Spinal pain examination. Back pain: when should you be examined? How to distinguish between inflammatory and tumor lesions

Examination for back pain

If the patient consults a doctor with back pain:

The doctor finds out in detail the chain of events that occurred (collects anamnesis), finds out what could lead to back pain and what concomitant diseases the person is suffering from.

• what measures have already been taken by the patient to relieve or reduce the intensity of pain.

• what general clinical examinations were done and whether they were done at all.

• conducts a physical examination of the patient, determining the location of the pain, irradiation (where it gives) and assesses the volume of available movements.

• makes a preliminary diagnosis, prescribes treatment or carries out the necessary procedures and manipulations.

If there is not enough information to make a diagnosis or differential diagnosis is required (what is it? Rupture of the fibrous ring or disc herniation?) -

• the doctor prescribes the necessary additional examination. This may be an x-ray, magnetic resonance imaging (MRI) or computed tomography (CT) scan. The latter is rarely used due to insufficient information content.

X-ray examination (X-ray images)- can reveal: osteophytes and uncovertebral arthrosis, instability of segments, deformation of vertebral bodies and articular processes, deformation and hypertrophy of articular facets due to osteochondral growths, arthrosis manifestations, spondylotic changes, narrowing of interarticular spaces, vertebral displacements (spondylolisthesis), osteoporosis, scoliosis, fractures and cracks, bifurcation of the posterior vertebral arch (Spina bifida), decreased disc height, subchondral sclerosis, formation of osteophytes, etc.

ATTENTION! Our medical center does not perform instrumental diagnostic methods such as MRI, CT or X-rays. Our specialists conduct a detailed analysis of the images already taken with a detailed explanation to the patient of the examination results and the need to prescribe any therapeutic measures for each specific case.

Analysis of complaints and anamnesis

Despite the differences in the description of each patient, it is important to actively identify characteristics that suggest a pathophysiological mechanism underlying the formation of the sensation of pain. Thus, the presence of acute, clearly localized pain, quickly regressing while taking analgesics, not accompanied by a change in surface sensitivity, is characteristic of nociceptive (somatogenic) pain syndromes associated, for example, with damage to the joints of the spine, ligaments and muscles. The occurrence of shooting, burning, poorly localized pain, accompanied by a change in sensitivity in the area of ​​innervation of the damaged dorsal root, is characteristic of neuropathic pain syndrome caused by compression or inflammatory radiculopathy. In this case, even when questioning the patient, it is possible to identify symptoms of sensory disorders: allodynia (pain sensations that occur when exposed to a non-painful stimulus), paresthesia (non-painful spontaneous sensations - “crawling”) and dysesthesia (unpleasant spontaneous or induced sensations). Damage to the anterior root or spinal nerve causes motor and sometimes autonomic disturbances (changes in sweating, skin temperature, etc.).

Chronic back pain can be formed on the basis of various pathophysiological mechanisms or their combination - nociceptive, neuropathic and psychogenic, but their specific gravity may be different. The nociceptive mechanism can play a leading role in the formation of chronic pain syndrome associated, for example, with damage to the joints (facet and sacroiliac). Such pain is usually aching in nature, occurs or intensifies with load on the affected joints and decreases briefly (for the duration of the action of the analgesic drug) after the injection of a local anesthetic into the area of ​​the affected joint. In all cases, it is necessary to analyze the situation in which the pain arose, the factors that intensify and weaken it, and the characteristics of previous exacerbations. Pain when internal organs are affected (visceral pain) is often poorly localized, may be accompanied by nausea, discoloration of the skin, excessive sweating, is colicky (“spasmodic”) in nature, and often radiates to the opposite half of the body.

Bizarre descriptions of pain (senesthopathy) allow one to suspect the presence of a psychogenic pain syndrome, but its diagnosis is only possible if other causes of pain are excluded.

Pain in the lumbar spine without irradiation to the limb in a patient under 50 years of age in the absence of a history of malignant neoplasm, clinical and laboratory signs of a systemic disease, or neurological disorders is more than 99% likely to be caused by benign musculoskeletal disorders, in particular MFPS or articular-ligamentous dysfunctions . However, even during the first examination of the patient, it is important to identify symptoms indicating that back pain may be a symptom of a more serious, usually somatic, pathology. Thus, you should pay attention to the presence of fever, local pain and increased local temperature in the paravertebral region, which are characteristic of an infectious lesion of the spine. Its risk is increased in patients receiving immunosuppressive and infusion therapy and suffering from HIV infection

and drug addiction. The presence of a tumor (primary or metastatic) may be indicated by causeless loss of body weight, a history of malignant neoplasm of any location, persistence of pain at rest and at night, as well as the patient’s age over 50 years. A compression fracture of the spine is more often diagnosed in cases of trauma, osteoporosis (long-term use of glucocorticoids and in patients over 50 years of age). Inflammatory spondyloarthropathy can be suspected in the presence of concomitant uveitis and arthralgias of other localization (including a history).

In table 1 shows the sensitivity and specificity of symptoms of dangerous diseases that potentially cause back pain.

Table 1. Sensitivity and specificity of symptoms of dangerous diseases potentially causing back pain (M. Harwood, 2005)

* Proportion of patients who have this symptom.
** The frequency with which a given symptom is not detected in a healthy population.

Physical examination

Physical examination includes neurological, neuroorthopedic and somatic examination. For pain in the back and extremities, a correctly conducted clinical examination allows in most cases to identify the source (or sources) of pain, clarify the pathophysiology of the pain syndrome, and suggest or accurately determine the nature of the underlying pathological process.

When examining a patient, it is important to pay attention to changes in posture, posture, gait, the presence of contractures, deformities and asymmetry of the limbs. It is necessary to evaluate the configuration of the spinal column, the preservation or change of physiological kyphosis in the thoracic and lordosis in the cervical and lumbar spine, their changes (strengthening or smoothing), the presence of scoliosis in standing, sitting and lying. As landmarks, the position of the shoulder girdle, angles of the shoulder blades, spines, iliac crests, distortion of the sacral rhombus, asymmetry of the gluteal folds, and the presence of joint deformities are assessed (Fig. 1).

rice. 1. Anatomical landmarks to identify posture asymmetry: 1 - position of the shoulder girdle; 2 - angles of the blades; 3 - iliac crests; 4 - gluteal folds; 5 - popliteal fossa

With leg length asymmetry, the posterior superior iliac spine is located higher on the side of the longer leg. On the same side, the knee, hip, facet joints and sacroiliac joints (SIJ) experience increased stress, and scoliosis forms.

