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How long for lower back pain to heal: Treating Lower Back Pain: How much bed rest is too much?

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Treating Lower Back Pain: How much bed rest is too much?

Treating Lower Back Pain: How much bed rest is too much?

Back pain is one of the most common reasons why people visit a health care provider. The good news is that the pain often goes away on its own, and people usually recover in a week or two. Many people want to stay in bed when their back hurts. For many years, getting bed rest was the normal advice. But current studies recommend no bed rest at all and stress that staying in bed longer than 48 hours not only won’t help but it may, in fact, actually delay your recovery. Here’s why:

Staying in bed won’t help you get better faster.
If you’re in terrible pain, lying down for a day to help ease the distress may seem like a good idea, but moderating your activities and staying active in a limited way is a more effective way to control your symptoms. Research suggests that if you can find comfortable positions and keep moving, you may not need bed rest at all.
Research shows that:

  • Lying down longer than a day or two day isn’t helpful for relieving back pain.
  • People can recover more quickly without any bed rest.
  • The sooner you start moving, even a little bit, or return to activities such as walking, the faster you are likely to improve.

Long bed rest can lead to slower recovery.
Staying in bed for any prolonged period can make you stiff and increase pain. When you don’t move and bend, you lose muscle strength and flexibility. With bed rest, you lose about 1 percent of your muscle strength each day. And you can lose 20 to 30 percent in a week. It becomes more difficult to return to any activity. As you become weaker and stiffer your recovery takes longer.

Who needs bed rest?
Almost no one! The only people who might require time in bed are those with unstable spinal fractures awaiting surgery.

What can I do for the pain?
Hot or cold packs often help. Some people can get pain relief from non-prescription analgesics or anti-inflammatory drugs such as ibuprofen (Advil, Motrin) or naproxen (Aleve). But no medication should be taken for an extended period of time.

When should I see a health care provider?
You should see your health care provider right away if:

  • You have severe continuous back pain that lasts longer than 48 hours.
  • You have severe continuous back pain and fever.
  • You have back pain with accompanying pain, numbness or weakness in one or both legs or feet. Your leg symptoms are more disabling than your back symptoms.
  • You have back pain and the onset of numbness in your private/genital region or changes in your ability to control your bladder and bowel function.

Manage back pain with regular exercise and professional help as required
If you have an attack of lower-back pain that is severe, continuous and not improving, assessment and treatment by a health care professional who focuses on the back or other musculoskeletal problems may help. These practitioners may use both active and passive techniques to help you feel better. Examples of passive techniques that may be used to get you moving include:

  • Heat or ice
  • Ultrasound
  • Manipulation (massage and movement)

An active approach, like walking or water aerobics is usually the most effective. Exercise is often the best way to relieve lower-back pain.

Check with your health care provider before starting an exercise program.

Work with an expert. It may help to work with a health professional (such as a physiotherapist) who can explain which activities are right for you.

Choose exercises you enjoy. Many activities can help relieve back pain. Try to include activities that strengthen the muscles around your trunk, your abdominal muscles as well as those in your lower back. Studies show the following activities help relieve back pain:

  • Lifting light weights
  • Yoga
  • Walking and using a treadmill
  • Water aerobics

Don’t cause more pain. Avoid exercises that flare up your back pain. But just because you may have back pain with some activities doesn’t mean you have done any harm. A trained therapist can teach you about the principle of ‘hurt versus harm’.

As you begin, you may want to avoid sit-ups with straight legs, leg lifts while lying on your back and shoulder presses or bicep curls while standing. Once you start to improve you can add more complex exercises to strengthen your back and all your core muscles.

Join an exercise program for people with chronic back pain. It might be easier to stick with exercise if you don’t “go it alone.”

Low Back Strain Causes, Treatments, Exercises, Prevention

Low back pain is a fact of life. Just about everybody will suffer from it sooner or later. One of the main causes of back pain, whether acute or chronic, is low back strain.

So what is low back strain? A series of muscles and ligaments in your back hold the bones of your spinal column in place. You can strain these muscles by stretching them too far, causing tiny tears in the tissue. The muscles are then weakened, so they may not be able to hold the bones of your spinal column in place correctly. The spine becomes less stable, causing low back pain.

And because nerves stretch out from the spinal cord throughout the entire body, low back strain can cause pain in areas other than your back.

Low back strain can be caused by:

  • Extreme physical exertion.
  • Falling.
  • Bending or crouching repeatedly.
  • Lifting heavy objects if you are not in shape.

It can also be caused by emotional stress, improper posture, being overweight, out of shape, or sitting in the same position for long periods of time. Even a severe cough can result in low back strain.

Keep in mind that low back strain can’t be blamed for all back pain. There are many other causes, like slipped discs, fractures, pinched nerves, arthritis, infections, and tumors.

What Does Low Back Strain Feel Like?

Symptoms of low back strain include:

  • Pain and stiffness in the back.
  • Pain in the buttocks and the legs, often in the back of the thigh.
  • Pain that worsens when bending, stretching, coughing, or sneezing.

Since some symptoms of low back strain are similar to those of more serious conditions, it’s important to get checked out by a doctor. Any numbness and weakness in your legs, or bowel and bladder problems, can be a sign of nerve damage — and that needs immediate medical attention.

To diagnose low back strain, your doctor will give you a thorough exam. You may also need X-rays, MRIs (Magnetic Resonance Imaging), and CT scans. These extra tests may only be needed if your pain doesn’t go away on its own or with conservative treatment.

What’s the Treatment for Low Back Strain?

Low back strain can be a painful and depressing injury. But the good news is that most cases heal on their own, given time. To speed the healing, you should:

  • Ice your back to reduce pain and swelling as soon as you injure yourself. Do it for 20-30 minutes every 3-4 hours for 2-3 days. You can also ice your back after physical activity.
  • Apply heat to your back — but only after 2-3 days of icing it first. Use heat on your back only after the initial swelling has gone down. You could use an electric heating pad or a hot water bottle. Or you could just soak in a hot bath.
  • Take painkillers or other drugs, if recommended by your doctor. Non-steroidal anti-inflammatory drugs (NSAIDs), like Advil, Aleve, or Motrin, will help with lower back pain and swelling. However, these drugs may have side effects. They should be used only occasionally, unless your doctor specifically says otherwise. Prescription painkillers and muscle relaxants are sometimes necessary.
  • Use support. Ask your doctor or therapist first, but consider getting a belt or girdle to add support to your back. Use it only short-term or for support with heavy or repetitive lifting.
  • Get physical therapy to build up strength, if your doctor recommends it. Do not stay in bed or on the couch all day. That will make it worse.
  • Maintain good muscle tone in your abdominal and lower back muscles.

No matter what people tell you, bed rest doesn’t work. People used to think that the best treatment for low back strain was to lie on your back until you felt better. But studies show it doesn’t help. In fact, after taking it easy for a day or two, you should usually start light physical activity.

When Will My Lower Back Strain Feel Better?

Recovery time depends on how serious your low back strain is. Mild cases may resolve in a couple of days. It can take many weeks for more serious strains. Remember that everyone heals at a different rate.

Once the back pain is gone, your doctor will probably want you to start a regular exercise routine. This will get your back muscles stronger and more limber. It will help you recover, and reduce your odds of low back strain in the future. Your doctor will probably want you to take up low impact sports, like swimming or using a stationary bike.

Whatever you do, don’t rush things. Don’t try to return to your previous level of physical activity until:

  • You can move as easily — without stiffness — as you did before your injury.
  • You feel no pain when you bend, twist, walk, run, and jump.

If you start pushing yourself before your low back strain is healed, you could end up with chronic back pain and permanent injury.

How Can I Prevent Low Back Strain?

Here are some tips to help you avoid low back strain:

  • If you feel any low back pain during physical activity, stop.
  • If you feel low back pain within a day of stepping up your workout, take it easy for a few days.
  • Get your back in shape. Exercise and stretch your back muscles regularly.
  • Avoid sleeping on your stomach. Sleep on your back or your side, and wedge a pillow under or beneath your legs.
  • When picking up something heavy, bend at the knees, not at the waist.
  • Lose weight if you are overweight.
  • Adopt good posture. Sit straight in chairs, with your back against the chair’s back.

Injured Your Back? Dos and Don’ts for a Quick Recovery

Angela Santini, MD is board certified in orthopedic surgery and fellowship trained in spinal surgery. She is a member of the Inova Spine Program with privileges at Inova Loudoun Hospital, which has earned the Gold Seal of Approval® from The Joint Commission for spine surgery. Dr. Santini serves as Chief Medical Director of Virginia Spine and Sports Orthopaedics in Loudoun County.

Back strains can occur anytime, anywhere, during almost any kind of activity. Luckily, “throwing your back out” is usually a temporary situation. The sudden onset of pain caused by twisting, lifting or bending is most often due to a muscle strain. As we age, we become more prone to muscle strains because our muscles lose elasticity.

Most people can identify the injury or activity that caused their pain. One minute you are bending over to tie your shoe, reaching for something in a cabinet or teeing off on the back nine. Then, out of nowhere, “OUCH!” – sudden tension and pain in the mid to lower back.

Throwing your back out can cause intense low-back pain and stiffness. It can even be an on–the-floor-can’t-move debilitating experience. Typical symptoms include muscle spasms with bouts of muscle tightening and difficulty standing up straight. You want pain relief and you want it now!

The good news is, in most cases, your back pain will go away on its own. Here are some at-home tips to help you feel better in the meantime.

DOs

  • Stop what you are doing and apply ice to ease the pain and inflammation. Cold therapy can be continued for about 20 minutes every 6-8 hours for the next 2-3 days. But remember – don’t put ice directly on your skin. It can damage the tissues and nerve endings.
  • You may find it helpful to lie flat on your back on a hard surface for support, rather than a cushy bed. This can help relax the injured muscles in the immediate aftermath.
  • Pain relievers such as acetaminophen, ibuprofen (Advil) and naproxen (Aleve) can help. However, they may not be advisable for anyone with kidney problems or a stomach ulcer. It’s a good idea to check with your doctor about which medications you should or should not take.
  • Once you are upright and stabilized, do whatever you can to stay that way so your injury does not worsen. That means avoiding bending, lifting or twisting through the spine. If you need to pick up something from the floor, keep your spine straight. When you brush your teeth or wash the dishes, maintain a straight, neutral spine, bending forward from your hips.
  • Sleep in a position that’s comfortable for your spine. Put pillows under your knees when you are on your back or a pillow between your legs if you sleep on your side. This helps the muscles to release.
  • If your pain persists after the third day, try a little moist heat. This can help reduce stiffness and improve blood flow to the injured area.
  • Massaging the affected muscle with firm pressure may help reduce tension. Press on the area for 30-60 seconds, then rub the surrounding area in a circular motion.
  • Drink water to stay hydrated when you are recovering from injury. Chronic dehydration can affect the strength and quality of your spinal muscles.
  • If tolerated, try to stay mobile in the first few days after your injury. Move gently. Mild movement is better than bed rest. Any lengthy bed rest can prolong your back pain.
  • When you are ready, engage in slow, easy stretching such as pulling your knees toward the chest. If it hurts doing any exercise, stop, slow down and try again later. Walking for short intervals can also help.
  • Get back to your regular activities, such as work, as soon as you can. Modify activities as needed. But remember, staying active will stimulate blood flow, increase flexibility and prevent spasms.

DON’Ts

  • Do not try to “play through the pain.” It is essential to let your body recover before resuming strenuous activity.
  • Do not sleep on your stomach. This can worsen back pain.
  • Do not perform heavy lifting or repetitive twisting of your back for up to six weeks. This can disrupt the healing process.
  • Do not ignore how you injured yourself. Make changes to the way you lift. Practice good posture and use judgement when lifting heavy items (ask another person to help you). Strengthen your core with abdominal exercises, which can protect your back. Do not sit in one position for long periods of time. Move around and stretch every 20 minutes to help prevent injury. Consider lifestyle changes such as losing weight to reduce your chances of recurring back issues.

After throwing your back out, it is natural to worry that your back will never get better. Listen to your pain and take care of yourself. You will most likely be on the road to recovery with these simple at-home solutions.

Symptoms that require prompt medical attention, but are not an emergency include:

  • Pain that has not reduced with at-home treatments
  • Pain that continues to interfere with your daily activities

Seek emergency medical attention if you have the following symptoms related to your back pain:

  • Bladder or bowel dysfunction
  • Numbness down one or both legs
  • Weakness or pain in your legs
  • Fever greater than 101.5 F, or other symptoms of illness

Low Back Pain Fact Sheet

If you have had lower back pain, you are not alone. Back pain is one of most common reasons people see a doctor or miss days at work. Even school-age children can have back pain.

Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly as a result of an accident or by lifting something heavy, or it can develop over time as we age. Getting too little exercise followed by a strenuous workout also can cause back pain.

There are two types of back pain:

  • Acute, or short-term back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases a few months are required for the symptoms to disappear.
  • Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain continues despite medical and surgical treatment.

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What structures make up the back?

The lower back—where most back pain occurs—includes the five vertebrae (referred to as L1-L5) in the lumbar region, which supports much of the weight of the upper body. The spaces between the vertebrae are maintained by round, rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. Thirty-one pairs of nerves are rooted to the spinal cord and they control body movements and transmit signals from the body to the brain.

Other regions of vertebrate are cervical (in the neck), thoracic (upper back), and sacral and coccygeal (below the lumbar area) segments.

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What can cause lower back pain?

Most acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move. Some examples of mechanical causes of low back pain include:

Congenital

  • Skeletal irregularities such as scoliosis (a curvature of the spine), lordosis (an abnormally exaggerated arch in the lower back), kyphosis (excessive outward arch of the spine), and other congenital anomalies of the spine.
  • Spina bifida which involves the incomplete development of the spinal cord and/or its protective covering and can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis.

Injuries

  • Sprains (overstretched or torn ligaments), strains (tears in tendons or muscle), and spasms (sudden contraction of a muscle or group of muscles)
  • Traumatic Injury such as from playing sports, car accidents, or a fall that can injure tendons, ligaments, or muscle causing the pain, as well as compress the spine and cause discs to rupture or herniate.

Degenerative problems

  • Intervertebral disc degeneration which occurs when the usually rubbery discs wear down as a normal process of aging and lose their cushioning ability.
  • Spondylosis the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.
  • Arthritis or other inflammatory disease  in the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae.

