It is probably impossible to find a single adult who did not know what “lumbar osteochondrosis” is.On average, every third healthy, middle-aged person, and sometimes more often, has had an episode of acute lower back pain in his life, and every fifth or sixth indicates that such problems arise regularly, and are even the “source” of sick leave.
However, patients are most often unable to explain in detail exactly what kind of disorder occurred in the lower back.Most of them have never been examined, and treatment, consisting of “injections,” “ointments,” and massage sessions, usually helps for a period of several months to a year.
If you “push” such a patient and start asking him about the diagnosis, then, after suffering a little, he will declare that he is sick with “osteochondrosis.”What does this disease mean in relation to the lumbar spine?
Osteochondrosis of the lumbar region - a disease or a “normal life”?
First of all, we need to state authoritatively: “osteochondrosis” cannot hurt.And it cannot manifest itself in any way, since this is a process of dystrophy and degeneration of the intervertebral discs, that is, cartilage, which consists of the nucleus pulposus and the fibrous ring.The intervertebral disc is cartilage, and is designed to work as a shock-absorbing “airbag”, softening vertical and angular accelerations - braking between adjacent vertebrae.
As is known, cartilage is devoid of nervous and vascular tissue, therefore processes occurring “purely in the discs” simply cannot affect neighboring structures and do not manifest themselves in any way.A similar example in vertebroneurology is Schmorl's hernia, in which the hernial protrusion is securely covered by the cancellous bone tissue of the adjacent vertebra.Intervertebral discs do not hurt.
Chondrosis (the suffix “-oz” means growth, enlargement), in this case, is not entirely correct.There is no growth or increase in cartilage tissue during human life.With fibrosis (cirrhosis) of the liver, you can notice that the mesh structure of the liver has begun to develop, to the detriment of function.
And with chondrosis (or osteochondrosis), the intervertebral discs just begin to change their configuration, under the influence of many years of stress.
They cause pressure on neighboring vertebrae, since, according to Newton’s law, every action under a static load gives rise to exactly the same reaction, or support reaction.How does osteochondrosis develop, and for what reasons does this happen?
Causes of “lumbar osteochondrosis”
Signs of lumbar osteochondrosis (more precisely, intervertebral discs) can be detected already at a young age, especially with various disorders of the musculoskeletal system.
These include, for example:
- congenital anomalies (different leg lengths);
- various types of flat feet (longitudinal, transverse);
- spinal column deformities (scoliosis);
- spondylolisthesis (slippage of the lower lumbar vertebra from the sacrum both forward and backward).
All these diseases can cause either an increase in the impact load on the spinal column (for example, with flat feet, when the elasticity of the arch of the foot decreases), or with pronounced asymmetry of the spine, when the supporting function is systematically realized due to the load on the edge of the disc.
It is known that during experiments it was found that healthy and young cartilages, if they were given a load evenly and statically over the entire surface, were able to withstand up to 2000 kg and even higher without damage to themselves.Of course, such a load does not exist in everyday life, but it can increase to such values when exposed to the edge of the disc.
If the support area is 20 times smaller, and the disc is not so healthy (for example, in old age), then an impact of 60-80 kg (for example, falling on ice while leaning on the side, with a load on the shoulders) can cause destruction of the disc, which can be in the form of a protrusion or hernia.
It is the appearance of a protrusion or hernia that indicates that the disc has become deformed and even “come out” from one or more sides.And, as you know, there is no empty space around the disk.As soon as the disc begins to contact the nerve roots, neighboring ligaments and muscles, then the consequences of osteochondrosis arise: reflex pain and muscle-tonic syndromes, which force the patient to consult a neurologist, chiropractor and massage therapist.
As long as the discs have a normal shape and wear out evenly, without extreme loads, then osteochondrosis of the lumbar spine worries the patient no more than the usual age-related wear of teeth, with which criminologists are well familiar.How do reflex pain syndromes manifest themselves?
Symptoms and signs of complicated lumbar osteochondrosis
You have already noticed that we are diligently “spreading” bridges: ordinary osteochondrosis is a completely inevitable process of normal aging of elastic intervertebral “pads” in the species “Homo sapiens”, since it moves vertically throughout life.And the “osteochondrosis” that patients with acute pain recall is a complicated condition.
