Dorsalgia (back pain) are one of the most frequent causes of complaints and appeals to medical care. In this case, in the course of life with a problem of back pains is facing the 70-90% of the population, and 28% of them will develop chronic pain syndrome, which leads to the term/long term disability, and reduced quality of life. Back pain beyond the limitations of life have an impact on the behavior/psyche of the people, which is manifested by the development of chronic emotional tension.
Pain syndromes papal legate mainly with osteochondrosis in lumbosacral department (lumbar, low back pain), which is characterized by high mobility and great physical effort, and are due to degenerative disease, and degenerative changes in almost all components of spine-segments of motion of the vertebral bodies of the vertebrae, intervertebral discs and connecting tissues).
Classification
On the basis of the classification of the degenerative disc disease is put on the pathogenic approach, which reflects a pathological process in a series of phases/degrees of degenerative-degenerative defeat, in accordance with the highlight the following.
Back pain lumbar 1 degree
This is the first (initial) degree of intra-disc of the pathological process, generating a hit from a disk pathological impulses. Low back pain 1 degree is characterized by the move of the pulposus of the nucleus inside the disk, i.e. the type of jelly nucleus penetrates through the cracks in the fibrous ring widths and its good to innervate the outside of the fiber. Therefore, when osteochondrosis of 1 degree occurs irritation of nerve endings and begin to be pain, which form the various reflections syndromes degenerative disc disease.
Back pain lumbar 2 degrees
Low back pain 2 measure is the degree of instability, i.e. the loss of direction of the disk that pertain to the fixation capacity. Dynamic characteristic of displacement in the overlying relatively vertebra below it, due to cracking of the pulposus of the nucleus and of the elements of the fibrous ring widths. 2 the degree of osteoarthritis is characterized by a syndrome of instability, appear reflection, and in part to compression syndromes.
Low back pain 3 degrees
This is a grade/stage of training of hernias of the intervertebral disc, caused by violation of the integrity of the structure of the fibrous ring widths (prolapse/protrusion). Osteochondrosis 3 degrees can be squeezed: the root of a spinal nerve, and also adjacent to the MTD vaso-neural education.
Low back pain 4 degrees
This is the stage of non-fibrous MTD and the gradual formation of bone-cartilage regional outgrowths of the vertebral bodies. In this case, as a mechanism of compensation occurs, the increase of the support surface of the vertebrae on the discs defective, you experience the stillness. These growths of bone, in some cases, such as herniated disc, can exert a pressure on the adjacent neuro-vascular education.
The symptoms of degenerative disc disease in the lumbar-sacral spine
Low back pain lumbosacral spine is manifested quite wide range: from a mild sense of discomfort in the lumbar area until the thrill of intense pain, which can triggered by the proximity to surge, hypothermia, increased in severity, etc. the set of clinical manifestations of degenerative disc disease of the lumbar are divided into the vertebral (compression), symptoms and extravertebral (reflex) symptoms.
The initial phase
The clinical symptoms of degenerative disc disease of the lumbar spine in the first phase are due protrusion the disc to the side of the spinal canal (is) and irritation rich with pain receptors the posterior longitudinal ligament. The main symptom of this stage is of variable severity of local pain syndrome — low back pain, low back pain, which conventionally are different degrees of severity of pain and duration of the pathological events. This phase is characterized by "a symptom of the edge" (flattening of lumbar lordosis and marked limitation due to pain in the acute period of the motions in the lumbar area of the spine.
In addition to local pain at the level affected by herniated disc due to a reflex muscle reaction in the majority of cases there is a marked tension paravertebral muscle ("la défense"), which contributes to the strengthening of the syndrome of pain, but also correcting/flattening of the physiological lumbar lordosis and limit the mobility of the spinal column.
Osteochondrosis the first phase of signs to create syndrome and other neurological manifestations (symptoms of voltage) are absent. Usually, with time, to the irritation of the receptors (pain) posterior longitudinal ligament observed adaptation, which promotes the immobilization affected intervertebral disc. The event, acute/subacute gradually decreases during the appropriate treatment and simple respect orthopedic mode. That is, it celebrates the transformation of the acute in remission, the duration of which varies widely, as the frequency of acute lumbalgia.
In this case, each new deterioration indicates a further shift in MTD (prolapse/protrusion), which causes an increase of pressure of the disk on the rear longitudinal beam. With time, this leads to a thinning of the ligament and reduce its strength and, consequently, the risk of a further disc prolapse and perforation of rear longitudinal ligaments during the next episode in the direction of the spinal canal, which leads to the development of a later stage of neurological complications.
The vessel-side of the binding phase (the phase of neurological disorders)
The set of pathological conditions (ischemia of the roots/spinal, complicated the formation of hernia of the disc and appearance of the occlusion of the accompanying artery radicular) fosters the development of movement disorders in a certain myotome and reduction of the sensitivity, in particular, the dermatome. As a general rule, the development of paresis/paralysis and muscle disorders of sensitivity preceded by a sudden movement, for which a time — pain in the lumbo-sacral appears to be acute in the short term, a radiant to the movement of the sciatic nerve (the so-called "giperalgeticheskie hypertensive sciatica"). In parallel, occurs muscle weakness in the area of innervation, or other ischemic of a spinal nerve, and occur sensitive disorders. Usually, occurs the occlusion artery root, that takes place together with the spinal nerve L5 into the spinal canal.
