Lumbar ischialgia
Lumboishialgia is a pain syndrome, which is characterized by the occurrence of sensations in the lower back, giving in one or both legs. The pain spreads mainly along the buttock, as well as along the back of the leg, but does not reach the fingers. The pain can be very different, but often it has a nagging, growing, burning character. In this case, the patient usually complains of a feeling of chilliness or heat. In most cases, the syndrome manifests itself suddenly after injury, sudden movement or lifting of gravity.
The content of the article:
Causes of lumboishialgia
Pathogenesis of lumboishialgia
Symptoms of lumboishialgia
Diagnosis of lumboishialgia
Treatment of lumboishialgia
Prognosis and prevention of lumboishialgia
Lumbar ischialgia
Painful sensations in patients usually occur against the background of osteochondrosis, intervertebral hernias, spondyloarthrosis. Lumboishialgia accounts for about 20-30 of all spinal pathologies. It is often diagnosed in people aged 25-45 years.
Causes of lumboishialgia
The appearance of this syndrome is primarily affected by people with overweight, intervertebral hernias, chronic spinal pathologies, infectious exacerbations. The risk group also includes production workers who are forced to carry a heavy load on the spine during the day, as well as people who work in one body position for a long time.
The causes of lumboishialgia can be very different, but in most cases it is a manifestation of lumbar spondyloarthrosis, herniated disc and other pathological changes of the spine. In elderly people, the cause of the disease is arthrosis of the hip joint, in which pain radiates to the lower back. Irritation of bone, ligamentous and muscular structures can also provoke pathology. In this case, patients are diagnosed with a bilateral pain reaction, which is problematic to determine the exact localization.
In neurology, it is also customary to identify a number of factors that can contribute to the development of pathology. These include problems with the spine: hypothermia of the spine, its age-related changes and injuries. Chronic stress, pregnancy, posture disorders, arthritis, excessive sports and physical activity can accelerate the development of a painful syndrome.
Pathogenesis of lumboishialgia
The pathogenesis of lumboishialgia is directly related to the cause that provoked it. For example, piriformis syndrome usually occurs with osteochondrosis, in which the area of the damaged intervertebral disc becomes a source of pathological impulses. At the same time, the patient’s nervous system perceives such impulses as pain and does everything possible to eliminate it by increasing muscle tone or immobilizing the affected area. The tension in the muscles extends beyond the source of pain, affects the piriformis muscle and the sciatic nerve. Due to muscle contraction, nerve compression occurs and pain occurs.
The cause of lumboishialgia can also be an intervertebral hernia, pathological processes in which lead to narrowing of the lumen of the spinal canal. This further leads to compression and inflammation of the sciatic nerve. As a result, motor and sensory nerve fibers are irritated, which provokes pain syndrome. Pain also appears as a result of severe hernia or its complications.
Symptoms of lumboishialgia
Lumboishialgia is characterized by the following common symptoms:
limitation of mobility in the lumbar region;
fixation of the back in a position where it is slightly bent forward;
the occurrence of pain along the nerve during movements;
a sharp increase in pain with a sudden change in body position;
changes in the temperature and shade of the foot coverings due to a violation of the blood filling process;
severe pain when trying to stand on your foot;
pain in the leg passes mainly along the knee, buttock, outer surface of the thigh;
along the course of the nerve, there is often a feeling of heat, burning, itching or cooling;
the pain increases sharply with colds, hypothermia, exacerbation of chronic diseases, fatigue;
there is stiffness of the lower back during walking, scoliosis may occur;
a Minor symptom is diagnosed — the patient, when changing position, first turns over to the healthy side, after which he pulls up the sick leg.
Symptoms of lumboishialgia may differ depending on the form. There are four forms of lumboishialgia in total:
Musculoskeletal
The cause of this form of the disease may be an isolated muscle-tonic syndrome, which has a vertebrogenic character. Pain impulses are usually localized in capsules of intervertebral joints, fibrous ring receptors, capsules of intervertebral discs. Often the cause of pain in the spine is the pathology of the facet joints. At the same time, it seems that the pain affects the nerve roots and gives into the leg, resulting in a muscle spasm. Thus, the pain becomes the cause of a muscle spasm, after which it increases.
At the same time, the muscles are in a state of spasm, and the pain gives to the leg, but does not reach the foot. By its nature, the pain differs significantly from the radicular, has a nagging character, and also manifests itself with different intensity. Musculoskeletal lumboishialgia can also occur due to myofascial pain syndrome, which occurs in case of overload of previously untrained muscles, joint pathology, visceral organ disease, developmental abnormalities. Symptoms of pathology are spasmodic muscles and painful seals in the muscles.
Neurodystrophic
This form of pathology occurs against the background of a muscular-tonic reflex. Its most frequent manifestations are periarthrosis of the knee joint, localization of pain in the lower back and its subsequent movement to the knee joint. The main distinguishing signs of pathology are pronounced lower back pain that has been bothering the patient for several years, immunity to medication, the presence of a large joint lesion on one leg. A patient with this form has pathological changes in the joints. Large joints undergo these changes: knee, ankle, hip.
