It is probably impossible to find a single adult who does not know what “lumbar osteochondrosis” is.On average, one in three healthy middle-aged people, and sometimes more often, has had an episode of acute low back pain in their life, and one in five or six indicates that these problems arise regularly, and are even the "source" of sick leave.
However, most of the time patients cannot explain in detail exactly what kind of disorder occurred in the lower back.Most of them have never been 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 "press" 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 state with authority: “osteochondrosis” does no harm.And it cannot manifest itself in any way, since it is a process of dystrophy and degeneration of the intervertebral discs, that is, of the cartilage, which is formed by the nucleus pulposus and the annulus fibrosus.The intervertebral disc is cartilage and is designed to function as a shock-absorbing “airbag,” softening vertical and angular accelerations (braking) between adjacent vertebrae.
As is known, cartilage lacks nervous and vascular tissue, so processes occurring "purely in the discs" simply cannot affect neighboring structures and do not manifest themselves in any way.A similar example in vertebroneurology is Schmorl's hernia, in which the hernial protuberance is securely covered by the spongy bone tissue of the adjacent vertebra.The intervertebral discs do not hurt.
Chondrosis (the suffix “-oz” means growth, enlargement) in this case is not entirely correct.There is no growth or increase in cartilage tissue during human life.In case of fibrosis (cirrhosis) of the liver, it may be noticed that the mesh structure of the liver has begun to develop, to the detriment of function.
And with chondrosis (or osteochondrosis), the intervertebral discs are just beginning to change their configuration, under the influence of many years of stress.
They cause pressure on neighboring vertebrae, since, according to Newton's law, each action under a static load produces exactly the same reaction or support reaction.How does osteochondrosis develop and why does it happen?
Causes of “lumbar osteochondrosis”
Signs of lumbar osteochondrosis (more precisely, of intervertebral discs) can be detected already at a young age, especially in various disorders of the musculoskeletal system.
These include, for example:
- congenital anomalies (different leg lengths);
- various types of flat feet (longitudinal, transverse);
- spinal deformities (scoliosis);
- spondylolisthesis (sliding of the lower lumbar vertebra from the sacrum forward and backward).
All of these diseases can lead to an increased impact load on the spine (for example, in flat feet, when the elasticity of the arch of the foot decreases), or a pronounced asymmetry of the spine, when the supporting function is systematically performed due to the load on the edge of the disc.
It is known that during experiments it was discovered that healthy and young cartilage, if a uniform and static load was applied to it over the entire surface, could withstand up to 2000 kg and even more without damage.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 an impact of 60 to 80 kg (for example, falling on ice lying on one side, with a load on the shoulders) can cause destruction of the disc, which can be in the form of a bulge or herniation.
It is the appearance of a protrusion or herniation that indicates that the disc has been deformed and even “comes out” on one or more sides.And, as you know, there is no empty space around the disk.As soon as the disc begins to contact the nerve roots, neighboring ligaments and muscles, the consequences of osteochondrosis arise: reflex pains and muscle tonic syndromes, which force the patient to consult a neurologist, chiropractor and masseuse.
As long as the discs have a normal shape and wear evenly, without extreme loads, osteochondrosis of the lumbar spine does not worry the patient any more than the usual age-related wear of teeth, with which criminologists are well familiar.How do reflex pain syndromes manifest?
Symptoms and signs of complicated lumbar osteochondrosis.
You may have already noticed that we are diligently "extending" bridges: common osteochondrosis is a completely inevitable process of normal aging of the elastic intervertebral "pads" in the species "Homo sapiens", 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 root compression.Signs of lumbar osteochondrosis, of course, are associated with pain due to the disc pressing on the segmental nerve root.In addition to pain, sensory, motor and vegetative-trophic disorders are possible.
Low back pain with osteochondrosis has the following characteristics:
1) Radicular pain.It is secondary and occurs like neuralgia, when an inflamed nerve root reacts very “violently” to a shock.
The pain is sharp, sudden, stabbing, penetrating in the lower back and possibly radiates to the leg.The pain appears and intensifies instantly, which is why it is called “lumbago”, or “lumbago”.It is this type of "lumbago" that causes a person to "get up in a hurry", since any movement causes increased pain.
In addition, the pain intensifies with the slightest cough, sneeze, straining, laughing, any situation where the swollen root is shaken.
If the root is part of the sciatic nerve, the pain “shoots” through the buttock to 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.In them, venous flow is difficult and they themselves are a source of pain.
