Why does my back hurt after sleep? The main causes of pain and prevention of back diseases. Bobyr Clinic

The lumbar region is the area of the spinal column that is subjected to the most stress. Sudden lifting of weights, prolonged uncomfortable posture, weakened muscle corset - all this can lead to periodic complaints of lumbar pain. However, if the pain occurs sharply, sharply, as if shooting through the lumbar region when moving, and especially bending the body, this is a reason to immediately consult a doctor.

Lower back pain when bending over may be a signal of more serious problems with the body that require immediate help. In the absence of professional treatment, this unpleasant symptom can result in a dangerous exacerbation of related diseases of the back and internal organs.

Possible causes of lower back pain when bending over

There are many reasons for worsening pain in the lumbar region when bending the body. First of all, pain in this area differs into primary and secondary.

Directly primary lower back pain occurs due to soft tissue diseases or problems with the spinal column in this area. It can be:

lower back injuries (blows, falls, bad turns, sprains);
intervertebral hernia;
displacement of the vertebrae or intervertebral disc;
osteochondrosis of the lumbosacral region, radiculopathy;
myositis, tuberculosis, lumbar polio.

Secondary pain is reflected from other organs, which are thus transmitted to the lower back. In this case, we may be talking about diseases of the genitourinary system and intestinal tract.

Pain in the lower back when bending over can also be a warning about an unhealthy lifestyle or inadequate physical activity in this area. It may be associated with prolonged stay of the body in one position (sedentary work, long periods of driving), lack of sports activity, or, conversely, overwork in the gym.

If your lower back hurts

The spine consists of 24 vertebrae connected to each other by intervertebral discs into a single whole.

Five vertebrae make up the lumbar spine. The vertebrae, formed by bone tissue, are separated by soft pads - discs that cushion the vertebrae during movement. The spinal cord passes through a canal formed by the lamina of the vertebrae.

Magnetic resonance imaging of the lumbosacral spine: A - normal; B — intervertebral disc herniation; B - osteochondrosis of the spine.

In the center of the intervertebral disc there is a porous core surrounded by an elastic fibrous ring.

Intervertebral disc herniation (top view): as a result of deformation, the porous substance protrudes beyond the fibrous ring and compresses the nerve roots emerging from the intervertebral foramen.

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Almost everyone is familiar with lower back pain. Ailments such as radiculitis and lumbago are very common causes of temporary disability, especially among people engaged in physical labor. Most often, lower back pain is associated with changes in the lumbosacral spine, which must be taken extremely seriously. Although pain in the lumbar region can also be a consequence of congenital anomalies of the spine and its ligamentous apparatus, acute and chronic infection, intoxication or even a tumor.

Lower back pain is sometimes unbearable, and sometimes a person tolerates it quite easily. The fact is that reactions to pain are individual, mental and age factors affect. In old age, the pain associated with radiculitis is very strong, although the perception of pain in older people is usually weakened. And in patients with mental illnesses, sensitivity to pain is significantly reduced, including with lumbosacral radiculitis.

Pain is a complex adaptive mechanism and is sometimes called the “watchdog” of health. Caused by external influences or problems in the body itself, it signals danger. Having received a pain signal, the body turns on defense mechanisms against adverse effects. Thanks to pain, a number of pathological processes reveal themselves before any external symptoms of the disease occur. So pain plays a positive role: it lets you know that it’s time to act. If you have pain in the lower back and sacrum, do not delay seeing a doctor. Remember the Eastern wisdom: “Treat a mild illness so that you don’t have to treat a severe one.”

In a third of patients, lumbar pain is caused by degenerative changes in the spine, which are collectively called “osteochondrosis.” Osteochondrosis is a complex of changes in the bones and ligaments of the spine caused by degeneration of the intervertebral discs. In addition, with osteochondrosis, bone outgrowths can form in the spine - osteophytes, which irritate the nerve roots and sensitive nerve endings of the spine and its ligaments, causing dull aching pain in the back.

Intervertebral discs are biconvex lenses, shaped to correspond to small depressions on the surface of the vertebrae. With age, discs lose moisture, dry out, and cracks, tears, and gaps appear in them. As a result, the vertebra becomes mobile and can slip off the disc, which will lead to narrowing of the intervertebral foramen and compression of the spinal nerve root passing here. The vertebrae of the lumbar region are the most mobile and at the same time experience the maximum load when lifting heavy objects. Therefore, the disks between them are most susceptible to deformation.

