low back pain
Introduction
Introduction to low back pain Low back pain is not a disease, but a group of syndromes that can be caused by a variety of causes. Low back pain is a frequently-occurring disease, often accompanied by leg pain, and has a high incidence among manual workers, such as porters, underground miners, carpenters, and car drivers. In the army, waist and leg pain is also one of the most vulnerable diseases of the warriors. The incidence of engineering, tanks and infantry is particularly high. It is worth noting that among the personnel engaged in agency work and long-term desk work, low back pain is also a common disease. . The auxiliary examination method of this disease mainly relies on image examination, mainly including the following: plain film examination, tomography, CT examination, and magnetic resonance imaging (MRI) examination. The disease may have different complications depending on the cause of low back pain. For example, some patients start with only low back pain, and gradually have weakness on one side of the lower limbs, limp, followed by paraplegia, and malignant lower back pain. The prognosis is mostly poor. If it is metastatic cancer, the prognosis is worse, which may lead to more complications. basic knowledge The proportion of illness: 10% Susceptible people: manual workers Mode of infection: non-infectious Complications: paraplegia
Cause
Causes of low back pain
Waist disorders (30%):
1. Damage:
(1) Spinal fractures and dislocations.
(2) ligament strain.
(3) Muscle strain.
(4) The ligamentum flavum is thickened.
(5) posterior facet joint disorder syndrome.
(6) Lumbar disc herniation.
(7) Lumbar spinal stenosis.
(8) Spondylolisthesis.
2, degenerative and atrophic osteoarthritis: the formation of the limbs of the vertebral body and the face of the facet joints, lumbar disc degeneration and osteoporosis.
3, congenital malformations: recessive spina bifida, fifth lumbar vertebrae, hooked spinous processes and semi-vertebral body.
4, posture: scoliosis, increased lumbar lordosis, hunchback and so on.
5, inflammation: spinal tuberculosis is a specific inflammation, spinal suppurative osteomyelitis is a non-specific inflammation, ankylosing spondylitis is also this type.
6, tumor: metastatic cancer accounts for a large proportion, such as breast cancer and prostate cancer metastasis, the primary tumors in the spine are hemangioma, giant cell tumor and chordoma.
Visceral disorders (30%):
1, digestive system disorders: peptic ulcer, pancreatic cancer, rectal cancer.
2 urinary system disorders: pyelonephritis, peri-renal abscess and so on.
3, gynecological diseases: uterine body inflammation, attachment inflammation, uterine posterior tilt, pelvic tumor, uterine prolapse and so on.
Prevention
Low back pain prevention
To prevent low back pain, there are mainly the following measures:
1. Use the correct posture.
People's lives are diverse and the activities are diverse. The correct posture not only saves time and effort, reduces the wear and tear of human bones, joints, muscles and ligaments, but also avoids various injuries caused by bad postures. For example: moving When taking heavy objects, first bend the lower jaws and then remove the weights, it is not easy to damage the waist. Otherwise, if the knees are straight, bending and lifting heavy objects can easily cause waist injuries and lumbar disc herniation. Work, study and life should prevent a long time from a single posture, correct bad posture, prevent overwork, especially the overload of the waist will inevitably cause damage to the waist muscles, ligaments and joints, and low back pain and leg pain.
2. Use a hard padded bed.
Sleep is one of the important parts of people's life. Nearly one-third of life is spent in bed. The suitability of bed directly affects people's health. The hard bed sleeps uncomfortable, and the soft bed sleeps easily. Causes deformation of the spine. When the time is long, there will be backache and leg pain. It is most suitable to add a mattress of 5-10 cm thick on the wooden bed.
3. Prevent wind and cold from invading.
Human beings live in nature and are often attacked by wind, cold, heat, dampness, dryness and fire. Chinese medicine believes that "the cold is painful, the cold is stagnation, the blood is impassable, the meridians are not smooth, and the impedi is painful." This series of pathological changes can lead to low back pain. For this reason, the living, working and learning environment should be dry and warm, especially not to sleep on cold and damp ground, to change clothes in time after rain, vigorous activity and out Do not take a cold shower immediately after sweating. The bed in winter should be warm, the countryside can sleep, and the city can use electric blankets, which can play a dual role in preventing and treating low back pain.
4. There is a diet.
Obese people are prone to low back pain. It is self-evident that their excessive weight increases the burden on the muscles, ligaments and joints. Therefore, one of the treatment measures is to control diet, lose weight and obesity. The extra burden on the lumbar vertebrae, especially in the elderly, women and women, is easy to gain weight after childbirth. It is very necessary to control diet and strengthen exercise. The main reason for middle-aged people to gain weight is as they grow older. The reduction in the amount of activity causes an increase in fat and, more importantly, an unreasonable diet.