This pain is painful, constant and not so acute.On the contrary, it intensifies not only with sudden movements, but also with prolonged stay in a monotonous position (impaired blood supply).
- Sometimes this myofascial syndrome occurs after an exacerbation 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 foot, leading to gait disturbances.
Loss of muscle mass occurs and one leg “loses weight.”Such a purely motor and painless disorder is rare and, if undetected, can lead to disability.
4) Sensory disorders.They arise along with pain and often exist after the pain ends, instead of the pain.They manifest as numbness, decreased sensitivity of the skin on the legs in the form of “stripes”, in the form of vertical stripes, and a feeling of “goosebumps” on the toes and feet.
- Sometimes, when vegetative fibers are damaged, the symptoms are combined with hyperhidrosis, cold skin, and impaired hair and nail growth.
These are the most common signs of complicated lumbar osteochondrosis that exist in the lumbar region.There are individual syndromes, such as lesion of the external cutaneous nerve of the thigh or lesion of 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 aggravation with your own hands”?How to treat lumbar osteochondrosis at home?
What to 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 spinal problems), things go like this:
- Elimination of the cause is the removal of pressure from a bulge, 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 elimination of swelling of the nerve root and the fight against inflammation;
- Eliminating symptoms (fighting pain, numbness, limited mobility) is done by returning to point 2, since eliminating swelling and inflammation, for example, will restore mobility and relieve pain.
Get rid 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 initially relieved, then, after massage sessions and treatment by a chiropractor, all symptoms disappear and surgery is not required.
The question of surgical intervention arises with the progression of weakness in the foot and with severe, intractable pain for 2 months.Additionally, surgery is required when there is a high level of 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 involves 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 fluid consumed are indicated.You can even give him a tablet of a mild potassium-sparing diuretic.
- It is recommended to use a semi-rigid orthopedic corset, which protects the muscles from excessive movement.
- From the first days, it is recommended to rub hot ointments containing NSAIDs and apply patches, for example, "pepper" patches.
- During the acute phase, you cannot warm up your back.As inflammation increases, swelling increases.Therefore, any heating pad is prohibited.You can warm yourself by removing your own heat (a woolen belt, warm ointments), which do not add it from the outside, but, on the contrary, bring it out from deep inside.
- 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 nervous tissue, eliminate inflammation and normalize muscle tone.
In the subacute period, after overcoming 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 altered 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 the swelling and inflammation have already subsided, but the muscle spasm has not yet completely resolved.
Exercises for lumbar osteochondrosis of the spine should be performed after a light general warm-up, with "warmed up muscles."
The main therapeutic factor is movement, not the degree of muscle contraction.Therefore, to avoid relapses, the use of weights is not allowed;A gymnastics mat and a gymnastics stick are used.With its help, you can effectively restore the range of motion.
They continue rubbing ointments on each other and using the Kuznetsov implicator.Swimming, underwater massage, Charcot shower are shown.It is during the exacerbation stage that medications for magnetic therapy and home physiotherapy are indicated.
Usually, treatment lasts no more than a week, but in some cases osteochondrosis can manifest itself with such dangerous symptoms that urgent surgical intervention may be necessary.
Complications of lumbar osteochondrosis of the spine.
We are talking, first of all, about a condition in which a herniated disc has turned into an independent fragment and, having penetrated the central canal, has formed a free sequestration.There you can compress the cauda equina nerves and suddenly (right in the gym, after an episode of acute pain), you can develop severe weakness or paralysis in the legs, numbness of the perineum.
After a few minutes, severe pain appears in the legs, and then 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, elimination of the sequestration and restoration of the function of the cauda equina nerves with their decompression.
However, more often than not, other complications arise.With age, multiple hernias and bulges appear, osteoporosis of the vertebrae appears, mobility simply decreases significantly, and the risk of acute back pain increases.These patients necessarily "take sick leave" a couple of 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 have understood, is for the most part not a disease, 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 movement: walking on all fours all our lives or, like Ichthyander, swimming in the depths of the ocean, constantly moving in the water since childhood.This is when the axial static load on the intervertebral discs will disappear and with it the signs of “chondrosis” will disappear.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 and individual prognosis of osteochondrosis, it all depends on the moment when the person "decided to come to his senses."If at this time there is no pronounced destruction of the intervertebral discs, bulges, hernias and deformations, then, subject to a healthy lifestyle and hygiene of physical activity, you may not have problems in 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 should be especially careful with sharp turns, physical exertion, improper lifting of weights and seasonal hypothermia, which usually cause an exacerbation of spinal osteochondrosis.