Pain in the spine

Mankind has acquired pain in the spine at the same time as walking. This unnatural way of movement for all terrestrial organisms allowed us to free our hands for work, but very much changed our musculoskeletal system, and far from the best.

As a result of the rectilinear, the spine sections were twisted, these physiological curves were called "lordosis" and "kyphosis". Bends have become necessary for the most amortization of loads during movement and maintaining equilibrium, because when you move regularly there comes a time when the whole body rests only on one point of support.

[1], [2]

Causes of pain in the spine

The main causes of pain in the spine are the overstrain of the muscles that support the spinal column (long back muscles), and those that attach to the spine at one end (trapezoidal and latitudinal). Conditionally, it is possible to divide these two muscles according to localization - the trapezoidal covers the scapula and is attached to the cervico-thoracic region, while the broadest covers the ribs from the side of the back and adjoins the lumbar region. Also, pains in blue can cause injuries, spondylolisthesis, inflammatory processes in the vertebrae and discs, degenerative processes in bone and cartilaginous tissues, hernia discs, irradiative pain in case of disruption in the internal organs, the third and fourth stage of oncological diseases.

[3],

Symptoms of pain in the spine

The feeling of pain is very, very individual, the symptoms of pain in the spine can be described by patients' complaints as painful, paroxysmal, acute, stitching, arising during motion, at rest, under static stress, constant on nothing. The description of the symptoms of pain is of diagnostic value and an accurate description of the time of onset and the nature of the pain can help the neuropathologist in the diagnosis. In general, often the description of symptoms begins with the words "the back hurts", then the localization and the nature of the sensations are indicated, then the time of the onset of pain is specified and, in the patient's opinion, the probable causes.

The most common pain associated with walking and having to work is the pain in the spine between the scapula, which accounts for about 80% of all complaints of back pain. Raised one shoulder (carrying a bag on the shoulder), the constant need to sit in the workplace in a half-stitched pose - these are the main reasons for the constant tension of the trapezius muscles that fix the trunk in a certain position. The mechanism of "fixation" is simple - the muscle is in a working, compressed state, which leads to its overstrain and the inability to relax, in this case it is possible to feel the fingers with dense formations in the thickness of the muscle tissue, which resemble strands (sometimes with knots), touching them causes an acute backache. In places of attachment to the spine, these spasms of muscle can injure the nerve sprouts that emanate from the spine, which leads to pain in the spine. All these sensations are, so to speak, superficial, "suprapopular" in nature.

Other causes cause pain in the spine under the shoulder blades, which is felt as hot, pulsating, aching, twisting, not dependent on body posture and static tension. If the pain is paroxysmal, felt under the scapula and gives into the arm (on the left side), one should suspect irregularities in the heart (pre-infarction, attack of angina, ischemia), if the pain in the spine under the scapula is felt evenly on both sides, it is probably a signal problems with the stomach, less often - the pancreas. Sometimes this kind of pain signals about pleurisy, extremely rarely - about problems with bronchial tubes. Often sharp pains under the shoulder blades, exacerbated by movements, are a consequence of intercostal neuralgia.

Very many pains that give back to the spine have their own cause of internal disease. In addition to the above-mentioned disruptions in the work of the heart, stomach and respiratory organs, pain in the spine can be felt acute attacks of renal colic and pulling, paroxysmal pain in the kidney in various inflammatory processes. Disturbances in the liver, gallbladder can manifest as a drawing, aching pain in the spine in the projection of the liver. Sensations described as "pains that give back to the spine" can be caused by intercostal neuralgia, for which a "giving" character is characteristic. Intercostal neuralgia reacts painful sensations to any movement, including the act of sneezing, coughing, practically not manifesting in complete rest, than it differs from the painful sensations caused by the dysfunction of internal organs.