Those suffering from lumbar osteochondrosis experience severe pain, and this is not only due to mechanical irritation of the nerve roots: when the membranes and septa of the intervertebral disc rupture, substances that irritate pain receptors are released.

At a later stage of the disease, the discs bulge, forming a so-called intervertebral hernia, which usually occurs in middle-aged and elderly people. The discs of the lumbar spine are most often affected, since the intervertebral foramina between the IV and V lumbar vertebrae and between the V lumbar vertebra and the sacrum are the narrowest, and the nerve roots passing through them are the most massive. Intervertebral hernia is very dangerous. And it’s not just that it pinches the nerve roots, causing pain like lumbosacral radiculitis. A massive herniated disc puts pressure on the spinal cord, which can lead to loss of sensation or even paralysis of the legs, as well as urinary problems.

The following symptoms are characteristic of a lumbar disc herniation: “spacers” - when standing up, the patient is forced to lean his hands on his knee or chair to reduce the load on the affected disc; “pillows” - the inability to lie on your stomach without placing a pillow under it; “landing” - the patient, trying to pick something up from the floor, does not bend over, but squats.

One of the main causes of spinal osteochondrosis is a violation of fat and salt metabolism. Sometimes osteochondrosis occurs as a consequence of an abnormal development of intervertebral discs, their congenital inferiority. External factors that provoke the development and exacerbation of lumbar osteochondrosis include: high humidity, sharp temperature fluctuations, drafts; significant and prolonged tension of the muscles and bone-ligamentous apparatus of the lumbosacral spine; its mechanical injuries and chronic infections.

The most common diagnosis for severe back pain is lumbosacral radiculitis. For a long time it was believed that this disease was of infectious origin. However, practice shows that patients usually do not have an increase in body temperature or an increase in the number of leukocytes in the blood and cerebrospinal fluid. Radiculitis almost never affects children. This means that in most cases, the cause of radiculitis is unlikely to be an infection.

Indeed, radiculitis is one of the most common manifestations of osteochondrosis. Pain in the lumbosacral region with this disease can be either acute or dull. It is usually unilateral, radiating to the buttock, the back of the thigh and the outer surface of the lower leg. Pain with radiculitis may intensify when changing body position, walking, coughing, sneezing, or straining. Sometimes it is combined with sensations of numbness, tingling, crawling, burning, itching. The sensitivity of the skin increases, the muscles of the lower back, buttocks, and legs become painful.

The symptoms of radiculitis are quite pronounced. The patient's gait and posture change, and characteristic movements and postures appear. When walking, he tilts his torso forward and towards his healthy leg. In a standing position, the affected leg is bent, which reduces the tension of the nerve trunks. Body movements in the lumbar spine are limited. On the sore side, the back muscles are tense. With radiculitis, the spine is often curved. The patient sits on the healthy buttock, tilting the torso back and tilting towards the healthy leg. If he needs to pick up an object from the floor, he squats or bends his torso forward, while bending his sore leg. When lying down, the affected leg is usually half-bent.

Mild forms of radiculitis practically do not limit the patient’s movement. If the disease progresses, muscle tone decreases, muscle weakness appears, and patients are bothered by itching and a “crawling” sensation. Lying in bed, sufferers cannot find a comfortable position for hours. They often feel cold, dry, or, conversely, wet feet. The skin on the feet turns pale or becomes bluish and thins. But when these symptoms appear, you should not hastily diagnose yourself with sciatica. A similar picture is given by panniculosis - inflammation of subcutaneous fat due to metabolic disorders in adipose tissue, as well as damage to the joints of the legs.

In addition to recurrent radiculitis, such an acute form of disease of the lumbar spine as lumbago, or lumbago, is very common. With lumbago, the nerve roots are irritated and a sharp, severe pain appears. It most often occurs in people engaged in heavy physical labor, as a result of overstrain of the lumbar muscles, and often due to hypothermia. But sometimes an attack of lumbago can be caused by acute and chronic infections, and it can also be one of the manifestations of radiculitis. The pain usually stops after a few days, but sometimes lasts two to three weeks. Until the attack goes away, it is better for the patient to remain in bed.

A special form of lumbago develops when, after heavy physical activity, muscle bundles, tendons are torn or hemorrhage occurs in the muscles. This type of lumbago manifests itself as back pain along the entire length of the spine and a feeling of general muscle fatigue.

