Back or lower back pain is the most common complaint of patients in general medical practice. They rank second (after respiratory diseases) in terms of the frequency of requests for medical care. There are many diseases that lead to pain. But the most common cause is osteochondrosis of the lumbar spine, whose symptoms and treatment we will discuss in this material.
Relatively recently, medicine considered this condition to be age-related changes in the spine, which it associated with the natural aging processes of the human body.
Today, lumbar osteochondrosis is considered a fairly serious disease that occurs in people of all ages. Currently, the incidence has a constant tendency to rejuvenate, and the disease is increasingly being diagnosed in people under the age of 30.
Causes
The reason for the development of lumbar osteochondrosis has not been determined yet. But in the face of this pathology, it is quite often possible to guess who is more prone to the disease and who is at risk.
Predisposing factors:
- Passive lifestyle. This includes people who lead a predominantly sedentary lifestyle. In the sitting position, the muscles of the corset relax, which increases the load on the lumbar spine.
- Hormonal metabolic disorders and endocrine diseases can negatively affect the metabolism in the tissues of the spine and contribute to the development of osteochondrosis.
- Various congenital and acquired abnormalities in the structure of the musculoskeletal system - curvature of the legs and spine, flat feet.
- Presence of constant heavy physical exertion on the spine, especially lifting heavy objects. In this case, we can talk about an occupational disease of such categories as weightlifters and people whose professional duties are associated with the constant lifting of heavy objects.
- Constant unhealthy diet and daily routine, regular stress, insufficient time for sleep, metabolic disorders.
The above points are the most common factors that create the preconditions for the development of the disease.
Degree of lumbar osteochondrosis
Manifestations of the disease depend on the degree of pathology development.
There are four degrees of osteochondrosis:
- Period of change and movement of the pulposus nucleus within the disc. Pain occurs due to irritation of the nerve endings located in the annular fibrosus and longitudinal ligaments. The patient feels local discomfort in the part of the spine where the affected disc is located: acute pain or lumbago in the lower back (lumbago), dull pain of a permanent nature (lumbodynia).
- Period of destruction of annular fibrosus. It is characterized by the appearance of instability and increased mobility of the vertebrae, which causes prolonged and permanent muscle tension. The patient feels symptoms such as constant lower back muscle fatigue, discomfort,
- The period of rupture of the annular fibrosus and the exit of the nucleus pulposus beyond its boundaries by the formation of a herniated disc. So-called radicular syndromes are observed, which are associated with compression of nerve roots by dropped fragments.
- The spine is severely deformed. The motor function of man is difficult. The main issue to be addressed is the patient’s disability. However, it must be emphasized that there is practically no pain at this stage of the disease. But this is not a signal to stop the disease, quite the opposite.
- There is pathological proliferation of bone tissue, which will further aggravate the condition.
The method of treatment of osteochondrosis of the lumbar spine will directly depend on the degree of the lesion, because it uses drugs, drugs that are not medical and surgical.
Symptoms of lumbar osteochondrosis
When osteochondrosis of the lumbar spine occurs, the main symptom is pain. The nature of the sensation of pain, the place of origin and the direction of spread depend on which receptors get irritation, ie how rough the changes are on the disc and surrounding tissues, there is a bulge or already a hernia, in which direction the bulge formed and so on.
List the main symptoms of lumbar osteochondrosis:
- Pain in the lumbar spine, painful in nature, intensified by sudden movements, change of body position, prolonged stay in one position. Pain reduction occurs when taking a horizontal position;
- In addition to pain in the lumbar spine, osteochondrosis can give a feeling of weakness in the lower torso and legs, as well as loss of tendon reflexes of the lower extremities;
- Curvature of the lumbar spine is common. Depending on the place where the curvature is observed, we distinguish between scoliosis (curvature of the spine to the right or left), lordosis (forward bending) and kyphosis (smoothing of the lumbar flexion);
- If osteochondrosis has resulted in constriction and dysfunction of the spinal cord, the patient may have uncontrolled urination and stool.
Additional features:
- cold skin and numbness in the lumbar region, buttocks;
- dryness, peeling, blue skin on the lower back and buttocks;
- violation of sweating in the buttocks;
- urination disorder;
- erectile dysfunction.