Pain in the upper part of the spine is most often associated with a disruption of the trapezius muscle. There are complaints of pain in the cervical region, which is caused by the constant necessary half-head when working at the table, which leads to overstrain of the muscles of the neck, as well as to fatigue of the muscles of the shoulder girdle. If we exclude the disruption of the work of organs (systems) having common innervation routes leading to the spinal cord, as well as to exclude injuries and internal injuries, the pain in the upper spine is a functional disorder and can be alleviated by the patient himself.

Almost the same causes and consequences in complaints of pain in the lower part of the spine, but the responsibility for them already extends to the latissimus muscles of the back that span the lumbar region. These muscles help to maintain the trunk in a vertical position and increase in volume (inflated) with constant lifting of weights and physical work, they also suffer from overexertion at unreasonably high loads, with overexertion and trauma, the pain from the broadest muscle resembles pain in violation of kidney function (and vice versa ). In the case of weakness of this muscle, spinal injuries are possible. The widest muscle can increase the volume of the chest, participating in the act of breathing, so, in pleurisy, pain can be triggered by the movement of this muscle. This muscle is involved in the formation of a pain signal for intercostal neuralgia.

Pain in the lower part of the spine is sometimes caused by radiculopathy (damage to the roots of the nerve processes), which is accompanied by a feeling of numbness, "goose bumps" along the course of the innervation violation (the back area, the external surface of the thigh, the overall decrease in the sensitivity of the body parts below the affected root).

In the event of injuries, overvoltages and ultra-high static loads, severe pains in the spine may occur, due to trauma (external or internal). When the external trauma is taken, the place and degree of damage are usually understood. In the event that the spine does not withstand the workloads, injuries to the vertebrae, intervertebral discs and processes that can be diagnosed by X-ray, CT or MRI can occur. Vertebrae can crack, deform and creep into each other, there may be fractures of the vertebral body or processes. Disks are abraded from the load, thinning and flattening, as a result of which the vertebrae clench and infringement of the outgoing nerve processes occur, the discs can also deform or "leak" - the contents of the disk core protrude as a hernia, which also disrupts the mobility of the spine and leads to infringement of the nervous processes. All these processes cause severe pain in the spine and require long-term treatment.

If the pain syndrome develops gradually and simultaneously with the increase in pain there is a noticeable decrease in the amplitude of motion, and problems with the back are gradually added to the problems with the joints of the legs and hands, then pain in the spine and joints should be considered as symptoms of a single disease. Common problems can be degenerative changes in the cartilaginous tissue throughout the body, caused by a metabolic disorder, a genetic feature or an infectious process, as a similar picture of pain can be seen with osteoporosis (degenerative bone tissue change). Most often with a systemic lesion of "cartilaginous" joints, Bekhterev's disease is diagnosed.

Acute pain in the spine often occurs with fresh trauma or inflammation. Separate lumbulgia, ishialgia and cocciogonia. Koktsigodiniya - the least studied condition of pain, arising in the coccyx and difficult to correct. The most likely cause of pain in the coccyx - trauma, a genetic predisposition to damage the ligamentous apparatus of the spine in the coccyx, inflammatory and degenerative changes. Ischialgia - damage to a large nerve, originating in the lumbar spine and passing along one of the limbs to the foot. The nerve was called sciatic, its infringement or damage by any means does not allow the patient to sit because of unbearable acute pain, which is removed by pain blockade blockers with the help of injections of pain medications. Lumbalia is caused by irritation of receptors located in the ligamentous ring of the intervertebral disc when it is injured, falling out and accompanied by a sharp, "shooting" pain, muscle spasm and immobilization of the patient. Lumbalia has an alternative name - "chamber".

As a rule, sharp pain in the spine is caused by irritation of nerve endings, which may be a consequence of their damage. External injuries rarely go unnoticed, injuries internal are not noticeable and are not always detected by palpation (probing), and it is not always possible to identify the injured area without diagnostic equipment. Internal traumatization occurs with uneven or very large physical exertion, with degenerative processes in cartilage or bone tissue and with genetic characteristics (predisposition) to the pathology of the spine. Irritation of the nerve endings (sharp pain in the spine) occurs with protusion (protrusion) of the intervertebral disc, with prolapse (prolapse of the nucleus of the disc), with fracture of the spinous processes, with muscle spasm of the long back muscles compressing the nerve processes, but in most cases establish the exact cause of pain I can not.