Nerve and spinal cord problems

  • Spinal nerve compression, inflammation and/or injury
  • Sciatica (also called radiculopathy), caused by something pressing on the sciatic nerve that travels through the buttocks and extends down the back of the leg. People with sciatica may feel shock-like or burning low back pain combined with pain through the buttocks and down one leg.
  • Spinal stenosis, the narrowing of the spinal column that puts pressure on the spinal cord and nerves
  • Spondylolisthesis, which happens when a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column
  • Herniated or ruptured discs can occur when the intervertebral discs become compressed and bulge outward
  • Infections involving the vertebrae, a condition called osteomyelitis; the intervertebral discs, called discitis; or the sacroiliac joints connecting the lower spine to the pelvis, called sacroiliitis
  • Cauda equina syndrome occurs when a ruptured disc pushes into the spinal canal and presses on the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.
  • Osteoporosis (a progressive decrease in bone density and strength that can lead to painful fractures of the vertebrae)

Non-spine sources

  • Kidney stones can cause sharp pain in the lower back, usually on one side
  • Endometriosis (the buildup of uterine tissue in places outside the uterus)
  • Fibromyalgia (a chronic pain syndrome involving widespread muscle pain and fatigue)
  • Tumors that press on or destroy the bony spine or spinal cord and nerves or outside the spine elsewhere in the back
  • Pregnancy (back symptoms almost always completely go away after giving birth)

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What are the risk factors for developing low back pain?

Anyone can have back pain. Factors that can increase the risk for low back pain include:

Age: The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. Loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.

Fitness level: Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. “Weekend warriors”—people who go out and exercise a lot after being inactive all week—are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise can help maintain the integrity of intervertebral discs.

Weight gain: Being overweight, obese, or quickly gaining significant amounts of weight can put stress on the back and lead to low back pain.

Genetics: Some causes of back pain, such as ankylosing spondylitis (a form of arthritis that involves fusion of the spinal joints leading to some immobility of the spine), have a genetic component.

Job-related factors: Having a job that requires heavy lifting, pushing, or pulling, particularly when it involves twisting or vibrating the spine, can lead to injury and back pain. Working at a desk all day can contribute to pain, especially from poor posture or sitting in a chair with not enough back support.

Mental health: Anxiety and depression can influence how closely one focuses on their pain as well as their perception of its severity. Pain that becomes chronic also can contribute to the development of such psychological factors. Stress can affect the body in numerous ways, including causing muscle tension.

Smoking: It can restrict blood flow and oxygen to the discs, causing them to degenerate faster.

Backpack overload in children: A backpack overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue.

Psychological factors: Mood and depression, stress, and psychological well-being also can influence the likelihood of experiencing back pain.

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How is low back pain diagnosed?

A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. Neurologic tests can help determine the cause of pain and appropriate treatment. Imaging tests are not needed in most cases but may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination.

Tests include:

Blood tests  are not routinely used to diagnose the cause of back pain but might be ordered to look for signs of inflammation, infection, cancer, and/or arthritis.

Bone scans can detect and monitor an infection, fracture, or bone disorder. A small amount of radioactive material is injected into the bloodstream and collects in the bones, particularly in areas with some abnormality. Scanner-generated images can identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.

Discography involves injecting a contrast dye into a spinal disc thought to be causing low back pain. The fluid’s pressure in the disc will reproduce the person’s symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection.

Electrodiagnostics can identify problems related to the nerves in the back and legs. The procedures include:

  • electromyography (EMG) assesses the electrical activity in a muscle and can detect if muscle weakness results from a problem with the nerves that control the muscles. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body.
  • evoked potential studies involve two sets of electrodes—one set to stimulate a sensory nerve, and the other placed on the scalp to record the speed of nerve signal transmissions to the brain.
  • nerve conduction studies (NCS) also use two sets of electrodes to stimulate the nerve that runs to a particular muscle and record the nerve’s electrical signals to detect any nerve damage.

Diagnostic imaging tests allow specialists to see into the body without having to perform exploratory surgery. Imaging includes:

  • Computerized tomography (CT) can show soft tissue structures that cannot be seen on conventional x-rays, such as disc rupture, spinal stenosis, or tumors.
  • Magnetic resonance imaging (MRI) creates a computer-generated image of bony structures and soft tissues such as muscles, ligaments, tendons, and blood vessels. An MRI may be ordered if a problem such as infection, tumor, inflammation, disc herniation or rupture, or pressure on a nerve is suspected
  • X-ray imaging can show broken bones or an injured or misaligned vertebra.

Myelograms enhance the diagnostic imaging of x-rays and CT scans. In this procedure, a contrast dye is injected into the spinal canal, allowing spinal cord and nerve compression caused by herniated discs or fractures to be seen on an x-ray or CT scans.

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How is back pain treated?

Acute back pain usually gets better on its own. Acute back pain is usually treated with:

  • Medications designed to relieve pain and/or inflammation  
    • analgesics such as acetaminophen and aspirin
    • non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen may be sold over the counter; some NSAIDS are prescribed by a physician 
    • muscle relaxants are prescription drugs that are used on a short-term basis to relax tight muscles   
    • topical pain relief such as creams, gels, patches, or sprays applied to the skin stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Common topical medications include capsaicin and lidocaine.
  • Heat and/or ice may help ease pain, reduce inflammation, and improve mobility for some people   
  • Gentle stretching (not vigorous exercise) upon advice by your healthcare professional

Exercising, bed rest, and surgery are typically not recommended for acute back pain.
Chronic back pain is most often treated with a stepped care approach, moving from simple low-cost treatments to more aggressive approaches. Specific treatments may depend on the identified cause of the back pain.

Step 1 Early treatments

Medications may include:

  • Analgesics and NSAIDS
  • Opioid drugs prescribed by a physician (opioids should be used only for a short period of time and under a physician’s supervision, as opioids can be addictive, aggravate depression, and have other side effects)  
  • Anticonvulsants—prescribed drugs primarily used to treat seizures—may be useful in treating people with sciatica
  • Antidepressants such as tricyclics and serotonin, and norepinephrine reuptake inhibitors have been commonly prescribed for chronic low back pain (prescribed by a physician)

Self-management:

  • Hot or cold packs
  • Resuming normal activities as soon as possible may ease pain; bed rest is not recommended
  • Exercises that strengthen core or abdominal muscles may help to speed recovery from chronic low back pain. Always check first with a physician before starting an exercise program and to get a list of helpful exercises.

Step 2 Complementary and alternative techniques include:

  • Acupuncture is moderately effective for chronic low back pain. It involves inserting thin needles into precise points throughout the body and stimulating them (by twisting or passing a low-voltage electrical current through them), which may cause the body to release naturally occurring painkilling chemicals such as endorphins, serotonin, and acetylcholine.
    • Behavioral approaches include:
    • Biofeedback involves attaching electrodes to the skin and using an electromyography machine that allows people to become aware of and control their breathing, muscle tension, heart rate, and skin temperature; people regulate their response to pain by using relaxation techniques   
    • Cognitive therapy involves using relaxation and coping techniques to ease back pain
  • Transcutaneous electrical nerve stimulation (TENS) involves wearing a battery-powered device which places electrodes on the skin over the painful area that generate electrical impulses designed to block or modify the perception of pain    
  • Physical therapy programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combination with other interventions  
  • Spinal manipulation and spinal mobilization are approaches in which doctors of chiropractic care use their hands to mobilize, adjust, massage, or stimulate the spine and the surrounding tissues. Manipulation involves a rapid movement over which the individual has no control; mobilization involves slower adjustment movements. The techniques may provide small to moderate short-term benefits in people with chronic low back pain but neither technique is appropriate when a person has an underlying medical cause for the back pain such as osteoporosis, spinal cord compression, or arthritis.

Spinal injections include:
Trigger point injections can relax knotted muscles (trigger points) that may contribute to back pain. An injection or series of injections of a local anesthetic and often a corticosteroid drug into the trigger point(s) can lessen or relieve pain.    

Epidural steroid injections into the lumbar area of the back are given to treat low back pain and sciatica associated with inflammation. Pain relief associated with the injections tends to be temporary and the injections are not advised for long-term use.

Radiofrequency ablation involves inserting a fine needle into the area causing the pain through which an electrode is passed and heated to destroy nerve fibers that carry pain signals to the brain. Also called a rhizotomy, the procedure can relieve pain for several months.

  • Traction involves the use of weights and pulleys to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Some people experience pain relief while in traction but the back pain tends to return once the traction is released.

Step 3 More advanced care options

Surgery
When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include:

  • Vertebroplasty and kyphoplasty for fractured vertebra are minimally invasive treatments to repair compression fractures of the vertebrae caused by osteoporosis. Vertebroplasty uses three-dimensional imaging to assist in guiding a fine needle through the skin into the vertebral body, the largest part of the vertebrae. A glue-like bone cement is then injected into the vertebral body space, which quickly hardens to stabilize and strengthen the bone and provide pain relief. In kyphoplasty, prior to injecting the bone cement, a special balloon is inserted and gently inflated to restore height to the vertebral structure and reduce spinal deformity.   
  • Spinal laminectomy (also known as spinal decompression) is done when a narrowing of the spinal canal causes pain, numbness, or weakness. During the procedure, the lamina or bony walls of the vertebrae are removed, along with any bone spurs, to relieve pressure on the nerves.     
  • Discectomy and microdiscectomy involve removing a herniated disc through an incision in the back (microdiscectomy uses a much smaller incision in the back and allows for a more rapid recovery). Laminectomy and discectomy are frequently performed together and the combination is one of the more common ways to remove pressure on a nerve root from a herniated disc or bone spur.    
  • Foraminotomy is an operation that “cleans out” or enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can narrow the space where the spinal nerve exits and press on the nerve. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve pressure on the nerve.
  • Nucleoplasty, also called plasma disc decompression (PDD), is a type of laser surgery that uses radiofrequency energy to treat people with low back pain associated with mildly herniated discs. Under x-ray guidance, a needle is inserted into the disc. A plasma laser device is then inserted into the needle and the tip is heated to 40-70 degrees Celsius, creating a field that vaporizes the tissue in the disc, reducing its size and relieving pressure on the nerves.   
  • Radiofrequency denervation uses electrical impulses to interrupt nerve conduction (including pain signaling). Using x-ray guidance, a needle is inserted into a target area of nerves and the region is heated, which destroys part of the target nerves and offers temporary pain relief.  
  • Spinal fusion is used to strengthen the spine and prevent painful movements in people with degenerative disc disease or spondylolisthesis (following laminectomy). The spinal disc between two or more vertebrae is removed and the adjacent vertebrae are “fused” by bone grafts and/or metal devices secured by screws. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together. Spinal fusion has been associated with an acceleration of disc degeneration at adjacent levels of the spine.     
  • Artificial disc replacement is an alternative to spinal fusion for treating severely damaged discs. The procedure involves removing the disc and replacing it with a synthetic disc that helps restore height and movement between the vertebrae.  
  • Interspinous spacers are small devices that are inserted into the spine to keep the spinal canal open and avoid pinching the nerves. It is used to treat people with spinal stenosis.

Implanted nerve stimulators

  • Spinal cord stimulation uses low-voltage electrical impulses from a small implanted device that is connected to a wire that runs along the spinal cord. The impulses are designed to block pain signals that are normally sent to the brain.
  • Dorsal root ganglion stimulation also involves electrical signals sent along a wire connected to a small device that is implanted into the lower back. It specifically targets the nerve fibers that transmit pain signals. The impulses are designed to replace pain signals with a less painful numbing or tingling sensation.
  • Peripheral nerve stimulation also uses a small implanted device and an electrode to generate and send electrical pulses that create a tingling sensation to provide pain relief.

Rehabilitation programs
Rehabilitation teams use a mix of healthcare professionals from different specialties and disciplines to develop programs of care that help people live with chronic pain. The programs are designed to help the individual reduce pain and reliance on opioid pain medicines. Programs last usually two to three weeks and can be done on an in-patient or out-patient basis.

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Can back pain be prevented?

Recurring back pain resulting from improper body mechanics may be prevented by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object), vibration, repetitive motion, and awkward posture.
Recommendations for keeping one’s back healthy

  • Exercise regularly to keep muscles strong and flexible. Consult a physician for a list of low-impact, age-appropriate exercises that are specifically targeted to strengthening lower back and abdominal muscles.
  • Maintain a healthy weight and eat a nutritious diet with sufficient daily intake of calcium, phosphorus, and vitamin D to promote new bone growth.
  • Use ergonomically designed furniture and equipment at home and at work. Make sure work surfaces are at a comfortable height.
  • Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of the back can provide some lumbar support. Put your feet on a low stool or a stack of books when sitting for a long time.
  • Wear comfortable, low-heeled shoes.
  • Sleeping on one’s side with the knees drawn up in a fetal position can help open up the joints in the spine and relieve pressure by reducing the curvature of the spine. Always sleep on a firm surface.    
  • Don’t try to lift objects that are too heavy. Lift from the knees, pull the stomach muscles in, and keep the head down and in line with a straight back. When lifting, keep objects close to the body. Do not twist when lifting.    
  • Quit smoking. Smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. Smoking also increases the risk of osteoporosis and impedes healing. Coughing due to heavy smoking also may cause back pain.

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What research is being done?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge of the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

As a primary supporter of research on pain and pain mechanisms, NINDS is a member of the NIH Pain Consortium, which was established to promote collaboration among the many NIH Institutes and Centers with research programs and activities addressing pain. On an even broader scale, NIH participates in the Interagency Pain Research Coordinating Committee, a federal advisory committee that coordinates research across other U.S. Department of Health and Human Services agencies as well as the Departments of Defense and Veterans Affairs.

The NIH HEAL (Helping to End Addiction Long-term) Initiative, launched in April 2018, is a trans-NIH effort (which NINDS co-leads) that aims to prevent opioid addiction and provide more non-drug treatment options for chronic pain. Back pain is one of the most common pain conditions worldwide and is a major contributor to the prescribing and use of opioids in America. The treatment of low back pain is a specific area of focus of the Initiative. The Back Pain Consortium established through HEAL will conduct studies to better understand the mechanisms of common pain conditions such as chronic low back pain, develop improved diagnostic and treatment tools, and identify, prioritize, and test therapies that reduce the need for opioid use for millions of Americans. For more about the HEAL Initiative, see https://www.nih.gov/heal-initiative.

NINDS-funded studies are contributing to a better understanding of why some people with acute low back pain recover fully while others go on to develop chronic low back pain. Brain imaging studies suggest that people with chronic low back pain have changes in the structure and function of certain brain regions. Other research seeks to determine the role of brain circuits important for emotional and motivational learning, and memory in this transition, in order to identify new preventive interventions. Furthermore, several studies are being conducted to identify and characterize bidirectional neural circuits that communicate between the spinal cord to brain, which are aimed at discovering and validating new interventional targets for low back pain.

Different studies are looking at the response to placebos in individuals with acute and chronic back pain. For example, one study is designed to examine brain properties for placebo response and critically assess the neurobiology of placebo pain relief for individuals with chronic pain. Another study is assessing ibuprofen plus acetaminophen compared to ibuprofen plus placebo in treating acute low back pain.
In addition to NINDS, other NIH Institutes— including the National Institute on Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Drug Abuse, and the National Center on Complementary and Integrative Health—fund research on low back pain. More information on NIH efforts on back pain research and on other disorders can be found using NIH RePORTER (http://projectreporter.nih.gov), a searchable database of current and past research projects supported by NIH and other federal agencies. RePORTER also includes links to publications and patents citing support from these projects.

