According to the WHO, almost a billion people worldwide suffer from back pain – and these are only the cases included in the official statistics. The prevalence of back pain and its impact on people’s quality of life and performance has prompted scientists around the world to study the condition. A large amount of data has accumulated, but they do not always reach application in medical practice. For example, one of the most likely diagnoses that a patient with back pain in Russia can receive is “osteochondrosis”.
“Osteochondrosis is a purely radiological diagnosis, the result of a radiologist, understood as natural age-related changes in the vertebrae. Their presence can almost never explain the patient’s symptoms. Studies were carried out: for example, a thousand patients with back pain and a thousand healthy people were taken. At the same time, according to X-ray and MRI data, both usually had approximately the same degenerative changes in the vertebrae, ”the neurologist Nikolai Votchitsev explained to socialbites.ca.
Many patients believe that their pain is associated not only with osteochondrosis, but also with the presence of an intervertebral hernia. One of the most common mistakes made because of this belief is to go to an MRI without a doctor’s appointment in the desire to save money on a second appointment.
“Osteochondrosis, protrusions, and hernias rarely cause back pain – different studies estimate between one and ten percent. Basically, back pain is associated with problems in the tissues surrounding the spine.
Sometimes back pain may occur due to reasons not related to the musculoskeletal system. For example, kidney disease can “give” the back, Vyacheslav Ushakov, a doctor in physical and rehabilitation medicine, told socialbites.ca.
According to Votchitsev, MRI is only a tool that allows you to test the clinical hypothesis of the doctor. But in some cases, pictures are indispensable. If there are red flags: the pain is acute and does not go away after taking anesthesia, there is weakness in the legs, numbness in the perineum, there is some kind of malfunction in the pelvic organs, the doctor will necessarily do an MRI, Ushakov explained. It is important that you get to the hospital as soon as possible.
“If you don’t have these red flags, you can try to manage your back pain on your own. But here everything depends on the patient’s condition. Mild pain you’re already familiar with isn’t usually dangerous. It may go away on its own in a few days or weeks. Pain from a herniated disc is difficult to confuse with anything, so the patient is unlikely to wait that long, ”explained Ushakov.
“Intervertebral hernias mostly hurt in the limbs, not the back. This type of pain may be accompanied by a lumbago, tingling sensation, goosebumps, muscle twisting, similar to an existing discharge. Sometimes there is muscle weakness. Most often, conservative therapy is sufficient in the treatment of hernia: from painkillers, anti-inflammatory and muscle relaxants to hormones and anticonvulsants.
The last type of drug works for neuropathic pain caused by hernias,” said Votchitsev.
There are many ways to deal with myofascial syndrome. However, there is no universal recipe and often a combination of methods is needed. But the most effective way is physical activity. The main thing is that the exercises are chosen by a competent specialist, otherwise they can do more harm. This applies not only to classes on land, but also to classes in the pool.
“Patients often find swimming as a remedy for all back problems, especially scoliosis. First, swimming does not protect against scoliosis and can make it worse if done without a competent trainer. Second, scoliosis and pain do not have a direct relationship. If a person’s scoliosis is less than 50 degrees, the pain will almost never be directly related to the curvature of the spine. Also, even in the fourth stage of scoliosis, there may be no pain, ”said Votchitsev.
A physical therapist can help you choose the right exercises. As Votchitsev explains, doctors in this specialty choose ergonomics, recommend exercises to a person, tell a person how to live to return to a full life after an injury or illness – in general, they do what goes beyond a one-hour appointment. orthopedist.
“Advice to patients: Do not confuse physical therapy with physical therapy. Physiotherapy – all kinds of electrophoresis, darsonval, magnetotherapy – in most cases has no effect. Of the hardware techniques, shock wave therapy, high-intensity laser, and high-intensity magnet have limited proven efficacy. All these procedures are prescribed by the doctor individually, ”explained Votchitsev.