Sometimes the pain in the spine is a consequence of medical trauma - surgical intervention. Actually, the pain after the operation on the spine may be a "syndrome of the operated spine" - a consequence of the progression of the adhesion-scarring process, which intensifies the compression of the nerve processes, the loss of the hernia in the new segment, the protrusion of the remnants of the removed disc, destabilization of the ligamentous apparatus in the operated site. Proceeding from the foregoing, it is extremely rare to recommend repeated surgical interventions, preferring conservative treatment.

Most patients who complained of pain along the spine experienced pains from overexertion of long, broad and trapezius back muscles. Pain manifests itself after physical exertion, and under physical. Loads should be understood not only physical work, but also static tension when sitting at a table by a computer). If the pain does not reveal a clear localization, then we can assume that relaxation (rest) of all the muscles of the back will ease the condition. If, after resting in the horizontal position, the pain does not decrease, then the probable cause may be hidden in irritation of the nerve endings, for example, in case of viral damage of the organism (herpes zoster). Sometimes the predecessor of pain along the spinal column is a condition described as "blown", that is, the provocateur is the cooling of the muscle region, which later spasms and traumatizes. Myofascial syndrome is a condition of pain in the muscles that is caused by microtraumas that lead to the formation of ligamentous tissue (scar) at the site of damaged fascia (muscle fibers), if the scar is formed near the nerve, the pain syndrome persists the patient long enough.

Sometimes aching pain in the spine increases, sometimes "releases", but in any case, a long period of pain indicates pathological processes. If the aching pain is localized in the cervical region, while the headache is attached, then one should pay attention to the overstrain and spasm of the muscles of the posterior surface of the neck. If the pain is in the thoracic region, then there may have been an overstrain with manual labor, lower back pain indicates loads that exceed the physiological capabilities of the body. If injuries are excluded, aching pain in the spine is most often a manifestation of osteochondrosis and / or osteoporosis. Osteochondrosis as a whole is a dystrophic-degenerative process of spinal column change. The beginning is manifested in pains of the spine, which are associated with a change in the height of the intervertebral space occupied by the disk. The disk "grows old," changing its hydrophilicity (the ability to retain fluid), thins and "withers." The vertebrae "sag", disturbing the nerve processes, this process is felt like aching pain in the spine, as chronic fatigue, which is difficult to eliminate.

In osteochondrosis, the next stage in the development of the disease will be an increasing, dull pain in the spine, which is not facilitated by prolonged rest. In connection with the development of degenerative processes, the vertebrae converge and the distance between the attachment points of the ligaments and muscles is reduced, which leads to mobility of the vertebrae relative to each other, the intervertebral joints experience overloads, long back muscles also try to compensate for the instability of the spine by strengthening the muscular corset. Vertebrae can be displaced relative to the axis of the spine and this process is able to pass with minimal pain, since the displacement does not always damage the nerve fibers.

However, osteochondrosis progresses and the next stage of disk destruction will be its crushing, exit of the core contents in the form of a hernia and rupture of the fibrous ring of ligaments, there is a stitching pain in the spine, subluxations of the vertebrae are formed. At the site of subluxation, the joint thickens, the growth of injured tissues. With the growth of cartilaginous and bone tissue in injured joints, the spinal cord can be infringed with a violation of its nutrition and function. However, stitching pain in the spine may be a signal of developing myositis, however in practice, in patients after 40 years most often stitching pains in the back testify to the development of osteochondrosis.

