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, and sometimes more often, has had an episode of acute low back pain in their lifetime, and one in five or six people report that such problems occur regularly, and are even the “source” of work stoppages.
However, patients are most often unable to explain in detail exactly what kind of disorder has occurred in the lower back.Most of them have never been examined and a treatment consisting of "injections", "ointments" and massage sessions is usually effective for a period of several months to a year.
If you "push" such a patient and start asking him questions about the diagnosis, then, having suffered a little, he will declare that he suffers from "osteochondrosis".What does this disease mean in relation to the lumbar spine?
Osteochondrosis of the lumbar region - a disease or “normal life”?
First of all, we must authoritatively state: “osteochondrosis” cannot harm.And this cannot manifest itself in any way, since it is a process of dystrophy and degeneration of the intervertebral discs, that is, the cartilage, consisting of the nucleus pulposus and the annulus fibrosus.The intervertebral disc is made of cartilage and is designed to function as a shock-absorbing “airbag,” softening vertical and angular acceleration – 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 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 firmly covered by the spongy bone tissue of the adjacent vertebra.The 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 the human lifespan.With fibrosis (cirrhosis) of the liver, you may 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 are just beginning to change their configuration, under the influence of many years of stress.
They cause pressure on neighboring vertebrae since, according to Newton's law, any action under a static load causes exactly the same reaction, or support reaction.How does osteochondrosis develop and for what reasons does it happen?
Causes of “lumbar osteochondrosis”
Signs of lumbar osteochondrosis (more precisely of intervertebral discs) can be detected at a young age, especially in various disorders of the musculoskeletal system.
These include, for example:
- birth defects (different leg lengths);
- different types of flat feet (longitudinal, transverse);
- spinal deformities (scoliosis);
- spondylolisthesis (sliding of the lower lumbar vertebra of the sacrum forwards and backwards).
All these diseases can cause either an increase in the impact load on the spine (for example, with flat feet, when the elasticity of the arch decreases), or with a pronounced asymmetry of the spine, when the supporting function is systematically carried out due to the load on the edge of the disc.
It is known that in the course of experiments it was found that healthy and young cartilages, if subjected to a uniform and static load over the entire surface, were able to withstand up to 2000 kg and even more without injury.Of course, such a load does not exist in everyday life, but it can reach such values when exposed to the edge of the disk.
If the bearing area is 20 times smaller and the disc is not as healthy (for example, in old age), then an impact of 60-80 kg (for example, falling on the ice while leaning on the side, with a load on the shoulders) can cause the destruction of the disc, which can take the form of a protrusion or herniation.
It is the appearance of a protrusion or herniation which indicates that the disc has become deformed and even “popped out” on 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 neighboring nerve roots, ligaments and muscles, then the consequences of osteochondrosis appear: reflex pain and musculo-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 evenly, without extreme loads, osteochondrosis of the lumbar spine does not worry the patient more than the usual age-related wear of teeth, which is well known to criminologists.How do reflex pain syndromes manifest?
Symptoms and signs of complicated lumbar osteochondrosis
You have already noticed that we diligently "spread" the 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 “osteochondrosis”, which patients with acute pain remember, is a complicated disease.
Maybe let's start with the signs of root compression.Signs of lumbar osteochondrosis are, of course, 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 occurs like neuralgia, when a swollen nerve root reacts very “violently” to a shock.
The pain is sharp, sudden, stabbing, piercing the lower back and eventually radiating up the leg.The pain appears and intensifies instantly, which is why it is called "lumbago", or "lumbago".It is this kind of "lumbago" that makes a person "rush to get up", since any movement leads to increased pain.
In addition, 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 to the popliteal fossa and below, and this is called “lumbar sciatica.”
2) Muscle pain.Near the nerve root are large muscle masses.Often in spring and autumn they “cool” and themselves swell and become dense.Venous outflow is hampered and they themselves are a source of pain.
This pain is painful, constant and less acute.On the contrary, it intensifies not only with a sharp movement, but also with a prolonged stay in a monotonous position (deterioration of blood supply).
