Spinal pain

Humanity acquired back pain at the same time as walking upright. This unnatural way of moving for all terrestrial organisms allowed us to free our hands for work, but it greatly changed our musculoskeletal system, and not for the better.

As a result of walking upright, the sections of the spine became curved, these physiological curves were called "lordosis" and "kyphosis". The curves became necessary for the greatest cushioning of loads during movement and maintaining balance, because during movement there regularly comes a moment when the whole body rests on only one point of support.

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Causes of pain in the spine

The main causes of pain in the spine are overstraining the muscles that support the spinal column (long back muscles) and those that are attached to the spine at one end (trapezius and latissimus dorsi). Conventionally, these two muscles can be divided by localization - the trapezius covers the shoulder blade and is attached to the cervical-thoracic region, and the latissimus dorsi covers the ribs from the back and adjoins the lumbar region. Also, pain in the spine can be caused by injuries, spondylolisthesis, inflammatory processes in the vertebrae and discs, degenerative processes in bone and cartilage tissue, herniated discs, radiating pain due to disruption of the internal organs, the third and fourth stages of cancer.

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Symptoms of Back Pain

The sensation of pain is very, very individual, the symptoms of pain in the spine can be described by patients' complaints as aching, paroxysmal, sharp, stabbing pain, arising during movement, at rest, under static tension, constant and independent. The description of pain symptoms has diagnostic value and an accurate description of the moment of occurrence and nature of pain can help a neurologist in making a diagnosis. In general, the description of symptoms often begins with the words "back hurts", then the localization and nature of sensations are indicated, then the time of pain occurrence is specified and, in the patient's opinion, the probable causes.

The most common pain associated with walking upright and having to work is pain in the spine between the shoulder blades, which accounts for about 80% of all complaints of back pain. Raising one shoulder (carrying a bag on the shoulder), the constant need to sit at work in a semi-bent position - these are the main reasons for the constant tension of the trapezius muscles, which fix the body 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, you can feel dense formations in the thickness of muscle tissue with your fingers, which resemble cords (sometimes with nodes), touching them causes acute pain in the back. In places of attachment to the spine, these spasmodic areas of the muscles can injure the nerve processes emanating from the spine, which leads to pain in the spine. All these sensations are, so to speak, superficial, "suprascapular" in nature.

Other causes cause pain in the spine under the shoulder blades, which is felt as hot, pulsating, aching, twisting, does not depend on the body position and static tension. If the pain is paroxysmal, is felt under the shoulder blade and radiates to the arm (on the left side), one should suspect interruptions in the work of the heart (pre-infarction condition, attack of angina pectoris, ischemia), if the pain in the spine under the shoulder blades is felt evenly on both sides, it is probably a signal of problems with the stomach, less often - the pancreas. Sometimes this type of pain signals pleurisy, extremely rarely - problems with the bronchi. Often sharp pains under the shoulder blades, aggravated by movements, are a consequence of intercostal neuralgia.

Many pains radiating to the spine are caused by diseases of the internal organs. In addition to the above-mentioned interruptions in the work of the heart, stomach and respiratory organs, pains in the spine can be felt as acute attacks of renal colic and nagging, paroxysmal pains in the kidneys during various inflammatory processes. Disturbances in the work of the liver and gall bladder can manifest themselves in the form of nagging, aching pains in the spine in the projection of the liver. Sensations described as "pains radiating to the spine" can be caused by intercostal neuralgia, which is characterized by a "radiating" character. Intercostal neuralgia reacts with painful sensations to any movement, including the act of sneezing, coughing, practically not manifesting itself in complete rest, which differs from painful sensations caused by dysfunction of internal organs.

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

The causes and effects of complaints of pain in the lower spine are practically the same, but the responsibility for them already extends to the latissimus dorsi muscles, which cover the lumbar region. These muscles help to support the body in an upright position and increase in volume (pump up) with constant lifting of weights and physical work, they also suffer from overexertion with an unreasonably large load, with overexertion and injury, pain from the latissimus dorsi resembles pain with kidney dysfunction (and vice versa). In case of weakness of this muscle, spinal injuries are possible. The latissimus dorsi muscle is able to increase the volume of the chest, participating in the act of breathing, thus, with pleurisy, pain can be provoked by the movement of this muscle. This muscle is involved in the formation of a pain signal with intercostal neuralgia.