Characteristic is the acute development of the syndrome of "sick of the palsy, of sciatica", is manifested in paresis/paralysis of the affected side and extensors of the foot/toes ("step-by-step" or "cock gait"), the countries in via of development to violations of the functions peroneal nerve. Thus, the patient raises the foot during walking, throwing it forward and slamming the front of the sock of the foot on the floor.
jpg" class='imgblock right center_mob'>The last phase of neurological events
Osteochondrosis of the spine, it is usually the cause of disturbances of the blood circulation in the great artery to the root canals, which supply the blood, the spinal cord (radicular-spinal artery). The vascularization of the spinal cord the lumbosacral level, it provides only a artery Adamcewicz, and some of the people present incremental, the artery spinal Depro—Gotteron, provides a blood supply to caudal of the department/cauda the cauda equina of the spinal cord.
Their functional insufficiency causes the slow development, cerebral vascular insufficiency of the spinal cord, clinical manifestation of which is the syndrome of intermittent claudication, accompanied by weakness of the legs and numbness, occurs when walking and goes away after a light sleep (shutdown). The most severe manifestation of neurological disorders in this phase are sharp circulatory disorders of the spinal cord of type spinal ischemic stroke.
Analysis and diagnostics
Diagnosis of lumbo-sacral and degenerative disc disease in the majority of cases it is not simple and is based on the analysis of the nature and location of the pain and their relationship with physical activity (history), the presence of trigger points of pain and symptoms of tension. Of the instrumental methods, the initial value assigned to computed radiography, and magnetic resonance imaging (photos below). To exclude a malocclusion somatic (metastases in the vertebral column, urolithiasis, pyelonephritis) can be assigned in the municipality/biochemical analysis of blood and urine.
The treatment of degenerative disc disease in the lumbar-sacral spine
The question of how to treat the back pain lumbar refers to one of the most frequent. First of all, the treatment of degenerative diseases–injuries and degenerative spine should be gradual and complex, which includes the treatment of medication, physiotherapy and, if necessary, surgical techniques.
The procedures and operations
In the treatment of degenerative disc disease of the lumbar is widely used physiotherapy: fonoforesi,/, electrophoresis with drugs (including painkillers and anti-spasmodics) galvanic/current pulses; electroneurostimulation; UHF; laser therapy; magnet therapy; EHF (extremely therapy, high frequency); OVEN (microwave therapy); shockwave therapy, acupuncture.
In the period of acute it is recommended that you comply with skeletal (orthopedic) mode and wearing the lumbar stabilizer corset. In this period it is necessary to limit/exclude the exercise amplitude, which cause pain or muscle tension. Do "through the pain" is strictly prohibited, the exercises must be performed very slowly and repeat for 8-10 times. Also the importance not to increase the lumbar lordosis during movement of the foot, which can cause an increase in pain. In the next phase, acute period of at least reduce the pain can include gradually isometric exercises for the large muscles in the buttocks and abdominal.
When soothing pain increase the opportunities and are included in the complex in general education/special exercise. In addition to the exercises to increase the strength of the extensors of the hip and abdominal are including exercises that increase the strength of the muscles of the back and bend the penis in the lumbar area of the spine. Run average rate of 15-20 reps. It should be the ratio that the charge osteochondrosis of the lumbar must be regular, and not from case to case.
Exercises of osteochondrosis of the lumbar spine in a period of remission, are addressed primarily to the strengthening of the corset of muscle to this area and increase mobility of the spine, however, should be performed with extreme caution. The number of repetitions of exercises of this period can be increased up to 50-100 times. An important task is the formation of an automatism muscles in the maintenance of a specific posture in any position (standing/sitting, when you walk in).
THERAPY with osteochondrosis of the lumbar spine can be performed in the pool (in the water, but she integrates the basic "dry" lessons). Of the other methods of THERAPY are extremely useful are: swimming, which is often regarded as "the most effective physiotherapy in the lumbosacral osteochondrosis", as well as a treadmill, - a path of health, skiing, ergometer, exercise with bandage rubber. Playing sports such as volleyball, large/small-tennis, rhythmic gymnastics is not recommended because of the many sudden movements that can cause a worsening of the disease.
Charging with dumbbells is performed step-by-step only in the supine position (on your back) for the elimination of vertical loads on the spine. You need to remember that when you choose to physical exercise frequent/permanent overload/minor injury of the vertebral column or uncoordinated tremors and movements along the axis of the spinal column, creating the risk of breaking the disc degenerated and another of acute pain. Extremely rewarding for the spine can be the yoga, however, many of the yoga exercises are quite complex and should be performed only under the guidance and supervision of an instructor. The best option at first, will, if the medical gymnastics osteochondrosis of the lumbar spine is held in an office where the medical THERAPY will show you a series of exercises that you can then perform at home.
These exercises are performed as morning exercises with osteochondrosis. It is not necessary to look for a different type of video, of PHYSIOTHERAPY or medical gymnastics, video, osteochondrosis, because the video does not allow you to form a proper biomechanical exercises and can be a cause of aggravation. Not less widely used and medical massage (manual, underwater, vacuum, bath tub). Massage with osteochondrosis lumbar spine allows you to remove/reduce the sensation of pain, eliminates the tension of the muscles of this area, to restore the mobility of the spinal column.
Surgical treatment is indicated in cases of significant spinal cord compression and direct decompression of the spinal canal. Includes several types of intervention: removal of herniated intervertebral disc, in possession of a microdiscectomy, laser reconstruction of the disk, the needle, the enhancement of the disc, the replacement of the intervertebral disc implant, the operations of stabilizing the vertebral segment.
Forecast
With timely and proper treatment, the prognosis is favorable. Worsens the prognosis of the emergence of a type of herniated disc L-S1 early involvement in the pathological process spine, and the subsequent formation of radiculopathy. The prognosis worsens dramatically acute development of the syndrome of compression of spinal cord/cauda the cauda equina with paralysis in the foot, disorders of the pelvic functions, fallout sensibility, in this case, the prognosis is improved compared with before has been fixed compression (herniated seizure).