Complication
Lumbar and leg pain complications Complications
The disease may have different complications depending on the cause of low back pain. For example, some patients start with only low back pain, and gradually have weakness on one side of the lower limbs, limp, followed by paraplegia, and malignant lower back pain. The prognosis is mostly poor. If it is metastatic cancer, the prognosis is worse, which may lead to more complications.
Symptom
Low back pain symptoms Common symptoms Right leg sore thigh pain involved pain thigh sore dull pain back pain sore roots symptoms painful back painful numbness discomfort thigh tingling
1. According to the onset of illness, it can be roughly divided into acute low back pain and chronic low back pain.
(1) Acute low back pain: Sudden onset of pain, more intense.
(2) Chronic low back pain: Pain persists, mostly when the degree is light or when it is heavy.
2. According to the nature of pain, it is divided into dull pain, soreness, pain, numbness, radiation pain, pain, diffusion pain, associated pain, persistent pain, intermittent pain, paroxysmal pain and so on.
Examine
Check of low back pain
The auxiliary examination method of this disease mainly relies on image examination, mainly as follows:
1. Plain film examination: the radiographs of each segment of the spine generally include the anteroposterior and lateral positions. According to the need, the left and right oblique slices can be photographed. The plain film examination can not diagnose the soft tissue injury of the waist and lumbar disc herniation, so the general soft tissue injury is low back pain. Patients do not need to take X-rays routinely. For patients with suspected bone lesions, such as fractures, tuberculosis, tumors, vertebral isthmus and spine slippage, plain film examination should be performed.
2, tomography: tomography, also known as tomography, used to capture images of any layer of tissue in the body, small lesions in the vertebral body, flat film can not be diagnosed with tomography, sagittal plane of the lumbar spine The tomogram can clearly show the sagittal diameter of the spinal canal and contribute to the diagnosis of spinal stenosis.
3. Myelography.
4, CT examination: CT is called electronic computed tomography, CT is a small damage and high resolution inspection method, because it can show the cross section of the spine, it can be found in tuberculosis, early tumor lesions, and Helps the diagnosis of lumbar spinal stenosis and lumbar disc herniation.
5. Magnetic resonance imaging (MRI) examination.
Diagnosis
Diagnosis of waist and leg pain
diagnosis
First, the patient should be asked in detail about the medical history, including the patient's age, gender and occupational status, the cause and onset of the disease, the nature and location of the pain, the length of the disease, and the physical condition of the past.
Secondly, for spinal examination, you can press the look, touch, sputum, movement, volume and nervous system examination, and proceed one by one in order to avoid omission. When making the examination, pay attention to moving the patient as little as possible or changing the position. Specific to patients with low back pain, can be divided into position, sitting position, supine position, prone position and other positions to check patients, but also should be combined with nervous system examination.
Finally, according to the specific circumstances, the corresponding joint and internal organs should be examined to rule out other diseases.
Differential diagnosis
In the differential diagnosis, the focus of this disease is to identify and diagnose the primary cause of low back pain:
(1) Acute lumbar sprain: There is a significant history of lumbar sprain and sprain. Immediately after injury, there is low back pain, limited activity, obvious tenderness at the waist, and the position cannot be changed freely. The pain is spastic pain, and the X-ray film is normal.
(2) lumbar muscle strain: mostly chronic low back pain, incidence under fatigue, related to climate change, pain is mostly bulging, can be relieved after rest, X-ray film can be no abnormalities, and some have congenital spina bifida and other deformities.
(3) lumbar disc herniation: more history of injury at the waist, waist with lower extremity radiation pain, mild and heavy symptoms, limited mobility, coughing, sneezing, bending over can aggravate symptoms, pain relief after rest, interspinous or spine There is obvious tenderness next to it, the straight leg raising test is positive, and there is corresponding nerve root innervation area sensation and movement disorder. X-ray or lumbar CT can help to confirm the diagnosis.
(4) lumbar spinal stenosis: recurrent episodes of low back pain, lower limb numbness walking, intermittent claudication, X-ray film or lumbar vertebra CT can be seen narrowing of the intervertebral space, the inner diameter of the spinal canal is narrowed.
(5) The third lumbar vertebrae transverse process syndrome: there is a history of sprain or strain. The third lumbar vertebrae has obvious tenderness and radiates to the lower back and buttocks. The cords and nodules can be touched near the three transverse processes.