- Sometimes such a 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, leg weakness may appear (for example, weakness when climbing stairs on one side), foot weakness, leading to gait disturbances.
Muscle wasting occurs and a leg “loses weight”.Such a purely motor and painless disorder is rare and, if left unnoticed, can lead to disability.
4) Sensory disorders.They occur at the same time as the pain and often exist after the pain ends, in place of the pain.They are manifested by numbness, decreased sensitivity of the skin of the legs in the form of "scratches", in the form of vertical stripes, and a feeling of "creeping goosebumps" in the toes and feet.
- Sometimes, when vegetative fibers are damaged, symptoms are associated 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 would take too long.
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 treatment.
For vertebrogenic pain (caused by problems in the spine), things go 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 spasms, the restoration of venous outflow in the muscles, the elimination 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 eliminating swelling and inflammation, for example, will restore mobility and relieve pain.
Getting rid of protrusion and hernia
Typically, this is not the starting point for treatment of acute back pain.Almost always, the pain syndrome is first relieved, and then, after massage sessions and treatment by a chiropractor, all symptoms disappear and no surgical intervention is required.
The question of surgical intervention arises with the evolution of the weakness of the foot, and with intense and intractable pain for 2 months.Additionally, surgery is necessary if there is high compression of the central canal, which contains the spinal cord, or cauda equina.
Treatment of lumbar osteochondrosis, medications
Treatment of lumbar osteochondrosis and its complications involves the following measures.In the acute phase (first day – second):
- In order to reduce swelling of the muscles and spine, a salt-free diet and limitation of 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, it is recommended to apply warming ointments containing NSAIDs and apply patches, for example, “pepper” patches.
- During the acute phase, you cannot warm your back.As inflammation increases, swelling increases.Any heating pad is therefore prohibited.We can warm ourselves by evacuating our own heat (a woolen belt, warming ointments), which do not bring 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 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 paresthesias.
Physiotherapeutic measures continue, the time has come to resort to exercise therapy for osteochondrosis of the lumbar spine.Its task is to normalize blood circulation and muscle tone, when swelling and inflammation have already disappeared, but muscle spasms have 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 and not the degree of muscle contraction.Therefore, in order to avoid relapses, the use of weights is not allowed;a gymnastics mat and a gymnastics stick are used.With their help, you can effectively restore range of motion.
The application of ointments and the use of the Kuznetsov implicator continues.Swimming, underwater massage, Charcot shower are offered.It is at the stage of the exacerbation that subsides that drugs for magnetotherapy and physiotherapy at home 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 urgently required.
Complications of lumbar osteochondrosis of the spine
First of all, we are talking about a condition in which a herniated disc became an independent fragment and, having penetrated the central canal, formed a free sequestration.There it can compress the nerves of the cauda equina, and it can suddenly (in the middle of 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 in the legs appears, then reflex urinary retention or the appearance of incontinence is possible, and impotence develops.This occurred in the form of cauda equina syndrome, a complication of a herniated disc.In this case, urgent intervention is necessary, removal of the sequestrum and restoration of the function of the cauda equina nerves with their decompression.
However, more often other complications arise.With age, multiple hernias and protrusions appear, osteoporosis of the vertebrae appears and mobility simply decreases significantly and the risk of acute back pain increases.These patients necessarily “take sick leave” several times a year and are often treated in sanatoriums.
Treatment prognosis
Osteochondrosis of the lumbar spine, which we discussed above, as we understood, is essentially not a disease, but simply a manifestation of inevitable aging and premature "shrinkage" of the intervertebral discs.
Can humanity be completely free 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".But another problem will arise: in the water, such a powerful structure will simply become useless and will begin to change until it disappears or is significantly reduced.
As for the personal and 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 intervertebral discs, protrusions, hernias and deformities, then, subject to a healthy lifestyle and hygiene of physical activity, you may not have problems with your 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 should be especially careful about awkward turns, physical exertion, improper lifting of weights and seasonal hypothermia, which usually cause an exacerbation of osteochondrosis of the spine.