This kind of pain, like throbbing pain in the spine, very often is a signal of problems in the work of internal organs, most likely kidneys. After exclusion of diseases of internal organs in the appearance of pulsating pain, it is possible to suspect disruption of the feeding vessels. Pulsating pain in the area of the collar zone also indicates muscular spasm (for example, after a long work at the table in an uncomfortable position), with subluxation and dislocation of the vertebrae (discs), similar pain in the lumbar region signals destructive changes (sprain of the intervertebral ring, disc displacement, inflammatory processes in the cartilaginous tissue of an infectious and non-infectious nature). As a rule, throbbing pain in the spine signals an acute process (for example, a fresh trauma).

With the transition of various destructive changes from acute to chronic processes, acute pain is replaced by dull, aching, most often pain in the spine can be manifested when pressing on the problem site, because acute pain at the end of the development of osteochondrosis subsides. Pain when pressing is manifested and with old injuries, when the body almost compensated for the defect, and with ineptly conducted massage as a result of exacerbation of degenerative processes in the vertebra. Pain in the spine with pressure can indicate the very onset of the inflammatory process, when only by a mechanical action (hand) can you find a sore point.

Pain in the spine when walking occurs in the case of the beginning of deformation associated with the hypertonicity of a certain group of muscles caused by trauma, prolonged nonspecific loads, and supercooling of the back area. Also, this kind of pain can be indicative of developing scoliosis. Also, pain during walking can indicate inflammation of the nerve root (radiculitis) in that part of the spine that signals pain when moving. It is possible that such signals are reported by osteochondrosis at the very onset of degenerative changes in the median discs with changes in the lumens between the vertebrae.

Pain in the spine when breathing very rarely speaks about organic changes, the most common cause of this pain is functional disorders, namely, inflammation, intercostal neuralgia. It is especially easy to diagnose neuralgia with asymmetrical appearance of pain during movement (inhalation, sneezing, coughing). At the same time, with some irregularities in the work of the heart when performing small physical exertion, with an increase in the amplitude of the movement of the ribs during inspiration, pain is felt behind the sternum, nearer to the back, with drawing pain under the scapula. Heart pain at rest does not immediately subside, unlike neuralgia.

Night pains in the spine are almost always associated with postures during sleep. However, it happens that the pain at night signals the beginning of violations. During the day, too weak signals do not reach consciousness due to congestion with information, events and signals from traffic or other pain. During the night rest the patient in a state of relative rest suddenly discovers a number of unpleasant sensations. Quite often, this way, pain signals from the kidneys, stomach, liver, peretruddivshihsya for the day muscles of the back. First you need to change the pillow and bed, then - to monitor your condition.

Pain in the spine after sleep is often associated with an uncomfortable posture due to a too soft or too hard coating on the bed. The cause of the pain is a muscle spasm that arises from the forced overstrain of the back muscles. In this case, the pain decreases or passes by the middle of the day. If the pain after sleep is associated with developing scoliosis caused by an incorrect posture, this kind of pain during the day does not go away at all, but there comes a sharp improvement after a massage session. Another common cause of back pain after sleep is the overall low muscle tone and stiffness (stiffness) of the muscles due to hypodynamia.

Wandering pain in the spine is caused by a wide variety of causes. With these pains, it is possible to suspect the inflammatory process of articular vertebral bags, and the nonspecific inflammatory process of nerve endings, and viral damage of the nerve endings of the skin, and the consequence of hypodynamia, and muscular overstrain, and trauma, and osteochondrosis, and neuralgia, and fibromyalgia. Quite often the fact of wandering pains indicates a non-somatic nature of pain. General fatigue or psychological exhaustion can manifest as wandering pains. Fatigue of the back.

Pain in the spine after trauma indicates a small inflammatory process that has begun. Most often, after an injury in the articular pouch of the spine, near the spinal cord or the disc, blood, lymph (hematomas) leaking out of the ruptured vessels accumulates, to dissolve (dissolve) these entities the body uses various lysing proteins that melt the "extra" formations. Also minor fragments of cartilaginous and bone tissues are to be melted and removed, if those were formed as a result of trauma. The process of melting is accompanied by a local increase in temperature, pain, and swelling. The degree of damage to the spine is objectively assessed only by a specialist.