When analyzing gait, you should pay attention to such features as avoiding complete transfer of body weight to the affected leg, which leads to a shortening of the time of support on it (antalgic gait). To reduce the load on the sore leg, some patients use additional means for support - surrounding objects, canes, crutches. With pathology of the hip joint, the shoulder on the affected side is often lowered. With back pain radiating to the leg, opposite symptoms are noted - drooping of the shoulder girdle on the side of the pain and a shift in the center of gravity to the “healthy” side. Pathology of the knee joint with the formation of varus or valgus deformity, which reduces the length of the limb, leads to a significant distortion of the pelvis with its tilt towards the “sick” side during the transfer of body weight to the affected leg. Pathological changes in the foot cause increased support on the unaffected area (heel, outer edge of the foot, sometimes the front part).

During a neurological examination, it is necessary to clarify the presence and nature of motor disorders, sensory and trophic disorders, and changes in tendon reflexes. If the cervical, thoracic, lumbar and sacral roots are affected, along with “positive” sensory disturbances in the form of pain, allodynia, paresthesia and dysesthesia, it is necessary to identify “negative” sensory symptoms (hypoesthesia, anesthesia of certain types of sensitivity: tactile, pain, temperature, vibration or joint-muscular). Sensitive, motor and autonomic disorders are localized in the area of ​​innervation of the affected root. Allodynia is considered one of the most important positive symptoms for neuropathic pain, including those associated with damage to the spinal roots. Allodynia is a painful sensation that occurs when a stimulus of a non-painful modality is applied. Patients with allodynia often complain of pain associated with the touch of clothing or bedding to the area where allodynia is localized. Mechanical (tactile) allodynia is caused by tactile stimuli, such as touching the skin with a piece of cotton wool or a brush. Temperature allodynia (cold or warm) occurs when the skin is irritated by a stimulus of low or high temperature. Hyperalgesia, like allodynia, is characteristic of neuropathic pain. Hyperalgesia is detected by comparing the sensations of pain when an injection is made with a blunt needle in the area of ​​pain localization and on a skin area outside the pain area, for example, on the contralateral symmetrical skin area or on the proximal area of ​​the skin with distal localization of pain. Static hyperalgesia is induced by light, blunt pressure. A special variant of hyperalgesia is hyperpathy, in which, after the application of a painful stimulus, not only an increased perception of pain is noted, but the pain continues and can even intensify within a few seconds after the cessation of painful stimulation. With secondary hyperalgesia, often observed in neuropathic pain, in addition to increased perception of pain, a wider spatial sensation is noted (not only at the point of application of the painful stimulus), sometimes with pain spreading beyond the tested dermatome.

The state of sensitivity is assessed using the following scale: 0 - absent (the patient does not feel touch with cotton wool, a brush, or a hand); 1 - sharply reduced (the patient does not feel a light touch with cotton wool, but feels a touch with a brush or hand); 2 - moderately reduced (sensitivity to a light touch with cotton wool is preserved, but less than in intact sections - proximally or contralaterally); 3 - normal.

It is convenient to study temperature sensitivity in the area of ​​the corresponding dermatome using a special cylinder with plastic and metal ends (Fig. 2) or test tubes with warm and cold water. The state of sensitivity is assessed on the following scale: 0 - absent (the patient does not feel the temperature difference during cold and warm exposure); 1 - sharply reduced (the patient makes a mistake in determining heat and cold, with exposure lasting at least 2 s); 2 - moderately reduced (sensitivity is preserved, but less than in intact sections - proximally or contralaterally); 3 - normal.

rice. 2. Study of temperature sensitivity in the zone of innervation of the L4 root with the Tiotherm instrument.

Pain sensitivity is examined by applying a light injection. The state of sensitivity is assessed using the following scale: 0 - absent (the patient does not feel the injection); 1 - sharply reduced (the patient makes a mistake in identifying the injection and dull irritation); 2 - moderately reduced (sensitivity is preserved, but less than in intact sections - proximally or contralaterally); 3 - normal. To determine the threshold of pain sensitivity to dull pressure, a tensoalgometer is used (Fig. 3). This tool allows you to identify static hyperalgesia and quantitatively characterize the TZ in MSPS and “sensitive” points in fibromyalgia (by pressing on the area of ​​local pain, the pain threshold and pain tolerance threshold, measured in kg/cm2, are determined). In addition, using a strain gauge algometer, you can measure the resistance of soft tissues (muscle tension), corresponding to the depth to which the strain gauge algometer leg can be immersed (mm) when pressed with a standardized force (3 kg).

The instrument for testing temperature sensitivity is a cylinder with plastic and metal ends. The state of sensitivity is assessed by alternately touching the cold (metal) and warm (plastic) ends of the cylinder. With preserved temperature sensitivity, the patient should feel the difference between cold and heat exposure

rice. 3. Strain algometer. The tensoalgometer allows you to quantify the amount of pressure on the patient’s skin necessary to cause pain. The device is installed perpendicular to the surface of the patient’s body, pressing is carried out smoothly until the patient feels pain. Pressure (kg/cm2) is indicated by the pressure gauge needle

Articular-muscular sensitivity is examined in the joints of the distal phalanges of the fingers or toes. The state of joint-muscular sensitivity is assessed using the following scale: 0 - absent (the patient does not feel movement); 1 - sharply reduced (the patient makes a mistake in determining the direction of movement in more than 50% of cases); 2 - moderately reduced (the patient makes a mistake in determining the direction of movement in less than 50% of cases); 3 - normal.

rice. 4. Study of vibration sensitivity in the zone of innervation of the peroneal nerve with a tuning fork calibrated at 128 Hz. When checking vibration sensitivity, the tuning fork is held by the stem without touching the jaws. The base of the tuning fork is installed on protruding areas of the bone, for example, on the dorsum of the terminal phalanx of the big toe. The patient is asked whether he feels vibration. The level of vibration is reflected on a digital 8-point scale on the distal part of the jaws and is determined by an optical phenomenon that creates the illusion of intersecting lines. The point of intersection of the lines shifts upward from values ​​0 to 8 points as the vibration of the tuning fork fades

The degree of vibration sensitivity impairment is assessed using a graduated tuning fork (128 Hz), the scale of which has divisions from 0 to 8 points (Fig. 4). The patient, lying with his eyes closed, is asked to report the presence of vibration. The researcher starts the vibration of the tuning fork by briefly striking its jaw against the palm. The base of the tuning fork is placed on protruding areas of the bone, for example, on the dorsum of the terminal phalanx of the big toe, the dorsum of the first metatarsal, the medial malleolus, the anterior superior iliac spine, the sternum, and the terminal phalanx of the index finger. The level of vibration is reflected on a digital 8-point scale on the distal part of the jaws and is determined by an optical phenomenon that creates the illusion of intersecting lines. The point of intersection of the lines shifts upward from values ​​0 to 8 points as the vibration of the tuning fork fades. The patient is asked if he feels vibration. To increase the reliability of the examination results, it is recommended to repeat the test several times and periodically touch it with a non-vibrating tuning fork. Normally, vibration sensitivity is more than 8 points for the hands and 7 points for the legs.