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Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P. O. Box 5801
Bethesda, MD 20824
800-352-9424

Information also is available from the following organizations:

American Academy of Family Physicians
11400 Tomahawk Creek Parkway
Leawood, KS 66211-2680
913-906-6000 or 800-274-2237

American Academy of Orthopaedic Surgeons
9400 West Higgins Road
Rosemont, IL 60018
847-823-8125

American Academy of Physical Medicine & Rehabilitation
9700 West Bryn Mawr Avenue
Suite 200
Rosemont, IL 60018
847-737-6000

American Association of Neurological Surgeons
5550 Meadowbrook Drive
Rolling Meadows, IL 60008-3852
847-378-0500 or 888-566-2267

American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA 95677-0850
800-533-3231

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
1 AMS Circle
Bethesda, MD 20892-3675
301-495-4484 or 877-226-4267; 301-565-2966 (TTY)

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“Back Pain Fact Sheet”, NINDS, Publication date March 2020.

NIH Publication No. 20-NS-5161

Back to Back Pain Information Page


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Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.

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How Long Is Too Long to Suffer From Back Pain?

Nothing makes a long day even longer than having to deal with back pain. If you’re suffering from lower back pain, even simple tasks like picking up a bag of groceries can feel overwhelming.

What’s more, the cause of your lower back pain may be more complicated than the actual twisting or lifting that brought it on in the first place — and preventing future pain means getting to the source of what caused it.

“If you wait to do something about lower back pain until it’s become debilitating, you’ve waited too long,” says Dr. Hosun Hwang, spine specialist at Houston Methodist Willowbrook Hospital. “Most people’s back pain dissipates in about a week or two, but if your pain is long-term or chronic, it’s time to see a spine specialist.”

What causes back pain?

Lower back pain may feel like aching, burning or sharp or dull pain that fluctuates in intensity from mild to severe. It can be due to a sports injury, from twisting or lifting something heavy or from working in your yard.

Dr. Hwang says back pain can happen to anyone, but some factors can increase your risk, including:

  • Age – older adults may be more susceptible to osteoarthritis and disc deterioration
  • Occupation – employees in jobs requiring repetitive bending, heavy lifting or long periods of standing or sitting are more likely to suffer back pain
  • Weight – excess weight adds stress to the spine and back muscles
  • Activity level – having a sedentary lifestyle, as well as weak back muscles and lack of core strength, make it easier to injure your back
  • Smoking habits – smoking decreases blood flow, reduces your body’s ability to heal and increases the risk of osteoporosis

 

“Chronic back pain may be caused by a variety of underlying conditions,” explains Dr. Hwang. “From spinal arthritis to sciatica to herniated discs, a spine specialist has the expertise needed to pinpoint the cause of your chronic back pain and develop a treatment plan that may resolve the issue or at least improve your quality of life.”

When to see a spine specialist for chronic back pain

Sometimes back pain comes on quick, and you know exactly what caused it. After some stretching, resting and pain relievers, you’ll remember to bend with your knees next time.

But, other times, people experiencing back pain are often left thinking: I don’t even remember when the pain started or what I did to cause it. The reality is that the source of you back pain may not always be evident — which can also make it hard to know when it’s time to see an expert.

Dr. Hwang says the following five signs likely indicate that it’s time to see a spine specialist for your back pain:

1. Your pain is severe. While some back pain is only mild to moderate, severe back pain is when your pain is constant, intense or gets worse when you’re resting or at night.

2. Your pain is persistent. If your back pain lasts longer than three months, it’s considered chronic and may require a tailored treatment plan.

3. Your pain isn’t isolated to your back. If your pain is traveling down your leg, you have numbness or weakness in your hips or legs, or you’re experiencing tingling in your legs and feet, it may be a sign that there’s pressure on your spine.

4. Everyday activities have become difficult. If your back pain is already affecting routine activities, don’t let it get so debilitating that it keeps you from doing things you enjoy.

5. You have other symptoms that are concerning. While rare, back pain is sometimes a sign of a serious medical condition, such as a spinal infection or spinal tumor. If your back pain is accompanied by fever, unexplained weight loss or bowel or urinary problems, tell your doctor.

If you’re experiencing any of these signs, a spine specialist can investigate the underlying cause of your back pain through imaging tests, such as X-ray, CT, MRI or myelogram. A myelogram uses contrast dye injected into the spinal canal with a CT scan to evaluate the spine. Or, your specialist may recommend an electromyography (EMG) — a test of your muscles and nerves.

“There are several ways to treat chronic back pain, including medications, physical therapy, injections and surgery — with the best treatment option usually depending on the cause and severity of your pain,” says Dr. Hwang. “We always start by using the least invasive, most effective treatment first. However, surgery may be necessary in some cases.”

Regardless of what’s causing your back pain, a spine specialist has the expertise needed to design a targeted treatment plan aimed at resolving your lower back pain and improving your quality of life.

Next Steps:

Back Pain | Treatments, Causes

Back pain is a common condition and in the UK, it is the largest cause of work-related absence. Back pain can be very uncomfortable, but it is not usually serious.
Brought to you by NHS Choices

This article has been updated

The evidence in this article is no longer current. Click here to see an updated and expanded article

Overview

Back pain can affect anyone, regardless of age, but it is more common in people who are between 35 and 55 years of age.

In the majority of cases, the cause of back pain can be linked to the way that the bones, muscles and ligaments in the back work together.

Top tips

  • Keep your back mobile. If you’re in so much pain that you have to go to bed, that’s fine – but try and get back on your feet as soon as possible.
  • Do not do any lifting. If you do, you’re likely to strain the back further.
  • Be careful bending your back – this puts a lot of strain on it, which can make your problems much, much worse.
  • Try some ice on the back. Apply an icepack or a bag of frozen peas wrapped in a towel to the base of your spine for five minutes.
  • Follow with 20 minutes of heat – a hotwater bottle wrapped in a towel, placed on the base of the spine. This will help reduce inflammation. You can use it on the spine while you sit down, or when you lie on the bed.
  • Take painkillers and anti-inflammatories, but stick to the recommended dosages and read the packet to ensure they’re suitable for you.

The structure of the back

The back is a complex structure consisting of:

  • 24 small bones (vertebrae), that support the weight of your upper body and form a protective canal for the spinal cord.
  • Shock-absorbing discs (intervertebral discs) that cushion the bones and allow the spine to bend.
  • Ligaments that hold the vertebrae and discs together.
  • Tendons to connect muscles to vertebrae.
  • A spinal cord, which carries nerve signals from the brain to the rest of the body.
  • Nerves.
  • Muscles.

The lower part of your back is known as the lumbar region, which is made up of five vertebrae, known as L1, L2, L3, L4 and L5. The lumbar supports the entire weight of your upper body (plus any extra weight that you are carrying), and it is under constant pressure, particularly when you are bending, twisting and lifting.

Lower back pain

Lower back pain, also known as lumbago, affects seven out of 10 people at some time in their lives. Lower back pain is a pain or ache on your back, in between the bottom of your ribs and the top of your legs.

Lower back pain can come on suddenly or gradually, and is sometimes the direct result of a fall or injury. The complex structure of your lower back means that even small amounts of damage to any part of the lumbar region can cause a lot of pain and discomfort.

Pain in your lower back is usually a symptom of stress or damage to your ligaments, muscles, tendons or discs. In some cases, if a nerve in your back is pinched or irritated, the pain can spread to your buttocks and thighs. This is known as sciatica (go to ‘Useful links’ for more information).

In most cases of back pain your back will heal itself, and staying active and continuing with your usual activities will normally promote healing. Back pain will usually last from a few days to a few weeks. Pain that lasts longer usually clears up after about six weeks.

However, in severe and persistent cases of back pain, it is important to seek medical advice so that a correct diagnosis can be reached and appropriate treatment given. Treatment for back pain will usually depend on the underlying cause of the condition. For example, pain that is caused by some types of arthritis may be treated using specific medicines.

Symptoms

Symptoms of back pain

The symptom of lower back pain is a pain or ache anywhere on your back, in between the bottom of the ribs and the top of the legs. The majority of cases of back pain usually clear up quite quickly.

However, if you experience back pain together with any of the following symptoms, visit your GP as soon as possible:

  • a fever,
  • weight loss,
  • inflammation or swelling on the back,
  • constant back pain that doesn’t ease after lying down or resting,
  • pain that travels to the chest or pain high up in your back,
  • pain down the legs and below the knees,
  • a recent trauma or injury to your back,
  • loss of bladder control,
  • inability to pass urine,
  • loss of bowel control, or
  • numbness around the genitals, buttocks or anus.

You should also seek medical advice if you’re experiencing back pain and:

  • you’re under 20 years old or over 55 years,
  • you have taken steroids for a few months,
  • you are a drug abuser,
  • you have or have had cancer, or
  • you have a low immune system due to chemotherapy or another medical condition (for example, HIV/AIDS).

Ask your GP for advice if your back pain has developed gradually and has got increasingly worse over several days or weeks.

Causes

Causes of back pain

Most cases of lower back pain are known as ‘non-specific’ because they are not caused by serious damage or disease, but by sprains, muscle strains, minor injuries or a pinched or irritated nerve.

Back pain can also be triggered by everyday activities at home or work, and by poor posture. For example, back pain may be triggered by:

  • bending awkwardly,
  • lifting, carrying, pushing or pulling incorrectly,
  • slouching in chairs,
  • standing or bending down for long periods,
  • twisting,
  • coughing,
  • sneezing,
  • muscle tension,
  • over-stretching,
  • driving in hunched positions, or
  • driving for long periods without taking a break.

Sometimes, you may wake up with back pain and have no idea what has caused it.

Common causes

Some common causes of back pain include:

  • pregnancy,
  • gynaecological problems in women, such as pelvic inflammatory disease (PID),
  • different types of arthritis, such as osteoarthritis,
  • stress-related tension,
  • viral infections,
  • bone disorders,
  • bladder and kidney infections,
  • osteoporosis (weak and brittle bones),
  • a trip or fall,
  • a trauma or injury, such as a fracture,
  • lack of exercise,
  • obesity, and
  • sleep disorders.

Serious back pain

The bulging or rupture of one or more of the intervertebral discs can sometimes cause serious back pain. This results in the inner jelly-like material (nucleus pulposus) pressing on the spinal cord or nerve roots, which run next to the disc. This is commonly known as a ‘slipped disc’, but is more accurately described as a ‘prolapsed’ (bulging) or ‘herniated’ (ruptured) disc.

The pain will usually be in your lower back, but you may also experience pain in you buttocks, thigh, calves, feet and toes, due to irritation of the sciatic nerve, which runs down both legs. Occasionally, the pain is also accompanied by pins and needles, numbness and weakness.

Intervertebral discs tend to dry out and weaken with age, or following an injury. This results in the discs becoming less flexible, which means they do not cushion the vertebrae as well as they did before. This is a common cause of stiffness and pain, particularly in the elderly. It also tends to be worse early in the morning.

Persistent lower back pain can also be caused by a number of rare conditions, such as:

  • congenital (inherited) spinal defects,
  • bone diseases,
  • shingles (an infection that affects the nerves),
  • fibromyalgia, or
  • cancer that has spread to the spine.

Diagnosis

Diagnosing back pain

Your GP will be able to diagnose back pain by discussing your symptoms with you and conducting a physical examination.

Usually, there is no need for tests, such as X-rays or scans, when diagnosing back pain. If you have simple back pain, tests are not always helpful because they often do not show anything unusual.

You’ll only usually be sent for tests if your pain lasts for longer than six weeks, if you have had an injury or blow to your back, or if your GP suspects that there may be an underlying cause for your pain.

For suspected disc problems, X-rays or a computerised tomography scan (CT scan) may be required. Your GP may suggest having a magnetic resonance imaging (MRI) scan, that uses a strong magnetic field and radio waves to produce detailed images of the inside of your body, in order to provide more accurate information about the soft tissues in your back.

In some cases, blood tests or a myelogram (a special kind of X-ray using an injected dye) may be needed.

A chiropractor, osteopath or physiotherapist?

Chiropractic and osteopathy are similar disciplines. Both osteopaths and chiropractors can diagnose by visual inspection and feeling by hand (palpation).

Chiropractic treatment tends to involve a more ‘direct’ approach, with an emphasis on adjustments of the spinal joints. Chiropractors also rely on X-rays, blood and urine tests and MRI scans for diagnosis.

The osteopathic approach involves mobilisation (slow, rhythmic stretching), pressure or ‘indirect’ techniques and manipulations on the muscles and joints.

Physiotherapists are trained to diagnose problems in the joints and soft tissues of the body. Physiotherapy for back pain provides a wide range of treatments to relieve pain, promote relaxation and restore movement. They include manipulation, mobilisation and massage. Exercise may also be used to increase general fitness or to strengthen muscles that support the spine.

Treatment

Treating back pain

Advice from Pain Concern

  • Learn to believe that your pain is what you say it is.
  • Pain makes you tired, sad and irritable. Explain this to your family and friends so they realise they are not to blame for you being unhappy.
  • Learn the art of relaxation and work at it daily. Relaxation tapes may help.
  • Get professional advice on appropriate exercise.
  • Set goals for yourself and break them down into workable parts – for example, by increase the distance you walk day by day.
  • Read positive and encouraging literature.
  • Ask your doctor about the availability of local pain-relief services, such as pain clinics.

Generally, back pain is categorised as:

  • Acute – where your back pain occurs suddenly and lasts for less than three months, and
  • Chronic – where your back pain develops gradually, over time, lasts for more than 12 weeks, and causes long-term problems.

However, most people with lower back pain experience mild pain and have occasional bouts of pain that are more severe. This can make it difficult to determine whether their back pain is acute or chronic.

Treating acute back pain

Most cases of acute back pain can be treated using self-help techniques. These are discussed below.

Over-the-counter (OTC) painkillers:
Paracetamol is usually recommended to treat acute lower back pain. If paracetamol proves ineffective, a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen may be used instead.

Stronger painkillers:
If your back pain symptoms are severe, your GP may prescribe a mild opiate-based painkiller, such as codeine, which can be taken in combination with paracetamol or a NSAID.

Muscle relaxants:
If your back pain symptoms are very severe, your GP may prescribe a muscle relaxant such as diazepam.

Diazepam can make you feel very sleepy, so do not drive if you have been prescribed this medication. After your course of diazepam has ended, you should wait at least 24 hours before driving. Diazepam will also make the effects of alcohol worse, so you should avoid alcohol while you are taking the medication.

Diazepam has the potential to be habit-forming, and can cause a number of unpleasant withdrawal symptoms when coming of the medication. To minimise these effects, your GP will not usually prescribe more than seven days worth of the medicine.

Exercise:
It’s important to remain as physically active as possible. While bed rest may provide some temporary relief from your symptoms, prolonged bed rest will make your symptoms worse.

Recommended exercises for back pain include walking and gentle stretching.

Your back pain may be so severe that you need to have some time off work. However, if this is the case, you should aim to return to work as soon as possible. While you may not feel any immediate benefit, research has shown the people who continue to work during an episode of back pain recover quicker than people who stay at home.

