Lumbar osteochondrosis is a pathological process that develops in the lumbar intervertebral discs, accompanied by their destruction. The development of this disease is facilitated by a number of predisposing factors that impair metabolic processes in the intervertebral discs. All symptoms of the disease are divided into several groups, depending on the mechanism of their occurrence. Treatment of lumbar osteochondrosis includes both methods of conservative therapy and surgery.
What is osteochondrosis of the lumbar spine
Osteochondrosis of the lumbosacral spine is a disease in which the intervertebral discs in this area undergo degenerative-dystrophic changes, which are subsequently combined with damage to the bone tissue of the vertebrae.
Lumbar osteochondrosis usually develops at the age of 30-35 years, but under the influence of injuries, uneven load on the back, the symptoms of the disease may appear earlier.
Symptoms of pathology
The symptoms of osteochondrosis of the lumbar spine occur as a result of the impact of altered structures of the spine on nearby vessels and nerve fibers. They are divided into several groups.
In the initial stage of the disease there is a feeling of discomfort, fatigue in the lumbar region, which is combined with unpleasant sensations in the gluteal region. Sometimes with uncomfortable movements, sharp turns of the body in the lumbosacral area, pain appears, which passes on its own in a short time.
As the pathology progresses, a person is concerned about pain in the lumbosacral region, radiating to the buttocks, hips, legs. If the pain appears suddenly, has a shooting character, it is called lumbago. Most often such a manifestation of osteochondrosis occurs when you try to lift any weight while riding with trembling, sneezing, coughing, change of body position.
Long-term pain with gradually increasing intensity is called lumbodinia. They occur when you stay in an awkward position for a long time after exercise.
The pain is often accompanied by paresthesias (feeling of crawling, tingling), burning sensation in the legs. There is stiffness in the lower back, which makes it difficult to move in this part of the spine. When trying to overcome this stiffness, the pain intensifies.
Piriformis syndrome often develops with pathology of the 5th lumbar and 1st sacral roots. This condition occurs due to compression of the sciatic nerve by the spasmodic piriform muscle, which is located between the sacrum and the upper femur. Localized tingling, numbness, or pain occurs in the buttocks area.
In some, with osteochondrosis of the lower back, there is a syndrome of the pelvic floor, manifested by coccygodynia - pain in the coccyx. There is also pain in the sacrum, perineum, passing to the gluteal area, inner, back of the thigh.
In iliopsoas syndrome, against the background of excessive tension of the latter, a person experiences pain in the lower back, groin or buttocks. Also, unpleasant sensations, paresthesias are noted in the anterior-external thigh area, less often in the lower leg.
These symptoms of lumbar osteochondrosis occur with mechanical damage to the spinal roots. The latter can be compressed by intervertebral hernias, osteophytes (bone growths), altered articular processes of the vertebrae, thickened yellow ligaments (ligaments connecting the arches of adjacent vertebrae).
An intervertebral hernia is a rupture of the fibrous ring of the intervertebral disc with subsequent exit from the pulpal nucleus. The hernia can form acutely, under the influence of considerable load or gradually, while the symptoms of lumbar osteochondrosis increase slowly.
The characteristics of the signs of an intervertebral hernia depend on its location, size. With the defeat of the spinal roots between:
- the third and fourth lumbar vertebrae give pain in the area of the anterior-inner part of the thighs, in the lower leg, the ankle from the inside, there is a characteristic decrease in the sensitivity of the anterior surface of the thigh;
- to the fourth and fifth lumbar vertebrae the pain from the gluteal area extends to the outer thigh, the lower leg, the back of the foot, and the sensitivity of the skin also decreases in these areas;
- fifth lumbar and first sacral vertebrae, pain from the gluteal area is given in the back of the thigh, lower leg, heel, the outer edge of the foot, which is accompanied by a violation of sensitivity in these areas.
If the intervertebral hernia is large, then a compression syndrome of the roots of the tail (roots of the spinal nerves from the level of the second lumbar vertebra to the fifth sacral vertebra) may develop. Signs of this form of osteochondrosis of the lumbosacral region include pain syndrome, motor disorders of the lower extremities, paralysis, decreased sensitivity, difficulty urinating.
There are blood vessels near the spinal roots that are compressed as a result of degenerative changes. In the initial stages of the disease compression of the arteries is rare, in the later stages it lasts a long time.
Signs of ischemia in osteochondrosis of the lumbar spine - pain, weakness in the legs during prolonged walking, disappearing after cessation of movement.