Motor disorders are often represented by weakness and wasting of muscles in the area of ​​innervation of the affected roots, as well as a decrease in tendon and periosteal reflexes. Muscle strength is assessed using the following conventional scale: 0 - normal; 1 - reduced by 25% compared to the intact side; 2 - reduced to 50% (for example, the patient cannot walk on his heels - for extensors of the feet, on his toes - for flexors); 3 - reduction by 75% (movements are possible only without resistance); 4 - reduction of more than 75% (muscle strength does not allow one to overcome the force of gravity - only downward and sideways movements are possible); 5 points - plegia (impossibility of contracting muscles innervated by the affected nerve).

Tendon reflexes are assessed separately for each limb. On the legs - Achilles and knee, on the arms - carporadial, as well as tendon reflexes with the biceps and triceps muscles. To assess the state of tendon reflexes, you can use the following scale: 0 - absent; 1 - sharply reduced; 2 - moderately reduced; 3 - normal.

When assessing vegetative and trophic disorders, it is necessary to pay attention to changes in color and turgor of the skin, the presence of hyperkeratosis, peeling, hypo- and hypertrichosis, and changes in the rate of nail growth.

It is necessary to know the so-called “indicator” muscles innervated by the corresponding roots, and the typical zones of sensory disturbances in the dermatomes corresponding to the affected root. The characteristic distribution of motor, sensory and reflex disorders in cervical and lumbosacral radiculopathy is presented in Table. 2 and table 3.

Table 2. Symptoms of damage to the cervical roots

Table 3. Symptoms of damage to the lumbar roots

In patients with pain in the lumbar spine, it is important to identify symptoms of damage to the roots of the cauda equina, which include: impaired sensitivity (anesthesia) in the anogenital region and distal parts of the legs, peripheral paresis of the muscles of the legs, loss of Achilles reflexes and pelvic disorders in the form of lack of urge to urination or defecation, retention or incontinence of urine and feces. Musculoskeletal pain syndromes are not characterized by any changes in the neurological status of the patient, but in some cases of MFPS, when a tense muscle compresses the neurovascular bundle or nerve, paresthesia is noted, and less commonly, hypalgesia or hyperalgesia in the area of ​​innervation of the corresponding nerve. Transient autonomic disorders may appear in the form of swelling and mild changes in skin color in the distal parts of the limb. The non-anatomical (“amputation”) distribution of sensory and motor disorders primarily reflects their psychogenic origin.

When discussing the anatomical and biomechanical features of the spine, a functional unit is identified as the vertebral motion segment (VMS), which is understood as a segment of the spine consisting of two adjacent vertebrae, the facet joints connecting them, the intervertebral disc and adjacent soft tissues: fascia, muscles, ligaments, nerves and blood vessels. There is probably not a single pathological process that in isolation affects the structures that make up the PDS. The main load on the spine is the impact of body weight on it, contraction of the attached muscles, and the gravity of their external forces associated with the movement of weights. The load is distributed among all PDS structures. Damage to the facet joints leads to changes in the condition of the intervertebral disc, and vice versa, degenerative changes in the disc cause dysfunction of the facet joints. Degenerative changes in the intervertebral disc of one SMS disrupt the biomechanics of at least the adjacent segments. The term “instability” of the PDS is often used. A clinically applicable definition of instability is a pathological response to stress, characterized by excessive mobility in an altered ROM. The necessary stability of the spine is ensured through the “passive” participation of connective tissue structures and the “active” participation of muscles. Loss of spinal stability can be caused by injury, age-related degenerative changes in the spine, muscle weakness, or a combination of these factors. Sometimes degenerative lesions of the PDS are considered as a three-stage process: dysfunction, instability and restabilization - phases that replace each other. In the dysfunction phase, traumatization of the SMS occurs. In the next phase, degenerative changes in the disc and facet joints develop in such a way that they no longer adequately withstand the forces acting on the SMS, and a sprain is formed. In this phase, an excessive amplitude of movements in the SMS is revealed. In addition to degenerative changes in the spine, repeated overloads also predispose to the development of instability, as they lead to ruptures of the fibrous ring, disc herniations, and injuries to the facet joints. In response to these changes, osteophytes begin to grow along the edges of the vertebral body and intervertebral disc. In the third phase, stabilization of the segment is noted due to an increase in fibrosis and the formation of osteophytes in the area of ​​the facet joints and intervertebral disc. Apparently, the last phase performs a “protective” function for the restabilization of the PMS, since in the phase of instability associated with age (35-55 years), the frequency of back pain increases, and its decrease is typical for older age.

Neuroorthopedic examination begins with an examination. Detection of changes during examination helps to understand the causes of musculoskeletal disorders developing in a patient - asymmetry in leg length, the presence of an oblique or twisted pelvis, and to explain the mechanisms of the formation of muscular-tonic or musculofascial pain syndrome associated with changes in posture and posture.

Palpation determines the soreness of muscles, joints and ligaments. With light palpation with a pressure of about 4 kg, multiple painful areas localized in different parts of the body, “sensitive” points characteristic of fibromyalgia, can be identified. MFPS is characterized by TZ - areas of local pain in the form of a tight cord located along the muscle fibers, revealed by palpation of the muscles. Widespread soft tissue tenderness, even with mild, superficial palpation, most often reflects the presence of psychogenic disorders (inappropriate pain behavior). It is also necessary to evaluate active and passive movements in the cervical, thoracic and lumbosacral spine.

