Pain at the top of the back

The causes of pain at the top of the back often remain unknown, and the methods of visual studies can not determine them. Loss of discs, spinal arthritis, muscle spasms are the most common diagnoses. Other problems can also cause pain at the top of the back.

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Lumbosacral radiculitis

The sciatic nerve is a very large nerve that begins in the lower back. It is formed in the spine and consists of the branches of the roots of the lumbar spinal nerves. It passes through the pelvis, and then descends deep into each buttock. Then he goes down into each leg. It is the longest and widest nerve in the body.

Pain at the top of the back is not a diagnosis, but a description of the symptoms. Anything that puts pressure on one or more lumbar nerve roots can cause pain in one part or all of the sciatic nerve. Herniated disc, stenosis of the spinal canal, osteochondrosis, spondylolisthesis or other disabilities of the vertebrae can all cause pressure on the sciatic nerve. And then there are pains at the top of the back, they can give back in them, legs.

In some cases, the pain of the sciatic nerve can be troubling when the muscle located deep in the buttocks clamps the sciatic nerve. It is called a pear-shaped muscle. The condition of pain is called pear-shaped muscle syndrome.

Usually such a syndrome develops after an injury. Sometimes it can be difficult to diagnose.

Pain at the top of the back due to emergencies

Several other serious diseases can also cause back pain. Often these symptoms develop within a short period of time, become more serious. Some of these diseases:

• Infections in the bone (osteomyelitis) or disk (diskitis)
• Cancer that has spread to the spine from another part of the body (most often lung cancer, colon cancer, prostate cancer and breast cancer)
• Cancer that develops in the bone (the most common diagnosis in adults, in particular, multiple myeloma, especially in middle age or in the elderly), benign tumors such as osteoblastoma or neurofibromas and blood cancer, including leukemia, can also cause back pain in children or adults
• Injuries

Other causes of pain at the top of the back include:

• Fibromyalgia and other pain syndromes.
• Diseases that cause back pain, arising from organ problems, are also associated with the spine (which is usually next to them). Such diseases include ulcers, kidney diseases (including kidney stones), ovarian cysts, and pancreatitis.
• Chronic diseases of the uterus or pelvic organs can lead to pain at the top of the back in women.

Risk factors

In most known cases, back pain starts with injury, and also after lifting heavy objects or sudden movements. Not all people have back pain after such injuries. In most cases, the causes of back pain remain unknown.

Aging

Intervertebral discs can begin to decay even up to 30 years. A third of adults over the age of 20 demonstrate signs of disc hernia (although only 3% of these disks cause painful symptoms). As people continue to age, their disks lose moisture and decrease in size, which increases the risk of developing spinal stenosis. The prevalence of back pain and lumbosacral sciatica are more concerned about the category of women during menopause, as they lose bone density.

In the elderly, the incidence of osteoporosis and osteoarthritis with back pain is a common problem for women and men. However, the risk of lower back pain does not necessarily increase steadily with age.

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Professions with an increased risk

Professions that include lifting, bending, torsion and finding in uncomfortable poses, as well as those that cause whole-body vibrations (for example, driving intercity trucks) pose a particular danger of pain in the lower back of the back. The longer a person continues this work, the higher the risk.

A number of companies are developing programs to protect themselves from back injuries. However, the elementary load on the back during prolonged sitting at the computer can increase the risk of developing pain at the top of the back, despite all the protective equipment: corsets, orthopedic chairs and so on. Office workers, in addition to having chairs, tables and equipment that support the back and help maintain a good posture, are also required to take care of the even back during sitting and breaks during work.

Pain in the back causes significant loss of working time and money. According to WHO, back pain is the cause of 60% of absences due to pain associated with the upper back.

Osteoporosis

Osteoporosis is a condition that is characterized by progressive loss of bone density, thinning of bone tissue and increased vulnerability to fractures. Osteoporosis can be a consequence of chronic diseases, or hormonal insufficiency, or old age. Regular exercise and vitamin-mineral supplements can reduce and even reverse the loss of bone density.