It should be especially emphasized: if your lower back hurts, this does not mean that the spine is affected. The cause of lumbar pain may be myositis (inflammatory process) of the lumbar muscles. The disease lasts a long time. The muscle pain is not as severe as with lumbago, but dull, aching. In this case, the muscles are compacted, painful when touched and stretched. In patients with chronic infections and metabolic disorders, myositis of the lumbar muscles can be combined with joint pain.

Back pain can be so severe that treatment is indispensable. Regardless of the cause of the attack, you must stay in bed in the first days. In the following days, as the pain calms down, the patient is allowed to walk, preferably on crutches at first to relieve the load on the spine. The bed should be hard - a thin mattress laid on a wooden board.

For local heating in the area of greatest pain, irritating ointments are used: finalgon, capsin, nicoflex, tiger ointment, Chaga cream, as well as mustard plasters or pepper plaster. A warm woolen scarf, an electric heating pad, a bag of heated sand, and leeches bring relief. Rubbing with anti-inflammatory and analgesic agents such as indomethacin, ortofenoic, voltaren and other ointments helps well. Irrigation of the lower back with ethyl chloride relieves pain. Hot compresses help with myositis.

Electrical procedures have an analgesic effect: transcutaneous electroanalgesia, sinusoidally modulated currents, diadynamic currents, electrophoresis with novocaine and others. Reflexology (acupuncture, moxibustion, electroacupuncture, laser therapy) and novocaine blockades are used for the same purpose. For radiculitis caused by displacement of intervertebral discs, traction therapy is used - stretching the torso on a bed or under water. These procedures must be performed in a hospital setting. Balneotherapy is effective - sodium chloride, radon, sulfide, turpentine, iodine-bromine baths, naphthalan, mud applications at low temperatures.

One of the actively developing types of therapeutic treatment for back pain has become the “biofeedback” method. Its principle was substantiated by the outstanding Russian physiologist P.K. Anokhin back in the 30s of the last century. The method involves learning to control the functions of your body. Here's what it looks like to use to treat back pain. The patient is given the task of relaxing the back muscles as much as possible. The patient sees his own electromyogram, reflecting muscle tension, on the monitor screen and, when they tense strongly, hears a sound signal. When relaxing, the amplitude of the electromyogram decreases and the sound disappears. As a result, the patient develops motivation to reduce pathological muscle tension. As a rule, results are not achieved immediately. In order for the patient to learn to relax and control muscle tone, five to six sessions are needed. In the future, patients are able to control the relaxation of the back muscles independently.

Of no small importance for eliminating pain and preventing attacks is the wearing of external support devices - orthoses: corset, semi-corset, posture corrector; reclinator (a special corset that eliminates tilt), a bandage, as well as belts: corset, anti-radiculitis, elastic, weightlifter’s or fitter’s belt. All of them prevent spinal deformation, improve venous and lymphatic drainage, and give a slim figure. It’s good if the material from which the belt is made includes wool.

You should only take into account that if you do not follow medical recommendations, then regularly wearing orthoses can cause harm. Firstly, you need to wear them over your underwear to avoid chafing. If your braces are too tight, it can impede breathing, digestion, and circulation in the lower half of your body. If you do not part with them day or night, the muscles of the lumbar spine may atrophy. Orthoses are useful for long periods of sitting at a desk, intense physical activity, and riding on public transport. The rest of the time it is better to do without them - the muscles must work. The ideal remedy for back pain has been and remains physical therapy. Your own muscle “corset” makes artificial “supports” for the spine unnecessary.

Sometimes, in order to relieve a painful attack, patients have to resort to taking anti-inflammatory and painkillers. For very severe pain, they are more effective in the form of intramuscular injections. Analgesics (analgin, baralgin, sedalgin, spazgan) and non-steroidal anti-inflammatory drugs (ibuprofen, ortofen, diclofenac, voltaren) are usually prescribed. It should be noted that indomethacin, donalgin, Nise and piroxicam do not combine well with certain medications (hypotensives, diuretics, etc.). Anti-inflammatory non-steroidal drugs should also not be abused. Contraindications to their use are peptic ulcer of the stomach and duodenum in the acute phase, severe liver dysfunction. To avoid complications, you need to take only one medication in short courses of 5-7 days, having previously selected it taking into account the individual characteristics of the body.

In old age (over 65 years old) with arterial hypertension, heart failure or peptic ulcer disease, it is better to replace non-steroidal drugs with so-called cyclooxygenase-2 inhibitors, such as celecoxib or Celebrex, rofecoxib or Vioxx, meloxicam or movalis, melox, nimesulide or nimesil, mesulide. These medications practically do not irritate the gastrointestinal tract and have no other side effects. It’s a good idea to take a course of injections of vitamins, especially group B.

