Low back pain or low back pain is an experience that every middle-aged and elderly person has had and is a common clinical symptom, but not every friend is clear about its pathogenesis and diagnosis, so here are some questions to discuss with you.
I. Common causes.
Low back pain is not a simple disease. It is a symptom caused by many diseases.
1. Those with negative X-ray findings
(1) lumbosacral joint or sacroiliac joint overwork or sprain
(2) Myofasciitis, wind chill or strain
(3) Nerve root inflammation
(4) Bursitis
(5) Bad posture
2.Diagnosis needs to take X-ray film for.
Lumbar disc herniation, spinal cord tumor, tuberculosis, aneurysm, degenerative spine, old vertebral fracture, osteoporosis, spinal slippage, ankylosing spondylitis, congenital malformation, syphilis typhoid and other infectious spondylitis, double sacroiliac joint lesions, spinal stenosis, etc.
3, lower limb disorders caused by.
Flatfoot, foot pad, corns, polio, congenital hip dislocation, etc.
4, caused by internal diseases.
(1) Gynecology: uterine fibroids
(2) urinary: prostatitis, prostate tumor, kidney stones
(3) gastrointestinal diseases: ulcer, tumor, perforation, posterior appendicitis, hernia, chronic constipation, visceral prolapse, hemorrhoids, colitis, perianal inflammation, sigmoid colon, rectal spasm.
(4) cholecystitis: peri-cholangitis, gallstones
(5) Infections: colds, influenza, malaria, typhoid
(6) Neurological disorders: fraudulent diseases.
Therefore, in order to treat back pain as soon as possible, you must first diagnose the cause of the disease, do not blindly.
Bone spurs or osteophytes
Middle-aged and elderly patients often complain that they have bone spurs, as if they are the culprit of all lumbar diseases, but this is not true. Bone spurs often grow in areas with a large range of motion and stress, such as the cervical spine, lumbar spine, knee, heel, etc. Not all bone spurs produce symptoms, and many symptoms are not caused by bone spurs. Bone spurs are the product of the body’s compensatory mechanism, which is designed to increase the area of stress and stabilize the joint. From a biomechanical point of view, different biomechanical effects produce different shapes of bone spurs. For example, (1) tensile stress The direction of the bone spur is the direction of tensile force. (2) Compressive stress According to the piezoelectric principle, the negative charge increases and Ca++ moves in its direction, producing deposition of Ca++, which gradually becomes hard and calcified. (3) Growth stress The intervertebral disc bulges in all directions by stressing the fibrous ring, producing bone spurs at the edge of the vertebral body and Lusska`s joint hyperplasia, and the pulling of the anterior longitudinal ligament and posterior longitudinal ligament can also form bone spurs. Orthopantomographies of the knee often reveal intercondylar spur hyperplasia, which is caused by tension of the “ten” ligament.
Treatment should not focus on the spur, which is the result of a pathological change rather than the cause, but rather a biomechanical malfunction. On the other hand, bone spurs are not the cause of all diseases, so they must not be eliminated as a matter of priority. Treatment should focus on the whole, on the biomechanical balance, and on soft tissue injuries such as muscles, ligaments, and fascia.
Third, herniated disc
Herniated discs can occur in the cervical, thoracic and lumbar regions, with the cervical and lumbar regions in particular having a high frequency of occurrence. The chances of herniation in the cervical and lumbar spine are not equal C4-7, L4, 5, L5S1 have more chances of occurrence, while the chances of thoracic disc herniation are less, because the protruding site is often the site with large force and large range of activities. The thoracic spine is very mobile, so the chance of occurrence is also very small.
It should be properly understood that a herniated disc does not necessarily produce a herniated disc. Herniated discs can be found in normal healthy people on physical examinations such as CT scans and MRI scans. On the other hand, the degree of herniation is not necessarily proportional to the severity of symptoms. Especially today, due to the popularity of CT and MRI many part of the patients have CT or MRI scan as soon as they have leg pain, and as a result, they find multiple stages of herniation, they are nervous and abnormal, and they seek medical help everywhere, which is not conducive to the recovery of the disease, because mental tension can aggravate the painful irritation and also produce some soft tissue damage. The imaging diagnosis is viewed correctly, and it must be combined with clinical examination. It is inappropriate to rely on images alone without taking into account the symptoms and signs. For example, there was a female patient in Cangzhou who heard that walking backwards would cure her back pain. The result was a compression fracture of the thoracolumbar vertebrae and a central disc herniation of L5S1 on CT examination, which led to a lot of money spent on X-rays, CT and MRI examinations. When he came to our hospital for examination, he only had pressure pain on the left side of chest 11, and he also felt pain in the combination of chest and waist. There was not a bit of pain in her back and legs, yet she asked me to make sure to treat her lumbar disc herniation.
Another problem is that not all herniated discs with multiple segments cause clinical symptoms, but which segment is causing the symptoms has to be determined based on a combination of symptoms, signs and imaging.
The third issue is that herniated discs cannot be viewed in isolation. As the biomechanics of the body’s joints are coordinated and compensated for, some small imbalances are self-repairing and compensated for by the body. Once there is a loss of compensation and the dynamic balance is disrupted, it must not be reflected in the disc alone, but the surrounding soft tissues and small joints, the spine, etc. will produce pathological changes, and at the same time the diseases of these surrounding tissues will also trigger the creation of herniation. Therefore, herniation is only one link in the chain of herniation, not the whole chain of symptoms. What is often referred to as a herniated disc includes two symptoms, on the one hand a lesion within the spinal canal and on the other hand a lesion outside the spinal canal. Intraspinal lesions generally refer to spinal cord compression or cauda equina compression, nerve root canal stenosis, distension, etc.; extraspinal lesions refer to lesions in soft tissues such as muscles, ligaments, and fascia. Intraspinal lesions are generally treated surgically, and extraspinal lesions are treated non-surgically.
The human body is an organic whole, and the entire skeletal structure is also a whole. With a herniated disc, the mechanical balance of the spinal unit is out of balance, and pain stimulates the body’s self-protection mechanism, producing painful scoliosis of the spine. Scoliosis triggers pelvic tilt, which in turn causes a bilateral imbalance in hip mechanics, which in turn is transmitted to the knee joint. The imbalance in knee joint mechanics is transmitted to the knee joint, which in turn produces soft tissue damage in the knee joint, such as aseptic inflammation of the lateral collateral ligaments, bursa, and subsellar fat pad. By the same token, the ankle joint can also produce injury. Conversely, the shoulder, hip, knee and ankle can also trigger discomfort in the head, neck and waist. Intricate, intertwined, internal and external, and left and right are the characteristics of this type of disorder. There is often a clinical phenomenon that hip disorders do not cause hip pain, but rather manifest as knee pain.
Sciatica
Due to the influence of traditional habits, individual doctors still have sciatica when diagnosing patients. So some patients say they have sciatica as soon as they have back and leg pain. In fact, sciatica is only a symptom, not a disease. A good number of diseases can cause sciatica, such as lumbar disc herniation, vertebral body slippage, pear muscle injury, lumbar degeneration, etc. The sciatic nerve outlet and the pathway along the sciatic nerve can produce sciatica if the sciatic nerve is provoked by the lesion. Therefore, the treatment of sciatic nerve alone is not possible, and the source should be sought.