Persistent back pain in children is likely a serious cause, which requires treatment more often than adults.

Fractures in athletes

Fractures (spondylolysis) of the spine are a frequent cause of back pain in young athletes. Sometimes a fracture associated with the spine can not so much worry a week or two after the injury. Spondylolysis can lead to spondylolisthesis, a condition in which the spine becomes unstable and the vertebrae slide relative to each other.

Hyperlordosis

Hyperlordosis is a congenital deformity with a bend in the lumbar region inside. Scoliosis, curvature of the spine in children, usually does not cause back pain. But the diseases associated with it can cause pain in the sacrum and hip joints in children and young people. These can be complications in the form of rheumatoid arthritis, which is currently defined by doctors as a separate medical problem. Injuries can also cause back pain in children.

Pregnancy and back pain at the top

Pregnant women are prone to pain at the top of the back due to the displacement of the abdominal organs, the redistribution of body weight forward and loosening of ligaments in the pelvic area when the body prepares for childbirth. High women are at greater risk than lower women.

Psychological and social factors of pain at the top of the back

Psychological factors are known to play an important role, forming three stages of lower back pain.

Some research data suggest that depression and inability to cope with them are more likely to provoke back pain than physical problems.

"Passive" style of coping with troubles (reluctance to confront problems) is closely related to the risk of pain in the neck or lower back.

Research

Social and psychological factors, as well as the degree of job satisfaction, all play a major role in the occurrence of back pain. For example, in one medical study, physiologists and psychologists compared the health of truck and bus drivers. Almost all drivers loved their work. Half of them told doctors about back pain, but only 24% sooner or later went to sick leave because of back pain.

Bus drivers, on the other hand, reported that their satisfaction with work was much lower than that of truck drivers, and these workers with back pain had significantly more work passes for reasons of pain than satisfied truck drivers, despite the lower burden on the back .

Another study showed that pilots who said they loved their work had fewer problems with their backs than their crews. And another study showed that low rank in office, low social support and high physical strain among soldiers was associated with an increased risk of back pain.

The likelihood of pain at the top of the back

Depression and a tendency to complain in response to stress also increases the likelihood that acute back pain will become a chronic disease. The way a patient perceives pain and copes with pain at the onset of an acute attack can actually change a patient's condition: either restore health or develop chronic diseases. Those who tend to overreact to pain and fear for their lives tend to feel out of control, which increases the risk of developing long-term back problems.

Studies also show that patients who reported to doctors about a prolonged emotional disorder have less favorable results after the operation.

It should be noted that the presence of psychological factors in no way detracts from the reality of pain and does not eliminate side effects. Recognizing this in many cases of back pain, you can help the doctor determine the range of treatment.

Pain at the top of the back - localization

Pain at the top of the back travels down the leg along the path of finding the sciatic nerve. Pain associated with sciatica nerve inflammation usually occurs when the nerve roots in the spinal cord are compressed or damaged. Symptoms may include tingling, numbness or pain in the back, which gives to the buttocks, legs and feet.

Pain or numbness due to lumbosacral radiculitis can vary over a wide range. It can be felt as a soft tingling, dull pain or burning sensation. In some cases, pain is a serious enough circumstance to lead a person to immobility.

Pain most often occurs in the back on one side and can give to the buttocks, legs and feet. Some people experience acute pain in one part of the leg or thigh and numbness in the other parts of the leg. The affected leg may feel weak or cold, blood flow is disturbed in it.

The pain often begins slowly and can gradually increase:

• At night
• After a person has stood or sat for a long period of time
• When sneezing, coughing, or laughing
• After hiking more than 50 - 100 m (especially if it is caused by stenosis of the spinal canal)

Pain in sciatica usually lasts for 6 weeks, unless there are other additional diseases. Pain that lasts longer than 30 days, or a person becomes worse by sitting, coughing, sneezing or tensing, may require recovery longer than this time. Depending on the cause of lumbosacral radiculitis, the symptoms of pain may appear and disappear.

