It is probably impossible to find a single adult who did not know what "lumbar osteochondrosis" is.On average, every third healthy, middle-aged person, and sometimes more often, has had an episode of acute back pain in his life, and every fifth or sixth indicates that such problems arise regularly, and are even the "source" of sick leave.
However, patients are often unable to explain in detail exactly what kind of disorder has occurred in the lower back.Most of them have never been examined and the treatment, consisting of "injections", "ointments" and massage sessions, usually helps for a period of several months to a year.
If you "push" 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 a "normal life"?
First of all, we must say with authority: "osteochondrosis" cannot hurt.And it cannot appear in any way, since this is a process of dystrophy and degeneration of the intervertebral discs, that is, the cartilage, which consists of the nucleus pulposus and fibrous rings.The intervertebral disc is cartilage, and is designed to work as a shock-absorbing "airbag", dampening vertical and angular accelerations - the braking between adjacent vertebrae.
As is known, cartilage is free of nervous and vascular tissue, therefore the processes that occur "just in the discs" simply cannot affect the neighboring structures and are not manifested in any way.A similar example in vertebroneurology is Schmorl's hernia, in which the hernial protrusion is well covered by the cancellous bone tissue of the adjacent vertebra.The intervertebral discs are not damaged.
Chondrosis (the suffix "-oz" means growth, expansion), in this case, is not entirely correct.There is no growth or growth of cartilage tissue during human life.With fibrosis (cirrhosis) of the liver, you may notice that the mesh structure of the liver has begun to develop, to the detriment of function.
And with chondrosis (or osteochondrosis), the intervertebral discs just begin to change their configuration, under the influence of many years of stress.
They cause pressure on neighboring vertebrae, since, according to Newton's law, any action under a static load causes exactly the same reaction, or support reaction.How does osteochondrosis develop and why does this happen?
Causes of "lumbar osteochondrosis"
Signs of lumbar osteochondrosis (more precisely, intervertebral discs) can already be detected at a young age, especially with various disorders of the musculoskeletal system.
These include, for example:
- congenital anomalies (different leg lengths);
- different types of flat feet (longitudinal, transverse);
- deformations of the spine (scoliosis);
- spondylolisthesis (slippage of the lower lumbar vertebra from the sacrum both anteriorly and posteriorly).
All these diseases can cause either an increase in the impact load on the spine (for example, with flat feet, when the elasticity of the arch of the foot decreases), or with pronounced asymmetry of the spine, when the supporting function is systematically realized due to the load on the edge of the disc.
It is known that during experiments it was found that healthy and young cartilages, if they were given a load evenly and statically over the entire surface, could withstand up to 2000 kg and even higher without harming themselves.Of course, such a charge does not exist in everyday life, but it can increase to such values when exposed to the edge of the disk.
If the support area is 20 times smaller, and the disc is not so healthy (for example, in old age), then a blow of 60-80 kg (for example, falling on the ice while leaning on the side, with a load on the shoulders) can cause the destruction of the disc, which can be in the form of a protrusion or hernia.
It is the appearance of a protrusion or hernia that indicates that the disc is deformed and even "popped" on 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 force the patient to consult a neurologist, chiropractor and massage therapist.
As long as the discs have a normal shape and wear evenly, without extreme loads, then osteochondrosis of the lumbar spine bothers the patient no more than the usual age-related tooth wear, with which criminologists are well acquainted.How are reflex pain syndromes manifested?
Symptoms and signs of complicated lumbar osteochondrosis
You have already noticed that we are diligently "spreading" bridges: ordinary osteochondrosis is a completely inevitable process of normal aging of the elastic intervertebral "pillows" in the "Homo sapiens" species, as it moves vertically throughout life.And the "osteochondrosis" that patients with acute pain remember is a complicated condition.
Let's start, perhaps, with the signs of radicular compression.Signs of lumbar osteochondrosis, of course, are accompanied by pain due to the pressure of the segmental nerve root by the disc.In addition to pain, sensory, motor and vegetative-trophic disorders are also possible.
Back pain with osteochondrosis has the following characteristics:
1) Radicular pain.It is secondary and appears as neuralgia, when a swollen nerve root reacts very "violently" to a friend.
The pain is sharp, sudden, shooting, piercing the lower back, possibly radiating to the legs.The pain appears and intensifies immediately, which is why it is called "lumbago", or "lumbago".It is this type of "lumbago" that makes a person "get up in a hurry", since every movement leads to increased pain.
In addition, the pain intensifies with the slightest cough, sneeze, strain, laugh - any situation in which the swollen root is shaken.
If the root is part of the sciatic nerve, the pain "explodes" through the buttocks into the popliteal fossa and below, and this is called "lumbar sciatica".
2) Muscle pain.Near the nerve root there are large muscle masses.Often, in spring and autumn, they "cool down" and themselves swell and become dense.Venous outflow is obstructed in them and they themselves are a source of pain.
This pain is painful, constant and not so sharp.On the contrary, it intensifies not only with sudden movements, but also with prolonged standing in a monotonous position (deterioration of blood supply).
- Sometimes such a myofascial syndrome occurs after an aggravation of a protrusion or hernia, when a sharp "hook" of the hernia "massages" the muscles and ligaments for a long time.
3) Movement disorders.Since the disc can compress not only the sensory but also the motor root, 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 discomfort in walking.