Let's start, perhaps, with signs of radicular compression.Signs of lumbar osteochondrosis, of course, are associated with pain due to the segmental nerve root being pressed by the disk.In addition to pain, sensory, motor and vegetative-trophic disorders are possible.
Lower back pain with osteochondrosis has the following characteristics:
1) Radicular pain.It is secondary and occurs like neuralgia, when a swollen nerve root reacts very “violently” to a shock.
The pain is sharp, sudden, shooting, piercing the lower back, possibly radiating to the leg.The pain appears and instantly intensifies, which is why it is called “lumbago”, or “lumbago”.It is this kind of “lumbago” that makes a person “stand up in a hurry,” since any movement leads to increased pain.
In addition, the pain intensifies with the slightest cough, sneezing, straining, laughing - any situation in which the swollen root is shaken.
If the root is part of the sciatic nerve, the pain “shoots” through the buttock into the popliteal fossa and below, and this is called “lumbar sciatica.”
2) Muscle pain.Near the nerve root there are large muscle masses.Often, in spring and autumn, they “get cold” and themselves swell and become dense.Venous outflow is hampered in them, and they themselves are a source of pain.
This pain is aching, constant, and not so sharp.On the contrary, it intensifies not only with sudden movement, but also with prolonged stay in a monotonous position (deterioration of blood supply).
- Sometimes such myofascial syndrome occurs after an exacerbation of a protrusion or hernia, when a sharp “hook” of the hernia “massages” the muscles and ligaments for a long time.
3) Movement disorders.Since the disc can compress not only the sensory, but also the motor root, the development of peripheral paresis, or even paralysis, is possible.At different levels of damage, weakness in the legs may appear (for example, weakness when climbing stairs on one side), weakness in the foot, which leads to gait disturbance.
Muscle wasting occurs and one leg “loses weight.”Such a purely motor, painless disorder is rare and, if left unnoticed, can lead to disability.
4) Sensory disorders.They arise along with pain, and often exist after the pain ends, instead of pain.They manifest themselves as numbness, decreased sensitivity of the skin of the legs in the form of “stripes”, in the form of vertical stripes, and a sensation of “crawling goosebumps” in the toes and feet.
- Sometimes, when vegetative fibers are damaged, symptoms are combined with hyperhidrosis, cold skin, and impaired hair and nail growth.
These are the most common signs of complicated lumbar osteochondrosis that exist in the lumbar region.There are individual syndromes, for example, damage to the external cutaneous nerve of the thigh, or damage to the cauda equina, epiconus, pure radiculitis or piriformis syndrome - but even a brief description of them would take too much time.
For patients, the above basic signs are enough to make an appointment with a neurologist.How can you “relieve the aggravation with your own hands”?How to treat lumbar osteochondrosis at home?
What to do during an exacerbation of lumbar osteochondrosis?
The basis of any treatment is etiotropic therapy (elimination of the cause), and pathogenetic treatment (affecting the mechanisms of the disease).It is accompanied by symptomatic therapy.
For vertebrogenic pain (caused by problems in the spine), things are like this:
- Elimination of the cause is the elimination of pressure from a protrusion, hernia, or spasmodic muscle on the nerve root;
- The impact on the mechanisms is the elimination of muscle spasm, the restoration of venous outflow in the muscles, the removal of swelling of the nerve root, and the fight against inflammation;
- Elimination of symptoms (fighting pain, numbness, limited mobility) is carried out by returning to point No. 2, since removing swelling and inflammation, for example, will restore mobility and relieve pain.
Getting rid of protrusion and hernia
As a rule, it is not the starting point for treating acute back pain.Almost always, the pain syndrome is initially relieved, then, after massage sessions and treatment by a chiropractor, all symptoms go away and surgery is not required.
The question of surgical intervention arises with the progression of weakness in the foot, and with severe, intractable pain for 2 months.In addition, surgery is required when there is high level compression of the central canal, which contains the spinal cord, or cauda equina.
Treatment of lumbar osteochondrosis, drugs
Treatment of lumbar osteochondrosis and its complications involves the following measures.In the acute phase (first day – two):
- In order to reduce swelling of the muscles and spine, a salt-free diet and limiting the amount of fluid consumed are indicated.You can even give a tablet of a mild potassium-sparing diuretic.
