The dorsopathy is a group of diseases of conjunctive tissue and musculoskeletal system, characterized by periodical pain in body and limbs. Dorsopathy of the lumbar spine is the most widely-spread disease of this group of spine diseases. In general the dorsopathy is a very widely-spread type of pathology, almost every second person is ill, at that every person suffers from it at least once during his/her life. But the periods of time, when the patient suffers from pain caused by this disease are short; some patients can acquire a chronic form of the disease, it is accompanied by a constant pain and leads to a long-term incapacity for work.
Osteochondritis is the main cause for development of the dorsopathy of the lumbar spine. Osteochondritis itself is a degenerative process, which takes place in the intervertebral discs, and intervertebral joints, vertebral bodies and ligamentous apparatus of the spine are gradually involved into this process. But the degenerative process itself is only a prerequisite of pain, but not its cause.
It’s worth remarking that particular evidences of the vertebral osteochondritis are the reason for the most diseases of the peripheral nervous system.
Widespread risk factors Besides distinct manifestation of the disease in the X-ray picture and clinical presentation very often practically do not depend on each other: half quantity of patients with frank changes in the spine does not suffer from the back pains at all.
Widespread risk factors
The most widespread risk factors are the following:
- Inherited predisposition, which is realized by the peculiarities of body tympanum of the patient (immunologic, endocrine, psychogenic, biochemical and etc.);
- Static and dynamic overload during work specially being in an uncomfortable position. In this case lack of knowledge or non-fulfillment of the simple ergonomic principles for performing working operations, body posture and etc.;
- Physical inactivity (irregular physical trainings, sedentary life style), rough change of physical activity loads, episodic serious physical loads for people having sedentary life style;
- Postural disorder and diseases of the spine (kyphoscoliosis, scoliosis, round back);
- overweight, frequent catarrhal diseases;
- bad habits (smoking, alcohol consumption), excessive spices, pickles, smoked and fried food consumption.
Pain manifestations and pain types in patients having dorsopathy
Clinically the osteochondritis reveals itself in major cases in the form of refectory syndrome, rarely in the form of compression syndrome. In the majority of cases damage of the sacral spine occurs, that is the reason why this particular type of dorsopathy is so “popular”.
A distinction is made between the following types of pain:
- local pain;
- projectional pain;
- nerve root pain (radicular);
- pain caused by muscles spasms.
Usually local pains are constant, diffusive, at that they have their centre in the damaged area of the spine. Also character of pain can change when the patient changes his/her body position.
Projectional pains have a different character, and they are very widespread. At that projectional pains are more diffusive, they are inclined to surface spreading, but according to its character and intensity they are very similar to local pains.
Nerve root pains have a shooting character. Usually nerve root pains are dull and aching, they can increase considerably when the patient is moving, and as a result the pains may become sharp. The nerve root pains almost always radiate to the limbs. Such kind of pain may become stronger when the person is moving or under the influence of some provoking factors such as coughing, sneezing, and some tension.
Now a lot of attention is paid to the pain syndrome, which appears in the result of muscle spasms. Besides, the reason for this pain is not only muscles spasm, but also trigger points and areas in hypertonia in tight muscles. It is quite possible that this pain syndrome has no attitude to the osteochondritis at all.
Specific symptoms of the disease
The most specific symptoms of dorsopathy of the lumbar spine: pain in the lumbar spine and feeling of heaviness in the back. As we have already mentioned this pain may have absolutely different character, it can appear when the patient is moving, bending, it may be constant, and sometimes it has a shooting character. Also sickness and dizziness may appear, in some cases buzzing in ears starts.
Early detection and diagnosing of the disease
At the beginning the doctor is collecting general information, patient’s complaints in order to detect the following:
- place of localization of the disease and place of pain irradiation;
- dependence of the pain on motions and body postures;
- early diseases and traumas of the spine (cancerous and innocent tumors and etc.);
- emotional state of the patient.
In this case in the result of investigations the doctor is to reveal some infectious processes, neoformations (cancerous and innocent), and somatic diseases, which can manifest themselves by the pain in the spine. During neurological investigations the emotional state of the patient is evaluated; the doctor determines if there were before any paralyses, palsies, loss of reflexes, sensation disorders. Also it is necessary to check local painfulness, range of motions in the limbs and lumbar-spine mobility.
After this some additional researches may be performed in order to precise the established diagnosis:
- spinal X-ray, which is done in several views;
- biochemical analysis of blood and general blood analysis;
- computer or magnetic-resonance imaging.
After the doctor has got all results of investigations and analyses it is possible to establish correct and precise diagnosis and to prescribe proper treatment.
Recommendations for dorsopathy treatment
Dorsopathy can be in one of the three forms:
- acute (up to three weeks);
- subacute (from three to twelve weeks);
- chronic (more than twelve weeks).
First of all treatment must decrease or remove totally the pain syndrome, which appears because of the disease. The main recommendations on this stage are the following: limitation of physical activity, application of non-steroidal anti-inflammatory medicines and muscle relaxants. This list may be added with some rehabilitation programs, comprising dosed and gradually growing movement and physical activity; sleeping on a special orthopedic mattress; individual movement pattern training, which must be chosen individually for every patient depending on his/her diagnosis.
It should be mentioned that treatment of dorsopathy demands a complex approach, it cannot be limited only to medicinal treatment, because in this case the muscles corset of the spine becomes weaker, and it will lead to new manifestation of the disease or to development of a new spine disease. On the other hand the patient cannot perform exercises of movement therapy in such state. During the first days it is necessary to remove inflammation and all factors which accompany the inflammation and also to reduce considerably the pain syndrome.
Standard scheme of acute back pain treatment
From the 1st to the 3d day: strict bed rest, anesthetic blockings by the hour, application of muscle relaxants.
From the 3d to the 10th day: semi-strict bed rest, anesthetic procedures by the hour, muscle relaxants, physiotherapy, moderate physical activity.
From the 10th to the 20th day: moderate limited activity, anesthetic procedures, remedial gymnastics, massage, manual therapy.
From the 20th to the 40th day: usual activity, anesthetics application only if it is necessary, active remedial gymnastics.
This scheme is standard, but it cannot be applied for all patients, the exercises should be chosen for every particular case of the disease. Treatment of dorsopathy should be held only by a specialist and only after full range of investigations and analyses performed; also the form of the disease and its course must be taken into consideration.
Treatment of acute form of dorsopathy
- bed rest (on a solid surface or on a special orthopedic mattress) during 1-3 days;
- light dry heat or cold;
- corset for several days;
- non-steroid and anti–inflammatory medicines;
- muscle relaxants;
- localized therapy;
- localized anesthetic blockings by the doctor’s prescription.
After the inflammatory process is removed it is possible to apply massage, manual therapy and physiotherapy.
It should be mentioned that self-treatment is inadmissible, only a doctor can prescribe medicines and procedures. Even if your acquaintances have already recovered and now they remember very well their treatment, there is no reason to follow their advices; medicines and the course of treatment can be prescribed only by the patient’s attending doctor according to the state of the patient, form and course of the disease.
Treatment of chronic form of dorsopathy
In this case the following medicines are prescribed:
- non-steroidal anti-inflammatory medicines;
- localized therapy (blockings, ointments);
- muscle relaxants;
- cartilage protectors.
When the symptoms of acute form of the disease are subsiding the drug-free methods of treatment are prescribed: physical and motion activity is increased; correction of psychological state of the patient is held, with this aim group and individual psychotherapy is applied in combination with anti-depressants. Also it is necessary to help the patient to form a new movement pattern.