Lumbago, symptoms and diagnosis
Lumbago is a sudden onset of paroxysmal intense lower back pain caused by a pathological process of the structures of the lumbar spine and intervertebral discs. Lumbago is exclusively and only vertebrogenic (from the spine) in nature. Naturally, intense lower back pain can also occur during pathological processes in the abdominal cavity (urolithiasis, appendicitis, peritonitis, etc.). However, this is not lumbago, but its differential diagnosis is justified by a slightly different clinic and data from the patient's somatic examination by a doctor.
Lumbago is based on several mechanisms:
- rapid movement of the nucleus pulposus altered by the dystrophic process or part of it towards the annulus fibrosus and irritation of the receptors of the sinuvertebral nerve of Luschka
- stretching or pinching of the capsular-ligamentous apparatus of the intervertebral (facet) joints in spondyloarthrosis
- an acute attack of muscular-tonic syndrome (fibromyalgia) of any psoas muscle radiating to the lower back, sometimes of a shingles nature or with a lumbago in the legs
Lumbago usually occurs when awkward movement, bending, lifting a weight, minor injury, or spontaneous. Clinical manifestations of pain in lumbago by patients are figuratively presented as follows: the onset of an attack - as a push, "rupture", crunch, as a piercing stabbing pain in deep tissues, as an electric shock, lightning, as compressing ("as if grabbed by ticks") or bursting, boring, cerebral, sometimes with a burning tinge or with a feeling of cold, spreading throughout the lower back or in its lower parts, more often symmetrically."
A patient with lumbago freezes in a forced position, and any movement of his increases the pain. At rest and in a horizontal position, the pain syndrome with lumbago sometimes decreases. Intense pain with lumbago usually lasts up to 30 minutes, sometimes longer. When trying to get up, the patient with lumbago spares the lower back. He first rests with his hands behind his back, then gets on all fours and slowly rises, as in myopathy, resting his hands on his hips.
Examination of a patient with a lumbago reveals tension in the paravertebral muscles in the lumbar region. Knee and Achilles reflexes with lumbago are not changed or evenly increased, paresis and paralysis, sensitivity is not impaired. With lumbago, positive symptoms of Lasegue, Neri, Dejerine can be determined. After a few hours or days, lumbago pain decreases and gradually goes away. Repeated exacerbations of pain or transformation into other reflexes and radicular syndromes of lumbar osteochondrosis are possible.
The opinions of various authors about the occurrence of lumbago in people of different age groups are contradictory. We do not exclude isolated cases of lumbago in adolescence and childhood, however, in each specific case, it is necessary to conduct a thorough differential diagnosis to exclude primary processes of a different nature.
By analogy with lumbago, they describe stenosis (stenosis - narrowing, constriction; salt - soleus muscle) - excruciating, compressing, cerebral, burning pain in the depths of the triceps muscle of the lower leg. Stenosolia occurs paroxysmally and immediately has a very intense character, and by the nature of the pain syndrome, it somewhat resembles a compressive pain in the region of the heart. With the Lasegue test, pain occurs in the buttock and the calf area. This condition must be distinguished from krumpy - painful tonic contraction of the triceps muscles of the lower leg. Isolated cases of krumpy are observed in childhood and adolescents.
Lumbodynia (low back pain), symptoms and diagnosis
Lumbodynia (low back pain) is subacute or chronic low back pain as a result of diseases of the structures of the spine. Lumbodynia occurs mainly with osteochondrosis of the lumbar intervertebral discs. In adults, in childhood and adolescence, lumbodynia occurs approximately equally often in boys and girls, only at the age of 17-18 years are males prevailing. Girls fell ill mainly at 11-12 years old (average 11.7 years), while boys at 13-17 years old (average 13.7 years). This may be due to the earlier physical and sexual development of girls.
Clinically, lumbodynia is manifested by the presence of moderate or mild pain in the lower back and signs of reflex-tonic muscular protection of the spine.