- It is recommended to wear a semi-rigid orthopedic corset, which protects the muscles from excessive movement.
- From the first days, rubbing in warming ointments containing NSAIDs and applying patches, for example, “pepper” patches, are recommended.
- During the acute phase, you cannot warm your back.As inflammation increases, swelling increases.Therefore, any heating pads are prohibited.You can warm up by removing your own heat (a wool belt, warming ointments), which do not add it from the outside, but, on the contrary, remove it from the depths to the outside.
- In the acute phase of lumbar osteochondrosis, short-term treatment can be carried out with intramuscular “injections” of NSAIDs and muscle relaxants.This will help relieve swelling of the nervous tissue, eliminate inflammation, and normalize muscle tone.
In the subacute period, after overcoming the maximum pain, “injections” should no longer be taken, and attention should be paid to restorative agents, for example, modern vitamin preparations of group “B”.They effectively restore impaired sensitivity, reduce numbness and paresthesia.
Physiotherapeutic measures continue, the time has come for exercise therapy for osteochondrosis of the lumbar spine.Its task is to normalize blood circulation and muscle tone, when swelling and inflammation have already subsided, but muscle spasm has not yet fully resolved.
Exercises for lumbar osteochondrosis of the spine must be carried out after a light general warm-up, on “warmed up muscles”.
The main therapeutic factor is movement, not the degree of muscle contraction.Therefore, in order to avoid relapse, the use of weights is not allowed; a gymnastic mat and a gymnastic stick are used.With their help, you can effectively restore range of motion.
Rubbing in ointments and using the Kuznetsov implicator continue.Swimming, underwater massage, Charcot shower are shown.It is during the stage of fading exacerbation that drugs for home magnetic therapy and physiotherapy are indicated.
Usually treatment takes no more than a week, but in some cases, osteochondrosis can manifest itself with such dangerous symptoms that surgery may be necessary, and urgently.
Complications of lumbar osteochondrosis of the spine
We are talking, first of all, about a condition when a disc herniation has become an independent fragment and, having penetrated the central canal, has formed a free sequestration.There it can compress the nerves of the cauda equina, and it can suddenly (right in the gym, after an episode of acute pain) develop severe weakness, or paralysis in the legs, numbness of the perineum.
After a few minutes, severe pain in the legs appears, and then a reflex urinary retention or the appearance of incontinence is possible, and impotence develops.This occurred as cauda equina syndrome as a complication of a disc herniation.In this case, urgent intervention is required, removal of the sequestrum, and restoration of the function of the cauda equina nerves with their decompression.
However, more often than not, other complications arise.With age, multiple hernias and protrusions occur, osteoporosis of the vertebrae appears, and mobility simply decreases significantly and the risk of acute back pain increases.Such patients necessarily “take sick leave” a couple of times a year and are often treated in sanatoriums.
Treatment prognosis
Osteochondrosis of the lumbar spine, the symptoms and treatment of which we discussed above, as we have understood, is for the most part not a disease at all, but simply a manifestation of inevitable aging and premature “shrinkage” of the intervertebral discs.
Can humanity be completely freed from lumbar osteochondrosis?This answer can be answered in the affirmative, but then we will have to master a different style of movement: walking on all fours all our lives, or, like Ichthyander, swimming into the depths of the ocean, constantly moving in the water from childhood.It is then that the axial, static load on the intervertebral discs will disappear, and along with it the signs of “chondrosis” will disappear.But another problem will arise: in water such a powerful structure will simply become unnecessary and will begin to change until it disappears or is significantly reduced.
As for the personal, individual prognosis for osteochondrosis, it all depends on the time when the person “decided to come to his senses.”If by this time there is no pronounced destruction of the intervertebral discs, protrusions, hernias and deformations, then, subject to a healthy lifestyle and hygiene of physical activity, you may not have problems with the lower back until a very old age.
In the same case, when there is already a “hot spot” in the lumbar region, for example, in the form of a hernia, which periodically compresses the nerve root, then the person needs to be especially careful from awkward turns, physical exertion, improper lifting of weights and seasonal hypothermia, which usually cause exacerbation of spinal osteochondrosis.