What are caused by back pain in fact?
- In the vast majority of cases back pain is caused by nonspecific mechanical causes: most commonly damaged ligaments and muscles that support the spine (70%), less often compression fractures in osteoporosis (4%).
- With the degenerative neural processes of the intervertebral discs and joints, which are in the Russian terminology is called osteochondrosis, manage to somehow connect the more than 10% of cases.
- Rarely, even if concisely, the pain is caused by protrusion = herniated disk, compressing the nerve roots, and then, for example, starts to hurt and numb in the thigh or the lower extremities (sciatica). So, alas, the so-called radiculopathy are caused by no more than 1-3% of acute lumbar pain.
- Often have to face the idiopathic pain, without any organic damage (basically psychogenic nature).
- Very rarely are they identified specific causes: infection or tumor (0,8%), or diseases of the internal organs, when the pain reflected to the back (1,5-2%).
- Despite popular opinion, congenital curvature of of posture (kyphosis, scoliosis) by themselves lead to the pain syndrome only rarely (< 1%).
And there are many other rare causes, which will only understand the expert.
In this way, most often back pain, not associated with each other backbone, and is caused by the anxiety of the muscle fibers and the ligaments of the back pain due to physical overload. They are for a long time does not heal, it forms around and a hotbed of inflammation, which also supports the substance ischemia and pain on the principle of vicious circle.
In our same kingdom-a condition that is not a pain in the back — all to blame osteochondrosis and notorious, herniated discs.
How to avoid incompetent treatment and "divorce" on the money
X-rays, MRI, CT, back pain and neck, as a rule, is not required. The doctor may prescribe such a study, if you have any symptoms of a serious damage to the spinal cord and the nerve roots in the form of peripheral disorders (paresis or paralysis of the muscles of the lower limbs, impaired sensitivity, impaired function of the pelvic organs). In 90% of cases of pain in the neck and back these studies are completely unnecessary and the default provisions should not.
A neurologist can prescribe you is a study, even without the described disorders, if the pain do not lose their intensity in the course of 4-6 weeks, despite correct treatment, or if there is suspicion of a specific process type of tumor or tuberculosis of the spine.
In our country adopted the default find all kinds of hernias (who is there just isn't) and scares all the sick images, however, in developed countries have long postulated: the correlation between back pain without peripheral symptomatology and the image on the x-ray image or a CT no.
Smart people just took 1000 people with pain without peripheral symptomatology and 1000's of perfectly healthy and all made the tomogram (CT and MRI). Finally, in both groups the number of people with herniated discs and without such turned out to be approximately the same. In addition, among surveyed were persons with those of Terry hiatal, who do not experience pain in the back, and vice versa — many of the suffering from pain, they had no hernia. This experiment has already repeated several times especially for rested, so no doubt they are not, remains in first place in the consideration of complaints and symptoms, and then assign a visual survey, if there are indications. In other words, treat the patient, not the images.
Herniated disc at all it is not too often involved in the development of many other diseases. Only in 4% of cases pain in the back can manage to spend some sort of theoretical relationship with an existing hernia, and so serious eject the discs, which require a radiology visualization and operative treatment, occur very rarely.
Why is our country's image or scan of the spine will not name just a lazy doctor? The first reason — the illiteracy of some doctors (see introduction for the identity of the domestic medical schools). And the second is the economic interest of health facilities and/or the attending physician.
In the last 10 years the main article of the income figures from the department of health and the main doctors and hospitals have become the commissions received from the companies-manufacturers of medical equipment and consumables. And here this gold mine have shown the device MRI (magnetic resonance imaging), CT (computed tomography), at the worst, the digital device x-ray. Back from the average scanner is 100 thousand dollars in a lump sum, but to prove that the fact is almost unreal. Here and bought everywhere, where is necessary and not necessary.
Another enterprising dr. provide such a stream, that on the MRI waiting queue for a month forward. To the conveyor worked regularly in many commercial doctors ' offices of doctors planted on the percentage of nominated studies (examination, ULTRASOUND and, of course, expensive CT and MRI).
Lumbar pain — boring thing, but held, as usual, about herself. Studies show that pain in the lower back without treatment leads over a week in 30-60% of patients after 6 weeks of healthy already 60-90%, while a year better 95%.
How to speed up recovery
And here the unfortunate patients bred — mother is not to grieve. Pain, because it w the whole in the brain is analyzed, and it means that the placebo-effect for headaches will work in every case — even when leech gave, at least in the hot pebbles, and even when a fan leaves the mold. Especially suggestible to you and magic spells, and favorable horoscopes and even homeopathy. One bad — placebo-effect is, by definition, is limited.