Pain in the spine with metastases is often enough as the primary manifestation of malignant process in the body. If neoplasms for a long time did not manifest themselves due to the fact that the lesions did not have a total damaging character and the state of the organism could be called a state of relative well-being, then the manifestations of pain in the spine were a consequence of mechanical compression of the roots of the nerve roots by the tumors. Most often, metastases grow without any external manifestations in the event that the liver, pancreas, kidney or spleen are affected. These organs are able to function even with a partial degeneration of their tissues, the kidney is a paired organ, the disruption of one's work is not always noticeable with the relative well-being of the other. If metastases disrupt the motor function of the spine, then this stage of development of cancer is likely to be inoperable. Help to the patient consists, basically, in anesthesia.

Spot pain in the spine indicates the presence of a local site of inflammation (damage), with a high degree of probability it is possible to judge pain at the site of nerve fiber damage due to thinning of the intervertebral disc (reducing the lumen between the vertebrae with damage to the nerve spine), as well as suggesting the displacement of the disc in his articular bag relative to the axis of the spine (protrusion), fracture (fracture of the part) of the vertebra due to excessive physical exertion, damage to the ligaments of the vertebral hernia vertebra, probable but also the onset of the inflammatory process (for example, arthritis).

Drawing pains in the spine indicate an abnormality in the internal organs (kidneys, liver) or problems with the muscular corset of the back. The state of fatigue, the desire to rub your back often pursues office workers and is associated with a prolonged static stress. Only in the case of a combination of these types of pain with chills, tingling and numbness in the limbs, one should suspect the development of osteochondrosis. In half the cases, the trailing pain in the back ends with a picture of unfolded neuralgic pains. But if the pulling pains appeared at the bottom of the waist, we can assume inflammatory diseases of the genitourinary system.

Pain in the spine during pregnancy also starts as a drawing, aching pain in the lower back. The reason for them is increased blood supply and increased uterine volume. Due to the fact that all the internal organs of a person have their attachment inside the cavities, these "fastenings" are most often based on the spine and, in our case, the pelvic bones, which, in turn, are fixed with a vertebral column at a certain angle. Redistribution of the internal space inside the lower abdomen leads to a change in the load on the spine, and a change in the angle of the joint of the pelvis and spine creates another source of stress. You can alleviate the condition with the help of a bandage, creating the illusion of an additional durable muscular layer.

Diagnosis of pain in the spine

Diagnosis of pain in the spine is often hampered by blurred symptoms and neglect of the process itself, since calls to a surgeon or a neurologist occur when it is difficult to independently block pain signals. The basis for diagnosis is both classic X-rays (minimum in two projections), and ultrasound, MRI, auxiliary, but not less valuable will be blood tests, urine, liquor-containing liquids. The main point in the diagnosis is the clarification of the cause of the pain, namely: pain is a consequence of a musculoskeletal system violation or signals problems in the work of internal organs. When clarifying the cause of pain, it is often invaluable to correctly compile an anamnesis with a detailed refinement of the probability of genetic predisposition to such violations. Modern medicine is unable to independently analyze the hereditary propensity to cause problems with the spine, but it is the anamnestic data that helps to correctly build a treatment strategy and make a prediction.

[4], [5]

Treatment of pain in the spine

Treatment of pain in the spine is carried out under the supervision and appointment of a neurosurgeon, a neuropathologist surgeon. Treatment of pain can be surgical and therapeutic. In difficult cases, when a patient is unable to help drugs and disorders in the spine have a life-threatening degree, they prefer surgical intervention. The operation is indicated for instability of the spinal column, which threatens the displacement of the vertebral bodies with subsequent trauma (compression) of the spinal cord, with the already existing disorders of the spinal integrity due to trauma, with progressive pathological changes in the cartilage (bone) tissue.