Pain in the lower spine is sometimes caused by radiculopathy (damage to the nerve roots), which is accompanied by a feeling of numbness, "pins and needles" along the path of the innervation disorder (part of the back, outer surface of the thigh, general decrease in sensitivity of the body parts below the affected root).

In case of injuries, overexertion and extremely high static loads, severe pain in the spine may occur due to its trauma (external or internal). With an external injury, the location and extent of the damage are usually clear. If the spine cannot withstand the working loads, injuries to the vertebrae, intervertebral discs and processes may occur, which are diagnosed by X-ray, computed tomography or MRI. Vertebrae may crack, deform and creep on each other, there may be fractures of the vertebral body or processes. Discs wear out from loads, become thinner and flatten, as a result of which the vertebrae close and the outgoing nerve processes become pinched, discs can also become deformed or "leak" - the contents of the disc core protrude in the form of a hernia, which also impairs the mobility of the spine and leads to pinching of the nerve 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 movement, and problems with the joints of the legs and arms are gradually added to the back problems, then pain in the spine and joints should be considered as symptoms of one disease. Common problems can be degenerative changes in cartilaginous tissue throughout the body caused by metabolic disorders, genetic features or an infectious process, and a similar picture of pain can also be seen in osteoporosis (degenerative changes in bone tissue). Most often, with systemic damage to the "cartilaginous" joints, Bechterew's disease is diagnosed.

Acute pain in the spine most often occurs with a fresh injury or inflammation. Lumbago, sciatica and coccygodynia are distinguished. Coccygodynia is the least studied condition of pain that occurs in the coccyx and is difficult to correct. The most likely cause of pain in the coccyx is injury, genetic predisposition to damage to the ligamentous apparatus of the spine in the coccyx area, inflammatory and degenerative changes. Sciatica is damage to a large nerve that originates in the lumbar spine and runs along one of the limbs to the foot. The nerve is called sciatic, its pinching or damage in any way does not allow the patient to sit due to unbearable acute pain, which is relieved by blocking the pain signal with injections of painkillers. Lumbago is caused by irritation of receptors located in the ligamentous ring of the intervertebral disc when it is damaged or prolapsed and is accompanied by sharp, “shooting” pain, muscle spasm and immobilization of the patient. Lumbago has a popular name - “lumbago”.

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, internal injuries are not noticeable and are not always detected by palpation (probing), i.e. it is not always possible to determine the injured area without diagnostic equipment. Internal trauma occurs with uneven or very large physical loads, with degenerative processes in cartilage or bone tissue and with genetic features (predisposition) to spinal pathology. Irritation of nerve endings (sharp pain in the spine) occurs with protrusion (bulging) of the intervertebral disc, with prolapse (loss of the disc nucleus), with a fracture of the spinous processes, with muscle spasm of the long muscles of the back that compress the nerve processes, but in most cases it is not possible to establish the exact cause of the pain.

Sometimes, pain in the spine is a consequence of a medical injury – a surgical intervention. Actually, pain after a spine operation can be a “syndrome of the operated spine” – a consequence of the progression of the adhesive-scarring process, increasing the compression of the nerve processes, the prolapse of a hernia on a new segment, the protrusion of the remains of the removed disk, the destabilization of the ligamentous apparatus in the operated area. Based on the above, repeated surgical interventions are extremely rarely recommended, with preference given to conservative treatment.

Most patients who complained of pain along the spine experienced pain from overexertion of the long, widest and trapezius muscles of the back. The pain appears after physical exertion, and physical exertion should be understood as not only physical work, but also static tension during sedentary work at a desk or computer). If the pain does not have a clear localization, then it can be assumed that relaxation (rest) of all the back muscles will alleviate the condition. If the pain does not decrease after rest in a horizontal position, then the probable cause may be hidden in the irritation of the nerve endings, for example, with a viral infection of the body (shingles). Sometimes the precursor to pain along the spine is a condition described as "blown through", i.e. the provocateur is the cooling of the muscle area, which later spasms and is injured. Myofascial syndrome is a condition of muscle pain caused by microtraumas, leading to the formation of connective tissue (scar) at the site of damaged fascia (muscle fibers). If the scar is formed near a nerve, then the pain syndrome haunts the patient for quite a long time.