Compression packs:
Many people with back pain find that using either hot or cold compression packs helps reduce pain. You can make you own cold compression pack by wrapping a bag of frozen food in a towel. Hot compression packs are often available from larger pharmacies. You may find it useful to use one type of pack after the other.

Treating chronic back pain

This will usually require a combination of self-help techniques and medical treatment. Treatment options are discussed below.

Painkillers:
As with acute back pain, painkillers are usually the first method of treatment for chronic back pain. Initially, it is likely that paracetamol will be recommended, but if your back pain is severe, codeine may be prescribed.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, should only be used for long periods under the advice of your GP. If long-term treatment using NSAIDs is required, your GP may prescribe gastro-protective medicines, such as proton pump inhibitors (PPIs).

Amitriptyline:
If your back pain is severe and does not improve with the use of painkillers, your GP may recommend a one-month trial of a medication called amitriptyline. Amitriptyline is usually used to treat depression, but it has also been found to be useful in treating nerve pain.

If you are prescribed a course of amitriptyline, you may experience some side effects including:

  • drowsiness,
  • dry mouth,
  • blurred vision,
  • constipation, and
  • difficulty urinating.

You should not drive if you are taking amitriptyline and it is making you drowsy.

Amitriptyline should not be taken by people with a history of heart disease.

Exercise:
As with acute back pain, if you have chronic back pain, you should try to remain as physically active as possible because doing so will reduce the severity of your symptoms. It is also recommended that you continue working, or return to work as soon as possible.

Regular exercise will help to strengthen the muscles that support your back. Exercise also promotes the production of endorphins, which are natural painkilling chemicals. Ask your GP for advice about a suitable exercise plan for you.

Bending, twisting, or placing strain on your back can be painful. However, excessively protecting your back can delay return to normal activities. The trick is to be careful when making potentially painful movements, but to pace your return to full normal activity.

Physiotherapy:
If you have chronic back pain, Your GP may refer you to a physiotherapist – a qualified specialist who will be able to help you to improve your range of movement.

A physiotherapist will be able to teach you exercises that strengthen the muscles that support your back, as well as improving the flexibility of your spine. They can also teach you how to improve your posture and reduce any future strain on your back.

Cognitive behavioural therapy (CBT):
Some studies have shown that a type of therapy called cognitive behavioural therapy (CBT) can help in the management of chronic back pain.

CBT is based on the principle that the way you feel is partly dependent on the way that you think about things. Studies have shown that people who train themselves to react differently to pain, by using relaxation techniques and maintaining a positive attitude, report that their levels of pain went down.

They were also more likely to remain active and take exercise, further reducing the severity of their symptoms.

Surgery:
Surgery may be an option to treat cases of chronic back pain when:

  • there is an identifiable cause, such as a ruptured hernia,
  • the symptoms have not responded to other forms of treatment, and
  • the symptoms are getting progressively worse.

The type of surgery that will be recommended will depend on the cause of your back pain. Some surgical options are listed below.

  • Discectomy – where the part of the herniated disc that is pressing on your nerve is removed.
  • Fusion surgery – if a vertebra has slipped out of place, it may be possible to fuse it into place using metal rods.
  • Injections – a variety of injections are available that a surgeon can make into your back in order to help relieve the pain.

As with all surgical procedures, spinal surgery carries some risks. For example, following surgery, there is a 10% chance of infection. If this occurs, further surgery may be required to clean out the infection, although some cases can be treated with antibiotics.

In the case of fusion surgery, there is a 1-2% chance of the vertebrae failing to fuse into place. If this occurs, further surgery will be required.

There is a very low risk that your spinal cord will be damaged during surgery. The chances of this happening are estimated to be six in 1,000 (0.6%). In the rare situation that the spinal cord is damaged during surgery, it could result in problems ranging from some muscle weakness to total paralysis. Your bladder and bowel control may also be affected.

Before having back surgery, your surgeon will be able to fully discuss the risks and benefits of the procedure with you.

Complementary therapies:
Some people with back pain choose to use complementary therapies alongside more conventional treatments, while others choose to use them as stand-alone treatments

Complementary therapies such as chiropractic, osteopathy, shiatsu and acupuncture may help to ease your back pain, and encourage you to feel relaxed.

An osteopath is a health professional who specialises in treating the skeleton and muscles, and chiropractor treats joint, muscle and bone problems, focusing on the spine.

Shiatsu is a traditional Japanese technique that is often described as ‘finger pressure’ therapy. It is a form of massage that works by applying pressure to energy lines in your body. A shiatsu therapist will use their fingers, thumbs and elbows to carry out the treatment.

Acupuncture is a form of traditional Chinese medicine which involves the insertion of very fine needles at key points in the body. This can help encourage the body to release its natural form of painkillers, known as endorphins. It can also help to stimulate nerve and muscle tissue.

For many complementary therapies, clinical studies have not produced conclusive evidence as to their safety and effectiveness. Therefore, if you are considering using a complementary therapy, you should carefully weigh up any benefits and potential risks and discuss it with your GP if you are uncertain.

Transcutaneous electrical nerve stimulation (TENS):
The transcutaneous electrical nerve stimulation (TENS) machine is an increasingly popular treatment method for people with long-term back pain. The machine delivers small electric pulses to your body through electrodes that are placed on your skin.

It is thought that these pulses work in two ways. A low electric pulse can encourage your body to produce more endorphins – the body’s own painkilling chemical. A high electric pulse can also block pain signals going from your back to your brain.

Many medical studies have been carried out on the use of TENS but the results have been conflicting. Some studies suggest that the machines are of little use, while other studies suggest that they may be able to help certain people.

You should only use a TENS machine under the direction of your GP or other healthcare professional.

The following people should avoid using a TENS machine:

  • pregnant women – unless specifically advised to by their doctor,
  • people with epilepsy,
  • people who have a pacemaker fitted, and
  • people with a history of heart disease.

Managing your pain

Pain management programmes can help you to learn how to manage your pain, increase your activities and have a better quality of life. This is done with a combination of group therapy, exercises, relaxation and education about pain and the psychology of pain.

People with persistent pain may be able to attend a specialist pain clinic for assessment and possible pain management. You need to be referred to a pain clinic by your GP or consultant. For more information on pain clinics in your area, contact the British Pain Society.

Prevention

Preventing back pain

To avoid back pain, you must reduce excess stresses and strains on your back and ensure that your back is strong and supple.

If you have persistent, recurring bouts of back pain, the following advice may be useful:

  • Lose any excess weight
  • Practise the Alexander technique.
  • Wear flat shoes with cushioned soles, as these can reduce the stress on your back.
  • Avoid sudden movements or muscle strain.
  • Try and reduce any stress, anxiety and tension.

Posture

How you sit, stand and lie down can have an important effect on your back. The following tips should help you maintain a good posture:

  • Standing – you should stand upright, with your head facing forward and your back straight. Balance your weight evenly on both feet and keep your legs straight.
  • Sitting – you should be able sit upright with support in the small of your back. Your knees and hips should be level and your feet should be flat on the floor (use a footstool if necessary). Some people find it useful to use a small cushion or rolled-up towel to support the small of the back. If you use a keyboard, make sure your forearms are horizontal and your elbows are at right angles.
  • Driving – make sure your lower back is properly supported. Correctly positioning your wing mirrors will prevent you from having to twist around. Foot controls should be squarely in front of your feet. If driving long distances, take regular breaks so you can stretch your legs.
  • Sleeping – your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight. If your mattress is too soft, place a firm board – ideally 2cm thick – on top of the base of your bed and under the mattress. Support your head with a pillow, but make sure your neck isn’t forced up at a steep angle.

Exercise

Exercise is both an excellent way of preventing back pain and reducing any back pain you might have. However, if you have chronic back pain (back pain that has lasted more than three months), you should consult your GP before starting any exercise programme.

Exercises like walking or swimming strengthen the muscles that support your back without putting any strain on it, or subjecting it to a sudden jolt.

Activities like yoga or pilates can help improve the flexibility and the strength of your back muscles. It is important that you carry out these activities under the guidance of a properly qualified instructor.

There are also a number of simple exercises you can do in your own home to help prevent or relieve back pain:

  • Wall slides – stand with your back against a wall with your feet shoulder-width apart. Slide down into a crouch so your knees are bent to about 90 degrees. Count to five and then slide back up the wall. Repeat five times.
  • Leg raises – lie flat on your back on the floor. Lift each heel in turn just off the floor while keeping your legs straight. Repeat five times.
  • Bottom lifts – lie flat on your back on the floor. Bend your knees so your feet are flat on the floor. Then lift your bottom in the air by tightening your stomach muscles while keeping your back straight. Repeat five times.

At first you should do these exercises once or twice a day, and then gradually increase to doing them six times a day, as your back allows.

These exercises are also useful for ‘warming up’ your back. Many people injure their back when doing everyday chores at home or work, such as lifting, gardening or using a vacuum cleaner. ‘Warming up’ your back before you start these chores can help prevent injury.

Lifting and handling

One of the biggest causes of back injury, especially at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent back pain.

  • Think before you lift – can you manage the lift? Are there any handling aids you can use? Where is the load going?
  • Start in a good position – your feet should be apart with one leg slightly forward to maintain balance. When lifting, let your legs take the strain – bend your back, knees and hips slightly but don’t stoop or squat. Tighten your stomach muscles to pull your pelvis in. Don’t straighten your legs before lifting as you may strain your back on the way up.
  • Keep the load close to your waist – keep the load as close to your body for as long as possible with the heaviest end nearest to you.
  • Avoid twisting your back or leaning sideways – especially when your back is bent. Your shoulders should be level and facing in the same direction as your hips. Turning by moving your feet is better than lifting and twisting at the same time.
  • Keep your head up – once your have the load secure, look ahead, not down at the load.
  • Know your limits – there is a big difference between what you can lift and what you can safely lift. If in doubt, get help.
  • Push, don’t pull – if you have to move a heavy object across the floor, it is better to push it rather than pull it.
  • Distribute the weight evenly – if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body.

Preventing back pain in children

Back pain in secondary-school-age children has been linked to heavy schoolbags and ill-fitting classroom seating. Nearly half of all teenagers in the UK have experienced occasional backache from poor posture, carrying overloaded bags, and an unhealthy lifestyle.

The best schoolbag for your child is a well designed backpack. This should be worn over both shoulders to balance out the weight. A heavy satchel or shoulder bag can put stress on your child’s spine.

Encourage your child to exercise regularly, or plan joint activities, such as a walk in the countryside or a trip to a swimming pool.

References

CKS Guidelines (2008). Lower back pain and /or sciatica

Waddell, G. (2004) The back pain revolution. 2nd edn. London: Churchill

Expert View

Back pain expert Philip Sell on the questions to ask

We asked Philip Sell, consultant orthopaedic and spinal surgeon, what he would want to know if he was suffering from back pain.

What is the cause of my back pain?
In 85% of cases, we’re unable to be precise about why people have back pain. This can be frustrating. It may be more helpful to think about what you can do to make your back better quicker. Research has shown that occupational factors or physical factors only play a small part in back pain. Your genes are probably the most significant factor in back pain.

When should I visit my GP with back pain?
See your GP as soon as possible if the back pain is combined with difficulty in passing urine or numbness between the legs or around the bottom. For people over the age of 55 with new back pain, a previous history of cancer surgery or loss of weight should also be medically checked as soon as possible.

Should I be resting?
You may feel it’s the wrong thing to do, but keep mobile and active. Resting, bed rest in particular, can prolong the duration of an episode of back pain. Most acute episodes of back pain will settle on their own, often within days rather than weeks. Taking pain relief and keeping active will stop stiffness setting in and keep muscles in good condition.

Are there any drugs to help me cope with the pain?
Constant pain can grind you down and make it more difficult to cope. Take a combination of painkillers and anti-inflammatories, such as paracetamol (1g) every six hours and ibuprofen (400mg) every eight hours. Short courses of this type of tablet are very safe, which is why they’re available over the counter. Ask your pharmacist if it’s OK for you to take ibuprofen.

Should I be worried that my back pain will get worse as I get older?
No. Even the most serious cases of back pain usually improve with time. As people age, the discs in the back lose some of their water content and become stiffer and less likely to prolapse or have sciatica.

My friends and family have been giving me advice about how to handle my back pain. I’m confused. What should I do?
Back pain and sciatica are common conditions and everyone seems to have a story. Mixed messages about what to do or what not to do can be confusing and a bit worrying. Use reliable information sources and make sure you’re treated early.

Real Stories

Anne’s story

‘I’ve picked up my life again’

Back pain was agony for Anne Parker, 68, from Berkshire, but thanks to the right diagnosis she’s now walking tall

“My bad back started 12 years ago, with pains in my right buttock. When I saw my GP, he said the problem was actually my back and gave me painkillers. I do orienteering so I tried to move and stretch more, but the pain just got worse. Then I saw an osteopath, who said I should rest.

“One morning, when I was getting up, I rubbed the bad spot on my spine. It triggered a sciatic spasm that left me immobile and screaming in pain. My GP gave me stronger painkillers and anti-inflammatories, which improved things when I was lying down or standing up, but sitting was agony. I still went walking, though. Now it’s recognised that exercise is one of the best things for certain kinds of back pain.

“A year later, I had an X-ray and an MRI scan and discovered I had a lateral stenosis, a build-up of tissue that blocks the spinal canal. The treatment was an injection of steroids into my spine. It took away the constant, gnawing pain. Three months later I was able to go orienteering again.”

Kiran’s story

‘I can continue going about my daily life’

Kiran Mohan, a 42-year old teacher, has suffered from lower back pain for the past seven years

“My back problems started in 1999 when I developed a severe pain in the heel of one of my feet, which gradually progressed to the other foot. It was incredibly painful and badly affected my walking. It was eventually diagnosed as plantar fasciitis, a condition where the heels and surrounding joints become inflamed. This condition means that I walk with a limp, which in turn kicked off my lower back pain.

“Because I’m a teacher, I’m unable to remain seated for most of the day to take the weight off my feet, which can make the problem much worse. My doctor recommended a lower back exercise class, which was a six-week course of relevant exercises. It did help and I found that the exercises gave me some relief. But over the years, I’ve also privately seen an osteopath, had acupuncture and tried Pilates. In addition, because of limping, I’ve had a couple of falls, which have caused whiplash and made my lower back pain much worse.

“In 2002, after trying just about everything, I started to see a chiropractor and since doing so I have seen a significant improvement. Unfortunately, due to my day-to-day life I’m not able to rest as much as I would like and no doubt this affects the rate of my recovery. Chiropractic treatment has certainly improved my quality of life and, with a few treatments along the way, I can continue going about my daily life.

Useful links

NHS Choices links

External links

This article was originally published by NHS choices

Taking care of your back at home: MedlinePlus Medical Encyclopedia

A common myth about back pain is that you need to rest and avoid activity for a long time. In fact, doctors DO NOT recommend bed rest. If you have no sign of a serious cause for your back pain (such as loss of bowel or bladder control, weakness, weight loss, or fever), stay as active as possible.

