It is probably impossible to find a single adult who does not know what “lumbar osteochondrosis” is.On average, one in three healthy middle-aged people, sometimes even more often, has had an episode of acute lower back pain in their life, and one in five to six people say that such problems occur regularly and are even the “source” of sick notes.
However, patients are usually unable to explain in detail what type of disorder has occurred in the lower back.Most of them have never been examined and treatment, consisting of “injections,” “ointments,” and massage sessions, usually helps over a period of several months to a year.
If you “push” such a patient and ask him about the diagnosis, after a little suffering he will declare that he has “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 have to say authoritatively: “Osteochondrosis” can’t do any harm.And it cannot manifest itself in any way, since it is a process of dystrophy and degeneration of the intervertebral discs, that is, the cartilage, which consists of the nucleus pulposus and the fibrous ring.The intervertebral disc is made of cartilage and is intended to act as a shock-absorbing “airbag” that dampens 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 intervertebral discs” simply cannot have any effect on neighboring structures and cannot manifest themselves in any way.A similar example in vertebroneurology is Schmorl's hernia, in which the hernia protrusion is securely covered by the cancellous bone of the adjacent vertebra.Discs don't hurt.
Chondrosis (the suffix “-oz” means growth, enlargement) is not entirely correct in this case.No growth or proliferation of cartilage tissue occurs during human life.With liver fibrosis (cirrhosis), you may notice that the network structure of the liver begins to develop, which has an adverse effect on its function.
And in chondrosis (or osteochondrosis), the intervertebral discs are just beginning to change their configuration under the influence of years of stress.
They exert pressure on neighboring vertebrae because, according to Newton's law, any action under static load causes exactly the same reaction, the support reaction.How does osteochondrosis develop and why does this happen?
Causes of “lumbar osteochondrosis”
Signs of lumbar osteochondrosis (more precisely, intervertebral discs) can be detected at an early age, especially with various diseases of the musculoskeletal system.
These include, for example:
- congenital anomalies (different leg lengths);
- different types of flat feet (longitudinal, transverse);
- Deformities of the spine (scoliosis);
- Spondylolisthesis (slipping of the lower lumbar vertebra from the sacrum forward and backward).
All of these diseases can lead either to an increase in the shock load on the spine (e.g. in flat feet, when the elasticity of the arch of the foot decreases) or with pronounced asymmetry of the spine, when the support function is systematically realized by the load on the edge of the intervertebral disc.
It is known that experiments have shown that healthy and young cartilage, when subjected to an even and static load over the entire surface, can withstand up to 2000 kg and even more without damage.Of course, such a load does not occur in everyday life, but it can increase to such values when there is load on the edge of the window.
If the contact surface is 20 times smaller and the intervertebral disc is not as healthy (e.g. old age), an impact of 60-80 kg (e.g. fall on ice while lying on one's side, loading the shoulders) can lead to destruction of the intervertebral disc, which can occur in the form of a bulge or rupture.
The appearance of a bulge or hernia indicates that the intervertebral disc has deformed and is even “protruding” from one or more sides.And as you know, there is no empty space around the hard drive.As soon as the intervertebral disc begins to touch the nerve roots, adjacent ligaments and muscles, the consequences of osteochondrosis appear: reflex pain and muscle tone syndromes, forcing the patient to visit a neurologist, chiropractor and massage therapist.
As long as the intervertebral discs have a normal shape and wear out evenly and without extreme loads, osteochondrosis of the lumbar spine does not worry the patient more than the usual age-related wear of teeth, with which criminologists are well acquainted.How do reflex pain syndromes manifest themselves?
Symptoms and signs of complicated lumbar osteochondrosis
You have already noticed that we diligently “spread” 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 “osteochondrosis,” which patients with acute pain remember, is a complicated disease.
Let's start, perhaps, with the signs of root compression.Signs of lumbar osteochondrosis are, of course, accompanied by pain arising from pressure on the segmental nerve root by the intervertebral disc.In addition to pain, sensory, motor and vegetative-trophic disorders are also possible.
Lower back pain with osteochondrosis has the following features:
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 and possibly radiating to the leg.The pain occurs and intensifies immediately, which is why it is called “lumbago” or “lumbago”.It is this type of “lumbago” that causes a person to “get up in a hurry,” since any movement leads to increased pain.
In addition, the pain increases with the slightest cough, sneezing, straining, laughing - any situation in which the swollen root is shaken.
When the root is part of the sciatic nerve, the pain “shoots” through the buttocks into the back of the knee and below, which is called “lumbar sciatica.”
2) Muscle pain.There are large muscle masses near the nerve root.In spring and fall they often “cold” and swell and become denser.Their venous drainage is obstructed and they themselves cause pain.
This pain is aching, constant and not that sharp.On the contrary, it increases not only with sudden movements, but also with a long 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 period of time.