Herniated disc

Herniated disc, which is sometimes (mistakenly) called a herniated intervertebral disc, is a frequent cause of severe pain at the top of the back and lumbosacral radiculitis. The disc in the lumbar region is protruded by the hernia, when it breaks or thinens, and the fluid inside the disc (pulpous core) pushes it outward.

A damaged disc may look different:

1. Convexity (prolabirovanie) - gelatinous nucleus was displaced from the disk a little and evenly distributed along the entire circumference - by 2-3 mm.
2. The protuberance (protrusion) - gelatinous nucleus was displaced somewhat asymmetrically and in different places - from 4 to 15 mm.
3. Extrusion - the gelatinous nucleus extends widely beyond the vertebrae or breaks off the disk in the form of a drop.

The nature of pain

Pain in the leg can be even stronger than back pain, in cases where doctors diagnose herniated discs. There is also a medical discussion about how pain develops due to a herniated disc, and how often it causes back pain.

Many people have problems with discs, bulges or ledges of discs and do not suffer from back pain. Extrusion (which occurs less frequently than two other types of hernia) is much more likely to cause back pain, since the gelatinous nucleus extends far enough to press on the nerve roots, most often the sciatic nerve. Extrusion hernias occur very rarely, however, while leg pain and back pain are very common. But there may be other causes of pain in the lower back of the back.

«Horse tail syndrome»

The fibrous group that surrounds and protects the disc contains a dense network of nerves and a high level of peptides that enhance the perception of pain. Discontinuities of this ring are frequent in patients with degenerative disc disease. In this case, there is a so-called horse tail syndrome - squeezing a bundle of nerve roots of the spinal cord, in appearance resembling a horse's tail. The cause, as a rule, is massive extrusion of the body of the disc.

The syndrome of the ponytail at the same time leads to serious consequences - complications of the bowel and bladder. This can cause permanent urinary incontinence if surgery is not performed in a timely manner.

The cauda equina syndrome includes:

• Stupid pain in the back
• Weakness or numbness in the buttocks - in the area between the legs, or on the inner thighs, in the back and legs
• Inability to control urination and defecation
• Pain is accompanied by fever (may indicate an infection)

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Lumbar degenerative joint disease

Osteoarthritis, which can cause pain at the top of the back, arises in the joints of the spine, usually as a result of aging, but also as a reaction to previous back injuries, excessive wear of the intervertebral disc, fractures. The cartilage between the joints of the spine is destroyed and the bones grow further, bone spurs develop. The intervertebral discs dry up and become thinner and brittle. The speed with which these changes develop varies depending on the characteristics of the human body.

As a result of these changes, a gradual loss of mobility of the spine and a narrowing of the space between the spinal nerves and the spinal cord appear, eventually leading to stenosis of the spinal canal. Symptoms may be the same as with a herniated disc or stenosis (narrowing of the spinal canal).

Stenosis of the spinal canal

Stenosis is the narrowing of the spinal canal, or narrowing of the opening (the so-called neural holes), where the spinal nerves are behind the redistribution of the spine. This condition usually develops with age, when the discs become more dry and begin to shrink. At the same time, the bones and ligaments of the spine swell or grow because of arthritis and chronic inflammation. However, other problems, including infections and congenital defects of bone tissue, can sometimes cause stenosis of the spinal canal.

Most patients report a gradual deterioration of their condition and back pain not immediately. In some people, back pain may be minimal, but at any time, any disturbance, for example minor injuries, can result in the inflammation of the disc, may cause pressure on the nerve roots and cause pain at the top of the back or in the other part.

The nature of pain

Patients may experience pain or numbness that they may give to both legs, or bother only on one side of the back or thigh. Other symptoms include a feeling of weakness and heaviness in the legs or buttocks. Symptoms, as a rule, are present or will be aggravated only when a person is standing or walking. Often the symptoms ease or disappear when the person sits down leaning forward. These positions can create more space in the spinal canal, thus reducing pressure on the spinal cord or spinal nerves. Patients with stenosis of the spinal canal usually can not walk for a long time, but they can ride a bicycle, experiencing a slight pain in the back and legs.