Sometimes aching pain in the spine increases, sometimes it “lets go away”, but in any case, a long period of pain indicates pathological processes. If aching pain is localized in the cervical region, and a headache joins in, then you should pay attention to overexertion and spasm of the muscles of the back of the neck. If the pain covers the thoracic region, then there may have been overexertion during manual labor, pain in the lower back indicates loads that exceed the physiological capabilities of the body. If injuries are excluded, then aching pain in the spine is most often a manifestation of osteochondrosis and/or osteoporosis. Osteochondrosis in general is a dystrophic-degenerative process of change in the spinal column. The onset is manifested in pain in the spine, which is associated with a change in the height of the intervertebral space occupied by the disc. The disc “ages”, changing its hydrophilicity (the ability to retain fluid), thins and “dries out”. The vertebrae “sag”, disturbing the nerve endings, this process is felt as a nagging pain in the spine, as chronic fatigue, which is difficult to eliminate.

With osteochondrosis, the next stage of the disease development will be increasing, dull pain in the spine, which is not relieved by prolonged rest. Due to the development of degenerative processes, the vertebrae come closer together and the distance between the attachment points of the ligaments and muscles decreases, which leads to the mobility of the vertebrae relative to each other, the intervertebral joints experience overload, the long muscles of the back also try to compensate for the instability of the spine by strengthening the muscular corset. The vertebrae can shift relative to the axis of the spine and this process can occur with minimal pain, since the nerve fibers are not always damaged during the shift.

However, osteochondrosis progresses and the next stage of disk destruction will be its crushing, the release of the contents of the nucleus in the form of a hernia and rupture of the fibrous ring of the ligaments, stabbing pain in the spine appears, subluxations of the vertebrae are formed. At the site of the subluxation, the joint thickens, the injured tissue grows. With the growth of cartilage and bone tissue in the injured joints, the spinal cord may be pinched with a disruption of its nutrition and function. However, stabbing pain in the spine can also be a signal of developing myositis, but in practice, in patients after 40 years of age, stabbing pain in the back most often indicates the development of osteochondrosis.

This type of pain, such as pulsating pain in the spine, is very often a signal of problems in the functioning of internal organs, most likely the kidneys. After excluding diseases of internal organs, one can suspect a malfunction of the feeding vessels in the appearance of pulsating pain. Pulsating pain in the collar zone also indicates a muscle spasm (for example, after prolonged work at a desk in an uncomfortable position), with subluxation and dislocation of the vertebrae (discs), such pain in the lumbar region signals destructive changes (stretching of the ligaments of the intervertebral ring, disk displacement, inflammatory processes in the cartilaginous tissue of infectious and non-infectious nature). As a rule, pulsating pain in the spine signals an acute process (for example, a fresh injury).

When various destructive changes transition from an acute state to chronic processes, acute pain is replaced by dull, aching pain, most often pain in the spine can manifest itself when pressing on the problem area, since acute pain subsides with the outcome of the development of osteochondrosis. Pain when pressing manifests itself both in old injuries, when the body has practically compensated for the defect, and in an ineptly performed massage as a result of exacerbation of degenerative processes in the vertebra. Pain in the spine when pressing can indicate the very beginning of the inflammatory process, when only mechanical action (by hand) can find the pain point.

Pain in the spine when walking occurs in the case of the onset of deformation associated with hypertonicity of a certain muscle group caused by trauma, prolonged non-specific loads, hypothermia of the back area. Also, this type of pain may indicate developing scoliosis. Also, pain when walking may indicate inflammation of the nerve root (radiculitis) in the section of the spine that signals pain when moving. It is possible that osteochondrosis reports itself with such signals at the very beginning of degenerative changes in the intervertebral discs with changes in the gaps between the vertebrae.