3) Movement disorders.Since the intervertebral disc can compress not only the sensory root but also the motor root, the development of peripheral paresis or even paralysis is possible.With varying degrees of damage, weakness in the legs (e.g. weakness when climbing stairs on one side) and weakness in the foot can occur, leading to gait problems.
Muscle loss 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 occur along with the pain and often persist after the pain has ceased, rather than the pain.They are manifested by numbness, reduced sensitivity of the skin of the legs in the form of “stripes”, in the form of vertical stripes and a feeling of “crawling goosebumps” in the toes and feet.
- When autonomic fibers are damaged, symptoms are sometimes accompanied by hyperhidrosis, cold skin, and impaired hair and nail growth.
These are the most common signs of complicated lumbar osteochondrosis 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 brief description would take too much time.
For patients, the basic symptoms mentioned above 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 if lumbar osteochondrosis worsens?
The basis of every treatment is etiotropic therapy (elimination of the cause) and pathogenetic treatment (influence on the disease mechanisms).It is accompanied by symptomatic therapy.
Vertebrogenic pain (caused by problems in the spine) looks like this:
- Eliminating the cause is eliminating the pressure exerted on the nerve root by a bulge, hernia, or spasmodic muscle.
- The effect on the mechanisms is to eliminate muscle spasms, restore venous outflow in the muscles, eliminate swelling of the nerve root and combat inflammation.
- Eliminating symptoms (fighting pain, numbness, limited mobility) occurs by returning to point No. 2, since, for example, eliminating swelling and inflammation restores mobility and relieves pain.
Eliminate bulges and hernias
It is usually 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 disappear and surgery is not required.
With progressive foot weakness and severe, persistent pain over 2 months, the question of surgical intervention arises.In addition, surgery is necessary if there is severe compression of the central canal containing the spinal cord or cauda equina.
Treatment of lumbar osteochondrosis, medications
Treatment of lumbar osteochondrosis and its complications includes the following measures.In the acute phase (first day – two):
- To reduce swelling of the muscles and spine, a salt-free diet and limiting fluid intake are indicated.You can even give a tablet of a mild potassium-sparing diuretic.
- It is recommended to wear a semi-rigid orthopedic corset that protects the muscles from excessive movement.
- From the first few days, it is recommended to rub warming ointments containing NSAIDs and apply plasters, for example “pepper” plasters.
- During the acute phase, you cannot warm your back.As the inflammation increases, the swelling increases.Therefore, any heating pads are prohibited.You can warm up by removing your own heat (a woolen belt, warming ointments), which do not supply 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 nerve tissue, eliminate inflammation and normalize muscle tone.
In the subacute phase, after the maximum pain has been overcome, no more “injections” should be given and attention should be paid to strengthening 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 completely subsided.
Exercises for lumbar osteochondrosis of the spine must be performed on “warmed up muscles” after a light general warm-up.
The most important therapeutic factor is movement, not the degree of muscle contraction.Therefore, to avoid relapse, 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.
Rubbing ointments and using the Kuznetsov implicator continues.Swimming, underwater massage, Charcot shower are shown.At the stage of subsiding exacerbation, drugs for home magnetic therapy 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
First of all, we are talking about a condition in which a herniated disc has become an independent fragment and, after penetrating the central canal, has formed a free sequestration.There it can compress the nerves of the cauda equina and cause sudden (right in the gym, after an acute episode of pain) severe weakness or paralysis in the legs or numbness in 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, removal of the sequestrum and restoration of the function of the cauda equina nerves with their decompression is required.
However, in most cases other complications also occur.With increasing age, multiple hernias and bulges occur, osteoporosis of the vertebrae occurs, mobility simply decreases significantly and the risk of acute back pain increases.Such patients have to take “sick leave” several 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, is, as we understood, largely not a disease, 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 yes, but then we will have to master a different style of movement: walking on all fours all our lives or, like Ichthyander, swimming to the depths of the ocean and constantly moving in the water since childhood.Then the axial, static load on the intervertebral discs disappears and with it the signs of “chondrosis”.But another problem will arise: in water, such a strong structure will simply become unnecessary and will begin to change until it disappears or is significantly reduced.
As for the personal, individual prognosis of osteochondrosis, it all depends on when the person “decided to come to his senses.”If at this time there is no pronounced destruction of the intervertebral discs, bulges, hernias and deformations, with a healthy lifestyle and hygiene, with physical activity, problems with the lower back can occur until old age.
In the same case, if there is already a “hot spot” in the lumbar region, for example, in the form of a hernia, which periodically compresses the nerve root, the person needs to pay special attention to unpleasant turns, physical exertion, improper lifting of weights and seasonal hypothermia, which usually lead to an exacerbation of osteochondrosis of the spine.