Dorsalgia (back pain) are one of the most frequent causes of complaints and requests for medical assistance. In this case, in the course of living with the problem dorsalgia facing 70-90% of the population, and 28% of them develop chronic pain syndrome, resulting in temporary/long-term disability and degradation of quality of life. The pain in the back of the exception of disability have an impact on the behavior/psyche of the population, which is manifested by a chronic course of the emotional tension.
Pain syndromes are primarily associated with osteochondrosis lumbosacral department (lumbar pain in the lower back), which is characterized by a high mobility/most of the physical activity, and are caused by a degenerated-degenerative changes in almost all components of the vertebral-motor segments of the spinal column (the body of the vertebrae, the intervertebral discs and connecting tissues).
Classification
In the framework of the classification of the degenerative disease of the disc is set to the pathogenic approach which reflects the process of the disease in the form of successive stages/degrees degenerated degenerative of the defeat, according to that, there are the.
Osteochondrosis of the lumbar spine and division of 1 degree
This is the first (initial) the degree of intra-disk of a pathological process, generating farms drive pathological impulsatsiyu. Osteochondrosis 1 characterized by the displacement of the nucleus pulposus inside the disc, that is to say, the nucleus gelatinous penetrates through the cracks in the fibrous ring and its good innervated exterior of the fiber. Accordingly osteochondrosis of 1 degree occurs irritation of nerve endings and begin to manifest by pain, which form the different reflex syndromes of degenerative disease of the disc.
Osteochondrosis of the lumbar spine and division of degree 2
Osteochondrosis 2 degree — this is the degree of instability, that is to say, loss of hit the drive of his rope capacity. The dynamic feature offset relatively to the top of the vertebra underlying it, which is due to the cracking of the nucleus pulposus and the elements of the fibrotic ring. 2 the degree of degenerative disc disease characterized by a syndrome of instability appear reflexes and partial syndromes.
Osteochondrosis 3 degrees
It is the degree of/stage of education of the hernia of the intervertebral disc, caused by the violation of the integrity of the structure of the fibrotic ring (pelvic organ prolapse/propulsion). Osteochondrosis 3 level in a hurry: the strain of the spinal nerve, as well as the lands adjacent to the MED vaso-the nerve of education.
Osteochondrosis of 4 degrees
It is the stage of the fibrosis of DME and the formation of bone-cartilage of the upper limit value of the outgrowths of the vertebral bodies. As a compensatory mechanism to increase the bearing surface of the vertebrae on the discs defective, occurs in the stillness. These bone expansion, in some cases, such as herniated discs can put pressure on lands adjacent neuro-vascular education.
The symptoms of the degenerative disease of disk lumbo-sacral spine
Osteochondrosis of the lumbosacral region of the spine manifests itself in rather wide limits: from a slight sympathy arrangements, feelings of discomfort in the lumbar area to sharp intense pain, which may be triggered by overwork is, a hypothermia, an increase in the severity and other to all of the clinical manifestations of the degenerative disc disease of the lumbar spine and share on vertebral (compression) symptoms and extravertebral (reflexes) symptoms.
The first step of the
The clinical symptoms of degenerative disc disease of the lumbar spine of the first phase are of the contribution the parish priest drive in the direction of the spinal canal (there is) and irritation of the rich painful receptors of the back of the ligament longitudinal. The main symptom of this phase is different from the severity of local pain syndrome — lumbago, lumbalgia, which is conditional on different level of severity of the pain and the duration of pathological events. At this stage of the typical "symptom of the board" (flattening of the lumbar lordosis) and expressed limited because of the pain in the acute period of movements at the level of the lumbar spine.
In addition to the local pain at the level of the disc disorder because of the occurrence of a muscle reaction in most cases occurs, expressed voltage paravertebral muscles (the defense), which helps to enhance the pain syndrome, as well as reducing/flattening physiological lumbar lordosis and limitation of mobility of the spine.