Normally, in the cervical spine, rotation is 80°, lateral bending is 45°, extension is 75°, flexion is 60° (Fig. 5). In the shoulder joint, the range of motion in the sagittal plane is 180° (total flexion and extension). 90° each corresponds to external and internal rotation. The total volume of adduction and abduction in the frontal plane is 180°. To quickly assess shoulder function, combined movements are examined. The patient is asked to place his hands behind his head, trying to touch the lobe of the opposite ear (external rotation, abduction and flexion, as well as the function of the supraspinatus, infraspinatus and teres minor muscles are assessed), and put his hands behind his back, trying to touch the angles of the shoulder blades (internal rotation, abduction and extension of the shoulder joint, function of the subscapularis muscle). If the patient can perform both movements freely, it is unlikely that there is pathology of the shoulder joint and rotator cuff.

rice. 5. Normal range of motion in the cervical spine

When examining a patient with pain in the neck and arm, radicular compression tests may be useful: tilting the head to the painful side with subsequent axial pressure on it leads to the appearance or intensification of radiating pain and paresthesia in the arm.

The Adson test allows you to identify signs of compression of the neurovascular bundle under the anterior scalene muscle. The patient is asked to take a deep breath, lift and turn the chin to the affected side. In this case, a maximum rise of the first rib occurs, pressing the neurovascular bundle to the tense muscle. The test is considered positive if it leads to a weakening or disappearance of the pulse in the radial artery on the same side.

The range of methods for neuroorthopedic examination of the thoracic spine is limited. The rib cage creates a relatively “rigid” frame, limiting the range of movements in a particular spinal segment. Upon examination, scoliosis can be detected in the thoracic spine. Its localization can be more accurately determined by the apex of the arch (thoracic, thoracolumbar), and its direction - along the side of the convexity. Scoliosis can be compensated (the plumb line fixed above the spinous process of the first thoracic vertebra is projected above the sacrum) or decompensated (the spinous process is located lateral to the sacrum). For the differential diagnosis of structural (often hereditary) and functional scoliosis, which occurs, in particular, against the background of an “oblique pelvis,” the Adams test is used. The patient, who is sitting or standing, is asked to lean forward. If, when performing flexion, scoliosis remains in the same place where it was detected in a standing position or sitting with a straight back, then the patient has gross changes characteristic of structural scoliosis. In thoracic scoliosis, rotation of the vertebrae can lead to the formation of a “thoracic hump” on the side of the convexity of the scoliosis.

The most popular method for determining the mobility of the thoracic spine is the assessment of its movements during extension. The patient, sitting on a couch or stool, clasps his hands behind his head and brings his elbows towards each other. The doctor fixes the patient’s forearms in front with one hand, and with the other one alternately palpates the individual segments between the spinous processes, determining their mobility during flexion and extension of the spine. This test helps evaluate the mobility of individual segments of the thoracic region and during lateral bending. Functional limitation of mobility (blocking) in the thoracic spine can be identified with a patient in the prone position by assessing the excursion of the chest during slow, deep inhalation and exhalation. As you inhale, the distance between the spinous processes increases. In the area where it is absent, there is most likely a functional blockade of the vertebral segments or costotransverse joints.

Compression of the subclavian artery

Sad statistics show that approximately half of the adult population suffers from back and lower back pain, but only one in five seeks qualified help from a doctor. A negligent attitude towards one’s health and unwillingness to undergo a spinal examination is fraught with the involvement of not only many muscles, but also some internal organs in the pathological process. Damage to the cervical spine results in severe headaches, ringing in the ears, blurred vision, and dizziness. If the thoracic region is affected, the functioning of the heart and lungs is disrupted. Severe lower back pain affects the functioning of the digestive organs and kidneys, and contributes to a decrease in libido in men.

When is a spinal examination necessary?

With regular lifting of weights, as well as due to jumping and falling, microtraumas of the intervertebral discs occur. The systematic nature of the negative impact contributes to the loss of elasticity of the discs - they become thinner, the distance between the vertebrae decreases. Accordingly, the nerve roots extending from the spinal cord are pinched. The result is discomfort and increasing pain in the lumbar spine. At the same time, swelling forms in the clamping area of ​​the unequal vascular bundle, due to which the patient experiences even more suffering. Destruction of the intervertebral disc leads to the fact that it loses its elasticity and shock-absorbing properties, causing even more injury.

Doctors' prognosis is based on the age at which the patient first encountered the disease. The most dangerous situation occurs in those patients who began to experience pain in the lumbar region at the age of 16-18 years. By the age of 21-23, they are likely to experience protrusions, and by the age of 32-34, intervertebral hernias. In old age, the condition of the spine only worsens, autonomic dysfunction, neuralgia, and vascular diseases develop.

A spinal examination is necessary if

• painful sensations do not go away during movement;
• intensifies at night;
• are characterized by high intensity;
• suddenly a lumbago appeared.

The need for an urgent visit to the clinic is indicated by fecal and urinary incontinence, recent injuries, and an oncological history. If the pain lasts more than two weeks, the disease can become chronic, which is difficult to treat. But when pain is localized in the lumbar region and first appears at the age of 55-65 years, doctors give a positive prognosis.

Symptoms

In most cases, the culprit of back pain is osteochondrosis. Intervertebral hernia manifests itself as pain when lifting heavy objects and unsuccessfully turning the body in an inclined position. After this, the patient feels weakness and pain in the leg - right or left. Discomfort increases with body movements, sneezing, coughing.

Radiculitis is easily recognized by sharp pain in the lumbar region.

If the patient experiences ongoing discomfort in the back of the head and shoulders when trying to turn his head, this indicates a chronic disease of the spine - cervical spondylosis, which provokes the growth and subsequent deformation of the vertebrae. Among other things, those suffering from back pain often complain of the inability to breathe deeply and lack of chest mobility.

In some cases, the cause of pain is injuries, sprains, falls and bruises. Immediate consultation with a doctor and timely treatment is a guarantee of complete relief from the problem. Lack of treatment is fraught with serious complications, which often lead to noticeable curvature of the spine.

Causes of back and lower back pain

A spinal examination helps identify the cause of a patient's back pain. Only an understanding of what is the catalyst for the illness allows you to choose a suitable treatment regimen. The back is the most extensive anatomical region, which includes the lower back and sacrum, neck, shoulder blades and spine. It is on the back that dozens of important anatomical structures are projected. This is due to the variety of factors causing illness. Typically, the causes of back and lower back pain are pathologies of the musculoskeletal system and various diseases:

• Osteoporosis.
• Disturbance of spinal circulation.
• Osteochondrosis.
• Radiculitis.
• Spondyloarthrosis.
• Intervertebral disc herniation.
• Scoliosis.

