It is probably impossible to find a single adult who does not know what “lumbar osteochondrosis” is.On average, every third healthy middle-aged person, and sometimes more often, has had an episode of acute low back pain in his life, and every fifth or sixth indicates that such problems occur regularly and are even the "source" of sick leave.
However, patients very often are not able 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 must state authoritatively: "osteochondrosis" cannot hurt.And it cannot manifest itself in any way, as it is a process of dystrophy and degeneration of the intervertebral discs, i.e. of the cartilage, which is made up of the nucleus pulposus and the fibrous ring.The intervertebral disc is cartilaginous and is designed to function 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, so processes occurring "purely in the discs" simply cannot affect nearby structures and do not manifest themselves in any way.A similar example in vertebroneurology is Schmorl's hernia, in which the hernial protrusion is firmly covered by the spongy 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.In fibrosis (cirrhosis) of the liver you may notice that the network structure of the liver has started 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 causes 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 deformity (scoliosis);
- spondylolisthesis (slipping of the lower lumbar vertebra from the sacrum both forwards and backwards).
All these diseases can cause both an increased impact load on the spine (for example, with flat feet, when the elasticity of the arch of the foot decreases), and with a pronounced asymmetry of the spine, when the support function is systematically realized due to the load on the edge of the disc.
It is known that during the experiments it was found that healthy, young cartilages, when subjected to a uniform and static load over the entire surface, were able to withstand up to 2000 kg and even more without harm 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 disk.
If the support area is 20 times smaller and the disc is not as healthy (for example at an older age), an impact of 60-80 kg (for example a fall on ice while leaning on one side, with a load on the shoulders) can cause destruction of the disc, which can take the form of a protrusion or herniation.
It is the appearance of a protrusion or herniation that indicates that the disc has become deformed and even "comes 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 come into contact with nearby nerve roots, ligaments and muscles, the consequences of osteochondrosis occur: reflex pain and tonic-muscular syndromes, which force the patient to consult a neurologist, chiropractor and masseur.
As long as the discs have a normal shape and wear out evenly, without extreme loads, osteochondrosis of the lumbar spine does not worry the patient more than the usual age-related wear of the 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 “widening” the bridges: ordinary osteochondrosis is a completely inevitable process of normal aging of the elastic intervertebral “pads” in the species “Homo sapiens”, since it moves vertically throughout life.And the “osteochondrosis” that acute pain patients remember is a complicated condition.
Let's start, perhaps, with signs of root compression.Signs of lumbar osteochondrosis are obviously associated with pain due to pressure on the segmental nerve root by the disc.In addition to pain, sensory, motor and vegetative-trophic disorders are possible.
Low back pain with osteochondrosis has the following characteristics:
1) Radicular pain.It is secondary and presents itself as neuralgia, when a swollen nerve root reacts very "violently" to a shock.
The pain is sharp, sudden, stabbing, penetrating the lower back, possibly radiating to the leg.The pain appears and intensifies immediately, which is why it is called “low back pain” or “lumbago”.It is this type of "low back pain" that causes a person to "get up quickly", since any movement leads to increased pain.
Also, the pain intensifies with the slightest cough, sneeze, 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 “cool” and swell and become dense.In them the venous outflow is obstructed and they themselves are a source of pain.
This pain is aching, constant and not that sharp.On the contrary, it intensifies not only with sudden movements, 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 "mass" long muscles and ligaments.
3) Movement disorders.Since the disc can compress not only the sensory root, but also the motor root, the development of peripheral paresis or even paralysis is possible.At different levels of damage, weakness in the legs (for example, weakness when climbing stairs on one side), weakness in the foot, leading to gait disturbances, may occur.
Muscle atrophy occurs and one leg “loses weight.”A purely motor, painless disorder is rare and, if left unnoticed, can lead to disability.
4) Sensory disorders.They arise along with the pain and often exist after the pain ends, instead of the 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 “creeping goosebumps” in the toes and feet.
- Sometimes, when the vegetative fibers are damaged, the symptoms combine with hyperhidrosis, cold skin, and reduced hair and nail growth.
