It is probably impossible to find a single adult who does not know what "lumbar osteochondrosis" is.On average, every third healthy, middle-aged person, and sometimes more often, has experienced an episode of acute low back pain in his life, and every fifth or sixth indicates that such a problem often arises, and is even a "source" of sick leave.
However, patients often cannot explain in detail the type of disorder that occurs in the lower back.Most of them are never examined, and the treatment, which consists of "injections," "ointments," and massage sessions, usually helps for a period of several months to a year.
If you "reject" such a patient and start asking him about the diagnosis, then, after suffering a little, he will declare that he is sick with "osteochondrosis."What does this disease mean in relation to the lumbar spine?
Osteochondrosis of the lumbar region - a disease or "normal life"?
First of all, we need to state authoritatively: "osteochondrosis" should not hurt.And it cannot manifest itself in any way, because this is a process of dystrophy and degeneration of the intervertebral disc, i.e. cartilage, which consists of the nucleus pulposus and the fibrous ring.Intervertebral discs are cartilage, and are designed to function as "airbags" that absorb shocks, softening vertical and angular accelerations - braking between adjacent vertebrae.
As is known, cartilage does not have nerve and vascular tissue, therefore the process that occurs "solely in the disc" cannot affect neighboring structures and does not manifest itself in any way.A similar example in vertebroneurology is Schmorl's hernia, where the protrusion of the hernia is safely protected by the cancellous bone tissue of the adjacent vertebrae.Intervertebral discs do not hurt.
Chondrosis (suffix "-oz" means growth, enlargement), in this case, is not completely correct.There is no growth or increase in cartilage tissue during human life.With fibrosis (cirrhosis) of the liver, you can see that the mesh structure of the liver has begun to develop, thus affecting function.
And with chondrosis (or osteochondrosis), the intervertebral discs only begin to change their configuration, under the influence of years of stress.
They cause pressure on neighboring vertebrae, because, according to Newton's law, every action under a static load gives rise to the same reaction, or support reaction.How does osteochondrosis develop, and for what reason does this happen?
Causes of "lumbar osteochondrosis"
Signs of lumbar osteochondrosis (more precisely, intervertebral discs) can be detected at a young age, especially with various disorders of the musculoskeletal system.
These include, for example:
- congenital anomalies (different leg length);
- various types of flat feet (longitudinal, transverse);
- spinal column deformity (scoliosis);
- spondylolisthesis (slippage of the lower lumbar vertebra from the sacrum forward and backward).
All these diseases can cause either an increase in the impact load on the spinal column (for example, with flat feet, when the elasticity of the arch of the foot is reduced), or with a clear asymmetry of the spine, when the support function is realized systematically due to the load on the edge of the disc.
It is known that during experiments it was found that healthy and young cartilage, if they are given an even and static load over the entire surface, can withstand up to 2000 kg and higher without damage to themselves.Of course, such a load does not exist in everyday life, but it can increase to such a value when exposed to the edge of the disk.
If the support area is 20 times smaller, and the disc is not very healthy (for example, in old age), then the impact of 60-80 kg (for example, falling on ice while leaning on the side, with a load on the shoulder) can cause the destruction of the disc, which can be in the form of a protrusion or hernia.
It is the appearance of a bulge or hernia that indicates that the disc has become deformed and even "comes out" from one or more sides.And, as you know, there is no free space around the disk.As soon as the disc begins to contact the nerve roots, ligaments and neighboring muscles, then the consequences of osteochondrosis arise: reflex pain and muscle-tonic syndrome, which forces the patient to consult a neurologist, chiropractor and massage therapist.
As long as the disc has a normal shape and wears evenly, without extreme loads, then osteochondrosis of the lumbar spine worries the patient no more than normal age-related tooth wear, which criminologists are familiar with.How does reflex pain syndrome manifest itself?
Complicated symptoms and signs of lumbar osteochondrosis
You have noticed that we are diligently "spreading" the bridge: common osteochondrosis is a normal aging process of the elastic intervertebral "pad" which is absolutely unavoidable in the "Homo sapiens" species, because it moves vertically throughout life.And the "osteochondrosis" that patients with acute pain remember is a complicated condition.
