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 arise regularly and are even the “source” of sick leave.
However, most often, patients cannot explain in detail exactly what kind of disorder occurred in the lower back.Most of them have never been examined, and treatment, which consists of “injections”, “ointments” and massage sessions, usually helps for a period of several months to a year.
If you “push” this patient and start asking about the diagnosis, then, after suffering a little, 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 need to state with authority: “osteochondrosis” cannot do any harm.And it cannot manifest itself in any way, as this is a process of dystrophy and degeneration of the intervertebral discs, that is, of the cartilage, which consists of the nucleus pulposus and the fibrous ring.The intervertebral disc is cartilaginous, and was designed to function as a shock-absorbing “airbag”, smoothing vertical and angular accelerations – braking between adjacent vertebrae.
As you know, cartilage is devoid of nervous and vascular tissue, therefore the 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 cartilaginous tissue during human life.With fibrosis (cirrhosis) of the liver, you may notice that the reticular 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 because, according to Newton's law, each 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 deformities (scoliosis);
- spondylolisthesis (sliding of the lower lumbar vertebra of the sacrum back and forth).
All these diseases can cause an increase in the impact load on the spine (for example, with flat feet, when the elasticity of the arch of the foot decreases), or with pronounced asymmetry of the spine, when the support function is performed systematically due to the load on the edge of the disc.
It is known that during the experiments it was found that healthy and young cartilage, if it received a uniform and static load across the entire surface, was capable of supporting up to 2,000 kg and even more without being damaged.Of course, such a charge 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 (e.g. in old age), then an impact of 60-80 kg (e.g. falling on the ice on your side, with load on your shoulders) can cause destruction of the disc, which can be in the form of protrusion or hernia.
It is the appearance of a protrusion or hernia that indicates that the disc has become deformed and even “come out” on one or more sides.And, as you know, there is no empty space on the disk.As soon as the disc begins to come into contact with neighboring nerve roots, ligaments and muscles, the consequences of osteochondrosis appear: reflex pain and muscle-tonic syndromes, which force the patient to consult a neurologist, chiropractor and massage therapist.
As long as the discs are normally shaped and wear evenly without extreme loads, osteochondrosis of the lumbar spine does not worry the patient any more than the usual age-related wear of teeth, with which criminologists are well familiar.How do reflex pain syndromes manifest?
Symptoms and signs of complicated lumbar osteochondrosis
You have already noticed that we are diligently “spreading” bridges: common osteochondrosis is a completely inevitable process of normal aging of elastic intervertebral “cushions” in the species “Homo sapiens”, as it moves vertically throughout life.And the “osteochondrosis” that patients with acute pain remember is a complicated condition.
Let's start, perhaps, with the signs of root compression.Signs of lumbar osteochondrosis, of course, are 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.
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, piercing, piercing the lower back, possibly radiating down the leg.The pain appears and intensifies instantly, which is why it is called “lumbago”, or “lumbago”.It is this type of “lumbago” that makes the person “get up in a hurry”, as any movement increases the pain.
Furthermore, 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 there are large muscle masses.Often in spring and autumn they “get cold” and swell and become dense.Venous flow is hampered in them and they themselves are a source of pain.
This pain is painful, constant and not so 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 this 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 root, but also the motor one, the development of peripheral paresis, or even paralysis, is possible.At different levels of injury, weakness in the legs may appear (for example, weakness when climbing stairs on one side), weakness in the feet, which leads to gait disturbances.
Muscle loss occurs and one leg “loses weight”.A purely motor and painless disorder is rare and, if it goes unnoticed, can lead to disability.
4) Sensory disorders.They arise along with the pain and usually exist after the pain ends rather than the pain.They manifest as numbness, decreased sensitivity of the skin on the legs in the form of “stripes”, in the form of vertical stripes, and a feeling of “goosebumps” on 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 exists in the lower back.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 these would take too long.
For patients, the above basic signs are enough to make an appointment with a neurologist.How can you “take the aggravation into 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 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 flow in the muscles, the removal of nerve root swelling and the fight against inflammation;
- Eliminating symptoms (combating pain, numbness, difficulty moving) is done by returning to point 2, as removing swelling and inflammation, for example, will restore mobility and alleviate pain.
Get 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 with a chiropractor, all symptoms disappear and surgery is not necessary.
The question of surgical intervention arises with progression of foot weakness and severe, intractable pain for 2 months.Additionally, surgery is necessary when there is high-level 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 – two):
- To reduce swelling of the muscles and spine, a salt-free diet and limiting the amount of fluid consumed are recommended.You can even give a tablet of a mild, potassium-sparing diuretic.
- It is recommended to use a semi-rigid orthopedic corset, which protects the muscles from excessive movement.
- From the first days, it is recommended to rub 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.Therefore, any heating pads are prohibited.You can warm up by removing heat itself (a woolen belt, warming ointments), which do not add it from the outside, but, on the contrary, remove it from the bottom outwards.
- 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 period, after overcoming 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 should be performed after a slight general warm-up, on the “warmed 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 gym mat and a gym stick are used.With their help, you can effectively restore range of motion.
Rubbing ointments and using Kuznetsov's implicator continues.Swimming, underwater massage, Charcot shower are shown.It is in the exacerbation mitigation phase that medications for home magnetic therapy and physiotherapy are indicated.
Typically, 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 in which a herniated disc has become an independent fragment and, having penetrated the central canal, formed a free sequestration.There it can compress the nerves of the cauda equina, and suddenly (right in the gym, after an episode of acute pain) develop severe weakness, or paralysis in the legs, numbness in the perineum.
After a few minutes, severe pain appears in the legs and then reflex urinary retention or the appearance of incontinence is possible, and impotence appears.This occurred as cauda equina syndrome as a complication of a herniated disc.In this case, urgent intervention is required, removal of the sequestration and restoration of the function of the cauda equina nerves with their decompression.
However, most of the time, 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.These patients necessarily “take sick leave” a few 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 understand, is, for the most part, not a disease, but simply a manifestation of inevitable aging and premature “shrinkage” of 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 from childhood.It is then that the static axial load on the intervertebral discs will disappear and with it the signs of “chondrosis” will disappear.But another problem will arise: in the 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 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 intervertebral discs, protrusions, hernias and deformations, then, subject to 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 lower back, for example, in the form of a hernia, which periodically compresses the nerve root, a person needs to be especially careful with awkward bends, physical exertion, improper lifting of weight and seasonal hypothermia, which often cause exacerbation of spinal osteochondrosis.