What causes back pain really?
- In the majority of cases back pain is caused by nonspecific mechanical causes: often damage to the ligaments and muscles that support the spine (70%), less compression fractures in osteoporosis (4%).
- With degenerative processes of the intervertebral discs and joints, which in Russian terminology is called degenerative disc disease, it is possible to associate no more than 10% of cases.
- Rarely, though aptly, the pain caused by protrusion of a herniated disc, compressing the nerve roots; then, for example, starts to hurt and numb thigh or leg (sciatica). Such trouble, called radiculopathy, due to no more than 1-3% of acute lumbar pain.
- Often faced with idiopathic pain without any organic damage (mostly psychogenic nature).
- Very rarely identifies a specific cause: infection or tumor (0,8%) diseases of internal organs, when the pain is projected in the back (1,5-2%).
- Contrary to popular belief congenital curvature posture (kyphosis, scoliosis) by themselves lead to pain syndrome is exceptionally rare (< 1%).
There are many other rare causes, which will only be dealt with by a specialist.
Thus, most back pain is not connected with a spine and caused a tear of muscle fibers and ligaments of the back caused by physical overload. They do not heal for a long time, forming itself around the focus of inflammation, which further supports tissue ischemia and pain according to the vicious circle principle.
In our Kingdom-state that is not back pain — everywhere is to blame low back pain and notorious for herniated discs.
How do you avoid improper treatment and "divorce" in the money
X-ray, MRI, CT scan for pain in the neck and back usually not required. Your doctor may prescribe these studies, if you have signs of serious damage to the spinal cord and roots in the form of peripheral disorders (paresis or paralysis of the muscles of the lower extremities, disorders of sensation, impaired functions of pelvic organs). In 90% of cases of pain in the neck and back such studies it is not necessary and the default should not be appointed.
A neurologist could prescribe such a study even in the absence of the violations described, if the pain does not lose its intensity for about 4-6 weeks, despite correct drug treatment, or if there is suspicion of a specific process, the type of tumor or tuberculosis in the spine.
In our country the default finds all sorts of hernia (only one there) and scare all the sick shots, however in developed countries has long been postulated: the correlation between back pain without peripheral symptoms and pattern on x-ray or CT scan, no.
Smart people just took 1000 people with pain without peripheral symptoms and 1000 completely healthy and did all the tomograms (CT and MRI). As a result, in both groups the number of people with herniated discs and those without were approximately equal. Moreover, among surveyed were persons with the plush hernias that have not felt pain in the back, and Vice versa — many of those suffering from pain had no hernias. This experiment has been repeated several times for particularly stubborn, so no question remains — first of all take into account symptoms and signs, and then assign visual studies when there is evidence. In other words, treat the patient, not his images.
A herniated disc is actually not so often involved in the development of other diseases. Only in 4% of cases of back pain can be some theoretical link with the existing hernia, and severe bulging discs, which require radiological imaging and surgical treatment, are extremely rare.
Why in our country the or MRI of the spine does not appoint just lazy doctor? The first reason is the ignorance of some doctors (see the entry about the identity of the domestic medical schools). And the second is the economic interest of health facilities and/or attending physician.
In the last 10 years the main source of income figures from health departments and head physicians of hospitals were the kickbacks received from manufacturers of medical equipment and consumables. And here a real gold mine was the MRI (magnetic resonance imaging), CT (computed tomography), at worst, digital x-ray devices. The pullback from mediocre scanner is 100 thousand bucks at a time, but to prove it is almost unreal. Here and bought everywhere, where is necessary or not.
Other enterprising doctors provide a stream of the MRI queue for a month forward. For piping to work properly, many commercial clinics of doctors were put on a percentage of assigned investigations (tests, ultrasound and, of course, costly CT and MRI).
Lumbar pain is a tedious thing, but is usually in itself. Studies show that lower back pain without any treatment is a week from 30-60% of patients after 6 weeks healthy has 60-90%, and a year to recover 95%.
How to speed up recovery
And here is the unfortunate sick bred — Mama do not cry. Pain, because it is all in the brain analyses, and therefore the placebo effect for pain will work in any case — though leeches became, though hot stones applied, even though the mugs lepi. Particularly suggestible will help and conspiracies, and favorable horoscopes and even homeopathy. One bad — placebo effect, by definition, limited.