Causes of lumbar osteochondrosis
Lumbosacral osteochondrosis develops under the influence of the following factors:
- Hereditary predisposition. The presence of this disease in close relatives increases the likelihood of its development in humans.
- Hypodynamia, uneven loading of the spine. Insufficient physical activity weakens the muscles of the trunk, and the lumbar spine experiences the greatest load when a person sits. The front bend of the trunk creates additional tension on the front edges of the vertebrae.
- Excessive physical activity, work associated with constant turns, bending, lengthening the trunk, tingling movements. These factors create excessive stress on the muscles of the back and provoke the formation of intervertebral hernias.
- Overweight, which creates an additional load on the musculoskeletal system.
- Poor posture, which contributes to the uneven distribution of the load on the spine.
- Congenital developmental disorders, trauma, diseases of the musculoskeletal system (eg osteomyelitis, tuberculosis).
- Flat steps. In this condition, the arch of the foot does not perform a cushioning function, as a result of which the intervertebral discs experience increased stress.
- Inflammatory processes, diseases of the internal organs. Lumbar osteochondrosis often develops against the background of endocrine disorders, pathology of the cardiovascular system, inflammatory lesions of the joints of the spine.
- Frequent psycho-emotional stress.
All these factors contribute to the disruption of the blood supply to the intervertebral discs, disruption of metabolic processes in them, reducing the elasticity of these structures and slowing down the processes of regeneration in them.
Lumbar osteochondrosis most often develops in athletes, whose back is constantly experiencing heavy physical exertion, periodically - injuries. Another category of people at risk are office workers, cooks, teachers, drivers, waiters, hairdressers. People in these professions spend a lot of time in one position during the day, which creates an excessive load on the intervertebral discs.
The degree of the disease
Depending on the severity of the degenerative-dystrophic changes, lumbosacral osteochondrosis has 4 degrees.
The intervertebral discs lose elasticity, become less elastic, their height changes slightly or remains the same.
Small cracks form in the fibrous rings of the intervertebral discs. The intervals between the vertebrae are reduced, the latter are shifted relative to each other. This leads to compression of the nerve roots, pain syndrome.
There is a rupture of the fibrous ring, the pulpal nucleus extends beyond its boundaries, resulting in the formation of an intervertebral hernia. . .The latter compresses the nerve fibers, blood vessels.
The spine is deformed, usually lordosis or scoliosis. In lordosis, the anterior curvature of the spine becomes more pronounced; scoliosis is a lateral curvature of the spine.
There is a pronounced deformity of the spine, which in combination with a pain syndrome hinders a person's motor activity. Osteophytes are formed - growths of bone tissue on the vertebrae, causing trauma to the surrounding tissues, interception of nerve fibers. The vertebrae are as close to each other as possible, markedly deformed.
Stages of the disease
The symptoms of osteochondrosis change with the progression of the disease and therefore there are 4 stages of the pathological process. In the first of them, discomfort in the lumbar region periodically appears. Unpleasant sensations usually occur after exercise, lifting weights or for a long time in an awkward position. This stage is characterized by a decrease in the elasticity of the intervertebral discs without a clear change in their height.
If the disease progresses to the second stage, the person experiences more severe, prolonged pain. During this period, cracks appear in the fibrous ring of the intervertebral disc, the intervals between the vertebrae decrease.
During the third stage, intervertebral hernias form, which often lead to damage to the spinal nerves. One worries about the constant pain radiating to the thigh, lower leg, the sensitivity of the skin in these areas is impaired.
The fourth stage is characterized by constant pain, pronounced restrictions on movement in the lumbar spine due to significant deformation of the vertebrae in this area.
Treatment of osteochondrosis of the lumbar spine
Before treating osteochondrosis of the lumbar spine, it is necessary to understand which connections of the pathological process and the symptoms it should affect. The activities performed must contribute to:
- elimination of inflammation;
- pain reduction;
- strengthening the muscles, eliminating their spasm;
- improving blood supply, metabolic processes in the spine;
- restoration of the normal range of motion, restoration of the sensitivity of the lower limbs.
Drug treatment of osteochondrosis of the lumbosacral spine is one of the components of conservative therapy. Drugs from the following pharmacological groups are used for this disease:
- Non-steroidal anti-inflammatory drugs. They suppress inflammation and reduce pain. Usually, in the acute period of the disease, injections are used for lumbar osteochondrosis, then, after reducing the pain syndrome, pills are used. Such gels and ointments are also used for topical application.
- Muscle relaxants. These funds reduce the spasm of the muscles around the spine, compress the nerve fibers, blood vessels, which reduces pain.
