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 had an episode of acute lower back pain in his life, and every fifth or sixth indicates that such problems occur regularly, and are even the "source" of sick leave.
However, patients are usually not able to explain in detail what kind of disorder has occurred in the lower back.Most of them have never been examined, and the treatment, which consists of "injections", "ointments" and massage, usually helps for a period of several months to a year.
If you "push" such a patient and start asking him for a diagnosis, then, after suffering a little, he will declare that he is ill with "osteochondrosis".What does this disease mean in relation to the lumbar spine?
Osteochondrosis of the lumbar region - disease or "normal life"?
First of all, we must say authoritatively: "osteochondrosis" cannot hurt.And it cannot be manifested in any way, because it is a process of dystrophy and degeneration of the intervertebral discs, that is, the cartilage, which consists of the nucleus pulposus and the fibrous ring.The intervertebral disc is cartilage and is designed to act as a shock-absorbing "air cushion", cushioning vertical and angular accelerations - braking between adjacent vertebrae.
As is known, the cartilage is devoid of nerve and vascular tissue, therefore the processes that take place "purely 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 securely covered by cancellous bone tissue of the adjacent vertebra.Intervertebral discs do not hurt.
Chondrosis (the suffix "-oz" means growth, increase), in this case, is not entirely correct.There is no growth or enlargement 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 in chondrosis (or osteochondrosis), the intervertebral discs are just beginning to change their configuration, under the influence of long-term stress.
They cause pressure on the adjacent vertebrae, because, according to Newton's law, any action under a static load causes exactly the same reaction, that is, the reaction of the support.How does osteochondrosis develop and for what reasons does it happen?
Causes of "lumbar osteochondrosis"
Signs of lumbar osteochondrosis (more precisely, intervertebral discs) can be detected already at a young age, especially in various disorders of the musculoskeletal system.
This includes, for example:
- congenital anomalies (different leg lengths);
- various types of flat feet (longitudinal, transverse);
- spinal column deformities (scoliosis);
- spondylolisthesis (slippage of the lower lumbar vertebra with the sacrum forward and backward).
All these diseases can cause either an increase in the impact load on the spinal column (for example, in flat feet, when the elasticity of the arch of the foot decreases), or in 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 established that healthy and young cartilages, if they are given an even and static load over the entire surface, can withstand up to 2000 kg and more without damaging themselves.Of course, such a load does not exist in everyday life, but it can increase to such values when exposed to the edge of the disk.
If the support surface is 20 times smaller, and the disc is not so healthy (for example, in old age), then an impact of 60-80 kg (for example, falling on 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 bulge or hernia.
The appearance of a bulge or hernia indicates that the disc is deformed and even "came out" on one or more sides.And, as you know, there is no empty space around the disk.As soon as the disk begins to touch the nerve roots, adjacent ligaments and muscles, then the consequences of osteochondrosis arise: reflex pain and muscle-tonic syndromes, 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 does not worry the patient 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 diligently "widen" the bridges: ordinary osteochondrosis is a completely inevitable process of normal aging of the elastic intervertebral "pads" in the "Homo sapiens" species, since 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 associated with pain due to the disc pressed segmental nerve root.In addition to pain, sensory, motor and vegetative-trophic disorders are possible.
Pain in the lower back 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 the shock.
The pain is sharp, sudden, shooting, piercing the lower back, possibly radiating into the leg.The pain appears and instantly intensifies, which is why it is called "lumbago" or "lumbago".It is this type of "lumbago" that makes a person "get up in a hurry", because every movement leads to increased pain.
In addition, the pain increases with the slightest cough, sneeze, strain, laugh - any situation in which the swollen root shakes.
If the root is part of the sciatic nerve, the pain "shoots" through the buttocks into the popliteal fossa and below, and this is called "lumbar sciatica".
2) Muscle pain.There are large muscle masses near the nerve roots.Often in spring and autumn, they "get cold" and swell and become thick.With them, venous outflow is difficult, and they themselves are the source of pain.
This pain is painful, constant and not so sharp.On the contrary, it is intensified not only by sudden movements, but also by prolonged stay in a monotonous position (deterioration of blood supply).
- Sometimes such myofascial syndrome occurs after 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 disk can compress not only the sensory but also the motor root, the development of peripheral paresis and 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 foot, which leads to gait disturbances.
Muscle loss occurs and one leg "loses weight".Such a purely motor, painless disorder is rare and, if not noticed, can lead to disability.
4) Sensory disorders.They arise together with the pain, and often exist after the pain has stopped, instead of the pain.They manifest as numbness, reduced sensitivity of the skin of the legs in the form of "stripes", in the form of vertical stripes, and a feeling of "creeping goosebumps" in the fingers and feet.