Let's start, perhaps, with signs of radicular compression.Symptoms of lumbar osteochondrosis are, of course, associated with pain due to segmental nerve roots being pressed by the disc.In addition to pain, sensory, motor and vegetative-trophic disorders are possible.
Lower back pain with osteochondrosis has the following characteristics:
1) Radicular pain.It is secondary and occurs like neuralgia, when the swollen nerve root reacts very "violently" to a shock.
The pain is sharp, sudden, shooting, stabbing in the lower back, may radiate to the legs.The pain appears and immediately intensifies, which is why it is called "lumbago", or "lumbago".It is a type of "lumbago" that makes a person "stand up in a hurry," because any movement leads to increased pain.
In addition, the pain increases with the slightest cough, sneeze, strain, laugh - any situation in which the swollen roots are shaken.
If the root is part of the sciatic nerve, the pain "shoots" through the back into the popliteal fossa and below, and this is called "lumbar sciatica."
2) Muscle pain.Near the nerve root there is a large muscle mass.Often, in the spring and autumn, they "get cold" and themselves swell and become dense.The outflow of veins is blocked in them, and they themselves are a source of pain.
This pain is painful, constant, and not very sharp.On the other hand, it is intensified not only by sudden movement, but also by prolonged stay in a boring position (impairment of blood supply).
- Sometimes such a myofascial syndrome occurs after the exacerbation of a protrusion or hernia, when the sharp "hook" of the hernia "massages" the muscles and ligaments for a long time.
3) Movement disorders.Since the disc can compress not only sensory, but also motor roots, the development of peripheral paresis, or even paralysis, is possible.At different levels of damage, weakness in the legs may appear (for example, weakness when climbing stairs on one side), weakness in the legs, which leads to walking disorders.
Muscle wasting occurs and one leg "loses weight."Pure, painless motor disturbances like that are rare and, if left unnoticed, can cause disability.
4) Sensory disturbances.They arise along with the pain, and often exist after the pain is over, instead of the pain itself.They manifest themselves as numbness, reduced sensitivity of the skin of the feet in the form of "stripes", in the form of vertical stripes, and the sensation of "crawling goosebumps" in the toes and feet.
- Sometimes, when vegetative fibers are damaged, symptoms are combined with hyperhidrosis, cold skin, and impaired hair and nail growth.
These are the most common symptoms of lumbar osteochondrosis that exist in the lumbar region.There are individual syndromes, for example, damage to the outer skin nerve of the thigh, or damage to the cauda equina, epiconus, pure radiculitis or piriformis syndrome - but even a brief description of them would take too much time.
For patients, the above basic signs are enough to make an appointment with a neurologist.How can you "relieve the severity with your own hands"?How to treat lumbar osteochondrosis at home?
What to do during exacerbation of lumbar osteochondrosis?
The basis of any treatment is etiotropic therapy (elimination of the cause), and pathogenetic treatment (affecting the mechanism of the disease).It is accompanied by symptomatic therapy.
For vertebrogenic pain (caused by problems in the spine), things go like this:
- Elimination of the cause is the elimination of pressure from a protrusion, hernia, or spasmodic muscle on the nerve root;
- The effect on the mechanism is the elimination of muscle spasms, the restoration of venous outflow in the muscles, the removal of nerve root swelling, and the fight against inflammation;
- Elimination of symptoms (against pain, numbness, limited mobility) is carried out by returning to point No.2, because removing swelling and inflammation, for example, will restore mobility and relieve pain.
Eliminates protrusions and hernias
As a rule, it is not the starting point for treating acute back pain.Almost always, the pain syndrome is initially relieved, then, after a massage session and treatment by a chiropractor, all symptoms disappear and surgery is not required.
The question of surgical intervention arises with the development of weakness in the legs, and with severe and uncontrollable pain for 2 months.In addition, surgery is required when there is a high degree of compression of the central canal, which contains the spinal cord, or cauda equina.
Lumbar osteochondrosis treatment, drugs
Treatment of lumbar osteochondrosis and its complications involves the following steps.In the acute phase (first day - two):
- To reduce muscle and spinal swelling, a salt-free diet and limiting the amount of fluid consumed are indicated.You can also give a mild potassium-sparing diuretic tablet.