- Chondroprotectors. These drugs prevent the destruction of cartilage tissue by normalizing metabolic processes in the intervertebral discs.
- Vitamin-containing preparations improve metabolic processes in nerve fibers, which leads to the suppression of inflammatory reactions.
- Corticosteroids have a pronounced anti-inflammatory effect, they are used in short courses in cases where drugs from other groups are ineffective.
Massage for osteochondrosis of the lumbar spine helps to improve blood circulation in the tissues, eliminate muscle spasm, reduce the severity of inflammatory reactions, as a result of which the pain becomes less.
Physiotherapy is also used to relieve the symptoms of osteochondrosis of the lumbar spine. Elimination of muscle spasm, pain, recovery of metabolic processes in the intervertebral discs is facilitated by:
- magnetic therapy;
- diadynamic currents;
- laser therapy;
- vibration therapy.
Magnetotherapy promotes relaxation of spasmodic muscles, normalizes local blood circulation.
Balneotherapy, which is a treatment with mineral water in the form of showers, baths, improves local metabolic processes, reduces pain.
Many are interested in when and how to treat lumbar osteochondrosis surgically. Surgical intervention is performed when:
- compression of the spinal cord, spinal artery;
- compression of the spinal nerves, accompanied by movement disorders;
- frequent, severe pain that is not relieved by medication;
- instability of the vertebrae.
During the operation, the damaged intervertebral disc is removed; this operation is called a disketotomy. The intervertebral disc is replaced with an artificial graft or bone fragment obtained from the patient's own pelvis. Sometimes, along with the intervertebral disc, the vertebral body is removed, such an intervention is called a coprectomy.
At the next stage of the operation the lumbar vertebrae are connected to each other so that they grow together in the future, this helps to prevent their instability, compression of the spinal nerves.
Therapeutic exercises for osteochondrosis of the lumbar spine
Therapeutic gymnastics for osteochondrosis of the lumbar spine is aimed at strengthening the muscles of the back, gluteal and thigh area. Regular exercise improves blood circulation in these areas, as well as in the lumbosacral spine. Metabolic processes in the intervertebral discs are stimulated, muscle spasm and pain are reduced.
Before starting training therapy for osteochondrosis of the lumbar spine, it is necessary to choose comfortable clothes made of natural fabrics that should not impede movement. However, it should be warm enough to avoid hypothermia in the back.
All exercises for lumbar osteochondrosis should be performed slowly, smoothly, with maximum concentration on muscle work. It is important to maintain deep, even breathing during exercise.
Gymnastics is performed no earlier than an hour after a meal.
When performing exercises in a supine position for osteochondrosis of the lumbosacral spine, it is important to use a thick round roller that is placed under the shins. This removes excess stress in the lower back.
It is advisable to write in the diary the plan, the results of the classes, the changes in the symptoms that occur. This information should be provided to the doctor for subsequent correction of the performed gymnastics complex.
If during training therapy with lumbar osteochondrosis a person experiences pain while performing any exercise, it is necessary to reduce its amplitude, the number of repetitions or to exclude from the complex.
All exercises for osteochondrosis of the lumbar spine are divided into:
- It is performed in the acute period with severe pain. They are aimed at general strengthening of the back muscles, facilitating breathing.
- It is performed in the acute period, when the pain subsides. Such exercises are aimed at strengthening the abdominal muscles, gluteal area.
- It is performed during remission when the pain is absent or mild. The exercise allows you to use a large number of muscles, involves active movements.
Exercises that are recommended for lumbar osteochondrosis in remission.
Prevention of lumbar osteochondrosis
To prevent the development of lumbar osteochondrosis, it is necessary to avoid excessive strain on the spine to avoid prolonged stay in awkward positions. Regular exercise is important to strengthen the muscles of the back and legs, and swimming is considered the most beneficial for the spine. On the recommendation of a doctor it is possible to use special orthopedic corsets, belts.
A balanced diet not only helps to reduce excess body weight and reduce the load on the spine, but also normalizes metabolic processes in tissues. Timely treatment of chronic diseases, especially pathology of the endocrine system, can prevent or delay the development of degenerative changes in the spine.
The symptoms of lumbar osteochondrosis change with the progression of degenerative-dystrophic processes in the spine. Complex conservative treatment, including the use of drugs, massage, physiotherapy, therapeutic exercises, is aimed at reducing inflammation, muscle spasm and pain. Surgical treatment is used only in the ineffectiveness of conservative therapy aimed at eliminating the intervertebral hernia, eliminating the complications of the disease.