However, it is important to understand that the disease is not always explained by diseases of the musculoskeletal system. Often pain is a consequence of damage to internal organs:

• Kidney diseases.
• Diseases of the gallbladder and liver.
• Intestinal problems.
• Interruptions in the functioning of the heart.
• Numerous lung diseases.

In a situation where the syndrome is caused by diseases of the internal organs, pain in the back and specifically in the lumbar spine does not disappear, no matter what the patient does. He can lie, sit, walk, but the intensity of the sensations does not decrease. At the same time, EUROMEDPRESTIGE doctors do not rule out the opposite situation. For example, osteochondrosis of the thoracic region makes itself felt by pain in the heart area, mistakenly taken for angina pectoris.

At the same time, it is not at all a fact that the projection of the internal organs will coincide with the localization of back pain. The pain itself can also be of a different nature. Dull and aching pain between the shoulder blades clearly indicates cardiac pathology. Sharp pain in the lumbar region, piercing when changing position, means lumbosacral radiculitis, disc herniation or sciatica. Pain that radiates to the thigh and groin area is a typical symptom of renal colic.

Spine examination and diagnosis

Only a carefully collected medical history and a thorough examination of the patient will help establish the exact cause of back pain. Diagnostics involves drawing up a clinical picture of the disease, consulting a neurologist, urologist, cardiologist, and other specialized specialists, as well as a number of special methods:

• Magnetic resonance imaging (gives a good effect if it is necessary to visualize the spinal cord).
• X-ray of the spine in two or three projections at once.
• Ultrasonography.
• Examination by a chiropractor.
• Comprehensive blood test, including biochemical.
• CT scan.
• Densitometry.
• Somatic examination.

In the process of collecting anamnesis, the doctor finds out the patient’s emotional state and possible stress, the localization of pain in the back, and the irradiation of pain in the lumbar spine. Asks about injuries and illnesses, records the relationship between sensations in the spine and body movements.

Diagnosis of the spinal column is aimed at studying the neurological status, muscle tone and signs of tension. In addition, it is important to determine the level of difficulty in movement due to pain when trying to lift the leg. Diagnosis of sensitivity is of primary importance, as it can decrease or, conversely, increase.

The purpose of a physical examination is to detect any infections, tumors, or diseases that may be the cause of back pain. Without clinical data, it is impossible to talk about compression and reflex complications of osteochondrosis. However, you need to understand that not all problems with the spine signal osteochondrosis, a disease that affects most adults and people over fifty years of age. Pain syndrome can be a manifestation of a much more serious illness, so it is very important to conduct the most competent examination of the spine and find the real cause of piercing pain in the lower back. Only in this case will the treatment be truly effective.

Treatment of back and lower back pain

The treatment program for back pain is always developed individually, based on the causes of the ailment, which may be different in each specific case. Basic methods include:

• Surgical intervention in emergency cases.
• Manual therapy.
• Therapeutic physical education (physical therapy).
• Taking medications.
• Physiotherapeutic activities.
• Spinal traction.
• Postisomerric relaxation.
• Organization of interspinous and paravertebral blockades.
• Various massages.

Conservative treatment, which consists of taking medications, can relieve pain and inflammation in the lumbar region and improve metabolic processes in the body. Painkillers are divided into two categories - non-narcotic and narcotic. Common analgesics are non-steroidal anti-inflammatory drugs. To improve immunity, immunomodulators and a complex of vitamins B and C are used. Currently, a modern, highly effective and safe method of treating problems of the spine, joints, and ligaments is gaining popularity - shock wave therapy, which is a hardware method of therapeutic effects on tissue using targeted acoustic waves of a certain frequency .

Doctors turn to narcotic painkillers only in extreme cases, when pain in the back and lumbar spine is almost unbearable, and other medications do not provide a noticeable effect. Narcotic injections are administered when back pain is not due to a slight muscle strain, but due to a malignant tumor or a dangerous injury.

Surgical intervention to remove a herniated disc is indicated only in specific cases when the spinal cord and roots of the cauda equina are quite strongly compressed. It also cannot be avoided if the patient is diagnosed with discogenic radiculopathy, accompanied by obvious paresis. The absence of any effect after conservative treatment for three to four months and a large disc herniation leave no choice but to consult a surgeon.

Physiotherapy methods

It is impossible to overestimate the benefits of physiotherapeutic procedures. Their gentle effect strengthens the back muscles, stabilizes the spine, has a positive effect on relieving lower back pain, and accelerates metabolic processes. The most effective in this regard is electrophoresis with calcium, as well as paraffin treatment and electrical stimulation. During the rehabilitation period, patients are recommended to visit mud resorts. Their positive effect on the path to recovery has been scientifically proven.

Exercise therapy and massages are also aimed at strengthening muscles and stabilizing the spine. They significantly reduce the intensity of pain, and sometimes can completely eliminate them. However, physical therapy and massage are indicated only after acute pain in the back and lumbar region has been relieved, otherwise the general course of the disease may have the opposite result. Therapeutic exercises are always carried out under the supervision of a doctor; heavy loads are excluded.

During the first lessons, most often no movements are made; all that is needed is to lie quietly on a flat, non-soft surface. At subsequent meetings, the doctor forces the patient to make movements that are small in amplitude and strength - first raising his legs from a lying position, then using special equipment. The most basic exercise for strengthening the spine, which evokes associations with cat stretching, is a backbend in a position where the patient is on all fours. If pain intensifies during physical therapy, you should stop exercising immediately.

Alternative Treatments for Low Back Pain

When the main methods of eliminating problems with the spine do not give the desired effect, doctors turn to alternative ones, including:

• Osteopathic effects
• Acupuncture
• Vacuum therapy

During manual therapy, the doctor actively kneads the spine with his hands. The goal is to release the nerves, displace misaligned vertebrae and return them to their original position, as well as eliminate pain. Despite the similarity of techniques, osteopathy is different: it has no specific contraindications and is often performed even against the background of exacerbation of pain.

In the East, acupuncture, used to eliminate the cause of back pain and fight many diseases, has been considered a unique remedy for thousands of years. At the EUROMEDPRESTIGE clinic, acupuncture is not just the insertion of needles into key points, but also the simultaneous administration of drugs. In addition, they are irradiated with a laser and influenced by magnetic waves.

The principle of use of vacuum therapy is reminiscent of the jars that our grandmothers used for their children and grandchildren. In order to relieve pain, a rarefied pressure, that is, a vacuum, is organized. Due to this, blood begins to circulate more actively in the affected area, greatly enhancing metabolic processes. At the same time, the doctor moves the cans, thus performing a vacuum massage. Vacuum therapy is considered one of the most effective means of relieving pain.