These symptoms indicate the onset of the disease and require medical intervention. Treatment of osteochondrosis can be carried out in a hospital and at home.
Diagnostics
The diagnosis of osteochondrosis involves the use of various methods, primarily palpation of the lumbar spine.
To confirm the diagnosis, the patient is sent for examination using diagnostic equipment:
- Radiography helps to assess the condition of the spine and each vertebra separately. The integrity of the intervertebral discs and spinal canal is also indirectly assessed.
- Tomography determines the degree of damage to the nerve endings and the mucous membrane of the spinal cord. And also assess the condition of the intervertebral discs.
- MRI - used to make a definitive diagnosis.
A correct diagnosis will help to understand how lumbar osteochondrosis is treated and what medications and procedures will be needed to do so.
Complications
Osteochondrosis of the lumbar spine can cause bulges and hernias due to significant loads on this spine. It is these complications that develop very quickly, so it is very important to treat them on time.
In addition, osteochondrosis can be complicated:
- inflammation of the sciatic nerve; spondyloarthritis; Schmorl's hernia; osteophytosis, spondylosis;
- spinal canal stenosis with spinal cord compression and dysfunction;
- compression of the cauda equina with pelvic organ dysfunction;
- chrome;
- paresis of the lower extremities.
Timely diagnosis and complex treatment can prevent the progression of complications.
Treatment of lumbar osteochondrosis
When lumbar osteochondrosis is diagnosed, treatment requires extensive complex therapy that includes:
- moderate physical activity;
- drug use;
- pulls the spine;
- manual therapy;
- physiotherapy;
- massage.
The osteochondrosis treatment scheme focuses on:
- removal of the inflammatory process;
- reduction of pain in the lumbosacral region;
- strengthening muscles in the lumbar region, buttocks, legs;
- removal of pathological muscle tension;
- improving the functioning of the pelvic organs;
- regulation of blood circulation and metabolic processes in the affected area;
- restoration of normal range of motion in the lower back and increased sensitivity of the lower extremities.
Surgery is used in only a few cases.
Medications
Such treatment of osteochondrosis of the lumbar spine includes taking tablets, injections and external (ointments and gels) medications. Medications used to fight this disease relieve pain and stop inflammation.
Depending on the manifestations, the doctor may prescribe different tablets for osteochondrosis of the lower back:
- pain relievers (analgesics);
- nonsteroidal anti-inflammatory drugs;
- muscle relaxants, to relieve muscle spasms that occur due to pain;
- chondroprotectors that regenerate cartilage tissue;
- corticosteroids (prescribed if all other treatments failed);
- vitamin preparations.
Very often in the treatment of osteochondrosis, tablets that calm the nervous system are prescribed, as well as antidepressants that fight stressful situations and depression.
Physiotherapy of lumbar osteochondrosis
As a rule, drugs alone are not enough to treat osteochondrosis. Physiotherapy procedures are used to relieve pain, relieve muscle cramps and stimulate metabolism and recovery processes:
- ampulse;
- phonophoresis;
- diadynamic currents;
- darsonvalization;
- magnetic resonance therapy;
- laser therapy.
Massage is prescribed when the main symptom of pain is removed or during remission in chronic pathology. It serves to relax tense muscles. Very often combined with warm-up procedures or a visit to the sauna. This will help increase the relaxing effect on the muscle tissue and stimulate blood circulation.
Manual therapy, which is performed only by a specialist in this area of treatment, increases blood circulation in the spinal cord, replaces the displaced discs of the spinal column.
Rehabilitation gymnastics
A whole range of physical exercises used in the diagnosis of lumbar osteochondrosis should help increase the mobility of the lumbar spine.
Healing gymnastics will not be effective if the exercises are performed from time to time. The main principle of exercise therapy is regularity. Constantly performing a certain set of exercises will help eliminate destructive processes in the intervertebral joints.
Surgery
Usually a doctor will order surgery only if serious complications develop. For example, an intervertebral hernia. The most common type of surgery is the removal of a damaged disc (discectomy).
This operation is considered the most productive method in this case, but at the same time it is prescribed only if other methods of treatment do not bring results within six months. In addition, the method of microsurgical and endoscopic treatment of the spine is widely used.