Muscle wasting occurs and one leg "loses weight".Such a purely motor, painless disorder is rare and, if left unnoticed, can lead to disability.
4) Sensory disorders.They arise along with the pain and often exist after the pain ends, instead of the pain itself.They are manifested as numbness, decreased sensitivity of the skin of the feet in the form of "lines", in the form of vertical lines and a sensation of "crawling hooks" in the toes and feet.
- Sometimes, when the vegetative fibers are damaged, the symptoms are combined with hyperhidrosis, cold skin and impaired growth of hair and nails.
These are the most common signs of complicated lumbar osteochondrosis that exist in the lumbar region.There are individual syndromes, for example, damage to the external cutaneous 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 "lighten the heaviness with your own hands"?How to treat lumbar osteochondrosis at home?
What should you do during an exacerbation of lumbar osteochondrosis?
The basis of any treatment is etiotropic therapy (elimination of the cause) and pathogenetic treatment (affecting the mechanisms 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 impact on the mechanisms is the elimination of muscle spasm, the restoration of venous flow in the muscles, the removal of nerve root swelling and the fight against inflammation;
- Elimination of symptoms (fighting pain, numbness, limited mobility) is carried out by returning to point no.2, as removing swelling and inflammation, for example, will restore mobility and relieve pain.
Removal of protrusion and hernia
As a rule, it is not the starting point for the treatment of acute back pain.Almost always, the pain syndrome is first relieved, then, after massage sessions and treatment by the chiropractor, all symptoms go away and surgery is not required.
The issue of surgical intervention arises with the progression of leg weakness and severe, intractable pain for 2 months.Additionally, surgery is required when there is high-level compression of the central canal, which contains the spinal cord, or cauda equina.
Treatment of lumbar osteochondrosis, medications
Treatment of lumbar osteochondrosis and its complications includes the following measures.In the acute phase (first day - two):
- To reduce swelling of the muscles and spine, a salt-free diet and limiting the amount of fluids consumed is indicated.You can also give a tablet of a mild potassium-sparing diuretic.
- It is recommended to wear a semi-rigid orthopedic corset, which protects the muscles from excessive movement.
- From the first days, rubbing with warming ointments containing NSAIDs and applying patches, for example, "pepper" patches, are recommended.
- During the acute phase, you cannot warm the back.As inflammation increases, swelling increases.Therefore, any heating pad is prohibited.You can warm yourself by removing your own heat (wool belt, heating ointments), which do not add it from the outside, but instead draw it from deep into 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 the swelling of nerve tissue, eliminate inflammation and normalize muscle tone.
In the subacute period, after overcoming the maximum pain, no more "injections" should be given and attention should be paid to restorative agents, for example, modern preparations of group "B" vitamins.They effectively restore damaged sensitivity, reduce numbness and paresthesia.
Physiotherapy 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 the swelling and inflammation have already decreased, but the muscle spasm has not yet been completely resolved.
Exercises for lumbar osteochondrosis of the spine should be performed after a light general warm-up, in "warmed-up muscles".
The main therapeutic factor is movement, not the rate of muscle contraction.Therefore, to avoid relapse, the use of weights is not allowed;a gymnastic mat and a gymnastic stick are used.With their help, you can effectively restore the range of motion.
Rubbing with ointments and using the Kuznetsov implicator continues.Swimming, underwater massage, Charcot shower are indicated.It is during the worsening phase of fading that medications for home magnetic therapy and physiotherapy are indicated.
Usually the treatment lasts no more than a week, but in some cases, osteochondrosis can appear with such dangerous symptoms that surgery may be necessary and urgent.
Complications of lumbar osteochondrosis of the spine
We are talking, first of all, about a condition when the disc herniation has become an independent fragment and, having penetrated the central canal, has created a free sequestration.There you can compress the nerves of the cauda equina and you can suddenly (in the gym, after an episode of acute pain) develop severe weakness, or paralysis in the legs, numbness of the perineum.
After a few minutes, severe pains appear in the legs, and then a reflex urinary retention or the appearance of incontinence is possible and impotence develops.This occurred as cauda equina syndrome as a complication of a herniated disc.In this case, urgent intervention is required, removal of the sequestrum and restoration of the function of the cauda equina nerves with their decompression.
However, more often than not, other complications arise.With age, numerous hernias and protrusions occur, osteoporosis of the vertebrae occurs, and mobility simply decreases significantly, and the risk of acute back pain increases.Such patients necessarily "take medical 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 discussed above, as we understood, for the most part is not a disease at all, but simply a manifestation of inevitable aging and premature "shrinkage" of the intervertebral discs.
Can humanity be completely freed from lumbar osteochondrosis?This answer can be answered in the affirmative, but then we will have to master another style of locomotion: walk on all fours throughout our lives, or, like Ichthyander, swim in the depths of the ocean, constantly moving in water from childhood.It is then that the axial, static load on the intervertebral discs will disappear, and with it the signs of "chondrosis".But another problem will arise: in water such a powerful structure will simply become unnecessary and begin to change until it disappears or is significantly reduced.
As for the personal, individual prognosis for osteochondrosis, it all depends on when the person "decided to come to his senses".If by this time there is no pronounced destruction of the intervertebral discs, protrusions, hernias and deformations, 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 presses on the nerve root, then the person should be especially careful from difficult turns, physical exertion, improper lifting of weights and seasonal hypothermia, which usually cause aggravation of spinal osteochondrosis.