Here are tips for how to handle back pain and activity:

  • Stop normal physical activity for only the first few days. This helps calm your symptoms and reduce swelling (inflammation) in the area of the pain.
  • Apply heat or ice to the painful area. Use ice for the first 48 to 72 hours, then use heat.
  • Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
  • Sleep in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.
  • DO NOT do activities that involve heavy lifting or twisting of your back for the first 6 weeks after the pain begins.
  • DO NOT exercise in the days right after the pain begins. After 2 to 3 weeks, slowly begin to exercise again. A physical therapist can teach you which exercises are right for you.

EXERCISE TO PREVENT FUTURE BACK PAIN

Through exercise you can:

  • Improve your posture
  • Strengthen your back and abdomen, and improve flexibility
  • Lose weight
  • Avoid falls

A complete exercise program should include aerobic activity such as walking, swimming, or riding a stationary bicycle. It should also include stretching and strength training. Follow the instructions of your doctor or physical therapist.

Begin with light cardiovascular training. Walking, riding an upright stationary bicycle (not the recumbent kind), and swimming are great examples. These types of aerobic activities can help improve blood flow to your back and promote healing. They also strengthen muscles in your stomach and back.

Stretching and strengthening exercises are important in the long run. Keep in mind that starting these exercises too soon after an injury can make your pain worse. Strengthening your abdominal muscles can ease the stress on your back. A physical therapist can help you determine when to begin stretching and strengthening exercises and how to do them.

Avoid these exercises during recovery, unless your doctor or physical therapist says it is OK:

  • Jogging
  • Contact sports
  • Racquet sports
  • Golf
  • Dancing
  • Weight lifting
  • Leg lifts when lying on your stomach
  • Sit-ups

TAKING MEASURES TO PREVENT FUTURE BACK PAIN

To prevent back pain, learn to lift and bend properly. Follow these tips:

  • If an object is too heavy or awkward, get help.
  • Spread your feet apart to give you a wide base of support.
  • Stand as close as possible to the object you are lifting.
  • Bend at your knees, not at your waist.
  • Tighten your stomach muscles as you lift or lower the object.
  • Hold the object as close to your body as you can.
  • Lift using your leg muscles.
  • As you stand up while holding the object, DO NOT bend forward. Try to keep your back straight.
  • DO NOT twist while you are bending to reach for the object, lifting it up, or carrying it.

Other measures to prevent back pain include:

  • Avoid standing for long periods. If you must stand for your work, place a stool by your feet. Alternate resting each foot on the stool.
  • DO NOT wear high heels. Wear shoes that have cushioned soles when walking.
  • When sitting, especially if using a computer, make sure that your chair has a straight back with an adjustable seat and back, armrests, and a swivel seat.
  • Use a stool under your feet while sitting so that your knees are higher than your hips.
  • Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods.
  • If you drive long-distance, stop and walk around every hour. DO NOT lift heavy objects just after a long ride.
  • Quit smoking.
  • Lose weight.
  • Do exercises to strengthen your abdominal muscles. This will strengthen your core to decrease the risk of further injuries.
  • Learn to relax. Try methods such as yoga, tai chi, or massage.

Your back pain – Ravijuhend

Back pain is pain that occurs in the area between the lower ribs and the gluteal folds and can spread to one or both legs. Almost all people can have lower back pain at some point in their lives – this is completely normal and almost always goes away on its own. More than 90% of low back pain is so-called non-specific low back pain with a good prognosis, which means that it is not caused by any dangerous disease or nerve root entrapment. Nonspecific low back pain is usually caused by small soft tissue changes such as muscle tension and tenderness in the tissues surrounding the spine. Very rarely, in only 0.9% of cases, low back pain is caused by a serious medical condition, such as a spinal fracture, tumor, infection, systemic inflammatory rheumatic disease, or other medical condition (see Signs of Danger). These conditions are different from nonspecific low back pain and can usually be diagnosed by your doctor with a questionnaire, examination, and, if necessary, a blood test.

It should be noted that even if the pain is very severe and interferes with daily activities, it is unlikely to indicate a serious illness or injury. With severe back pain, there may not be any visible damage or tissue damage – your back just feels tender. Even with small changes, the pain receptor system can be activated and cause pain. Factors that can affect your pain sensations include mood and stress levels, previous pain sensations, sleep quality, lifestyle, and general physical health.

Low back pain usually diminishes over a period of a few days to 2-3 weeks, but sometimes it takes longer. Lower back pain may recur, but this does not mean there is a serious cause for concern. Sometimes low back pain with a good prognosis can also last a long time. Constant, i.e. chronic low back pain is pain that lasts more than 12 weeks. Why our brain and the pain receptor system at some point decide that the pain will remain, even if there is no damage – we, unfortunately, do not know.Longer-lasting low back pain may be due to our own thinking or behavior that interferes with recovery. Factors such as the intensity of pain, accompanying shooting pain in the legs, obesity or smoking can contribute to the persistence of low back pain and the formation of disability in the presence of intense pain. Depression, fear of illness, intense fear of pain, hard physical work, job dissatisfaction, or seeking social security are inhibited from recovery.In some cases, repetitive movements and forced postures can contribute to the persistence of lower back pain.

Thoughts that may make recovery slow:

  • Pain is dangerous and uncontrollable
  • I probably have a very serious illness, the doctors cannot find it
  • The pain probably gets worse when I move more and do something more actively
  • The pain must completely disappear before I can return to work
  • I do not exercise because it is not a treatment
  • I am only helped by passive methods of treatment, such as warming, electrotherapy, acupuncture, manual therapy, etc.d.
  • I have frequent mood swings (depression, anxiety)
  • I was left alone with my problems
  • My job is too difficult for me and aggravates my illness
  • I have no job, I could lose my job
  • I handle my illnesses and treatments so thoroughly that I no longer have enough time and energy for daily activities such as work, hobbies and friends

Low back pain usually does not mean serious injury. Low back pain in 99% of cases does not indicate a life-threatening disease.

Spinal tests (x-rays, computed tomography, or magnetic resonance imaging) usually do not help find the cause of non-specific low back pain. The examination does not change the rate of recovery from lower back pain or the treatment plan. Many of the changes found during examinations may scare you, but in fact they are quite common, occur in many people and do not cause pain.At the same time, surveys carried out “just in case” have risks that are best avoided. For example, ionizing radiation from X-rays and computer examinations increases the risk of cancer. In addition, changes observed during the examination can cause severe stress, anxiety and anxiety, even if they are minor. A person may begin to believe that his back is damaged and needs protection, because of this, the fear of pain increases, the muscles become even more tense and movement becomes more difficult.The above, in turn, complicates recovery and increases the likelihood of unnecessary surgery. Imaging exams are important in deciding whether to undergo surgery or to identify serious causes of back pain, such as tumors, infections, and vertebral fractures. Only a very small group of people (less than 1%) have serious conditions that cause back pain that your doctor can recognize.

Not all causes of back pain can be recognized during examinations.Lifestyle risk factors are very important!

Schematic diagram of the need for an examination

In the case of non-specific low back pain, examinations in the acute pain phase (up to 6 weeks) are usually not required.

There are many things you can do to relieve back pain. The pain can be frightening and it is natural to be afraid of it, but avoidance of physical activity, fear and reluctance to leave bed tend to keep the pain alive.

For normal or non-specific low back pain, physical activity does not harm the back. The pain goes away more quickly if you stay physically active and continue with your daily activities for as long as possible despite the pain. Pain relievers can also help you recover faster. Limit (but do not rule out) activities that make your pain worse, but at the same time gradually increase the amount of other physical activity.

Normal daily activities include going to work, household chores, and leisure.Continuing a normal life will distract you from pain as much as possible and your back will not weaken or numb.

If it is really necessary to take a sick leave, it should be short-term and its goal should be to return to work as soon as possible, if possible at least part-time .

When the pain subsides, you can try more vigorous back exercises. In the case of more complex conditions, rehabilitation treatment is necessary.

There are other ways to treat pain besides physical activity: get enough sleep, quit smoking, manage stress, and achieve a healthy weight.

Tips for recovering from back pain:

  • In case of back pain, it is necessary to move and gradually increase the load
  • Do not be afraid of pain, because pain does not necessarily mean dangerous injury or damage
  • If your back hurts, relax, breathe calmly, move and try to move your back as usual
  • Movement and stress keep your back strong and healthy
  • Your leisure activities are not hazardous to your back.
  • Forward bends are safe.
  • Try to get back to work as soon as possible
  • Move regularly if you feel better
  • A good night’s sleep, weight management and smoking cessation will help you get rid of back pain
  • Quitting smoking helps keep your back healthy

The goal of pain management is to reduce the discomfort caused by your pain and quickly regain mobility.Pain relievers are never used as the only treatment.

Do not endure pain! The sooner you can control your pain, the faster you will recover. When the pain subsides, you can also increase your physical activity!

Pain relievers should be used to treat low back pain for a short time. Immediate pain relief effectively promotes recovery and allows you to quickly restore your daily rhythm of life.If the pain persists after 5-7 days, even if you are on pain relievers and are still active, talk to your family doctor.

Medicines

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac, dexketoprofen, naproxen, aceclofenac, ketoprofen, and etoricoxib are commonly required to treat low back pain. Side effects from taking these drugs for a long time can include damage to the gastrointestinal tract (such as stomach and small intestine ulcers), kidney damage, and worsening or complication of cardiovascular disease (from high blood pressure to heart attack).If you have any of the above conditions, your doctor will need to evaluate how well this type of medication is right for you. Sometimes your doctor will need a combination of medicines to relieve pain: add paracetamol or use opioids such as tramadol, codeine, oxycodone, and morphine. These medicines can cause side effects such as nausea, vomiting, constipation, and drowsiness. Therefore, opioid use can affect your ability to perform activities that require concentration, such as driving a car.Opioids are more likely to be taken for a short time while the pain is severe and NSAIDs have no effect or are contraindicated. Opioids may be necessary for very severe back pain, but you should not be afraid that you may become addicted to their short-term use.

Other drugs that affect the nervous system are sometimes added to the pain management regimen. Antidepressants are also used to treat low back pain, especially for chronic pain. In the human brain, there are many similarities between the mechanism of chronic pain and the mechanism for regulating mood or stress.Therefore, antidepressants may be part of a chronic pain regimen, not because you are depressed or stressed, but because antidepressants relieve pain through other mechanisms.

To relieve pain and achieve faster treatment results, the following principles should be observed:

  • Pain medications should be taken by mouth (tablets), no injections or other drugs are required.
  • Initially, pain relievers should be taken regularly at regular intervals.
  • Anesthetic drug (s) are selected individually depending on the severity of pain, concomitant diseases, etc.
  • Medicines should be taken in the correct amount (optimal dose), i.e. not too little and not too much
  • Pain management is gradual, that is, if one drug does not relieve pain, then more effective drugs are included in the treatment regimen
  • The same types of pain relievers cannot be combined with each other.For example, ibuprofen, a member of the NSAID group, is not used in combination with diclofenac from the same group.
  • Do not take several medicines with the same active ingredient, as this can cause a dangerous overdose.
  • Tell your doctor or nurse if you have or have any gastrointestinal problems, bleeding, asthma, liver, kidney, or heart disease, or allergies to medications.

Untreated pain that lasts for several weeks along with a feeling of fear can lead to chronic pain and / or depression.In the case of a chronic pain mechanism, the brain’s pain control center is disrupted. In this case, pain relief becomes more difficult, and you will need even more of your own activity, specialist interventions and medications to heal.

In the case of chronic pain, the pain management regimen should be reviewed. Sometimes it is necessary to improve other aspects of treatment (rehabilitation, cognitive-behavioral therapy, etc.) and to revise the pain management regimen.

Discuss additional treatments with your family doctor.

When acute back pain occurs, you can first try to find body positions on your own to ease the pain and movement. Then, restorative treatment is usually not required. When the initial pain subsides, it is recommended that you continue with the exercise.

If necessary, your doctor will refer you to a physical therapist who will teach you the exercises and make sure they are available to you and performed correctly. People with seemingly large, strong muscles are often surprised to learn that certain muscles are actually weak and need to be trained separately.

The physical therapist will create an exercise program that suits you. In the future, you must do the exercises yourself. Moderate exercise and muscle maintenance will help relieve or eliminate your pain and reduce the risk of recurrence of pain attacks or pain becoming chronic.

You can also try the exercises in the water. This can be beneficial for recovery, as people with back problems are encouraged to exercise in the water and swim.

If your pain persists with the initial mild methods or continues to bother you for more than 8 weeks, you need a complex, comprehensive rehabilitation. To do this, your family doctor will refer you to a rehabilitation doctor (rehabilitation therapist) who will draw up an individual treatment plan for you. The rehabilitation physician uses combination therapy and, if necessary, in addition to the physiotherapist, includes other members of the rehabilitation team of specialists, such as an occupational therapist, clinical psychologist and specialist in pain management.

Additional assistance is often required using passive therapy in which the individual is not actively involved, such as electrotherapy, stretching therapy, manual therapy, and massage. Nevertheless, the main key aspect of successful treatment is considered to be the activity of the patient himself and the further process of recovery, improvement and maintenance of physical shape. However, manual therapy, acupuncture, and massage combined with exercise can also relieve pain.Electrotherapy and the use of orthoses for lower back pain are not recommended.

In the very acute phase of back pain, warming creams and warm treatments (such as paraffin wax and mud) should be used with caution in the beginning, as they can worsen back pain. In most cases, they are well suited for the pain relief phase and chronic pain.

In the case of chronic back pain, your rehabilitation treatment may take longer, as part of this, the physiotherapist will develop an individual exercise program that will take into account the specifics of your condition.Exercise may gradually become more intense as you recover.

For persistent low back pain, your health care provider or rehabilitation therapist may consider referring you to a clinical psychologist who will use a variety of treatments and teach you how to best deal with your pain. If your mood has fallen and medications have not helped, sometimes you need to see a psychiatrist to relieve depression.

Exercise, keeping the spine in motion, and strengthening the muscles reduce pain and prevent pain from recurring.That is, physical activity plays an important role in the treatment of low back pain. Therefore, regular physical activity should be a faithful companion in your life in the future.

Already during the first onset of lower back pain, it is recommended to start doing aerobic training for the first 2 weeks, and then extend the training period. If the pain subsides, back exercises should be added. As your physical fitness improves, you can start training your muscles throughout your body.

You should do aerobic workouts longer and more often.Additional workouts can be carried out on weekends. Stretching is part of the workout routine, it relieves muscle tension and is very important for heavy, high-load exercise and older adults.