Osteochondrosis of the first phase of the signs of syndrome, radicular and other neurologic manifestations (symptoms of tension) are missing. Usually, with time, to the irritation of the receptors (pain) to the back of the ligament longitudinal stresses adaptation is facilitated by immobilization of the victim disk. Event, acute/subacute decreases gradually with the proper treatment and strict compliance of the orthopedic mode. It is, underlines the transformation of exacerbation of remission, the duration of which varies within wide limits, such as the frequency of worsening lower back pain.
In this case, each new aggravation of the shows on the offset of the MAP (prolapse/protrusion), which leads to the intensification of the pressure of a disc on the rear longitudinal ligament. With time, this leads to the thinning of the ligaments and the reduction of its strength, and therefore an additional risk of prolapse of the disc and the perforation of the back of the ligament, a longitudinal, in the next episode, next to the spinal canal, resulting in the development of the next phase of neurological complications.
Vaso-root stage of neurological disorders)
A set of pathological events (ischemia category roots/cerebro-spinale, exacerbated by the formation of a herniated disc and the appearance of the concomitant occlusion root of the artery) promotes the development of movement disorders, in a particular myotome and to the reduction of the sensitivity of a particular of the dermatome. Generally, the development of paresis/paralysis and muscle disorders of sensitivity, preceded by a sudden movement, followed immediately with the pain in the lumbosacral region appears to be acute, transient, irradiating along the sciatic nerve (the so-called "giperalgeticheskie the crisis of sciatica"). At the same time, produces a muscle weakness in the area of the nerve supply to an ischemic spinal nerve, and the sensitive appear of the disorders. As a general rule, the occlusion root of the artery with a spinal nerve L5 within the vertebral canal.
Characteristic is the acute development of the syndrome of paralysis sciatica", which is manifested paresis/paralysis on the side system of the extensors of the foot/toes ("stepper motor" or "cock" approach), which develops when disorders peroneal nerve. Such a patient very raises the leg when walking, throw him forward and slams the front part of the walker texas ranger-michel foot on the ground.
jpg ' class='imgblock right center_mob'>The last step in the neurological manifestations of the
Osteochondrosis of the spine, is usually the cause of blood circulation disorders in the large root canal the board of trustees of the arteries that supply blood to the spinal cord (radicular-spinal artery). The vascularization of the spinal cord lumbosacral level provides only an artery Adamcewicz, and some people present additional artery lumbar Depro—Gotteron, ensuring the blood supply of the caudal department/the horse tail of the spinal cord.
Their functional impairment led to the slow development of vaso-cerebral insufficiency, spinal cord injury, the clinical manifestation is the syndrome of intermittent claudication, accompanied by a weakness of the legs and numbness, occurring during walking and disappears after the light leisure activities (judgment). The most severe manifestation of neurological disorders in this stage are acute circulatory disorders of the spinal cord by the type of spinal ischemic stroke.
The analyses and diagnostics
The diagnosis of lumbosacral degenerative disc disease in most cases does not cause problems and is based on an analysis of the nature and location of the pain and of the communication with the physical exercise (history of the disease), the presence of trigger points of pain and symptoms of tension. Instrumental methods of a leading role relegated to the x-ray, computer and magnetic resonance imaging (photo below). To the exclusion of the pathology of somatic (metastases in the spine, urolithiasis, pyelonephritis) can be generic of the biochemical analysis of blood and urine.
The treatment of degenerative disc disease of the lumbosacral region of the spine
The question of how to treat pain in the lower back lumbar refers to one of the most frequently asked questions. First of all, the treatment of degenerated degenerative lesions of the spine should be progressive and integrated, including drugs, physiotherapy and, if necessary, surgical methods.
Of procedures and operations
In the treatment of degenerative disc disease of the lumbar spine and is widely used in physics: phonophoresis/electrophoresis of drugs (including analgesics and anti-spasmodics) galvanic/close current; electroneurostimulation; UHF; laser; magnetic field therapy; EHF (extremely high frequency therapy); MICROWAVE (microwave therapy); shock-wave therapy of acupuncture.
