An Inside Look At Back Pain

Back pain is one of the most frequently encountered complaints in people of working age.

Back pain often indicates pathological processes occurring in our body. Successful treatment of back pain begins with a correct diagnosis and identifying the underlying cause of the disease. Therefore, treatment should be directed towards eliminating the root cause.

Causes of Back Pain

Back painStatistics indicate that the major reasons for back pain are:

  1. Herniated disc
  2. Rupture of the fibrous ring
  3. Spinal stenosis
  4. Myogenic pain (pain originating from muscles)
  5. Facet arthropathy.

Herniated disc

Disc herniation is characterized by the following by:

  • History of injury or a history of frequent Microfracture (sports, running, jumping etc)
  • Pain may be aggravated by sitting, coughing, sneezing, bending forward and straightening the legs
  • Possible sensory disturbances in the form of numbness or paresthesia (abnormal sensations)
  • Reduced muscle strength and atrophy (in a later stage)
  • Positive Lasegue Test/ Straight Leg Raising Test (SLR)
  • MRI or CT scan may reveal violations in the intervertebral disc in the form of disc herniation and nerve root involvement

Clinical manifestations of disc herniation depend on its degree – protrusion or prolapsed and orientation (isolated medial and posterolateral, and foraminal or extraforaminal), etc.

Rupture of the fibrous ring

Rupture of the fibrous ring is characterized by the following features:

  • History of injury
  • Back pain is more pronounced than pain in the leg (usually)
  • Leg pain can be both bilateral and unilateral
  • Positive Lasegue Test/ Straight Leg Raising Test (SLR) (but MRI or CT data do not provide radiological confirmation root compression as in disc herniation)
  • Pain is also enhanced when sitting, bending forward, coughing and sneezing, straightening the legs

Myogenic pain (Pain originating from Muscles)

It is characterized by the following features:

  • History of single or repeated muscle strains
  • Recurrence of pain associated with increase in muscle tension
  • Back pain occurs on electrical stimulation of paravertebral lumbar muscles
  • Electrical stimulation of the gluteus maximus causes pain in the buttocks and thigh
  • Pain in the lower back
  • Pain is worse in the morning and after a rest, as well as on cooling
  • Pain increases on prolonged muscular work and the most intense pain is just after the cessation of muscular load
  • Pain on palpation of the involved muscles
  • Pain may be exacerbated by the active and passive muscle contraction
  • MRI and CT did not reveal any pathological changes

Lumbar stenosis

Lumbar stenosis is often a consequence of age-related changes in the spine. It is characterized by the following:

  • Pain in the back and/ or in leg appears after walking a certain distance
  • Symptoms gradually increase when you continue to walk
  • Weakness and numbness in the legs
  • Flexion relieves symptoms
  • MRI and CT scans reveal a decrease in disc height, hypertrophy of the facet joints, degenerative spondylolisthesis.

Facet arthropathy

Facet arthropathy is characterized by the following features:

  • History of injury
  • Pain appears immediately on extension of the spine
  • Back pain increases with flexion on the affected side
  • Pain stops after administration of corticosteroids and/ or anesthetic into the joint (this is also the treatment of back pain with facet arthropathies)

Diagnosis of back pain

Diagnosis begins with a careful history. Doctors asks the patient about the complaints, course of the disease, its forms and features, evaluates the neurological symptoms – whether there is a decrease of tendon reflexes, to determine where the reduced sensitivity of the skin, etc.

The most accurate method of diagnosis of diseases of the spine is magnetic resonance imaging (MRI) and computed tomography (CT scan) of the spine. These are important to study the structure of the spine, to diagnose the presence or absence of herniation of intervertebral disks, and to know the general condition of the vertebrae of the spinal cord.

In modern neuroradiology, MTP diagnosis is considered the most sensitive and accurate method of examination.

Treatment of Backache

It is clear that the treatment of back pain begins with detection and accurate diagnosis of the underlying cause. The diagnosis can be established on the basis of clinical examination and if necessary updated with modern diagnostic methods. The most informative method in use today is magnetic resonance imaging or MRI.

Correct diagnosis and identify the causes of pain predetermine treatment program that includes one or more treatment options that have synergistic and complementary action. Medical treatment, surgery, physiotherapy and many other treatment options are available and can be used if advised by doctor and acceptable to the patient.

We can also use one or more of the following techniques:

Prevention of back pain

There are some basic rules that help maintain a healthy spine and prevent back pain. These include:

Avoid bending your back when walking or standing walk.

Sit properly with back in upright position against back rest of chairs.

Do not lift or carry weight in bending position.

Sleep properly and perform moderate exercise.

The most important in the prevention of back pain and many other diseases is a healthy lifestyle that includes regular balanced diet, exercise, avoiding bad habits and controlling your emotions.

Dr. Lisa MD, Readers Bureau, Contributor

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