Treatment of pain in the spine with instability of the spinal column by the surgical method is most often performed with osteochondrosis. Its goal is to remove the damaged disk and stabilize (unfortunately, fixed) relative to each other two adjacent vertebral bodies. This allows to stop the pain syndrome without its renewal on this site in the future. Another indication for surgical intervention is a herniated intervertebral disc. Hernial protrusion often overstretches the articular pouch or damages the nerve processes, that the pain relief syndrome is not possible with conservative methods.

Treatment of pain in the spine by removing the body of the hernia allows to fully restore the patient's working capacity and to stop the pain syndrome.

Another indication for surgical intervention is spondylolysis. In this violation, the joint bag is not able to fix the vertebral body, as other methods of fixation are damaged (the vertebra breaks or breaks the legs of the vertebral body, fixing it in a certain position). Fragments of the body or legs permanently have a traumatic effect on the nerve processes or the spinal cord, the ligaments of the joint bag of the intervertebral joints weaken with age, and the operation to stabilize the damaged area is the only way to protect the vertebra from slipping and traumatizing the nerve pathways.

However, the first choice in the treatment of various disorders remains conservative treatment (with the exception of cases of some conditions of emergency care). Treatment of pain in the spine often consists of the complex administration of painkillers, decongestants, anti-inflammatory drugs, continues with a set of physiotherapeutic procedures, exercise therapy, the use of supporting corsets and a change in lifestyle.

Treatment of pain in the spine requires a long intake of chemicals (drugs), which carries a heavy load for the liver, so you should adhere to a sparing diet throughout the treatment period and do not create an additional burden on the liver and kidneys (especially the complete elimination of alcohol).

In the case when assistance should be given instantly with sudden acute pain, various blockades are used. Blockades are local and segmental. Local blockades are used in the case when analgesic solutions are injected into the focus of pain in order to remove the pain signal at the injection site, and the blockade blockade is used for distal (remote) anesthesia of any part of the body (organ) for which the blocked nervous pathway is responsible for innervation. Blockades are very popular as a method of treating pain in the spine. Most often used:

• Novocaine is the most popular anesthetic, its advantages in low toxicity have long been appreciated, novocaine is destroyed at the injection site, minimally loading the excretory system, however it is not strong enough, often provokes allergies;
• lidocaine - it retains the analgesic effect more stable, but it is metabolized by the liver, taking into account this unique deficiency, as well as low allergenicity, low toxicity, duration and relative strength of anesthetic properties, lidocaine is the most frequent choice in blockades;
• mesocaine - is close to lidocaine, has a slightly less pronounced anesthetic effect, but a sufficiently affordable and low allergenic drug;
• prilokain - the least toxic of all of the above, but not inferior to them in terms of time of action. From the shortcomings of the drug should be noted a low degree of penetration into nerve fibers, because of its low toxicity and prolonged local anesthesia, prilocaine is used in the anesthesia of children;
• carbocaine - has a very long anesthetic effect, however it is toxic, extremely slow, which can lead to accumulation of a dose;
• marcain is extremely toxic, but the duration of the action can last up to 16 hours, the use of this drug should always be justified by the necessary benefit, be sure to provide medical monitoring of the patient's condition.

In order to reduce the dose of analgesic to reduce its toxicity, but with the preservation of the general time of the anesthetic effect, prolongants are used. One of the prolongators are vasoconstrictors, namely adrenaline. Apply epinephrine in almost homeopathic doses, not a complete drop of 0.1% solution of epinephrine in 20 ml of analgesic mixture. It should be remembered that any large-molecule compounds, such as the patient's own blood, can be mixed with analgesics and injected into the problem area. The blood molecules adsorb the molecules of the anesthetic, remain in the muscle tissue for a long time, delaying the analgesic with it, thereby increasing its effectiveness.

