperature of the two sides of the body is measured: up to the supposed damage site and below it.

For the purpose of differential diagnosis of lumbulgia and diseases of the abdominal cavity organs, ultrasound (ultrasound) can be used. If it is necessary to detect the damage of any muscle, ligament or tendon, examine them directly by this method.

To determine the presence of an inflammatory process in the body of an infectious or non-infectious nature that can become the cause of lumbargia, conduct laboratory tests, in particular a general blood test, urine, rheumatological tests and others.

Principles of treatment

First of all, the treatment of the underlying disease should be performed, against which a pain syndrome in the lower back appeared. Depending on this disease, patients with lumblagia are treated by neuropathologists, therapists or orthopedists.

To facilitate the patient's condition and speed up the recovery, the patient is recommended:

1. Bed rest. In the acute period of the disease, it will be much more useful for a patient to be in bed for 3-5 days than to spend this time in the lines of a polyclinic or in search of the right medicines. Peace is the most important component of treatment, without observance of which other types of therapy will not have the desired effect.
2. Medication:

• non-steroidal anti-inflammatory drugs, or NSAIDs (meloxicam, rofecoxib, diclofenac, nimesulide and others); these medicines help reduce the severity of the inflammatory process and reduce pain; drugs are given a short course - 5-7, rarely - more days with compulsory protection of the stomach in the form of simultaneous administration with NPVS blockers of the proton pump (omeprazole, rabeprazole and others);
• muscle relaxants (usually used tolperisone, rarely - sirdalud); relax the spasmodic muscles, reducing the manifestations of the above-described syndrome of muscle tension;
• vitamins B (neurorubin, neurobion, milgamma and others); nourish the nerve tissue, improving the transfer of momentum from the neuron to the neuron;
• diuretic drugs (furosemide, torasemide); apply in case of tissue edema in
  area of ​​injury; also to the drug in a similar effect can be attributed L-lysine escinate,which in addition to anti-edema has anti-inflammatory and analgesic effect;
• drugs that improve blood circulation (pentoxifylline, nicotinic acid and others);
• antidepressants and, more rarely, anticonvulsants: in the case of recurrent chronic lower back pain with prolonged admission (6-10 weeks), these drugs affect the centers of pain, reducing the severity of the pain syndrome;
• chondroprotectors (Mukosat, Dona, Rumalon and others) - move on the articular cartilage, activating the metabolic processes in it, thereby partially restoring its structure and slowing the progression of the disease; apply long courses - 2-3-6 months 2-3 times a year.

1. Physiotherapy and methods of alternative medicine:

• massage;
• manual therapy (gentle techniques);
• reflexology;
• percutaneous electrostimulation;
• osteopathic techniques;
• ultrasound therapy;
• laser therapy;
• cryotherapy;
• kinesiotherapy;
• hirudotherapy;
• vacuum therapy;
• spinal traction;
• exercise therapy (rightfully considered one of the most effective methods of eliminating chronic pain in the lower back - helps strengthen the muscles of the back and the press);
• some other methods.

It is worth noting that some of the above methods can be used to stop the pain syndrome in acute period of the disease, and others - only when the main symptoms are eliminated and the effect needs to be consolidated.

1. Surgery. It is recommended to individual patients in cases where conservative treatment has not had the desired effect or medicamental methods can not be effective in this disease.

Forecast

With lumbar prediction directly depends on the reasons for which it arose. In a number of cases - with only the emerged pathological process provided that it is adequately treated - the prognosis is favorable (the symptoms regress and no longer bother the person). If the pain in the back arose against the background of chronic diseases of internal organs and the spine, as well as as a result of injuries, the prognosis relatively favorable or unfavorable (the latter particularly applies to malignant neoplasms, as the cause of lumbargia).

Prevention

To prevent the development of pain in the lumbar region, it is necessary to avoid increased stress on the spine:

• do not lift weights; if it is necessary to lift the load, do not perform this action, bending over straight legs, and bend the legs in the knees and, holding his back straight, lift the load, using the muscles of the arms and legs, not the back;
• to work at the computer to choose a comfortable chair with a back of anatomical shape;
• for sleep use an orthopedic mattress.

In addition, you should strengthen your back muscles by swimming, fitness, cycling or other sports.

An active lifestyle is also important: walking, daily walks in the fresh air. It is necessary to avoid hypothermia and eat properly, controlling body weight, not allowing weight gain.

If these recommendations are followed, the risk of developing vertebrogenic lumbagia will be significantly reduced.

With regard to the prevention of non-vertebral lumbalgia, you should carefully consider your health, timely addressing to the doctor about any somatic pathology and follow his recommendations for treatment.