In the acute, it is recommended to adhere to skeletal (orthopedic) mode-to-wear lumbar stabilization brace. In this period, it is appropriate to limit or exclude physical exercises, amplitude, causing pain or muscle tension. Commit to "through the pain" it is strictly forbidden, the exercises should be performed very slowly with the repetition of 8-10 times. Also it is important to avoid the increase of the lumbar lordosis during movements of the feet, which can cause an increase in pain. The next stage of the acute period to measure the reduction of pain, you can gradually introduce isometric exercises for great glutes and the abdominals.
When calming the pain increase the chances and are included in the services of common educational special of the year. In addition to the exercises to increase the strength of the extensor muscles of the hip and the abdominal muscles includes exercises that increase the strength of the muscles of the back and with a deformation at the level of the lumbar spine. That run on average at a rate of 15 to 20 repetitions. It should be understood that the loading osteochondrosis of the lumbar should be regular, and not on a case-by-case basis.
Exercises with osteochondrosis of the lumbar spine in a period of remission are primarily aimed on strengthening muscular corset of this area and increase the mobility of the spine, however, they must be executed with extreme caution. The number of repetitions of this period may be increased up to 50-100 times. An important task is the training of the automaticity of the muscles in maintaining the posture particular in any position (standing/sitting, walking).
LFK osteochondrosis of the lumbar spine is possible in the pool (in the water, but she does that complete the base of the "dry" course). Other methods of PHYSIOTHERAPY are extremely useful are: swimming, which is often regarded as "the most effective physiotherapy in the sacral osteochondrosis", as well as the treadmill track, terrenkur, skiing, ergometer, exercise, black rubber. For practicing sports such as volley-ball, large/small-tennis, rhythmic gymnastics is not recommended due to the multitude of sudden movements that could cause an exacerbation of the disease.
Loading of the weights is done only in supine position, dorsal (on the back) to the exceptions of the vertical load on the spine. It should be noted that when selecting the physical exercise frequent/permanent overload/the minor injuries of the spine or uncoordinated tremors and movements on the axis of the spine creates a risk of rupture degenerated disc and a worsening of the pain. Extremely useful for the spine can be the yoga, however, many yoga exercises are quite complex and must be performed exclusively under the direction and supervision of an instructor. The best option in a first time, it will be, if the gymnastics medical, osteochondrosis of the lumbar spine is performed in a dental office, where the doctor of PHYSIOTHERAPY will show you exercises that you can do at home.
These exercises are performed as gymnastics in the morning low back pain. It is not necessary to look at the different type of video of GYMNASTICS or gymnastics, video, osteochondrosis, because the video does not form the proper biomechanics of exercises and can cause an exacerbation. Not less widely used, and medical massage (by hand, underwater, vacuum, hydro-massage). Massage low back pain lumbar can eliminate/reduce the sensation of pain, eliminate tension in the muscles of this area, restorer of the mobility of the spine.
The operating, the processing is carried out in the case of significant compression of the spinal cord, and aims to decompress the spinal canal. Includes different types of intervention: removal of the herniated disc, the holding of the microdiscectomy, the laser of the reconstruction of a disk, punktsionnoy the valuation of disc replacement intervertebral disc implant, the operations of stabilizing the vertebral segment.
Forecast
During the treatment prompt and adequate favourable weather. Worsens the prognosis of the appearance of the lateral aspect of the herniated disc L-S1 with the start of the involvement in the pathological process of the binding and the subsequent formation of radiculopathy. Forecast deteriorates during the acute phase of development of syndromes of compression of the spinal cord/cauda equina with paralysis in the legs, disorders of the pelvic functions, the impact of the sensitivity, in this case, the prognosis is improving, the earlier is resolved compression (hernia, sequestration).