Treatment of pain in the spine does not stop at blocking the pain signal. It is necessary to use drugs that reduce inflammation in the focus of pain. One of the most powerful anti-inflammatory drugs for "spinal" should be recognized as a group of steroid hormones. Steroid hormones in the minimal dose practically have no influence on the general hormonal background, do not disrupt the work of the adrenal glands, but they quickly stop the degenerative processes in the tissues, reduce the level of pain sensations. However, contraindications to the use of hormones should always be taken into account - the presence of metabolic disorders by type of diabetes, old age with the extinction of the adrenal glands, the presence of purulent and septic processes (which can be stimulated by the decrease in the nonspecific immune response of the organism), ulcer disease.

If the benefit of using the drug was assessed as exceeding the potential harm, then the choice of steroids comes from the following medicines:

• hydrocortisone - the most famous of the analogues of hormones, begin to be used with 5 mg hydrocortisone per blockade, necessarily in a diluted form, with analgesics, since the drug is capable of causing tissue damage at the site of administration;
• Dexamethozone is much more active than its predecessor (approximately 30 times), however, it is more toxic and more likely to cause necrosis upon administration (requires careful dilution), begin to be administered at a dosage of 1 mg .;
• kenalog - a modern drug that requires a single injection, is extremely slow to deactivate. With the first blockade, the use is not justified, since in the presence of a kenologist it is difficult to make a prediction, if necessary, the frequency of repeated injection should not exceed 1 time per week.

Treatment of pain in the spine involves "replenishing" the tissues with vitamin preparations, especially the vitamin B vitamins are especially beneficial for the trophic processes. Vitamins of this group help in the regeneration of tissue, potentiate the action of analgesics, improve the conductivity of nerve fibers. However, one should take into account the high allergic ability of vitamins of this group, the use of all three vitamins in this syringe is unacceptable, it is most desirable to use 1 species in 1 day.

Also, to reduce the development of an allergenic reaction and reduce the level of nonspecific inflammation, antihistamines are mandatory. The introduction of papaverine or no-shpa as muscle relaxants to relieve the condition with muscle pain in the spine is shown.

Exercises for pain in the spine

Exercises for pain in the spine are an integral part of the rehabilitation program. Therapeutic physical training in various medical institutions is aimed at maintaining the patient's completeness of the amplitude of movements and minimizing the consequences of spinal cord injury. In case of hypodynamia and morning pain, simple warm-up exercises are shown, with scoliosis and various deforming processes, the complex of exercises is selected individually in combination with massage, with degenerative and traumatic disorders the complex of exercise therapy should start with simple exercises, for example:

• Lying on his back in a position of complete rest, begin flexing and extension of the arms in the elbow joint, legs - in the knee with a sliding heel on the bed;
• The next stage will be the bending of the arms in the shoulder joint (lifting the arm up one by one), the leg is bent at the knee at rest, the other is bent at the knee and in the horizontal plane is withdrawn to the side and returns to the bed.
• The next stage will be in the prone position, bringing the leg, bent at the knee, to the chest, drawing in the space of the circles with the elbows of the hands in turn.
• In carrying out all these exercises in passing, you should train diaphragmatic breathing.

In the subacute period, one can practice lifting the head from the pillow, bringing the chin to the chest, kneeling and arched back to the likeness of a cat, an imitation of lying on a bicycle.

All kinds of exercises should initially be practiced in the presence of a specialist, later, on a method of printing, to repeat independently at home.

Exercises for pain in the spine should be performed systematically, at a slow pace, while maintaining the recommended speed and the number of repetitions. In no case can you hold your breath while doing the exercises, if pain occurs, stop the gym and go to a specialist.

[6], [7], [8]

How to relieve pain in the spine at home?

If complex analgesic mixtures are unavailable and the pain has overtaken the patient suddenly, before meeting with the doctor, you can ease your condition by taking medications with a common analgesic effect. Independently you can take ketones, ibuprofen, naproxen, nimesulide, deksetorofen (the effect is felt about half a hour, the duration of anesthesia is up to 5 hours), ketarolac. Simultaneously with these drugs, you can take no-shp as muscle relaxant, suprastin as the most affordable antihistamine drug, it is possible to use diuretics to reduce swelling at the site of injury. Categorically contraindicated thermal procedures!