Pain in the spine when inhaling very rarely indicates 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 pain during movement (inhalation, sneezing, coughing). At the same time, with some disorders in the work of the heart, when performing small physical activities, with an increase in the amplitude of movement of the ribs when inhaling, painful sensations are noted behind the breastbone, closer to the back, with a pulling pain under the shoulder blade. Heart pain at rest does not immediately subside, unlike neuralgia.

Nighttime back pain is almost always associated with sleeping positions. However, it happens that pain at night signals the onset of disorders. During the day, too weak signals do not reach consciousness due to overload of information, events and signals from movement or other pains. During a night's rest, the patient in a state of relative peace suddenly discovers a number of unpleasant sensations. Quite often, pain signals from the kidneys, stomach, liver, back muscles overworked during the day are detected in this way. To begin with, you should change your pillow and bed, then observe your condition.

Back pain after sleep is often associated with an uncomfortable posture due to a bed surface that is too soft or too hard. The cause of the pain is a muscle spasm caused by forced overstrain of the back muscles. In this case, the pain decreases or goes away by the middle of the day. If the pain after sleep is associated with developing scoliosis caused by poor posture, then this type of pain does not go away at all during the day, but there is a sharp improvement after a massage session. Another common cause of back pain after sleep is general low muscle tone and muscle stiffness (rigidity) due to physical inactivity.

Wandering pain in the spine is caused by a wide range of reasons. In such pains, one can suspect an inflammatory process of the joint bags of the vertebrae, and a non-specific inflammatory process of the nerve endings, and viral damage to the nerve endings of the skin, and a consequence of hypodynamia, and muscle strain, and injuries, and osteochondrosis, and neuralgia, and fibromyalgia. Quite often, the fact of wandering pain indicates a non-somatic nature of pain. General fatigue or psychological exhaustion can manifest as wandering pain. Back fatigue.

Pain in the spine after an injury indicates the onset of a minor inflammatory process. Most often, after an injury, blood and lymph (hematomas) that have leaked from torn vessels accumulate in the joint capsule of the spine, near the spinal column or disc. To eliminate (resorb) these formations, the body uses various lysing proteins that melt the "extra" formations. Minor fragments of cartilage and bone tissue, if they were formed as a result of the injury, are also subject to melting and removal. The melting process is accompanied by a local increase in temperature, pain, and swelling. The degree of damage to the spine can only be objectively assessed by a specialist.

Pain in the spine with metastases is quite common as a primary manifestation of a malignant process in the body. If the neoplasms did not manifest themselves for a long time due to the fact that the lesions were not of a totally damaging nature and the state of the body 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 nerve processes by tumors. Most often, metastases grow without any external manifestations if the liver, pancreas, kidney or spleen are affected. These organs are able to function even with partial degeneration of their tissues, the kidney is a paired organ, the disruption of one 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 the development of an oncological disease is most likely already inoperable. Help for the patient consists mainly in pain relief.

Point pain in the spine indicates the presence of a local area of inflammation (damage), with a high degree of probability it is possible to judge the pain at the site of damage to the nerve fiber due to thinning of the intervertebral disc (reduction of the lumen between the vertebrae with damage to the nerve process), it is also necessary to assume the displacement of the disc in its joint capsule relative to the axis of the spine (protrusion), a fracture (breakage of a part) of the vertebra due to excessive physical exertion, damage to the ligaments of the joint capsule by a herniated disc, probably also the beginning of an inflammatory process (for example, arthritis).

Nagging pains in the spine indicate a malfunction of the internal organs (kidneys, liver) or problems with the muscular corset of the back. The state of fatigue, the desire to rub the back often haunts office workers and is associated with prolonged static tension. Only in the case of a combination of these types of pain with goosebumps, tingling and a feeling of numbness in the limbs should one suspect the development of osteochondrosis. In half of the cases, nagging pains in the back end with a picture of extensive neuralgic pain. But if nagging pains appear in the lower back, one can assume inflammatory diseases of the genitourinary system.