Acute back pain is not effective, the following treatment methods:
- therapeutic massage;
- extension of the spine.
In the acute phase these methods are not only not recommended but potentially harmful.
Have no advantages over normal drug therapy are costly in time and Finance methods:
- manual therapy (manipulation of the bones changes from massage);
- acupuncture = acupuncture.
In the acute period of some short-term effects can be methods of distraction therapy-type pepper patch, cans, any burning ointment. The same principle works and acupuncture. Here the effect is due to the shift of the brain from the pain to a new source of irritation. As a result, the brain does not focus on one place and the pain subsides.
A good effect of heat warming her muscles. The effect, however short-lived, but still.
That really helps with acute pain in back/neck
Only 3 things have been proven conclusively effectiveness:
- drugs from the group of NSAIDs (non-steroidal anti-inflammatory drugs);
- drugs from the group of Central muscle relaxants designed along with NSAIDs;
- maintaining vigorous activity during the disease (bed rest does not help, but hinders recovery).
Cheap and cheerful. Everything else in the acute phase of placebo — effect or Scam. Although I must say, that older people can recommend to go to the clinic for any of the placebo treatments, as long as they are not stale. By itself, the walk to the doctor has had on their health effects.
Does it matter which NSAID to drink? Maybe give them a shot? Maybe medication is better to RUB into the affected area?
The answer to the first question is clear: the pain is effectively removed any NSAIDs. But everywhere there are nuances. Some NSAIDs better effect on pain, and other inflammation.
Anyway, how exactly do you take anti-inflammatory medication through mouth or injection, with or without food side effect on the stomach works the same way. Ulcer is exacerbated because the pill irritates the gastric mucosa through direct contact, but because inhibiting the synthesis of COX-1 after the drug has already been found in the blood.
Beyond the subcutaneous tissue and adjacent muscles and ligaments these drugs almost does not penetrate, and what penetrates, is carried by the bloodstream and is distributed evenly throughout the body. Even when the blockade drug is administered with a long needle, bringing her right to the nerve — will not bring the cm and the effect can not be entirely.
However, if you smear a lot, of blood in the whole body sooner or later will create a sufficient concentration of the NSAID and then the analgesic effect is achieved as if you this drug drank or injected. Here are just a pill to drink still easier, and have a concentration of active substance thus more reliable. Such medicines with an NSAID are more effective for bruises and sprains superficial muscles and ligaments.
If you are able to make preformed drug injections you absolutely nowhere – even so, even so, and the drug acts the same way.
What to do if the acute period has passed
Usually, back pain occurs on the background of General inactivity, which leads to weakness of muscles and ligaments that support the spine. With a weak back any overload (a violation of ergonomics and landing movements, or incorrect lifting of heavy loads by hand) lead to injuries of ligaments and muscles or to the degradation and protrusion of the intervertebral disc with all the consequences.
- strengthen the back (if you are already sick, consult with experts for the selection of complex physical therapy, but if healthy do morning exercises, isometric exercises, swim and generally lead an active lifestyle with the physiological activation of the entire musculature of the body);
- pay attention to ergonomics (like sitting in the office, as the tool wear in manufacturing, as digging the garden at the cottage).
Strengthening the back and proper ergonomics in daily and household activities are the only non-surgical treatment for chronic back pain is worsening, and effectively prevent recurrences.
Tips on preventing overload of the back:
- Never lift weights in a standing position. Sit down, grab the suitcase handle and stand with him. Lift weights with your legs, not your back.
- Under no circumstances swear to tell the truth and do not pull at an angle of 45° to the axis of the spine. The spine under load needs to move only in 2 dimensions is strictly forward-backward or left-right.
- You cannot bend and straighten the back with simultaneous rotation. It is especially dangerous when lifting and carrying heavy loads.
- When you carry a heavy burden in one hand, his other hand firmly push against the thigh (this technique allows the right to redistribute the load on the muscles of the back).
- Ever since the APE stood up on its hind legs, the back was her weak spot. Do not overload the back without special needs. Purchase suitcases on wheels, use the carts in the airports and at stations, do not skimp on the tea porters. If you have doubts, have the right orthopedic backpack, distribute the weight evenly through the body.
- And, of course, strengthen your back regular exercise as SOON AS ACUTE PAIN SUBSIDES. Possibly get rid of excess weight.