Anesthetics for pain in the spine are selected based on the individual characteristics and nature of the disorders. Drugs can be local or general, in the form of injections, tablets or patches. In case of myalgia, preparations of general action, tableted or in plasters, are shown, so all muscle relaxants will have an analgesic effect. In case of muscle injuries, it is possible to impose low-warming bandages, apply cream with local irritating, warming and analgesic action. With pain associated with injuries to vertebral bodies, you should temporarily take analgesics and rely on all the prompt help. With injuries of intervertebral discs and ligaments of joints, with various inflammatory processes, analgesics only accompany the main process of treatment and painkillers for pain in the spine in this case should be combined with diclofenac, ketoprofen, indomethacin, diuretics.

Ointment for pain in the spine

Ointment from pain in the spine is used with a slightly pronounced pain syndrome, mainly with myalgia of different nature. Long-term use of ointments with degenerative changes (osteochondrosis and tons) is not justified, since in such diseases an integrated approach to treatment is needed. Ointments by the mechanism of action can be warming, anaesthetising, cooling, combined. Also ointments can contain steroids, chondroprotectors, be homeopathic and massage. Despite such an abundance, it is easy to tolerate almost any combination of ointments (avoiding, of course, mutually exclusive types of cooling with warming). Ointment from pain in the spine is used, usually at home, and the choice remains with the patient.

Popular ointments and gels to reduce the pain remain:

• Fastum-gel - contains anti-inflammatory and analgesic components, essential oils. When applying it is necessary not to reduce the recommended dose of the gel, carefully rub it until the substances are completely absorbed. Similar action has the finalgel, voltaren (contains diclofenac), nurofen (containing indomethacin and ibuprofen);
• Dolobene-gel is a combined preparation consisting of anti-inflammatory, analgesic, decongestant components with a regenerating effect. The composition of the drug includes dimethyl sulfoxide, heparin, dexpanthenol.
• Finalgon, apizartron, capsicum manifest themselves as anesthetic preparations with a warming effect. Causing local expansion of the vessels, they provoke a rush of blood warming the affected area, which somewhat accelerates the recovery processes. Especially shown the use of these drugs after supercooling.
• Chondroxide is a drug-chondroprotector, the directed action of which is concentrated on potentiating the regeneration of cartilaginous tissue, slowing down the processes of aging (thinning) of the cartilage.

Ointment from pain in the spine always has an indication in the instructions for the minimum amount of ointment for a single application and for the desired duration of treatment. Only warming ointments are used symptomatically.

Prevention of pain in the spine

One of the main points in maintaining the health of the back is prevention.

Prevention of pain in the spine is a constant problem of society with a tendency to hypodynamia and changes in physical activity. It is necessary to minimize the traumatization of intervertebral discs by physical stresses in all ways. Wearing a corset (bandage) slightly reduces the amplitude of movements in the lumbar (most often affected) section of the spine. It is necessary to exclude the inclination of the trunk forward from everyday activity, even when doing household chores should be as much as possible to maintain the vertical position. When lifting weights, do not bend over, but squat and lift with a load from the vertical position of the back, do not bend over when training, but sit down, if this is not possible, then sit on one knee (for example, left), placing the gravity of the trunk on an even surface of the thigh in this case right). In the elevator, to ease the compression, when braking the car, it is necessary to lean your back on the elevator wall with your legs slightly extended forward, so the back fully adjoins the elevator wall, which will somewhat ease the jerk load when stopping or overclocking. If you manage to occupy a horizontal position in the middle of the day, put as high a platen as possible under the knees, stretching the muscles of the waist and unloading the lumbar region.

Prevention of pain in the spine is to maintain a diet to maintain optimal weight, wearing shoes on an elastic sole with a low heel, constant training of the muscular corset of the spinal column. To date, the prevention of pain in the spine is one of the leading places in the prevention of diseases of the musculoskeletal system, which is experiencing the destructive impact of technological progress of mankind.