But in any case, painkillers and anti-inflammatory drugs relieve only the symptoms of the disease, without eliminating its cause. The so-called disease-modifying, basic or slow-acting drugs can improve the functional state of the spine: glucosamine sulfate (Dona) in powders and ampoules and chondroitin sulfate (Structum) in capsules. Preparations are also produced that combine these two components in one dosage form: “Chondro” and “Arthra”. These drugs are natural polysaccharides found primarily in cartilage tissue. Due to their viscosity, they play the role of lubricating articular surfaces, and also participate in the synthesis of new bone and cartilage tissue. Therefore, preparations of these polysaccharides slow down the process of destruction of cartilage tissue, that is, they prevent the development of osteochondrosis.

Typically, drug treatment relieves pain. But sometimes, with a herniated disc, intense pain persists even after long-term treatment. Then the hernia has to be removed surgically.

When the acute period of the illness has passed, doctors usually prescribe massage, physical therapy or manual therapy. Patients are recommended to undergo sanatorium-resort treatment in sanatoriums for patients with diseases of the musculoskeletal system and the peripheral nervous system.

In conclusion, I would like to emphasize once again that the causes of lumbosacral pain are very different. The pathological processes that cause these pains can lie both in the lumbosacral region itself (spine, musculo-ligamentous apparatus, nerve roots, nerve ganglia) and beyond. The famous Russian neurologist V.K. Khoroshko wrote: “At least the entire lower half of the human body is interested in the development of lumbar pain.” Sometimes pain occurs with certain diseases of the central nervous system, circulatory disorders in the abdominal aorta, diseases of the abdominal and pelvic organs, and neuroses. Attributing back pain to radiculitis without confirming the diagnosis with examinations is not only frivolous, but also dangerous. Diagnosis often causes difficulties even for doctors and requires a number of additional studies, including the most complex modern ones, which began to be used in the last two decades: computed tomography, positron emission tomography, nuclear magnetic resonance, ultrasound examination. Therefore, before starting treatment, be sure to consult a neurologist.

Illustration “Five vertebrae make up the lumbar spine.”

In what cases should you urgently consult a doctor?

Trying to cope with pain on your own, much less endure severe pain, is unacceptable. However, in some cases, if there is severe pain in the lower back, a visit to the doctor must be arranged immediately. This:

recent injury to the lumbar region or spine;
a rise in body temperature in parallel with an increase in pain;
acute pain that does not go away within several hours (days);
feeling of numbness in the legs, lower back;
movement and coordination disorders;
problems with urination or defecation.

Prevention

The most effective way to prevent lower back pain is to adjust your lifestyle in order to spare the kidneys, spine, and pelvic organs, but if pain does occur, then this should be the reason for an urgent visit to a specialist:

avoid hypothermia;
avoid physical inactivity;
play sports at an amateur level (swimming has a particularly beneficial effect on the condition of the spine and back muscles);
eat properly and balanced: avoid overeating, minimize fatty, spicy, excessively salty foods;
eliminate alcohol and nicotine;
drink at least 1.5 liters of clean water daily, excluding tea, coffee or juices;
keep your body mass index at a normal level: excess weight has a bad effect on the condition of the spine, and too little can cause kidney prolapse.

If a person has already been diagnosed with a pathology of the musculoskeletal system, it is advisable to take preventive courses at least twice a year, according to European and Russian recommendations for the rehabilitation of spinal pathologies, in accordance with the doctor’s prescription.

Complex therapy

To achieve maximum effect and enhance the positive outcome of treatment, several approaches to treating lower back discomfort are used. This:

Drug therapy. Includes various medications for oral administration (analgesics, muscle relaxants, chondroprotectors, vitamins), anti-inflammatory and analgesic ointments and gels, injections, medicinal patches.
Physiotherapeutic procedures (SWT, magnetic therapy, electrophoresis, acupuncture, darsonvalization).
Dieting.
Bed rest, restriction of movements, wearing a corrective corset.
Physiotherapy. This therapy works well in cases where lower back pain is caused by weak muscles and lack of physical activity.
Manual therapy and massage courses. Taking such courses is beneficial for the whole body in general, and under the hands of a professional, pain in the spine is very quickly relieved.
Surgical intervention. This is a last resort measure for treating low back pain - the basis for surgery is serious diseases in this area that cannot be cured in any other way.