EUROMEDPRESTIGE doctors pay special attention to the treatment of myofascial pain and compression complications of osteochondrosis. Treatment of pain in the back and lumbar spine caused by osteochondrosis is based on providing the patient with complete rest. While in a relaxed state, he should avoid any sudden bending of the body and uncomfortable postures.

The chronic course of the disease requires regular visits to the clinic for injections and physiotherapeutic procedures. But if osteochondrosis has worsened, it is strictly forbidden to violate bed rest. For two to three days you need to sleep on a hard mattress and take medications prescribed by your doctor. Such measures can change the nature of the pain, making it less severe.

If you can’t completely stop moving, you need to put a corset on your neck or lower back, and also use special ointments. Additionally, compresses, hydrocortisone and novocaine blockades should be done. If the pain in the sacrum and lower back subsides, it is important to begin strengthening the back muscles, gradually increasing physical activity.

The chronic course of radiculopathy and reflex symptoms requires physiotherapeutic procedures, reflexology, taking anti-inflammatory drugs, manual therapy and visiting special resorts.

Regardless of the developed treatment regimen, each patient must strictly adhere to the orthopedic correct regimen.

Complications of untreated spinal diseases

Doctors at the EUROMEDPRESTIGE medical center insist on timely treatment of back diseases, since a careless attitude towards one’s own health can result in serious consequences.

Instability in the spinal motion segment, accompanied by excessive mobility between two vertebrae, occurs as a negative consequence of injury. It is caused by a sprain or sudden restriction of movement of a specific vertebra. Instability in osteochondrosis of any etiology develops against the background of a decrease in the height and volume of the discs. As a result of this, the ligaments located between the vertebrae lengthen and lose the ability to maintain their position relative to each other. Such instability always manifests itself as pain in the chest, lower back, and neck. Unpleasant sensations intensify in the evening and at moments when the patient takes certain positions. Disorders in the cervical spine provoke frequent migraines and dizziness when turning the head.

It is important to realize that excessive mobility of the cervical vertebrae in children under five years of age is not a reason for panic, provided there are no birth injuries, any disturbances in the development of the baby, or headaches. However, in any case, only consultation with a specialist on stabilization of the vertebrae can remove all concerns and clarify the situation.

The statistics kept by doctors clearly illustrate the common complications of osteochondrosis - protrusion and disc herniation. Clinically, they do not have any special differences, however, with a hernia, the symptoms are much more acute, since a hernia is the contents of the nucleus that have fallen through a crack in the fibrous ring of the intervertebral disc. Protrusion is a protrusion in which the disc remains intact on the outside. In any case, a thorough examination of the spine will allow you to correctly assess the situation, determine the location of the hernia or protrusion, and establish the true causes of pain in the lumbar region and its irradiation to the limbs. Even with chronic osteochondrosis, with which the patient lives for years, protrusions and hernias occur only as a result of disproportionate axial loads, that is, lifting heavy objects, jumping from heights, twisting the body, and stress. Accordingly, a lifestyle in which the patient avoids risk factors will help to avoid complications.

Prevention of back and lower back pain

To prevent problems with the spine, pain in the lumbar region, cervical and thoracic regions, doctors at the EUROMEDPRESTIGE clinic strongly advise adhering to the following recommendations:

• If you work in an office, make sure that the chair or armchair is comfortable and provides good back support.
• Correct any curvature of the spine and poor posture in a child during childhood.
• Try to keep your back straight, as correct posture relieves stress on the spine.
• Fight excess weight. Weight is one of the main causes of back pain; it negatively affects the spine.
• Then make sure that your diet contains foods high in vitamins, magnesium and calcium (beans, fish dishes, fresh milk, spinach, wholemeal bread, nuts, peas).
• Don't bend over unnecessarily.
• If you are forced to carry weights, distribute them evenly; choose a backpack between a backpack and a bag. When lifting weights from the floor, lean on your legs, your spine should be relaxed. At the same time, bend your knees and keep your back straight.
• Pay attention to physical activity. Only regular exercise helps create a muscle corset. It is not enough to just sit straight and stand against the wall - the muscles must remember about posture, even when you forget about it.
• When reaching something from the top shelves, use a chair or a ladder, do not reach.

Taking your own health seriously, timely examination of the spine and following the doctor’s recommendations will help you avoid serious problems in the future.

Advantages of "EUROMEDPRESTIGE"

Our medical center has been helping people fight back diseases for many years. People turn to us because:

• We do not recognize the victories of the disease and promise recovery even in the most difficult situations.
• We offer consultations and treatment from the best doctors in the capital.
• We use the latest diagnostic equipment made in Germany.
• We have developed a system of discounts, which makes treatment with us profitable.
• We know how important it is to make quality medical services accessible to everyone, therefore prices at EUROMEDPRESTIGE are among the most affordable.

"EUROMEDPRESTIGE": by contacting us today, you are making a choice that will change your life for the better tomorrow!

So, yesterday we started talking about back pain and decided that before starting treatment, it is necessary to undergo a full examination and consult with a doctor, determine the causes of the pain and develop a joint treatment plan. To do this, you need an orthopedic doctor, a neurologist or a specialized center for the treatment of back and spine problems. What will the examination include?

Beginning of the examination - detailed conversation

Initially, it will be important for the doctor to find out how your problem arose and what was its main cause. First of all, the doctor needs you to list all your main complaints - the nature of the pain (dull, sharp, sharp, shooting), as well as the circumstances of its occurrence - breaking your back, lifting something heavy, being on your feet for a long time, falling, getting injured. Tell the doctor the exact location of the pain, where the pain is referred to, whether they have accompanying symptoms (headaches, malaise, limitation of movement), information about what helps relieve the pain, how it changes due to exercise, throughout the day, etc. .

The main questions your doctor will ask you are:

You need to indicate the place where it hurts the most at the moment and where it hurt before,
- do you have pain early in the morning, do you wake up from these pains,
- Do pain occur when you tilt your head back, or do they weaken and disappear?
- can you turn your head well?
- have you had any injuries to your neck or head?
- are there any restrictions and pain when turning your head, does crunching occur during movement?
- Do you experience attacks of headaches and dizziness?
- Are the pains that arise paroxysmal or constant?
- Do you experience pain, tingling sensations, weakness and numbness in your hands?
- is there an increase in pain when moving, do your shoulder areas hurt?