Spondylolisthesis

Spondylolisthesis occurs when one of the lumbar vertebrae slides over the other, or is on the sacrum.

In children, spondylolisthesis usually occurs between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum. This is often associated with a birth defect in this area of the spine. In adults, the most common cause is degenerative joint disease (eg, arthritis). The pain usually passes between the fourth and fifth lumbar vertebra. It is more common in adults over 65 years and women.

Other causes include spondylolisthesis due to stress fractures (usually gymnasts) and traumatic fractures. Spondylolisthesis can sometimes be associated with bone disease.

Spondylolisthesis can range from mild to severe. This can lead to lordosis (abnormal lumbar lordosis), but at later stages, or may lead to kyphosis in the upper part of the spine.

Symptoms may include

• Back pain
• Pain in the thighs and buttocks
• Muscle pain
• Numbness in some parts of the body

Neurological disorders (weakness of the legs or changes in sensations) can result from pressure on the nerve roots, and can cause pain that travels down the legs.

Inflammatory diseases and arthritis

Inflammatory diseases and arthritis syndromes can cause inflammation in the spine. Rheumatoid arthritis can be localized in the cervical spine (neck). A group of diseases with spondyloarthropathy can cause back pains at the top. These include

Bechterew's disease - is a chronic inflammation of the spine, which can gradually lead to the fusion of the vertebrae. Vertebrae, as a rule, are severe and painful in the morning, pain during movement or exercise becomes quieter. In most cases, the symptoms develop slowly, over time. In severe cases, the symptoms become much more expressive, for a short period of time, and the patient develops postural defects.

Reactive arthritis or Reiter's syndrome is a group of inflammatory diseases that are associated with certain joints, lower back, urethra and eyes. There may be ulcers (lesions) on the skin and mucous membranes.

Psoriatic arthritis is diagnosed in about 20% of people suffering from psoriasis, which contributes to the development of arthritis associated with the spine, as well as many joints.

Enteropathic arthritis is one of the types of arthritis associated with inflammatory bowel diseases, the most common forms are ulcerative colitis and Crohn's disease. About 20% of people with inflammatory bowel disease feel symptoms of pain in the spine.

There are many treatments for these potentially dangerous diseases without the use of surgery.

Osteoporosis and compression fractures

Osteoporosis is a disease of the skeleton, when the amount of calcium contained in the bones slowly decreases to the extent that the bones become brittle and prone to fractures. This usually does not cause pain, unless the vertebrae are deformed, in which case the pains are often serious. Pain can affect more than one vertebra.

With a compression fracture of the vertebrae, the bone tissue of the collapse of the vertebra, more than one vertebra may lose its functions. Fracture of the vertebrae of the thoracic and lower parts of the spine as a result of osteoporosis, as a rule, affects the fact that pain symptoms can be intensified when walking.

Pressure on the spinal cord can also be troubling, creating symptoms of numbness, tingling, or weakness. Symptoms depend on the area of the back that has suffered, but most fractures are stable and do not cause neurologic symptoms.

Injuries of muscles and ligaments - lumbar deformities

Deformities and damage to the muscles and ligaments supporting the back are the main causes of low back pain. The pain is usually more common in the muscles next to the spine, and can be associated with spasms in these muscles. The pain at the top of the back can go into the pain of the buttocks, but very rarely descends further down the leg.

Prognosis of pain at the top of the back

Most people with acute back pain return to work for a month and are fully restored within a few months. According to one medical study, about a third of patients with uncomplicated low back pain improved significantly after a week of treatment, and two-thirds of patients were restored in 7 weeks.

However, studies show that currently up to 75% of patients suffer from at least one relapse of back pain during the year. After 4 years, less than half of the patients may no longer appear symptoms of pain at the top of the back.

Special conditions with the health of patients, which the doctor takes into account, can increase the rate of recovery.

For example, in most patients with a herniated intervertebral disc, the condition still improves (although real physical improvement may be slower than pain reduction). The researchers tried to identify factors predicting an increased risk of relapse of pain and found that only depression is the most important factor for most who have not yet recovered.