The onset of pain in lumbodynia is usually preceded by various external influences on the structures of the spine:
- lower back injury
- systematic physical fatigue or excessive physical effort
- jerky movements
- working in an uncomfortable position
- acute respiratory diseases
- exacerbation of foci of focal infection
It was also found that the onset of pain in lumbodynia in children often coincides with an intense increase in height (up to 8-10 cm per year) and body weight, which contributes to the development of spinal instability. In about 20% of patients with lumbodynia, mainly in adolescents, transverse whitish stripes (stretch marks, striae distensae) are detected in the lumbosacral region. This is an indirect confirmation of musculoskeletal inadequacy during the period of intensive skeletal growth.
When examining sick children with lumbodynia, in most cases, the soreness of the paravertebral points and spinous processes is determined. The tension of the lumbar muscles in children with lumbodynia is established in about 25% of cases, which is much less common than in adults. The rare occurrence of this muscular-tonic syndrome in lumbodynia can be explained by the fact that the tension of the paravertebral muscles depends mainly on the severity of pain and is a protective reflex for immobilizing the affected spine.
Symptoms of pain provocation ("tension") with lumbodynia are moderately or weakly expressed and are determined in about 1/3 of patients: the most common symptom of Lasegue and, in isolated cases, Neri, Dejerine, Wasserman, Matskevich. Motor disturbances and changes in tendon-periosteal reflexes with lumbodynia are absent. With lumbodynia in its pure form, there are also no violations of sensitivity.
On radiographs of the spine in children and adolescents, the smoothness of the lumbar lordosis and Schmorl's hernia was often (approximately in 50%). Schmorl's hernias are usually multiple, large in size, often located in the anterior areas of the sites of the upper lumbar vertebrae, sometimes causing deformation and a decrease in the height of 1 or 2 vertebrae. In the lower lumbar vertebrae, the discs usually prolapse into the posterior halves of the pads. Small single Schmorl's hernias are probably of no clinical significance. In some cases, they differ significantly from the classic mushroom-shaped Schmorlev cartilaginous nodules and are a reflection of the widespread lesion of the intervertebral discs.
Pain syndrome (lumbodynia) in the presence of multiple Schmorl's hernias in most cases is persistent and is difficult to conservative therapy. Somewhat less often, with lumbodynia, small antalgic scoliosis of the lumbar spine is determined, often combined with the smoothness of the lumbar lordosis. A decrease in the height of the intervertebral spaces was extremely rare.
In addition to these changes in patients with lumbodynia, congenital anomalies of the lumbosacral spine are revealed:
- splitting of the vertebral arch - spina bifida
- transitional lumbosacral vertebra - lumbarization and sacralization
The course of lumbodynia can be long, chronic, with periods of remission and recurrence of back pain alternating. Even after the disappearance of the pain syndrome with lumbodynia, the feeling of discomfort in the lower back persists for a long time, which indicates that the patient's treatment and rehabilitation are not completed or not completed until the end.
Lumboischialgia (sciatica), symptoms and diagnosis
Lumboischialgia (sciatica) is a acute, subacute or chronic lower back pain radiating to one or both legs. Like lumbodynia, lumbar ischialgia includes pain symptoms and syndromes of the corresponding localization, caused by pathology of the spine, mainly osteochondrosis of the lumbar intervertebral discs. The onset of lumboischialgia is usually facilitated by the influence of the same factors as in lumbodynia.
In terms of clinical manifestations and symptoms, lumboischialgia has some common features with lumbodynia:
- with lumboischialgia (sciatica) and lumbodynia, the patient has moderate or mild pain syndrome
- lumboischialgia (sciatica) and lumbodynia have the same frequency of occurrence in children and adults, male and female
- lumboischialgia (sciatica) and lumbodynia are considered as reflex syndromes of lesions of the peripheral nervous system as a result of diseases of the spine
However, there are several quantitative and qualitative differences between lumboischialgia and lumbodynia. So, with lumboischialgia, in almost all cases, symptoms of tension are determined, and tension of the lumbar muscles is detected much less often than in adults with this pathology and children with lumbodynia. Unlike lumbodynia, in patients with lumbar ischialgia, mild hypalgesia on the feet is sometimes determined; on the side of pain localization, there may be slight hypotension and hypotrophy of the muscles of the thigh and lower leg. In addition, with lumboischialgia, knee and Achilles reflexes may decrease, vegetative disorders in the form of hyperhidrosis (excessive sweating) and chilliness of the legs are noted.