- It is recommended to wear a semi-rigid orthopedic corset, which protects the muscles from excessive movement.
- From the first days, rubbing in a warming ointment containing NSAIDs and applying a patch, for example, a "pepper" patch, is recommended.
- During the acute phase, you should not warm your back.As inflammation increases, swelling increases.Therefore, any heating pad is prohibited.You can warm the body by releasing your own heat (wool belt, heating ointment), which does not add it from the outside, but, on the contrary, removes it from the depths to the outside.
- In the acute phase of lumbar osteochondrosis, short-term treatment can be carried out with intramuscular "injections" of NSAIDs and muscle relaxants.This will help relieve swelling of nerve tissue, eliminate inflammation, and normalize muscle tone.
In the subacute period, after overcoming the maximum pain, "injections" no longer need to be taken, and attention should be paid to restorative agents, for example, modern vitamin preparations of the "B" group.They effectively restore impaired sensitivity, reduce numbness and paresthesia.
Physiotherapeutic measures continue, the time has come for exercise therapy for osteochondrosis of the lumbar spine.Its task is to normalize blood circulation and muscle tone, when swelling and inflammation have subsided, but muscle spasms have not been completely resolved.
Exercises for lumbar osteochondrosis of the spine must be carried out after a light general warm-up, on "muscles that warm up".
The main therapeutic factor is movement, not the degree of muscle contraction.Therefore, to avoid repetition, the use of weights is not allowed;gymnastic mats and gymnastic sticks are used.With their help, you can effectively restore range of motion.
Rubbing in the ointment and using the Kuznetsov implicator continues.Swimming, underwater massage, Charcot shower are indicated.It is during the fading aggravation stage that home magnet therapy and physiotherapy are indicated.
Usually treatment takes no more than a week, but in some cases, osteochondrosis can manifest itself with such dangerous symptoms that surgery may be required, and immediately.
Complications of osteochondrosis of the lumbar spine
We are talking, first of all, about the situation when the disc herniation has become a free fragment and, having penetrated the central canal, has formed a free absorption.There it can compress the nerve of the cauda equina, and it can suddenly (right in the gym, after an episode of acute pain) have severe weakness, or paralysis of the legs, numbness of the perineum.
After a few minutes, severe pain in the legs appears, and then retention of reflex urination or the appearance of incontinence is possible, and impotence develops.This occurs as cauda equina syndrome as a complication of disc herniation.In this case, immediate intervention is required, the removal of the sequestrum, and the restoration of the function of the cauda equina nerves with their decompression.
However, more often than not, other complications arise.With age, various hernias and protrusions occur, vertebral osteoporosis appears, and mobility decreases significantly and the risk of acute back pain increases.Such patients necessarily "take sick leave" several times a year and are often treated in sanatoriums.
Treatment prognosis
Osteochondrosis of the lumbar spine, the symptoms and treatment of which we have discussed above, as we have understood, is largely not a disease at all, but only an inevitable manifestation of aging and premature "shrinkage" of the intervertebral disc.
Can humans be completely freed from lumbar osteochondrosis?This answer can be answered in the affirmative, but then we have to master a different style of movement: crawling all our lives, or, like the Ichthyander, swim to the depths of the ocean, always moving in water from childhood.At that time the axial, static load on the intervertebral disc will disappear, and along with it the signs of "chondrosis" will disappear.But another problem will arise: in water, such a strong structure will become unnecessary and will begin to change until it disappears or is significantly reduced.
As for the personal, individual prognosis for osteochondrosis, it all depends on the time when the person "decided to become aware."If at this time there is no destruction of the intervertebral disc, protrusion, hernia and obvious deformation, then, subject to a healthy lifestyle and hygiene of physical activity, you may not have problems with the lower back until a very old age.
In the same case, when there is already a "hot spot" in the lumbar region, for example, in the form of a hernia, which periodically compresses the nerve root, then the person needs to be especially careful from awkward turns, physical exercise, improper weight lifting and seasonal hypothermia, which usually cause the exacerbation of spinal osteochondrosis.