- Sometimes, when the vegetative fibers are damaged, the symptoms are combined with hyperhidrosis, cold skin and disturbed 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 basic signs listed above are enough to make an appointment with a neurologist.How can you "hands down the aggravation"?How to treat lumbar osteochondrosis at home?
What to do during exacerbation of lumbar osteochondrosis?
The basis of any treatment is etiotropic therapy (removal of the cause) and pathogenetic treatment (influence on disease mechanisms).It is followed by symptomatic therapy.
For vertebrogenic pain (caused by problems in the spine), things are like this:
- Eliminating the cause is eliminating the pressure from the protrusion, hernia or spasmodic muscle on the nerve root;
- The effect on the mechanisms is the removal of muscle spasm, the restoration of venous outflow in the muscles, the removal of nerve root swelling and the fight against inflammation;
- Removal of symptoms (fighting against pain, numbness, limited mobility) is done by returning to point no.2, because by removing swelling and inflammation, for example, it will restore mobility and relieve pain.
Removal of protrusions and hernias
As a rule, it is not the starting point for the treatment of acute back pain.Almost always, the painful syndrome is alleviated at first, and then, after massage and treatment by a chiropractor, all symptoms disappear and surgery is not necessary.
The question of surgical intervention arises with the progression of weakness in the foot, and with severe, irreparable pain lasting 2 months.In addition, surgery is required when there is high compression of the central canal, which contains the spinal cord, or cauda equina.
Treatment of lumbar osteochondrosis, drugs
Treatment of lumbar osteochondrosis and its complications includes the following measures.In the acute phase (the first day or two):
- In order to reduce muscle and spine swelling, a salt-free diet and limiting the amount of fluid intake is indicated.You can even 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, it is recommended to apply warming ointments containing non-steroidal anti-inflammatory drugs and to apply plasters, for example, "pepper" plasters.
- During the acute phase, you cannot warm your back.As the inflammation increases, so does the swelling.Therefore, heaters of any kind are prohibited.You can warm yourself by removing your own heat (wool belt, heating oils), which do not add it from the outside, but on the contrary, take 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 non-steroidal anti-inflammatory drugs and muscle relaxants.This will help relieve swelling of nerve tissue, remove inflammation and normalize muscle tone.
In the subacute period, after overcoming the maximum pain, "injections" should no longer be taken, and attention should be paid to restorative agents, for example, modern vitamin preparations of group "B".They effectively restore impaired sensitivity, reduce numbness and paresthesias.
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 subsided, but the muscle spasm has not yet been completely resolved.
Exercises for lumbar osteochondrosis of the spine must be performed after a light general warm-up, on "warmed-up muscles".
The main therapeutic factor is movement, not the degree of muscle contraction.Therefore, in order 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 range of motion.
The rubbing of the ointment and the use of the Kuznetsov implicator continue.Bathing, underwater massage, Charcot shower are shown.In the worsening phase, drugs for home magnetotherapy and physiotherapy are indicated.
Usually, the treatment does not last more than a week, but in some cases, osteochondrosis can manifest itself with such dangerous symptoms that an operation may be needed, and that urgently.
Complications of lumbar osteochondrosis of the spine
It is, first of all, a condition when the disc herniation became an independent fragment and, breaking through the central channel, formed a free sequestration.There it can compress the nerves of the cauda equina, and it can suddenly (immediately 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 pain occurs in the legs, and then reflex retention of urine 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 sequester and restoration of the function of the cauda equina nerves along with their decompression.
However, more often than not, other complications arise.Over the years, multiple hernias and protrusions appear, osteoporosis of the vertebrae appears, simply mobility significantly decreases and the risk of acute back pain increases.Such patients must "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 discussed above, as we understood, is mostly not a disease, but simply a manifestation of inevitable aging and premature "reduction" of the intervertebral discs.
Can humanity completely get rid of lumbar osteochondrosis?This answer can be answered in the affirmative, but then we will have to master a different style of movement: walk on all fours all our lives, or, like Ichthyander, swim in the depths of the ocean, constantly moving in water from childhood.Then 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 will begin to change until it disappears or is significantly reduced.
As for the personal, individual prognosis for osteochondrosis, everything depends on the time when a person "decided to come to his senses".If by that time there is no pronounced destruction of the intervertebral discs, protrusions, hernias and deformations, then, with a healthy lifestyle and hygiene of physical activity, you may not have problems with the lower back until 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 occasionally compresses the nerve root, then a person should be especially careful of awkward turns, physical exertion, improper lifting of weights and seasonal hypothermia, which usually cause aggravation of osteochondrosis of the spine.