Neurovascular
The development of pathology in most patients often occurs due to hypothermia. At the same time, chills, numbness of the left or right leg, pain, and a feeling of heaviness are observed in patients. During the clinical examination, the doctor diagnoses vegetative disorders, which are manifested by dry skin, a change in its color, swelling in the shin area. Patients may also be diagnosed with pseudoendarteritis syndrome, which is characterized by paleness of the fingers.
Neuropathic
The main clinical manifestations of this type of disease include:
shooting pains of a radicular nature, which are given to the calf, hip, buttock, foot, and also increase when moving in the lumbar region;
the presence of various symptoms of loss of the damaged root (loss or decrease of tendon reflexes, hypesthesia, atrophy or hypotrophy of muscles with the formation of peripheral paresis).
Usually, in order to make an accurate diagnosis, the doctor does not focus solely on the presence of painful sensations in the root zone. A doctor can make a diagnosis if there are symptoms of a damaged root falling out. It should also be taken into account that this type of disease accounts for about 5% of cases.
Diagnosis of lumboishialgia
The diagnosis of lumboishialgia begins with a clinical examination of the patient. During the examination, the doctor conducts a dynamic and static examination of the spine, checks the condition of the sciatic nerve, identifies signs of neoplasms or infection. The main symptom of the disease, which the neurologist necessarily pays attention to, is a sharp increase in pain when palpating the exit point of the sciatic nerve to the hip. During the clinical examination, the abdominal and pelvic organs are additionally examined.
The most accurate instrumental method of diagnosing pathology is considered to be radiography of the lumbar spine. With its help, it is possible to detect a decrease in the height of the intervertebral discs, hypertrophy of the articular processes, sclerosis of the closure plates, uneven narrowing of the spinal canal.
Treatment of lumboishialgia
Neurologists and vertebrologists are engaged in the diagnosis and treatment of the disease. Therapeutic measures to eliminate back pain are carried out against the background of the fight against the causes that caused it (hernia, osteochondrosis). If the disease has an acute course, the patient needs to organize a high-quality bed rest: his bed should be elastic and rigid. To eliminate pain, the doctor may prescribe analgesics. In case of severe pain, which cannot be eliminated in any way, they resort to blockades — injections with painkillers directly into the pain center. Patients with lumboishialgia are also shown local irritating procedures: rubbing, distracting techniques, pepper patch.
In the acute phase of the disease , the patient is prescribed the following groups of drugs:
Muscle relaxants to eliminate muscle spasms (sirdalud, midocalm, baclosan).
Novocaine blockades are injected into the spine to eliminate extremely severe pain, which conventional painkillers do not help to get rid of (diprospan, hydrocortisone).
Diuretics for the removal of edema of nerve trunks (lasix).
B vitamins are prescribed to improve the conductivity of nerve roots, as well as to restore muscle fibers (milgamma, neuromultivitis).
Sedatives (relanium, phenazepam, tranquilizers, sleeping pills).
Blood circulation activators (actovegin, trental, eufillin).
Physiotherapy will complement the therapeutic treatment of lumboishialgia: therapeutic sleep, acupuncture, mud baths, massage, manual therapy. At the same time, the most effective method of eliminating pain is considered therapeutic massage, during which special attention is paid to the impact on the sacrum and lower back. Systematic massage of this area allows you to activate and improve blood flow, slow down the development of the disease, restore metabolism in the spinal column.
If drug therapy and physiotherapy do not work and the pain increases, in this case, surgical intervention is prescribed. Indications for surgery: serious pelvic disorders, severe pain syndrome, compression of the spinal cord, lower paraparesis. In most cases, surgical treatment of intervertebral hernias is performed, during which the damaged discs are partially or completely removed. According to the indications, discectomy, endoscopic discectomy, microdiscectomy can also be prescribed.
To reduce pain and prevent possible relapses, patients are shown to undergo a course of therapeutic gymnastics. This course of exercises is aimed at strengthening the muscles that surround the vertebral column, thereby reducing the risk of dislocation of the vertebrae and making them more resistant to stress. Patients should perform exercises in specialized institutions under the supervision of specialists. However, over time, after completing a course of physical therapy, they will be able to continue their studies at home on their own.
The complex of therapeutic gymnastics necessarily includes exercises that promote muscle stretching (body turns, bends, back deflection). Exercises aimed at restoring the mobility of the hip joints and spine (squats, leg swings, lifting the body from the prone position) are also considered effective. Patients are also recommended to exercise on exercise machines and yoga.
Prognosis and prevention of lumboishialgia
In most cases, the pathology has a benign character and a favorable prognosis. However, poor and untimely treatment of it, as well as relapses, can lead to disruption of metabolic processes, tissue deformation and the formation of nodes at the depth of the muscles.
Neurology has developed a whole range of preventive measures to prevent the disease. First of all, it is necessary to treat spinal pathologies in a timely manner and prevent their development.
Neurologists also strongly recommend refraining from prolonged stress on the spine, which leads to its pathological changes. While performing physical exercises, it is worth avoiding the load on unprepared muscles, and also try to form the right muscle corset. Patients should be engaged in strengthening the correct posture, monitor their weight, avoid bad habits. If all these recommendations are followed, the disease can be prevented or the risks of its recurrence can be eliminated.