In acute pain in the back are not effective the following methods of treatment:
- therapeutic physical training;
- therapeutic massage;
- traction of the spine.
In the acute phase, these methods are not only showing up but also can hurt.
They have no advantages over normal healing therapy as a cost to time and finances methods such as:
- manual therapy (manipulation of the straightening of the bones, an excellent massage);
- acupuncture = acupuncture.
In the acute period of a short-term effect may give methods dissipates therapy the type of pepper spray plasters, cans, no burning ointment. Works on the same principle, and acupuncture. Here the effect is achieved by the switching of the brain with the bald head on the new focus of irritation. Eventually, the brain focuses on one place and the pain subsides.
Good effect gives the heat warming the muscles. Effect, true short-term, but still.
What really helps for acute back pain/cervical spine
Only 3 things have been proven conclusive efficacy:
- drugs from the group of NSAIDS (non-steroidal anti-antiinflammatory drugs);
- drugs from the group of central muscle relaxation, which together with the NSA;
- maintaining an active activity at the time of the disease (bed rest, not only not help, but on the contrary, prevents healing).
Cheap and cheerful. Everything else in the acute period — a placebo-effect, or divorce is on the money. Although now suffice to say that the elderly we can recommend it as a clinic for any kind of placebo treatments, if only they weren't stale. Itself is walking distance to the doctor, has the effect.
It depends on what the NSA drink? And can do injections? And can, cure it is better to rub into the sore spot?
The answer to the first question without hesitation pain is effectively removed any NSA. But everywhere has its own nuances. Some of the NSA to better act on pain, inflammation.
No matter exactly how you take anti-inflammatory drugs — through the mouth or in the form of a hand, with or without food — side effects on the stomach works as well. Ulcer outgrows it's not because the tablet irritates the mucous membrane by direct contact, but because it is inhibited synthesis of COX-1 after the drug has already become in the blood.
Outside of the subcutaneous tissue and adjacent muscles and ligaments such drugs are almost not penetrate, and what penetrates, is posted blood flow and is evenly distributed throughout the body. Even during the blockade of the drugs injected with a long needle, to straight to the nerves — not to a centimeter, and the effect may not be at all.
However, if the paint thickly and often, in the blood throughout the body, sooner or later created a sufficient concentration of the NSA and then the analgesic effect will be achieved if you have taken this medicine drink he did, or injection. It is just drinking a pill is still easier, and the concentration of the relevant substance in this way it is ensured better. As a drug with an NSAID are more effective in injuries and sprains of the superficial muscles and ligaments.
If you are unable to take tablets, medicine, injections will give you a completely useless – at least, so, at least there, and the cure is the same.
What to do when the acute period has passed
Usually, back pain will occur on the background of the overall hypoaktivita, which leads to weakness of muscles and ligaments that support the spine. When a weak back any of his congestion (disorder ergonomics of the landing and movement or while lifting weights manually) lead to damage to the ligaments and muscles, or to the degradation and protrusion of a herniated disc, with all the consequences.
- strengthen your back (if you already sick, consult with experts to design a comprehensive physical therapy, and if healthy — do morning exercises, isometric exercises, swim away and not keep moving way of life with the physiological involvement of the entire musculature of the body);
- pay attention to ergonomics (how you sit in the office, both wearing tool for the production, how do you like the bed at the cottage).
Strengthen the back and correct ergonomics in everyday and domestic activities are the only non-surgical device for the treatment of chronic pain in the back outside of an exacerbation, and is also effective in the prevention of recurrence.
Tips on preventing overload of the back:
- Never answer the gravity in the position in a standing position. Sit down, grab the handles of trunks and stand together with him. Lifting weights your legs and not your back.
- Under any circumstances nothing do not lift and do not pull at an angle of 45° to the axis of the spine. The spine is under load must perform movements only in 2 planes – top forward-backward or left-right.
- You cannot bend and straighten your back is parallel to its rotation. It is especially dangerous when lifting and repositioning the weights.
- When you're carrying heavy to carry in one hand, the other hand firmly press to the hip (this trick allows you the right to redistribute the load on the muscles of the back).
- Ever since the ape stood up on the back paws, spin has become its weak point. There is no load on your back without special needs. Buy suitcases on wheels, use the shopping carts at airports and train stations, do not skimp on the tea luggage racks. If we are in doubt, keep the right orthopedic backpack, assigned severity evenly throughout the body.
- Well and, of course, strengthen your back is regular exercise, once the ACUTE PAIN SUBSIDES. Options to get rid of against excess weight.