Back pain during pregnancy also begins as a nagging, aching pain in the lower back. The reason for this is increased blood supply and an increase in the volume of the uterus. Due to the fact that all internal organs in humans have their own attachment inside cavities, these "attachments" are most often based on the spine and, in our case, the pelvic bones, which, in turn, are attached to the spinal column at a certain angle. Redistribution of internal space inside the lower abdomen leads to a change in the load on the spine, and a change in the angle of articulation of the pelvis and spine creates another source of tension. The condition can be alleviated with the help of a bandage, creating the illusion of an additional strong muscle layer.

Diagnosis of pain in the spine

Diagnosis of pain in the spine is often complicated by the vagueness of symptoms and the neglect of the process itself, since a visit to a surgeon or neurologist occurs when it is already difficult to independently block pain signals. The basis for diagnosis is both classic X-ray images (at least in two projections), and ultrasound, MRI, auxiliary, but no less valuable will be blood, urine, cerebrospinal fluid tests. The main point in making a diagnosis is to clarify the cause of pain, namely: is the pain a consequence of a disorder of the musculoskeletal system or signals problems in the functioning of internal organs. When clarifying the cause of pain, a correctly collected anamnesis with a detailed clarification of the likelihood of a genetic predisposition to such disorders is often invaluable. Modern medicine is not able to independently analyze the hereditary predisposition to the occurrence of problems with the spine, but it is the anamnestic data that helps to correctly build a treatment strategy and make a prognosis.

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Treatment of back pain

Treatment of pain in the spine is carried out under the supervision and by prescription of a neurosurgeon, a surgeon neurologist. Treatment of pain can be surgical and therapeutic. In difficult cases, when drugs are unable to help the patient and the disorders in the spine are of a life-threatening degree, surgical intervention is preferred. Surgery is indicated for instability of the spinal column, which threatens displacement of the vertebral bodies with subsequent trauma (compression) of the spinal cord, with existing violations of the integrity of the spine due to trauma, with progressive pathological changes in cartilaginous (bone) tissue.

Surgical treatment of spinal pain due to instability of the spinal column is most often performed in case of osteochondrosis. Its purpose is to remove the damaged disc and stabilize (unfortunately, immobile) two adjacent vertebral bodies relative to each other. This allows to stop the pain syndrome without its recurrence in this area in the future. Another indication for surgical intervention is intervertebral disc herniation. Herniated protrusion often overstretches the joint capsule or damages nerve processes so much that stopping the pain syndrome by conservative methods becomes impossible.

Treatment of spinal pain by removing the herniated body allows the patient to fully restore his/her ability to work and relieve pain.

Another indication for surgical intervention is spondylolysis. In this disorder, the joint capsule is unable to fix the vertebral body, since other methods of fixation are damaged (the vertebra breaks or the pedicles of the vertebral body that fix it in a certain position break off). Fragments of the body or pedicles constantly have a traumatic effect on the nerve processes or spinal cord, with age, the ligaments of the joint capsule of the intervertebral joints weaken, and surgery to stabilize the damaged area is the only way to protect the vertebra from slipping and traumatizing the nerve pathways.

However, conservative treatment remains the first choice method for treating various disorders (except for some emergency situations). Treatment of back pain most often involves a combination of painkillers, decongestants, anti-inflammatory drugs, and continues with a range of physiotherapy procedures, exercise therapy, the use of support corsets, and lifestyle changes.

Treatment of back pain requires long-term use of chemicals (medicines), which puts a lot of strain on the liver, so you should stick to a gentle diet throughout the entire treatment period and not create additional strain on the liver and kidneys (it is especially important to completely eliminate alcohol).

In cases where immediate assistance is required for sudden acute pain, various types of blockades are used. Blockades are local and segmental. Local blockades are used when analgesic solutions are injected into the pain site in order to eliminate the pain signal at the injection site, and segmental blockades are used for distal (remote) pain relief of any part of the body (organ) for the innervation of which the blocked nerve pathway is responsible. Blockades are very popular as a method of treating spinal pain. The most commonly used are:

• 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 - maintains the anesthetic effect more stably, but is metabolized by the liver, given this its only drawback, as well as low allergenicity, low toxicity, duration and relative strength of anesthetic properties, lidocaine is the most common choice for blockades;
• mesocaine – similar to lidocaine, has a slightly less pronounced anesthetic effect, but is a fairly affordable and low-allergenic drug;
• prilocaine is the least toxic of all the above, but is not inferior to them in terms of duration of action. Among the disadvantages of the drug, it should be noted the low degree of penetration into nerve fibers; due to its low toxicity and long-term local anesthesia, prilocaine is used for anesthesia of children;
• carbocaine - has a very long-lasting anesthetic effect, but is toxic and is excreted extremely slowly, which can lead to accumulation of the dose;
• Marcaine is extremely toxic, but its effect can last up to 16 hours, the use of this drug should always be justified by the necessary benefit, it is necessary to ensure medical supervision of the patient's condition.

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

Treatment of back pain does not stop at blocking the pain signal. It is necessary to use drugs that reduce inflammation in the center of pain. One of the most powerful anti-inflammatory drugs for "spinal patients" should be recognized as a group of steroid hormonal drugs. Steroid hormones in minimal doses have virtually no effect on the overall hormonal background, do not disrupt the work of the adrenal glands, but sharply stop degenerative processes in tissues, reduce the level of pain. However, one should always take into account contraindications to the use of hormones - the presence of metabolic disorders such as diabetes, old age with fading adrenal glands, the presence of purulent and septic processes (which can get an impetus in development with a decrease in the non-specific immune response of the body), the presence of ulcerative diseases.

If the benefit from using the drug has been assessed as exceeding the potential harm, then the choice of steroids is made from the following medications:

• hydrocortisone is the most well-known of the hormone analogues; use begins with 5 mg of hydrocortisone per 1 block, necessarily in diluted form, with analgesics, since the drug can cause tissue damage at the injection site;
• dexamethasone is much more active than its predecessor (approximately 30 times), but is more toxic and can more often cause necrosis when administered (requires careful dilution), administration begins with a dosage of 1 mg.;
• Kenalog is a modern drug that requires a single injection and is deactivated extremely slowly. During the first blockades, its use is not justified, since it is difficult to make a prognosis in the presence of Kenalog; if a repeat injection is necessary, the frequency should not exceed once a week.

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

Also, to reduce the development of an allergic reaction and reduce the level of non-specific inflammation, antihistamines are prescribed without fail. The introduction of papaverine or no-shpa as muscle relaxants is indicated to alleviate the condition with muscle pain in the spine.

Exercises for back pain

Exercises for back pain are an integral part of the rehabilitation program. Therapeutic physical training in various medical institutions is aimed at maintaining the patient's full range of motion and minimizing the consequences of spinal damage. In case of hypodynamia and morning pain, simple warm-up exercises are indicated, in case of scoliosis and various deforming processes, a set of exercises is selected individually in combination with massage, in case of degenerative and traumatic disorders, a set of exercise therapy should begin with simple exercises, for example:

• Lying on your back in a position of complete rest, begin bending and unbending your arms at the elbow joint, your legs at the knee joint, sliding your heel along the bed;
• The next step will be bending the arms at the shoulder joint (raising the arms up one by one), the leg - one bent at the knee in a state of rest, the other straightened at the knee and in a horizontal plane is moved to the side and returned to the bed.
• The next step will be to lie down and bring your leg, bent at the knee, to your chest, drawing circles in space with your elbows one by one.
• While doing all these exercises, you should also practice diaphragmatic breathing.

In the subacute period, you can practice lifting your head from the pillow with your chin to your chest, kneeling and arching your back like a cat, or imitating riding a bicycle while lying down.

All types of exercises should initially be practiced in the presence of a specialist, and later, according to the method printout, repeated independently at home.

Exercises for back pain should be performed systematically, at a slow pace, maintaining the recommended speed and number of repetitions. In no case should you hold your breath when doing the exercises; if you experience pain, you should stop the exercises and consult a specialist.

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How to relieve back pain at home?