All these questions must be answered in detail, which will be recorded in the patient’s card. It is also worth indicating to the doctor whether you have previously had skeletal injuries, health problems, somatic diseases, metabolic disorders and other disorders in your life.

Stage two – detailed inspection

An important point in the entire examination is to conduct a detailed examination of the back and neck, and the whole body. The doctor will ask you to undress at least to the waist so that they can examine your back in detail. First of all, a visual examination of your sore areas and back is carried out, muscles are palpated, active movements are assessed, the volume of these movements is measured, as well as special physical (provocative) tests. All these methods pursue the following goals in their reproduction:

First of all, reproduce the pathological symptoms to understand the level of the problem,
- determine the level of damage,
- find out the specific causes of pain.

In addition, if radicular pain, sensory disturbances and problems with arm movement occur, or if pain occurs in the arms below the elbows, a neurological examination will also be indicated, in addition to a general clinical examination and examination. How is this inspection carried out? First of all, during the examination you need to sit on the couch and place your hands on your hips. The doctor will carefully examine the possibility of voluntary movements in the cervical spine and in all other parts; they will also look at the position of the head and the level of the shoulders, and the contours of the neck in direct and lateral projection. If it is acute torticollis, the head will tilt to the side and may be slightly turned to the side opposite to where it hurts. With whiplash injuries of the neck or with severe osteochondrosis of the cervical spine, the head can be fixed and can be completely motionless; in order to turn the head, the patient begins to turn the whole body, while the head remains in its position.

Stage three - probing problem areas

First of all, during the examination, the doctor will focus his actions on certain anatomical landmarks that are necessary to identify defects and problems. When palpating, you need to lie on the couch on your stomach, relax your shoulders, put your forehead on your palms, and tilt your head slightly to the side. First of all, the spinous processes of the vertebrae are palpated (those edges of the vertebrae that can be felt with tubercles under the skin). Immediately below the back of the head, the doctor will determine the spinous process of the second cervical vertebra C2; normally, there is a deflection (lordosis) in the neck and the processes of the vertebrae from the third to the fifth are difficult to palpate, so how they are located is determined approximately. Next, the spinous process of the sixth cervical vertebra C6 is probed, and such a vertebra is accessible only with strong flexion of the neck. But the spinous process of the seventh cervical vertebra will be the largest, and it will protrude at the base of the neck.

The area of ​​the spinous processes is probed with the thumbs on both sides, with both hands, with the fingers placed parallel and the surface of the neck palpated from top to bottom, from the second to the seventh vertebrae. When palpating the hand, the doctor holds it straight, and when placing his fingers on the area of ​​the spinous process and applying slight pressure, the doctor finds out whether there are sensitive points (trigger points) and whether there is pain in the area of ​​the vertebrae. In addition, the articular processes of the vertebrae running on the sides are also palpated, two to three centimeters to the left and to the right of the midline drawn through the spinous processes. These zones are probed with the thumbs, which have their pads facing each other. It is also necessary to palpate the cervical lymph nodes, the thyroid gland area and the muscles on the neck itself.

Stage four - assessing active movements

It is important for the doctor to evaluate the functions of both the spine itself and other joints, determining the range of active and passive movements. During the examination, you will be seated on a couch, your spine will be flexed and extended in different directions, tilted in different directions, and rotated in different directions. If the range of motion is not reduced and does not cause pain, at the end of each movement the doctor applies additional force in the direction of movement and determines whether pain has arisen. It is important to describe in detail all problems in the movements.

Stage five - conducting a neurological examination

A detailed neurological examination is carried out if pain occurs, if there is a feeling of crawling, problems with movements and impaired sensitivity in the arm, especially in the area from the fifth cervical to the first thoracic vertebrae. Signs of compression in the area of ​​the spinal roots include pain and paresthesia in the area of ​​the nerve branch, decreased muscle strength in this area and hyporeflexia (decreased tendon reflexes). Thus, if the fifth cervical vertebra is damaged, the abduction of the arm and the biceps reflex are impaired; if the sixth cervical vertebra is damaged, forearm flexion and the biceps reflex, the radial reflex are affected; if the seventh vertebra is damaged, forearm extension and the triceps reflex are affected, and the area between the cervical and thoracic vertebrae is damaged. leads to problems with extension and flexion of the hand.

What else is needed?

First of all, the course of examination should include those research methods that would make it possible to accurately determine the cause that caused neck pain and would help exclude organic pathology of the spinal cord and spinal column. Usually, the examination begins with general clinical methods - a general blood test and ESR studies, blood tests for biochemical indicators, identification of rheumatoid factors in the blood, determination of special indicators - HLA B27, urine tests to exclude somatic and infectious diseases, metabolic disorders.

Also indicated are x-rays of the cervical spine in two projections to study the structure of the bone skeleton, computed tomography of the spine in the cervical and thoracic regions, computed tomography with myelography, especially before surgery for hernias in the area of ​​intervertebral discs, as well as scintigraphy of bone tissue, as well as magnetic resonance scanning of the spine. Computed tomography is not prescribed for all patients with neck pain; it is prescribed for questionable X-ray results, for suspected organic pathology of the spinal cord and spine, and before surgery.

How to treat this? We'll talk tomorrow.

EXAMINATIONS AND TESTS FOR BACK PAIN

Because a variety of medical conditions can cause back pain, a thorough medical history will be part of the evaluation, and your doctor will ask you many questions regarding the onset of the pain (Have you lifted heavy objects and felt sudden pain? Has the pain gotten progressively worse?). He or she will want to know what increases or decreases the pain. Your doctor will ask you about recent illnesses and related symptoms, such as cough, fever, difficulty urinating, or stomach problems. For women, the doctor will want to know about vaginal bleeding, cramping, or discharge. In these cases, pelvic pain often radiates to the back.

The doctor will look for signs of nerve damage. Reflexes are usually tested using a neurological hammer. This is usually done on the knee and below the knee. While lying on your back, you will be asked to lift one leg, then both legs, with and without the assistance of a doctor. This is done to check the nerves, muscle strength and the presence of tension in the sciatic nerve. Sensation is usually tested by using a pin, paper clip, or other sharp object to test for loss of sensation in the legs.

Depending on what your doctor suspects, he may do an abdominal exam, a gynecological exam, or a rectal exam. These tests determine the presence of diseases that may cause back pain. The lowest nerves in your spinal cord serve as the sensory area for the rectal muscles, and damage to these nerves can cause an inability to control urination and bowel movements. Therefore, a rectal examination is necessary to check that there is no nerve damage in that area of ​​the body.