  • Aerobic Training:

– walking, Nordic walking, swimming, cycling, water gymnastics, dancing, etc.
– 30 minutes at least 5 days a week with moderate physical activity

  • If you are overweight, then if you feel well, you should continue training.
  • Overweight Exercise is a moderate-intensity workout lasting at least 60 minutes and at least 5 days a week.
  • Muscle training – 8-12 times for the whole body, each exercise for large muscle groups 2-3 times a week
  • Stretching at least 3 days a week, and stretching exercises are recommended after each workout

Regular exercise guarantees good health, the main thing is that the exercise is pleasant for you, so your mood will improve.Participation in group training also works well.

Pilates and oriental exercises such as Tai Chi and Yoga are very effective with regular exercise to treat chronic pain and prevent back pain. These exercises simultaneously strengthen muscles and restore tissue elasticity and spine mobility.

When exercising, you should first monitor your well-being in order to prevent inappropriate postures.

If necessary, ask your doctor, physician or physiotherapist for advice on the exercise that is right for you.

Be sure to seek advice if you have osteoporosis, spinal instability, advanced osteoarthritis or other serious joint problems, or if you have had a knee or hip replacement.

If the pain persists despite everything, it will be helpful for you to learn to live with your pain.

Recommendations for people with back pain:

  • Stay physically active
  • If you have to sit for a long time, get up every 15 minutes – stretch, walk and use large muscle groups
  • Use ladder
  • Get off one stop early and walk
  • Dance every time good music sounds, at least half a minute
  • Get good cleaning and maintenance tools that are comfortable to work in an upright position.Swap hands and sides of your body
  • Purchase a special therapy rubber ball (fitball) or a balance stand that is installed on the chair to watch TV while sitting on them. Take a short walk or stretch during each commercial break
  • Stop watching TV or using the computer every quarter of an hour, change your seating position or posture.
  • Take a break from daily activities or work if you are in pain
  • Do not delay the work until your strength runs out, but finish 5-10 minutes earlier and rest
  • Use reminder tools as needed
  • During the treatment of back pain, it helps to understand that back pain (if there was no injury) usually does not mean any kind of back injury or dangerous illness.Move, be active, work and do what is important to you
  • Physiotherapists can help you design customized exercises as needed
  • Don’t fall into the trap of someone confidently promising to tidy up your back – this rarely works in the long run, it’s important to remember that you are the only real key to successful treatment and good back health!
  • When you are sent for a test, keep in mind that many of the test results are common to all people.
  • If back pain persists and causes concern, seek advice from your family doctor.
  • In the event of any danger signs, contact your family doctor immediately
  • The team of specialists involved in the treatment of chronic nonspecific back pain often includes several specialists (e.g. physiotherapist, rehabilitation physician, pain specialist, clinical psychologist)

Contact your (family) doctor immediately if you have any of the following symptoms (so-called danger signs):

one.Low back pain accompanied by difficulty emptying or controlling bladder or bowel
2. Low back pain accompanied by numbness around the genitals or both legs
3. Back pain is accompanied by a feeling of weakness in the leg (s), which increases every day
4. Back pain is the result of a more serious injury
5. Constant very severe back pain, which does not decrease after taking painkillers
6.Generally feeling unwell with low back pain, episodes of fever, or unexplained weight loss
7. Severe increasing pain, unexplained weight loss, previously diagnosed malignant neoplasm

Iliopsoas syndrome: symptoms, pain and treatment in Moscow

What is iliopsoas syndrome

Syndrome of the iliopsoas muscle, or, more precisely, myofascial syndrome of the iliopsoas muscle, is a pathology that develops in the thickness of muscle tissue.Under the influence of a number of pathological factors, a spasm of a small area of ​​muscle fibers occurs. This microscopically small area of ​​spasmodic muscle fibers is called the starting point or trigger point. Under certain conditions, the trigger point is activated and triggers a painful spasm of the entire muscle. Thus, myofascial syndrome of the iliopsoas muscle is the presence of one or more trigger points in it, which can cause a very painful spasm of the iliopsoas muscle.

Often, the syndrome of the iliopsoas muscle develops against the background of osteochondrosis, protrusion or disc herniation. In these cases, the pain that is actually caused by a spasm of the iliopsoas muscle is mistakenly considered to be the action of a hernia, osteochondrosis or protrusion. Faced with such a situation, it is really possible to make a mistake and get away from the correct diagnosis, if you do not have good theoretical and practical training. Myofascial syndrome of the iliopsoas muscle is an insidious and complex disease that requires experience and knowledge from the doctor.

Location and structure of the iliopsoas muscle

Symptoms of the syndrome of the iliac psoas muscle

With iliopsoas muscle syndrome, the symptom, most often, is lower back pain, which has a number of features:

  • First, this pain is distributed vertically – along the spine.
  • secondly, if one iliopsoas muscle hurts, the symptoms are painful on one side, and if both muscles, then the whole lower back hurts from top to bottom.
  • thirdly, the pain increases in an upright position – standing and walking, and decreases – lying with bent legs. Moreover, you can lie on your back and on your side, the main thing is that your legs are bent. But most conveniently – on the side, in the embryo position.

The second zone of pain, after the lower back, is the thigh-groin and lower abdomen. If such pain is felt on the right, it is important not to confuse it with appendicitis, especially with its chronic form. And, if we are already talking about the relationship with internal organs, it is worth noting that when the iliopsoas muscle hurts, the symptoms of pain can increase due to the effect on the intestinal muscle.For example, in patients with constipation. Also, a clear relationship has been described between the painful sensations of female internal genital organs and the iliopsoas muscle [Ibid. Volume II. P.110].

The next common symptom of iliopsoas syndrome is pain when getting up, especially from a low couch or chair. The same sensations arise when trying to sit up from a lying position. In the most severe cases, the patient, in general, cannot stand upright, but only moves on all fours.

Another symptom of iliopsoas syndrome can be scoliosis. This is due to unilateral shortening of the affected muscle, leading to a temporary lateral curvature of the spine.

Violation of extension in the hip joint is manifested by the fact that it is difficult for the patient to take the leg back. This condition is also a typical symptom of iliopsoas syndrome.

As you can see, all the symptoms are quite clear, however, some of them are characteristic of other muscles as well.In medicine, it is important to be able to distinguish – differentiate – situations when the symptoms are similar, but the causes are different. This is what is called differential diagnostics. In general, keep in mind that some muscles produce pain patterns similar to those of iliopsoas syndrome. For example, the square muscle of the lower back gives a similar pain. The difference is that with a lesion of the square muscle, the pain increases with coughing and deep inhalation, which does not happen with damage to the iliopsoas muscle. The second difference is that the iliopsoas muscle gives vertical lower back pain, while the square one gives horizontal, transverse pain.The same, transverse back pain, can cause damage to the abdominal muscles. In general, when you think that the iliopsoas muscle hurts, the symptoms must always be differentiated from other possible causes, and it is very difficult to do it yourself, without a competent doctor and qualified manual diagnostics.

Iliopsoas muscle. Anatomy. Pain zones.

We have two iliopsoas muscles – left and right. They are located inside the body. Imagine the spine.The spine has a back that can be touched from the back and a front that faces the stomach, more precisely, our internal organs. So, the iliopsoas muscles are located on the spine from the side of the abdomen. Starting at the top, at the diaphragm and ribs, they stretch inside the body, along the entire lumbar spine and sacrum; then through the pelvis they go out in the groin area to the thigh and are attached there in a small section, each on its side. Now let’s put this in a slightly different perspective.Before us is the human stomach – the anterior abdominal wall. Inside, under it, is the intestine. Below it, in the depths – the kidneys, and under the kidneys are the iliopsoas muscles, which lie on the front surface of the spine. Have you presented? Thus, the iliopsoas muscles attach to the spine and pelvis with their larger side, and to the thigh only in a small area.

These details are very important. By understanding how the iliopsoas muscles are located and where they attach, it will be easy for you to understand why they most often cause lower back pain.

What is the Hair Principle?

If you pull a person by the hair, then he will feel pain not in the hair itself, but where the hair is attached to the head – at its root. We call this principle the hair principle. A similar picture occurs with a spasm of the iliopsoas muscle – pain occurs where the muscle is attached. And, as we said, most of the iliopsoas muscle is attached to the lumbosacral spine. Therefore, it is in the lower back that a painful attack occurs in 85% of patients.In the remaining 15%, pain occurs where the second end of the muscle is attached – in the groin – thigh – lower abdomen area.

Diagnosis and treatment of iliopsoas muscle syndrome.

The treatment of iliopsoas muscle syndrome is handled by a chiropractor. But, in order to start treatment, you need to make sure that the pain is caused by the muscle, and not another problem. Hence, a diagnosis is needed. And here I would like to draw your attention to the following.If it were so that while a person is sick with one disease, the other does not “cling” to him – it would be easy and simple for doctors to make diagnoses. But, unfortunately, everything is much more complicated. Simultaneously with the syndrome of the iliopsoas muscle, a person may have osteochondrosis, protrusion, and herniated disc, and arthrosis of the hip joint, and a whole bunch of other diseases. Try to correctly identify the cause of the pain and make an accurate diagnosis in such a situation. And here, a truly indispensable diagnostic method is muscle testing.It is safe to say about him that he accurately identifies sore and affected muscles. Our doctors are fluent in this method and will be able to clearly identify the syndrome of the iliopsoas muscle. And when the diagnosis is established, you can safely start treatment.

Sign up for the diagnosis of the iliopsoas muscle at the Spina Zdorova clinic

  • Let’s find out what causes the symptoms – the syndrome of the iliopsoas muscle, osteochondrosis, protrusion or herniated disc.Let’s do manual muscle testing.
  • Duration of diagnostics – 30 minutes. This is a full-fledged examination, and not a 2-minute “feeling” for show.
  • The diagnosis is carried out personally by Dr. AA Vlasenko, a doctor with 30 years of experience, an expert in the treatment of myofascial and radicular syndromes.

Treatment of the syndrome of the iliopsoas muscle consists of the main and auxiliary methods. The main type of treatment for the syndrome of the iliopsoas muscle is mild manual therapy, auxiliary – medications, physiotherapy, exercise therapy, etc.Gentle manual therapy is fundamentally different from conventional manual therapy. Already in its very name there is an answer to the question: “What’s the difference?” She is soft. Mild manual therapy is very similar to osteopathy and massage for lumbar-iliac muscle syndrome, but it is significantly superior in effectiveness.

In addition to manual intervention, the treatment of iliopsoas muscle syndrome may require ancillary medication. This is usually required for advanced and chronic forms of iliopsoas syndrome.According to the tradition established in our clinic and being adherents of the ecology of the internal environment of the body, we try not to prescribe medications without good reason.

Gentle manual therapy relaxes the iliopsoas muscle effectively and safely. With the help of deep study, it will relieve stress and spasm and reliably eliminate pain syndrome.

Benefits of treatment in the Spina Zdorova clinic

  • Guarantee of complete and qualified treatment.The word “complete” is the key word in our work.
  • High qualifications and extensive practical experience – 30 years.
  • We consider each case individually and comprehensively – no formalism.
  • Synergy effect.
  • Guarantee of honest attitude and fair price.
  • Location a stone’s throw from the metro in the very center of Moscow.

Postoperative Period – Fusion – HUG Neurosurgical Service Geneva | HUG

Day of surgery

Before you are transferred to your ward, you will receive thorough care in the anesthesia ward.A team of service personnel will answer your questions, coordinate and provide assistance related to your health condition.

After the operation, you can start drinking as soon as the sounds of intestinal peristalsis appear (“rumbling” in the abdomen or flatulence). The nurse, with your help, will regularly assess your pain and adjust your medication based on the severity of the pain. However, do not hesitate to tell the nursing staff about any pain or discomfort you are experiencing.

For 48 hours every four hours, day and night, the nurse will check your limb sensitivity and mobility.

After the operation, you will remain on your back for the time specified by the surgeon, and then a member of the service team will help you roll onto your side using the positions below.

Relaxed position with a pillow
under the knees

On the side with a pillow
between the legs

The first days after surgery

You can usually start eating the next morning, after permission from the neurosurgeon from the speed of the resumption of intestinal transit.At the discretion of the neurosurgeon, you can be placed on a bed with a raised (30 °) headboard without using a pull-up rack. You will be given an x-ray (x-ray or CT scan) either during surgery or within 48 hours after surgery, but always before the first ascent.

The first time you get up, a nurse or physical therapist will help you sit on the edge of the bed and then into the wheelchair. You will then be taken to the washroom to clean yourself up.

Depending on your surgery, your doctor may prescribe a brace or neck collar to help support your spine during movement.

“The hardest thing in the early days was movement: getting up, moving in bed, sitting down was painful. Physical therapists quickly taught me how to climb according to a strict protocol. They gave me an illustrated brochure that beautifully depicted the correct postures showing how to avoid movement in the operated areas.The pain became less and less every day. I was looked after all the time, even at night ”
Mark, 55 years old

How to get out of bed correctly?

These exercises help protect your back while lifting. Strictly follow these guidelines throughout your recovery period.

For cervical spine surgery

Roll over on your side with your whole body

Raise the back of the bed as much as possible

Lower your legs and push off

with your hands

back straight

For lumbar spine surgery

Roll over on your side with your whole body

Keep your back straight, lower your legs and push with your hands to sit down

Keep your back straight From 3 to 6 after surgery

You can shower, being careful not to get the dressing (s) wet.The service staff will help you wash your back.

The physiotherapist will walk with you down the hallway. You will do the exercises with him, and he will advise you on the movements and / or postures that you will need to adhere to.

Toning exercises for the trunk after lumbar spine surgery.

The movements described below will strengthen the dorsal and abdominal muscles.

While exhaling, press on the bed with your head, with both hands, left foot and extended right leg, while inhaling, relax.Perform this exercise again, pressing with your now right foot and extended left leg. If you can, repeat the exercise 10 times on each side.

While exhaling, press your left hand on your right knee, while inhaling, relax. Do this exercise again with the other leg. If you can, repeat the exercise 10 times on each side.

As soon as possible, the physiotherapist will guide you to the stairs and go up and down the stairs with you.

Back pain: how to become a chronicler | Articles

Headache, back problems, joint discomfort – everyone at least once in their life experienced this on themselves. However, there are people who are quite healthy who suffer from pain all their lives. A neurologist, associate professor of the Department of Nervous Diseases and Neurosurgery of the Faculty of Medicine of the First Moscow State Medical University named after M.V. AND.M. Sechenova, member of the board of the European Federation of Pain Maxim Churyukanov.

– People who all the time seem to be complaining for no reason that something hurts them, are they not making it up? Is there really such a phenomenon – pain as a chronic disease?

– Of course, the prevalence of this problem is very high. In Europe, officially one in five, 20% of the population, 75 million people, suffer from chronic non-cancer pain. This is pain that has been present for more than three to six months.There is such a strange term, a concept that has been talked about for a long time – “painful disease”. That is, at present, chronic non-oncological pain is considered not as a symptom, but as an independent disease.

– Is there such a diagnosis?

– In 2022, a new international classification of diseases will appear. It has already been adopted by the World Health Organization, and sometime until 2022 we will work to adapt it to the Russian language and translate it.There is already a heading “Chronic pain as a diagnosis”. It is important that such a diagnosis can only be made by a doctor after a reasonable thorough examination and examination of the patient and the correct interpretation of the results of the examination.