These are the most common signs of complicated lumbar osteochondrosis that exists in the lumbar region.There are individual syndromes, for example damage to the external cutaneous nerve of the thigh, damage to the cauda equina, epiconus, pure radiculitis or piriformis syndrome, but even a short description of these would take too long.
For patients, the above basic signs are enough to make an appointment with a neurologist.How can you “ease the aggravation with your own hands”?How to treat lumbar osteochondrosis at home?
What to do during an exacerbation of lumbar osteochondrosis?
The basis of any treatment is etiotropic therapy (elimination of the cause) and pathogenetic treatment (affecting the mechanisms of the disease).It is accompanied by symptomatic therapy.
For vertebrogenic pain (caused by spinal problems), things are like this:
- Elimination of the cause consists in eliminating the pressure exerted by 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 nerve root swelling and the fight against inflammation;
- Elimination of symptoms (fighting pain, numbness, limited mobility) is carried out by returning to point No.2, as removing swelling and inflammation, for example, will restore mobility and relieve pain.
Eliminate protrusion and hernia
As a rule, it is not the starting point for the treatment of acute back pain.Almost always the pain syndrome initially relieves, then, after massage sessions and treatment by a chiropractor, all symptoms disappear and surgical intervention is not necessary.
The question of surgery arises with progression of foot weakness and severe, intractable pain for 2 months.Additionally, surgery is necessary when there is a high level of 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 (day one – two):
- To reduce swelling of the muscles and spine, a salt-free diet and limiting the amount of liquids consumed are recommended.You can also give a tablet of a mild potassium-sparing diuretic.
- It is advisable to wear a semi-rigid orthopedic corset, which protects the muscles from excessive movements.
- From the first days it is recommended to rub in warming ointments containing NSAIDs and to apply plasters, for example "pepper" plasters.
- During the acute phase it is not possible to warm the back.As inflammation increases, swelling increases.Therefore any heating pad is prohibited.You can warm yourself by removing your own heat (a woolen belt, warming ointments), which do not add it from the outside, but, on the contrary, remove it from the depths outward.
- In the acute phase of lumbar osteochondrosis, short-term treatment can be carried out with intramuscular "injections" of NSAIDs and muscle relaxants.This will help relieve swelling of nervous tissue, eliminate inflammation and normalize muscle tone.
In the subacute period, after passing the maximum pain, no more "injections" should be done 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.
Physiotherapy measures continue, the time has come for physical 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 completely resolved.
Exercises for lumbar osteochondrosis of the spine should be performed after a light general warm-up, on “warmed-up muscles”.
The main therapeutic factor is movement, not the degree of muscle contraction.Therefore, to avoid relapses, the use of weights is not permitted;a gymnastics mat and a gymnastics stick are used.With their help, you can effectively restore freedom of movement.
Continue rubbing ointments and use Kuznetsov's implicator.Swimming, underwater massage and Charcot shower are shown.It is during the attenuation phase of the exacerbation that drugs for home magnetotherapy and physiotherapy are indicated.
Usually treatment lasts 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
This is, first of all, a condition in which the herniated disc 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 can suddenly (right in the gym, after an episode of acute pain) develop severe weakness, or paralysis of the legs, numbness of the perineum.
After a few minutes, severe pain appears in the legs, then reflex urinary retention or the appearance of incontinence is possible and impotence develops.This occurred as cauda equina syndrome as a complication of a herniated disc.In this case, urgent intervention is required, removal of the seizure and restoration of the function of the nerves of the cauda equina 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 treatments of which we discussed above, as we understand, for the most part is not a disease at all, but simply a manifestation of the 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 in the depths of the ocean, constantly moving in the water since childhood.It is then that the axial and static load on the intervertebral discs will disappear and with it the signs of “chondrosis” will disappear.But another problem will arise: in water such a powerful structure will simply become superfluous and begin to change until it disappears or significantly reduces.
As for the personal and individual prognosis of osteochondrosis, it all depends on the moment when the person "decided to come to his senses."If by this time there is no pronounced destruction of the intervertebral discs, protrusions, hernias and deformations, then, provided a healthy lifestyle and physical activity hygiene, 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 pay special attention to awkward turns, physical exertion, improper weight lifting and seasonal hypothermia, which usually cause exacerbation of spinal osteochondrosis.