If complex analgesic mixtures are not available and the pain has suddenly overtaken the patient, before meeting with the doctor, you can alleviate your condition by taking general analgesic drugs. You can take ketanov, ibuprofen, naproxen, nimesulide, dexketorofen (the effect is felt in about half an hour, the duration of anesthesia is up to 5 hours), ketorolac on your own. At the same time as these drugs, you can take no-shpa as a muscle relaxant, suprastin as the most accessible antihistamine, and diuretics can be used to reduce swelling at the site of injury. Thermal procedures are strictly contraindicated!

Painkillers for back pain are selected based on individual characteristics and the nature of the disorder. The drugs can be local or general action, in the form of injections, tablets or patches. For myalgia, general action drugs are indicated, in tablets or patches, and all muscle relaxants will also have an analgesic effect. For muscle injuries, you can apply weak warming bandages, use creams with a local irritant, warming and analgesic effect. For pain associated with injuries to the vertebral bodies, you should temporarily take analgesics and still lean towards surgical assistance. For injuries to intervertebral discs and joint ligaments, with various inflammatory processes, analgesics only accompany the main treatment process and painkillers for back pain in this case should be combined with diclofenac, ketoprofen, indomethacin, diuretics.

Ointment for back pain

Ointment for back pain is used for mild pain syndrome, mainly for myalgia of various origins. Long-term use of ointment for degenerative changes (osteochondrosis, etc.) is not justified, since such diseases require a comprehensive approach to treatment. Ointments by the mechanism of action can be warming, analgesic, cooling, combined. Ointments can also contain steroids, chondroprotectors, be homeopathic and massage. Despite such abundance, it is easy to allow almost any combination of ointments (avoiding, of course, mutually exclusive ones such as cooling with warming). Ointment for back pain is usually used at home, and the choice is up to the patient.

The following ointments and gels remain popular for pain relief:

• Fastum-gel - contains anti-inflammatory and analgesic components, essential oils. When using it is necessary not to reduce the recommended dose of the gel, rub thoroughly until the substances are completely absorbed. Finalgel, Voltaren (contains diclofenac), Nurofen (contains indomethacin and ibuprofen) have a similar effect;
• Dolobene-gel is a combination drug consisting of anti-inflammatory, analgesic, anti-edematous components with a regenerating effect. The drug contains dimethyl sulfoxide, heparin, dexpanthenol.
• Finalgon, apizartron, capsicam manifest themselves as painkillers with a warming effect. Causing local vasodilation, they provoke a rush of blood, warming the affected area, which somewhat accelerates the recovery processes. The use of these drugs is especially indicated after hypothermia.
• Chondroxide is a chondroprotector drug whose targeted action is concentrated on potentiating the regeneration of cartilage tissue and slowing down the aging process (thinning) of cartilage.

An ointment for back pain always has instructions on the minimum amount of ointment for a single application and the desired duration of the course of treatment. Only warming ointments are used symptomatically.

Prevention of back pain

One of the most important points in maintaining back health is prevention.

Prevention of back pain is a constant problem in a society with a tendency to physical inactivity and changes in physical activity. It is necessary to minimize trauma to the intervertebral discs by physical activity in all possible ways. Wearing a corset (bandage) somewhat reduces the range of motion in the lumbar (most often affected) spine. It is necessary to exclude forward bends of the body from everyday activity, even when doing household chores, it is necessary to maintain an upright position as much as possible. When lifting weights, do not bend over, but squat and rise with a load from a vertical position of the back, when putting on shoes, do not bend over, but sit down, if this is not possible, then you should sit on one knee (for example, the left), placing the weight of the body on the flat surface of the thigh (in this case, the right). In an elevator, to ease the compression when the cabin brakes, you should lean your back against the wall of the elevator, slightly pushing your legs forward, so that your back is completely adjacent to the wall of the elevator, which will somewhat ease the load of the jerk when stopping or accelerating. If you manage to take a horizontal position in the middle of the day, you should put as high a bolster as possible under your knees, thus stretching the muscles of the lower back and unloading the lumbar region.

Prevention of back pain consists of following a diet to maintain optimal weight, wearing shoes with elastic soles and low heels, and constant training of the spinal column muscle corset. Today, prevention of back pain is one of the leading areas in the prevention of diseases of the musculoskeletal system, which is experiencing the destructive influence of human technological progress.