Doctors can use several tests to understand what is causing back pain. No test is 100% perfect for determining the absence or presence of disease.

The medical literature is clear: if there are no dangerous symptoms of acute back pain, there is no need to use imaging studies. Because 90% of people experience relief from back pain within 30 days, most doctors will not refer you for testing for acute, uncomplicated back pain.

X-ray examination not generally considered useful in assessing back pain, especially in the first 30 days. In the absence of dangerous symptoms, its use is contraindicated. X-rays are indicated for severe trauma, minor trauma for those over 50, people with osteoporosis, and those taking steroids for a long time.

Myelogram is an x-ray test in which an opaque dye is injected directly into the spinal canal. Its use has recently declined sharply as MRI is now used. This study is now performed in combination with CT and only in special situations when surgery is planned.

Magnetic resonance imaging (MRI) is a complex and very expensive study. The research does not use X-rays, but uses very strong magnetic radiation to create an image. MRI may be used after 1 month of symptoms to investigate more serious causes of the problem.

Nerve studies

Electromyogram, or EMG, is a test that involves inserting very small needles into muscles. Electrical activity is monitored. This test is usually used for chronic pain and to determine the extent of damage to the nerve roots. The test can also help doctors differentiate between nerve root disease and muscle disease.

Before your doctor treats your back pain, he or she may conduct tests to determine the cause of your back pain. The doctor will test your range of motion and nerve function and perform a manual examination to locate the area of ​​discomfort.

Blood and urine tests will indicate whether the pain is due to infection or other systemic problems.

X-rays are useful in determining the location of a fracture or other bone injury.

Computed tomography (CT) or magnetic resonance imaging (MRI) may be needed to analyze soft tissue damage. X-rays and CT scans are only used to check for direct spinal injury, back pain with fever, or nerve problems such as excessive weakness or numbness.

An electromyogram (EMG) may be done to determine possible muscle and nerve damage.

Because back pain has a number of causes, the goals of treatment are to relieve pain and restore mobility. Basic treatment is to relieve back pain from a sprain or minor injury. Applying ice may help, as may taking aspirin or another nonsteroidal anti-inflammatory drug to reduce pain and inflammation. Once the inflammation subsides, apply a heating pad to relax the muscles and connective tissue.

Prolonged bed rest is no longer considered necessary in most cases of back pain, but is considered potentially harmful, delaying recovery and causing further problems. In most cases, you are encouraged to continue normal, non-effortful activities (such as walking). After this, supervised exercise or physical therapy begins. Physical therapy treatment may include massage, ultrasound, whirlpool baths, controlled heat, and a customized exercise program to restore full range of motion to the back. Strengthening your abdominal and back muscles will help stabilize your back, and you can prevent further back damage by doing gentle stretches to maintain good posture.

If back pain interferes with normal activities, your doctor will recommend taking pain medications. Over-the-counter medications such as Tylenol, aspirin, or ibuprofen may help. Your doctor may prescribe a strong anti-inflammatory drug or an opioid/acetaminophen combination—Vicodin or Percocet. Some doctors also prescribe muscle relaxants. But remember that these drugs affect the brain first and then the muscles, and often cause drowsiness.

If your doctor is unable to help control your back pain, he or she may refer you to a spine specialist or pain management specialist. Sometimes these doctors use injections of steroids or anesthetics to control pain. Recently, new methods of treating pain have been developed. One is radiofrequency ablation, the process of delivering electrical stimulation to specific nerves to make them less sensitive to pain, or delivering enough electricity to destroy the nerve and stop further pain. A similar procedure that applies heat to a herniated disc can seal the disc so that it no longer presses on the nerve roots, causing pain. Other medications, such as antidepressants and anticonvulsants, are sometimes prescribed to relieve pain associated with irritated nerves.

Some doctors believe that using transcutaneous nerve stimulation (TCNS) can help relieve back pain. Electrodes attached to the body deliver a low-voltage electrical current to help relieve pain. With appropriate training, patients can use PCSI independently to relieve pain while recovering from a back strain or moderate spinal injury.

Surgery for nonspecific spinal pain is a last resort. In cases of persistent pain due to severe nerve damage, rhizotomy—surgical separation of the nerve—may be necessary to stop pain signaling to the brain. A rhizotomy can correct symptoms caused by friction between the joint surfaces of the spine, but it does not help with other problems, such as herniated discs.

Chiropractors play an important role in the treatment of back pain. The American Agency for Healthcare Research and Quality has recognized spinal manipulative therapy as effective in the treatment of acute low back pain. Some researchers suggest that early chiropractic adjustments for acute back pain may prevent the development of chronic problems. Other doctors caution against the use of certain chiropractic manipulations, especially those that involve harsh twisting of the neck.

Osteopathic treatment combines drug therapy with spinal manipulation or traction, followed by physical therapy and exercises.

Acupuncture can provide temporary or complete relief from back pain. It can be used alone or as part of a comprehensive treatment plan that includes medications. Clinical advances along with positive research results from the National Institutes of Health have identified acupuncture as a viable treatment option for people suffering from low back pain.

If you are consulting with a therapist about cognitive behavioral therapy (CBT), your treatment may include stress management, behavioral accommodation, and relaxation techniques. CBT can reduce the intensity of back pain, change the perception of pain levels and disability, and even relieve depression. The National Institutes of Health considers CBT useful for relieving low back pain.

Other behavioral programs have shown the same result - their participants were able to reduce their medication use, changing their views and attitudes towards pain.

If low back pain is due to muscle tension or spasm, biofeedback may be effective in reducing pain intensity, reducing medication use, and improving quality of life. Biofeedback can help you train your muscles to respond better to stress or movement.

The Pilates technique and the Feldenkreis method are specialized forms of physical activity that help you learn to move more coordinated, flexible and graceful. They can help reduce pain and relieve stress. Some of the yoga asanas can help reduce lower back pain, improve flexibility, strength and balance. Yoga is a good stress reliever and can help with the psychological aspects of pain. Aquatic therapy and exercise can also improve flexibility and reduce chronic low back pain. The unique properties of water make it a particularly safe environment for exercise with a sore back; it creates little resistance, comfort and relaxation.

Why do doctors tap my back during an examination? Ask any therapist about this - by tapping on your back, the doctor will find out about the condition of your lungs in the simplest, fastest, cheapest, most painless and reliable way, and you won’t even need an X-ray for this