Photo: Depositphotos

– How is chronic pain different from acute pain?

– Basically, these are two completely different states. There is a concept of physiological pain, that is, good, if I may say so, when it is a signal of some kind of danger.When there is damage, there is a signal and the person does something to save himself. And this is the correct physiological response. But when pain exists for a long time, it loses its physiological features and becomes pathological. That is, bad pain that does not carry a danger signal. It already brings suffering on its own – the tissue heals, the damage is repaired, and it continues to hurt.

– How to determine when it shouldn’t hurt anymore, where is this line?

– It is impossible to say what this line is, for this it is necessary to examine the patient.For example, his back hurts. We now know which pathological changes can really give pain as a symptom, and which cannot. If earlier, for example, it was believed that osteochondrosis is the cause of all back pain, now views are changing, and we understand that not the osteochondrosis itself, but other reasons can lead to this. Acute pain is a signal, chronic pain is pain that already exists outside the area of ​​damage. These are peculiar, complex mechanisms already inside the nervous system, they are wrong, they are broken.So we must identify them and influence them.

– What is the mechanism of pain in trauma?

– When a person is damaged, he is perceived by receptors that are located in the surface tissues. They fix this damage, and the signal is transmitted through the peripheral nerve to the spinal cord, then enters certain parts of the brain, which are responsible for the perception of this information. Based on previous experience, the nervous system analyzes whether it is dangerous or not, it all takes milliseconds.And if it is dangerous, it gives a signal in order to avoid this damage. Therefore, we withdraw our hand if, for example, we are burned or pricked – that’s it, the nervous system has realized that it is dangerous and it does not need to be done. This is a reaction to acute pain.

– What about chronic pain?

– Everything is different here. If this signal, which initially appeared, comes to the nervous system, which does not quite adequately perceive it …

– … why?

– This is a very difficult question.As a rule, this depends on many factors: how a person understands the danger of one or another injury, what is his previous painful experience, cultural traditions, how he was brought up in the family, how his parents reacted to his first steps and falls. This is all that determines the formation of the cognitive components of pain. This is how the nervous system is prepared to receive a signal. If he comes to a place where not everything is set up correctly or a person has received inadequate information about pain that is happening, then everything begins.

Photo: Depositphotos

– For example?

– A prime example is back pain. Now on the Internet everyone is frightened with hernias, protrusions in the spine, they write that this is the cause of back pain, it is very dangerous, that it always needs to be urgently treated, and if not treated, it will certainly lead to something terrible. Some medical organizations even deliberately create fear in their patients. If, after reading this, his back suddenly starts to hurt, subconsciously there is a feeling that this may be associated with some dangerous condition.And if he does not understand this immediately, then on the basis of the alleged danger, this insignificant signal will begin to persist for a long, long time in the nervous system. And then, in order to break this vicious circle, a person will need not just treatment in the form of pain relievers or massage, but cognitive-behavioral psychotherapy. Abroad, this is one of the main methods of treating such conditions.

– And can this help?

– And it helps!

– That is, just a person read something, made up his mind and got sick?

– For example, a situation when a patient comes to the doctor and is told: look, according to the results of the examination there is no evidence that you have any serious problem there.You just do not have enough physical activity – you are sitting in the car, you have the wrong seat, let’s increase the activity a little, and you will feel good. “Is that all?” The patient asks. “Yes all”. He leaves, his situation returns to normal in his head, he realizes that he can easily cope with the problem. Another situation, if he comes, and they tell him: take sick leave, don’t go anywhere for two weeks, after that you don’t need to move, if you start playing sports now, it will hurt even more… That’s it, a person begins to move less, his weight increases, he becomes overgrown with an even greater complex of problems, if he does not understand where all this is coming from.

– You said that the occurrence of chronic pain depends on upbringing, on cultural characteristics. How should a child be raised to protect him from chronic pain?

– It is necessary to educate adequately. We did research, and there was a problem – chronic headache. And we looked at when these patients were children, whether there were cases of chronic headache in the family, how often, how adults dealt with it.And most importantly, was there any overprotection on the part of the parents. It turned out that overprotection in childhood was directly associated with the occurrence of chronic headache in adults. We are not talking about genetic predisposition, but we are talking about upbringing. They recalled that in childhood they often observed: tired parents come home, they have a headache, everyone gathers around them, put some cool rag on their foreheads.

When a child often has to see such an attentive attitude to pain syndrome, this will most likely contribute to the fact that if he already gets sick in adulthood, this information will come to the nervous system, which has remembered: pain is something which makes it possible to get attention.This is one of the mechanisms for the formation of the situation when emotional experiences cause pain in a person. This is a defensive reaction, a desire to protect oneself, an unconscious desire to receive some kind of attention, help, support. This is laid down in childhood, and then transforms into pain in an adult state.

Photo: Depositphotos

– But children often do this when they lack attention. Can it really turn into a chronic problem in the future?

– Of course.A child, for example, when he takes his first steps, does not yet know what pain is, what danger is. Suddenly he falls, he is surprised, he may even laugh. But sometimes it causes a very violent reaction from those around him: he sees that his mother is running with her eyes round with fear. He understands that something has happened. And this little emotional shock will be associated with danger. After all, he learns emotions, it will be fixed with him, and during his life he will then face it.

– What a horror!

– This is not horror, this is physiology. Somewhere there should be guardianship, but somewhere this exaggerated emotionality can harm the child, because then he will have a reaction to any insignificant emotional shock in the form of pain in the head, back or somewhere else. He will suffer throughout his life, and it will be very difficult to cope with it.

– There are cases when private medical centers, in an effort to survive and earn money, find something that is not in fact, for the sake of an expensive examination, for example.Here, after all, for the patient the question arises not even of financial losses …

– Unfortunately, yes. Therefore, we are often faced with a situation when a patient comes to us for consultation with a very large list of examinations, consultations of specialists, used methods of treatment that do not help. And the more advice he gets, the more worried he becomes. Moreover, all examinations are different – the conclusion of the neurologist from the conclusion of the surgeon, the conclusion of the surgeon from the conclusion of the therapist, and so on.He has five diagnoses, and he does not understand what is the problem with him?

– What should he do, where to run if he is completely disoriented?

– For this, there is a system of training specialists abroad who are specialized in the treatment of pain syndromes. There is the concept of pain medicine, the concept of postgraduate training of specialists who, having already received some kind of education, being neurologists, therapists or surgeons, receive advanced training specifically on the problem of pain.And people have the opportunity, if traditional treatment does not help, turn to this specialist for help.

– What about us?

– Not yet.

– Planned?

– There is the Russian Interregional Society for the Study of Pain. It is an official subdivision of the International Association for the Study of Pain and the European Pain Federation, which is represented in 37 countries of the Eurasian continent. This organization is working to bring the principles of pain medicine to those countries where it is not yet developed.And we have repeatedly raised this issue within the framework of the conferences that we held and signed resolutions. Last year we had a very large meeting, there was a representative from the State Duma Committee on Health Protection and it was decided that this direction will gradually develop.

Photo: Depositphotos

– The problem of pain relief has been actively discussed in our country lately.

– When people talk about pain relief, it is most often associated with palliative care, with cancer patients and providing them with opioid analgesics.This is a very important issue, but it is not the only one. As for the rest of patients with chronic non-oncological pain, very little has been done in this direction. In Russia, now mainly private centers are opening, which are engaged in this, they are usually called the “Pain Center” or “Pain Clinic”. Some of them are purely commercial, and some are working on the right principles for commercial purposes. They turn to us, we give them recommendations, interact with them.In Russia, I think, there are already about 20 such centers.

– Isn’t that enough?

– This is very small. If we consider, for example, Belgium with its small population, then there are 40 centers. And we still have 20 for the whole huge country, and there will be about 10 good and correct ones.

– What prevents us from opening more? What do you think the state should do in this direction?

– First, we must convey to the public the urgency of the problem.The idea that pain is a symptom of osteochondrosis or something else is still very strong. The problem will be solved when a system of pain relief is created in the country. The solution is very simple, we have already proposed to create a system of several levels. First, we give primary care specialists – therapists, general practitioners – the knowledge they need to understand the problem correctly, and they solve it in 90% of cases.

10% of patients remain where the problem is not immediately clear.They must move on to the next stage – these are pain clinics, which can be located on the basis of city hospitals. Several rates are allocated there, literally several beds, this practically does not require costs. There are already some opportunities for examining the patient. But if he was not helped there, then there is the concept of a tertiary level. This is where 1–2% of patients with the most complex pain syndromes come to. This can be done on a university basis. Each city has a large medical university, on the basis of which an appropriate center can be organized.When a person has been helped at the level of this center, he returns to his therapist, and he continues the treatment according to the recommendations. This is such a system, it allows you to solve this problem.

– And what is the benefit for the state?

– In terms of economic benefits, it is enormous if we address chronic pain, and it has been proven in the United States and Europe. We do not need high-tech equipment to solve this issue, only very small changes in the education system and training of specialists.The costs are minimal, the economic efficiency is very high. Because the cost of treating pain is enormous. In Europe, it is estimated that it is billions annually, with only a few percent spent on treatment and examination of patients. The vast majority are indirect economic losses.

Photo: Depositphotos

– What are they?

– A person with chronic pain cannot work normally. If someone is suffering from migraines, try asking them if they can work during the attack.And if the attack lasts longer? And after it, a person cannot work normally. And if these attacks become frequent, the migraine becomes chronic, then this is more than 15 days a month. And if such a person tries to work, then the result of his work is close to zero. He has to give him a certificate of incapacity for work, pay for sick leave …

– How will you treat this, cheaply and effectively, except for correcting your lifestyle?

– First of all, this is a properly selected pharmacotherapy, that is, the prescription of drugs.We often prescribe the wrong medication for pain.

– Why?

– Because different types of pain are very different in their mechanisms of occurrence. The pain that develops as a result of trauma is one pain, nerve damage is another, neuropathic, there is also dysfunctional, psychogenic pain. There are at least four types, and each of them needs its own approach. Without this knowledge, the specialist cannot correctly prescribe the treatment to the patient.In addition, the 10-15 minutes available at the therapist’s appointment are not enough.

Usually a person comes, for example, says that his knee hurts. He is prescribed an anesthetic, but what is the mechanism of pain, what causes it, the doctor has neither the knowledge nor the ability to decide. Therefore, a drug is prescribed that may not help. If it doesn’t help, then we are wasting time. A person takes this treatment, it takes a week or two. He comes back and says: it didn’t help. He is prescribed another drug – another two weeks.And now more than three months have passed, and chronic pain is forming, which is difficult to cope with.

Photo: Depositphotos

– Okay, the right drugs, what else?

– The second task is to resolve the issues of the use of non-drug methods of treatment. Correct approaches to motor rehabilitation for pain syndromes are very important. It would seem that it sounds corny: physiotherapy exercises, so that a person learns to move correctly, perform exercises correctly and, most importantly, do it.

Also massage, if required, manual therapy, reflexology. Yes, they do not have proven effectiveness according to modern principles of medicine, but in some cases they help. Physiotherapy approaches can also be used, but again they are not included in modern international recommendations, because a lot depends on the individual response, on the mood of the person. That is, if he is in the mood for a certain treatment, it helps. If he believes that only leeches help and nothing else, they will help him, and this is great, we will not figure out whether this is a placebo or not a placebo.

– What about something new, modern, high technology?

– When it comes to chronic pain that does not respond to any treatment methods, the technology of installing neurostimulators is used. That is, a stimulator is placed, electrodes are placed on the spinal cord or the brain, they provide an electrical stimulus. There are certain parts of the nervous system that are stimulated to relieve pain. And this can be done continuously. But these are severe pain syndromes, such as resistant neuropathic, phantom pain.

– Can it last long?

– And if it is not treated, it will not end, it becomes permanent, chronic. And for such pain, approaches such as neurostimulation are warranted. The neurostimulator is installed for life.

Photo: Depositphotos

– Is it possible to simulate whether acute pain will turn into chronic pain in each specific case?

– I think not, because this is determined by many factors and not only and not so much the degree of injury, its nature, duration, but rather by the state of the human nervous system at the moment.

– What is the relationship here?

– There is an English saying: “No brain – no pain”. That is, if there is no head and the brain does not perceive it, then there will be no pain in a person.

– Where is chronic pain most often localized?

– Most often this is what is called musculoskeletal pain, joints, back, then headache comes.

– Even joints? That is, nothing can happen there, everything is born in the head?

– Minor changes may occur, but even these give signals.If the signal arrives and is assessed as harmless, then everything is fine, there will be no pain, the body itself will regulate that it is not dangerous. But if this minimal signal comes to the nervous system and is perceived there as dangerous, with exaggeration, then it will hurt for a very long time. Any pain is associated with the head, without the reaction of the nervous system, pain does not exist. Everything is determined by the adequacy of the reaction of the nervous system to the signal that comes to it.

– That is, any doctor, to whom a patient comes to an appointment, needs to be very careful in his statements?

– Very neat.Moreover, he must understand and correctly interpret the results of modern research methods. You can now go to any center and say: make me a tomogram of the spine, I will not wait for a referral from the clinic, now I will deal with my pain myself. The conclusions are very large, none of them will say: everything is in order. There will be written five or six lines, there will be protrusions, spondyloarthritis, osteochondrosis and other words that are difficult to pronounce. And the fact that in 90% of cases out of 100 these words that are written there have no clinical meaning, the doctor must explain this.It matters only in 5% of patients. In most cases, this does not need to be treated, this is normal. Unfortunately, the body is so arranged that it does not get younger over the years, and after 20 years, changes begin to be noticeable in a person. And with the current organization of labor, this happens sometimes even earlier.

– And future doctors in universities are taught the rules for treating patients, they are aware of what can be said and what is not?

– Regarding the problem of pain, there is no special course in student education.Here, at the First Medical University, in our department, there is a course on pain medicine, it is author’s, it is not for all students. In addition, there are optional disciplines, I teach “Neurogenic Pain Syndromes”, where about 20 lectures on this topic are read. But this is still selective: 15 students studied with me, another 100 students attended lectures, and thousands of students study at the university. And tens of thousands of future doctors are studying in the country, who, unfortunately, do not receive this knowledge.

Photo: Depositphotos

– That is, if the doctor said that “everything is fine, don’t worry” or “what do you want at your age”, then you can relax and forget, it will pass faster? After all, many people think: this is a bad doctor, I will go to another.

– Here you come and say: it hurts. He looks at you and says: forget, nothing hurts you. This is not a good doctor. It’s another matter if the doctor listened to you carefully, examined you, if required, prescribed additional examination methods. And then he says: yes, you have a pain here, but we conducted such and such a survey, which is the most informative here, such and such a study, and based on the results of these examinations and analyzes, we do not see any obvious reasons, let’s figure it out. – so your pain may be related.The doctor must explain everything to you, show and argue why he thinks so.