Sometimes people with back pain or herniated disc avoid physical activity for fear of harming themselves. However, there is not much evidence for this.
“If a person has an acute condition and neuropathic pain occurs, it’s really worth taking care of yourself by limiting physical activity. Another thing is when some kind of domestic event occurs, for example, “muscle pulling”, and the doctor excludes a serious illness. If we are talking about a simple myofascial pain syndrome, you need to numb the patient with drugs, kinesio tape or something, and this is always done by a doctor. The pain that remains after that does not harm health in any way. Statistically, 80% of these persistent pains go away on their own within two weeks.
Hernias that do not cause symptoms, which in most cases are found incidentally on MRI, are also not a contraindication for physical activity, but there are exceptions, ”Vitchitsev explained.
You can add kinesio taping to your workouts. According to Votchitsev, performed by a qualified doctor, it can help with myofascial syndrome, although its effectiveness has not yet been fully confirmed by studies. You can use myofascial relaxation (self-massage on the roller) before training or for relaxation.
“However, I strongly recommend asking a professional to show you the application technique before using it yourself,” Votchitsev warned.
Experts agree that the effect of dry needling therapy, which differs from traditional acupuncture, is limited. This method is developed in the practice of Western medicine and is based not on the effect on specific active points in the body or on the energy balance, but on the direct action of a needle to relax a spasmodic muscle. It may work in some cases, but don’t rely on it. Massage can work in the same way.
From the point of view of evidence-based medicine, massage is purely for pleasure. But sometimes it can work wonders. As strange as it may sound, massage can affect the central nervous system, so the mechanical effect of the massage therapist’s hands on muscle tissue is secondary.
By simplifying, the massage therapist can “explain” to the nervous system, to the brain that the spasm is no longer needed, the muscle can be relaxed. This relieves the pain. However, if the person does not change their lifestyle, start doing regular and meaningful exercise and reduce their stress level, the pain may return as soon as the massage course is over.
With back pain, people turn to different specialists: neurologists, vertebrologists, chiropractors, osteopaths, kinesiologists. Rehabilitologist Ushakov warns patients: “Any doctor undertaking to treat you should review your MRI scans. A person who has not seen them has no right to manipulate your back. Maybe your pain is due to a hernia, maybe something else. Of course, pain from direct spinal problems is statistically rare, but still the spine is a complex structure, you can not work with it blindly. It’s better for your health to be safe.”
“A separate issue is osteopaths. It is a formal medical discipline that includes self-taught with certificates after dubious courses, as well as osteopathy, craniosacral therapy, manipulation of internal organs and direct work with joints and muscles. The first is a dubious discipline, because putting the hands on it is supposed to straighten the skull bones, regulate the flow of cerebrospinal fluid, and treat almost everything in the world with it. The same osteopaths who specialize in the latest technique are quite normal physical therapists who are knowledgeable about the subject and have an adequate approach to solving musculoskeletal problems. When it comes to the biomechanical approach, it’s important to understand which specialist you trust with your health. For example, the widely advertised applied kinesiology can give a wow effect, but as a rule it is short-term, which requires you to repeatedly turn to the specialist, ”warned Votchitsev.
If you have already tried all the physical methods, but the pain persists, there is no need to despair. Maybe antidepressants will help. Votchitsev emphasized that this does not mean that you will need to consult a psychiatrist, because a neurologist can also prescribe antidepressants.
“Chronic pain, and not just back pain, causes restructuring of the central nervous system at the cellular and biochemical level. In this condition, patients often develop a depressive state. They describe their pain as debilitating, they get used to it, they sleep poorly, and they often come to the doctor regularly. These patients Often benefit from antidepressants. Not only depressed, but also anxious patients are often prone to back pain. One of the main causes is muscle hypertonicity. It’s like a “growing” shell on a person in response to stress. Some anti-anxiety medications often help you get rid of this hypertonicity quickly. allows,” Votchitsev summarized.