There are several clinical variants of lumboischialgia:
- lumboischialgia with leading muscle-tonic
- lumboischialgia with vegetative-vascular manifestations
- lumboischialgia with neurodystrophic manifestations
In childhood, with lumboischialgia, muscular-tonic disorders predominate significantly, vegetative-vascular disorders are much less common, and the neurodystrophic form of lumbar ischialgia in children and adolescents has not been detected, but this does not exclude the possibility of its existence at this age.
On radiographs of the spine, with the same frequency as in lumbodynia, scoliosis of the lumbar spine is found, often combined with the smoothness of the lumbar lordosis. At the same time, much less often than with lumbodynia, Schmorl's hernias are found, more often there are such indirect signs of lumbar osteochondrosis as a decrease in the height of the intervertebral spaces, "fish vertebrae", lateral displacement of the vertebral body.
Congenital malformations of the lumbosacral spine are much more common than in other clinical manifestations of lumbar osteochondrosis (50%). They by themselves do not lead to the occurrence of lumbosacral pain (lumboischialgia), however, they contribute to a decrease in the static stability of the spine and accelerate the development of degenerative changes in the adjacent anomaly in the intervertebral disc with increased physical exertion. It can be assumed that lumboischialgia in children, in contrast to lumbodynia, occurs with less external influences against the background of more pronounced congenital changes in the spine. This ultimately contributes to the subsequent development of radicular syndromes of lumbar osteochondrosis.
Treatment of lumbago (low back pain) and sciatica
A patient with lumbago (low back pain) and sciatica should be kept in bed for 3-5 days and, if possible, lie on a hard surface. It is recommended to put a rolled blanket or pillow under the knees in the supine position to relieve the muscles of the lower back. In the lateral position, relief from pain and can be provided by a pillow or cushion lying between the knees.
In moving or sitting position, a patient should use a lumbar brace.
From medications for lumbago, lumbodynia, and lumbar ischialgia, dehydrating drugs (furosemide, diacarb, lasix), pain relievers and non-steroidal anti-inflammatory drugs (analgin, revodipa, rheopirin, ibuprofen, voltaren, diclofenac, xefedamicam) are prescribed, vapors nialamide) drugs. In some cases, carbamazepine analogs (finlepsin) may be effective for lumbago.
In the future, the patient himself with lumbago, lumbodynia, and lumbar ischialgia, whenever possible, chooses professions in which there is no increased physical exertion on the spine, temperature drops in the workplace, exposure to vibration, long-term work in a forced monotonous position.
Benefits of sleeping with a pillow between your legs:
- Reduce or prevent low back pain
- Reduce sciatica pain
- Reduce knee pain
- Reduce hip pain
A pillow that is flatter and is not too big or too small may work well. You want a pillow that will raise up the knee just enough so that the spine is level.
Depending on the severity of the manifestations and causes of lumbago, lumbodynia and lumbar ischialgia, the following therapeutic actions are possible in the conditions of our clinic:
- drug therapy (NSAIDs, analgesics, hormones)
- therapeutic injections - injections of drugs into the cavity of the intervertebral joint, spinal canal, trigger points in the muscles
- manual therapy (non-surgical "reduction" of the vertebral disc herniation using muscle, articular and radicular techniques)
- physiotherapy (UHF, TENS, etc.)
- surgical treatment
The intervertebral joints of the lumbar spine (facet joints) can also be treated with blockages. Therapeutic injections with local anesthetic and hormonal drugs are performed to accelerate the relief of pain and inflammation and obtain an early positive clinical effect.
Usually, for therapeutic injections, low doses of anesthetic (novocaine, lidocaine) and cortisone injected into the lumen of the affected joint are sufficient.
When combined with a properly selected physiotherapy regimen, these blockages can have a good and long-term effect on the patient.