– Are there any risk groups that are predisposed to developing chronic pain syndrome?

– We have the concept of “yellow flags”, these are signals or signs that potentially pain can become chronic. As a rule, this is due to the duration of the pain syndrome. If a person has pain and before that there were already some other problems, then he is at risk.If a person has signs of psychoemotional disorders in the form of anxiety, depression, concomitant diseases – diabetes mellitus, hypertension. Analyzing the psycho-emotional state and concomitant diseases, one can understand whether this pain will become chronic or not. Guess at least.

– If a person is a skeptic in life, then nothing can help him?

– Nothing may help. In this case, we are treating not just a patient, but a person. A person who has his own ideas about pain, about what can get rid of it, and we must understand this.If a patient comes to us who is not disposed to treatment with pills and is very skeptical about it, then it is useless to prescribe pills to him. Because in addition to the placebo effect, which helps, there is the opposite effect – nocebo. That is, a person knows that pills will not help, has read all the possible side effects, and he will get these side effects. Therefore, it is useless to prescribe something to a person who says: you know, I think that it will not help me – this will make me sick here, it will make me worse.If at the same time he says that they put needles for me, or did a massage, and it all helps me great, of course, we will treat him with what has already helped him. He has an attitude, his nervous system is ready for it to help. And let it help him, there is no need to convince him.

– There are people who don’t like everything. What to do with them?

– If a person has something in pain and if he wants to get rid of the pain, then he will look for methods and will be tuned in to the method that will help.If he came and said: it hurts and nothing will help me, then either he has a deep depression, then it is necessary to consult a psychiatrist, or he is already inventing something.

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Back sprain: symptoms and treatment

Stretching of the back muscles is a common condition that is characterized by damage to muscle fibers and soft tissues. It is accompanied by pain and discomfort, aggravated by sudden movements. To restore damaged structures, it is recommended to follow the doctor’s prescriptions, attend physiotherapy and osteopathy sessions.

In the clinic of Doctor Length, all patients with back sprains are treated with a comprehensive treatment and an individual approach. The combination of traditional methods and author’s methods of therapy allows you to get a guaranteed result in improving the patient’s well-being.

The main reason for stretching back muscles is a sharp increase in load, leading to damage to muscle fibers and soft tissues. This condition can occur when playing sports, at work associated with physical labor, as well as with sudden movements.

Risk factors for injury:

  • Weak muscle frame that cannot withstand intense motor loads;
  • low level of physical activity, leading to unpreparedness of the musculoskeletal system;
  • traumatic injuries;
  • diseases of the spine, muscular system.

These conditions are characterized by an increased risk of injury to the skeletal muscles located on the back. In this case, the patient develops characteristic symptoms.

How does sprain manifest itself: signs and symptoms

The main symptom of muscle stretching is a sharp pain syndrome, which is accompanied by limited mobility. The patient has difficulty trying to turn the torso to the side or bend over. Similar symptoms are associated with reflex muscle spasm.

Severity of pain – from mild to intense, in which any movement is impossible. The area of ​​damage may be swollen, swollen, reddened when compared to healthy areas of the body.With a traumatic origin of damage on the skin, hematomas become noticeable.

Pain in some cases extends to the groin, buttocks or thighs. This is due to irritation of the nerve bundles when they are damaged. If the pain is localized, then only soft tissues or muscles are damaged.

Allocate several degrees of severity of stretching:

  • Moderate degree is characterized by mild pain syndrome, which disappears within 2-4 days.
  • Moderate severity is associated with severe pain that restricts a person’s mobility and requires seeking medical attention.
  • Severe muscle strain leads to severe swelling, bruising, limited range of motion. Symptoms persist for several weeks. During this period, the patient needs complex treatment.

If the back muscles are stretched, pain persists for more than 2 days, or if it is impossible to move the body, you should immediately seek medical help.

Treatment approaches

Stretching the back muscles requires complex therapy. In the first 2-3 days, it is recommended to observe bed rest, complete immobilization. This allows you to avoid the progression of damage, prevent the complications of injury. Cold compresses are used to reduce the severity of edema. The use of painkillers, anti-inflammatory drugs is possible.

The clinic practices modern methods of treatment – manual therapy, osteopathy, Di-Tazin procedures, kinesio taping and physiotherapy techniques.They work in combination, providing quick restoration of damaged tissues, disappearance of pain, and finding balance in movements.

Di-Tazin therapy

Di-Tazin treatment is the author’s method of non-invasive elimination of muscle strain and other diseases of the musculoskeletal system. It combines three types of exposure: photodynamic laser therapy, multicomponent electrophoresis, manual techniques. Each of these methods has its own positive effect on the body:

  • Manual techniques eliminate muscle tone disorders, normalize blood circulation in the damaged area.
  • Electrophoresis with drugs stimulates the restoration of damaged muscle fibers and soft tissues. Medicines with anti-inflammatory, analgesic and stimulating effects are used.
  • Photodynamic treatment with the introduction of Photoditazin into the body. This drug accumulates at the site of injury. When this area is exposed to an LED installation, drug molecules are activated, stimulating regeneration.

The Di-Tazin therapy method can be used in patients of any age.The list of contraindications is minimal. The procedure is not used if the patient has benign or malignant neoplasms.

Osteopathy

This is a modern branch of medicine, which differs from other areas of medical care in an integrated approach to the diagnosis and treatment of diseases. The best osteopaths in our clinic take into account the systemic nature of the human body, the individuality of reactions to any internal and external factors. Thanks to this, the doctor can establish the true root cause of the pathology, and, having eliminated it, achieve a complete recovery of the patient.

In osteopathy and manual therapy, the doctor uses only hands to influence the human body. This allows you to achieve high safety while maintaining the effectiveness of treatment. Such therapy should only be provided by a specialist who has received the appropriate basic training and has experience in the treatment of such diseases.

A positive therapeutic effect is observed when using exercise therapy and massage. Both methods are indicated for patients outside the acute period of stretching, when restoration of damaged structures is required.With physiotherapy exercises and massage, the blood supply to muscles and soft tissues is improved, their regeneration is stimulated, which avoids complications and the progression of disorders.

When stretching the muscles, it is possible to use kinesio taping. This is a modern technique for the prevention and treatment of such injuries, which is actively used in professional sports. Tape is a special adhesive tape applied to the back by a specialist. Thanks to this device, the load on muscle fibers, tendons, ligaments, and soft tissues is reduced.With independent kinesio taping, the effect may be absent, since the tapes are applied in a certain way.

In addition to the indicated methods of treating muscle stretching, drugs are used, and outside the acute period – physiotherapy procedures. Such techniques are aimed at eliminating the symptoms of damage, primarily pain and inflammatory changes. In the clinic of Doctor Length, therapy is mainly based on modern approaches: osteopathy, manual and Di-Tazin therapy.Their combination allows you to quickly remove the clinical manifestations of the disease in patients, gradually achieving complete recovery.

Why do patients come to us?

Doctor Length Clinic has a long and positive experience in the treatment of back muscle sprains. It was made possible by the following factors:

  • Using only modern methods of diagnosis and treatment. All our approaches are based on scientific research. The work uses the clinical guidelines of the Russian and foreign medical communities.
  • All specialists of the medical institution undergo regular training at the leading centers of osteopathy and manual therapy, mastering new techniques, improving their qualifications.
  • Appointment of rehabilitation measures that restore the patient’s quality of life, prevent relapses.
  • Individual approach to each patient. Stretching of the back muscles is often associated with diseases of the musculoskeletal system, internal organs or the nervous system. Thanks to osteopathy, it is possible to identify the root cause of violations, to choose methods for its elimination.

To make an appointment with a doctor, call by phone or leave a request on the website. The center administrator will contact you and answer your questions.

Treatment of a contusion in the back

A bruise in the back is called damage to soft tissues as a result of a strong blow, fall, accident, etc. Such injuries are fraught with serious danger, since there are not so many soft tissues in the back area that could reduce the consequences of a blow by taking it over.On the contrary, there is a high risk of damaging the spine and causing irreparable harm to health.

Symptoms

  • severe pain syndrome, especially during movement;
  • throbbing pain;
  • 90,015 edema;

  • the appearance of a hematoma in the area of ​​injury;

Otherwise, it all depends on which particular part of the back was injured.

Types of bruises

Depending on the location of the injury, there is the following classification of back injuries and their consequences:

  • In case of injury of the upper back , the cervical vertebrae may be affected.Sometimes this entails respiratory failure, paralysis, decreased muscle tone and paresis, impaired sensitivity.
  • Injury to the middle of the back can lead to loss of coordination and sensitivity of the limbs. The victim may feel pain in the heart, experience discomfort while breathing.
  • Injuries of the lower back are fraught with urination disorders and decreased sensitivity of the legs.

The most dangerous are bruises that affect the spinal cord.The consequences of such an injury can be varied: from circulatory disorders to rupture of nerve endings and paralysis.

Complications

In case of back injuries, the following complications are possible: injury to the kidney, spine, lungs; fractures of ribs, vertebrae; exacerbation of osteochondrosis; retroperitoneal hematoma;

Treatment of a contusion in the back

Regardless of the severity of the injury, the patient is assigned to bed rest. In the future, it is important to alternate a state of rest with little physical activity.

Pain relievers are used, anti-inflammatory ointments are applied. After a few days, it is permissible to use heat compresses and carry out physiotherapy procedures. These activities can be carried out independently, without visiting a doctor.

If there is a suspicion that the bruise is accompanied by any complication, you should seek the help of a qualified specialist. The doctor will examine the patient and, if necessary, send for an x-ray or computed tomography.

If the examination showed the presence of complications, then specific treatment is applied depending on the nature of the injury, up to surgery.

A bruise in the back is an uncommon, but very dangerous injury. Therefore, it is better to play it safe and get diagnosed.


Our clinics in St. Petersburg

Medical Center South-West

Etc.Marshal Zhukov 28k2
Kirovsky district

  • Avtovo
  • Veterans Avenue
  • Leninsky Prospect

You can get detailed information and make an appointment by calling
+7 (812) 640-55-25

90,000 Treatment of diseases of the spine by plasma lifting

Spinal pain is a scourge of modern society.This symptom has bothered every adult at least once in his life. American experts argue that this is one of the most common reasons for seeking medical attention and temporary disability.

The most problematic part of the spinal column in older people is the lower back. It is she who experiences the most intense loads, she constantly has to withstand the weight of the whole body. With age, degenerative changes grow in the intervertebral discs – they “dry out”, lose elasticity.As a result, protrusions and intervertebral hernias occur. They become a source of chronic pain, sciatica, sciatica.

Computerization and an increase in the number of office workers have led to the fact that neck problems are becoming more common. In addition to pain, they lead to dizziness, chronic fatigue, and decreased performance.

Usually, people who experience pain in the neck or lower back are treated by neurologists with a diagnosis of osteochondrosis or intervertebral hernia.Most often, in order to alleviate the patient’s condition, doctors prescribe drugs from the NSAID group (ibuprofen, naproxen, etc.), physiotherapy, blockade with anesthetics and corticosteroids.

All of these methods are effective, but only for a certain amount of time. They help to cope with symptoms, but do not solve the main problem: degenerative processes in the intervertebral disc continue. It is difficult to influence them, because the disc continues to experience increased stress, and its blood supply in humans is rather weak and deteriorates even more with age.Natural regeneration mechanisms fail.

Nowadays, more and more often you can hear about the modern effective method of treating diseases of the spine – plasmolifting, or PRP-therapy. Studies have been conducted that have shown that this technique helps to improve the condition of the intervertebral disc, activate recovery processes in it and relieve pain for a long time. Doctors of the SOVA clinic successfully use PRP-therapy in their practice.

What is PRP Therapy?

The abbreviation PRP is derived from the English name for the platelet rich plasma technique, which translates as “platelet-rich plasma”.The essence of the method is that blood is taken from the patient, placed in a centrifuge and plasma, which contains a high concentration of platelets, is separated. It turns out a “cocktail” rich in special biologically active substances – growth factors . It is injected into problem areas (in our case, into the intervertebral disc), and growth factors activate the regeneration processes.

In fact, PRP therapy is a type of plasma lifting. It is most popular in cosmetology. But recently it has been used with great success to treat diseases of the musculoskeletal system.The method is indicated for arthrosis, tunnel syndromes, tendinitis, dysfunctions of the sacro-hip joint. The efficacy of PRP therapy for pain in the spine has also been fairly well studied.

What are the advantages of the method?

PRP therapy has significant advantages over classical methods of treating spinal pain:

  • It does not just eliminate the symptoms, but acts on the cause of the pathology. Growth factors contribute to the repair and healing of the intervertebral disc.
  • The method helps patients who have long been unsuccessfully treated with NSAIDs, blockades and physiotherapy.
  • After a course of treatment, a long-term effect is achieved, while pain relievers only work for a relatively short time.
  • The method is highly safe and has a minimum of contraindications. After all, the patient’s own plasma is used as a medicine. It does not have negative effects on the body, does not cause allergic reactions.
  • Some patients are able to avoid spinal surgery thanks to the use of PRP therapy.
  • The positive effect comes rather quickly. The patient usually feels noticeable improvement within 4-6 weeks.

How is the procedure carried out?

A PRP session usually lasts about an hour. It is carried out on an outpatient basis; this does not require hospitalization in a hospital. Two weeks before the procedure, you will have to stop taking NSAIDs, drugs that reduce blood clotting, stop smoking and alcohol.

It takes approximately 25-30 minutes to prepare platelet-rich plasma. A small amount (20-50 ml) of blood is taken from the patient’s vein and placed in a centrifuge – a special apparatus that rotates at high speed, and due to this, plasma saturated with platelets is separated from the blood.

Then the finished preparation is injected with a needle into the intervertebral disc or tissues surrounding the spinal column. In this case, the doctor precisely controls the position of the needle tip using an X-ray.

In the SOVA clinic, PRP-therapy is carried out by experienced doctors who have undergone special training, strictly observing the technology.

For some time, pain may be disturbed at the injection site. Not all pain relievers can be used to relieve it, because some of them slow down the healing process. The doctor will recommend a suitable medication.

The number of procedures depends on the severity of the pain and the nature of the pathology. It usually takes two to six sessions of PRP therapy to achieve a lasting effect.During and after the course of treatment, it is necessary to continue physical therapy, physiotherapy, a course of massage, to avoid factors that worsen the condition of the spine (lifting heavy loads, long-term work with a computer in an uncomfortable position, etc.).

Are there any contraindications?

Despite the fact that PRP therapy is a safe method of treatment, for some conditions it cannot be performed:

  • Autoimmune diseases;
  • malignant tumors;
  • decreased platelet count and deterioration in blood clotting;
  • anemia;
  • immunodeficiency states;
  • Sodium citrate intolerance – This substance is added to a blood test tube to prevent clotting.

Usually, PRP therapy is not considered as the primary treatment for diseases of the spine. The question of the possibility of its implementation arises after a person has been treated with medications for a long time unsuccessfully.