This material is intended for people without medical education who want to know more about osteochondrosis than what is written in popular publications and on the websites of private clinics. The patient asks the doctor a variety of specialist questions that characterize a complete misunderstanding of the topic of osteochondrosis. Examples of such questions include: "why does my osteochondrosis hurt? ", "Congenital osteochondrosis is found, what should I do? " Perhaps the apotheosis of such illiteracy can be considered a fairly common question: "Doctor, I have early signs of chondrosis, how"This article aims to compile material on osteochondrosis, its causes, manifestations, methods of diagnosis, treatment and prevention, and answer the most frequently asked questions. Since all of us, without exception, are patients with osteochondrosis, this article will be useful to everyone.
What is osteochondrosis?
The name of the disease is scary when it is not clear. The medical suffix "-oz" means proliferation or enlargement of some tissue: hyalinosis, fibrosis. An example is cirrhosis of the liver, when the connective tissue grows and the functional tissue, hepatocytes, decreases in number. There may be an accumulation of pathological proteins, or amyloid, that should not be there. This storage disease will later be called amyloidosis. There may be significant enlargement of the liver due to fatty degeneration, called fatty hepatosis.
Well, it turns out that with intervertebral osteochondrosis, the cartilage tissue of the intervertebral disc increases in volume, because "chondros, χόνδρο" translated from Greek to Russian means "cartilage"? No, chondrosis, or, more precisely, osteochondrosis is not a storage disease. No actual growth of cartilage tissue occurs in this case; we are only talking about changes in the configuration of intervertebral cartilage discs under the influence of physical activity over many years, and we examined above what happens in each individual disc. The term "osteochondrosis" was introduced into the clinical literature by A. Hilderbrandt in 1933.
How does the biomechanics of a dehydrated disc change its shape? As a result of excessive load, the outer edge swells, breaks, and protrusions are formed, and then intervertebral hernia, or cartilaginous nodes that protrude beyond the normal contour of the disc. That is why chondrosis is called chondrosis, because a cartilaginous node - a hernia - arises where cartilage should not be, behind the outer contour of a healthy disc.
The edges of the vertebrae, which are adjacent to the disc, are also hypertrophied, forming coracoids, or osteophytes. Therefore, a joint violation of the configuration of cartilage and bone tissue is collectively called osteochondrosis.
Osteochondrosis refers to the dystrophic-degenerative process, and is part of the normal, normal aging of the intervertebral disc. None of us are surprised that the face of a 20-year-old girl will be slightly different from her face at the age of 70, but for some reason everyone believes that the spine, her intervertebral discs, do not experience the same temporary. change. Dystrophy is a nutritional disorder, and degeneration is a violation of the structure of the intervertebral disc that follows a long period of dystrophy.
Causes of osteochondrosis and its complications
The main uncomplicated physiological cause of osteochondrosis can be considered the way a person moves: walking upright. Humans are the only species on earth that walks on two legs among all mammals, and this is the only means of locomotion. Osteochondrosis became the scourge of mankind, but we freed our hands and created civilization. Thanks to walking upright (and osteochondrosis), we not only invented the wheel, the alphabet and mastered fire, but you can also sit at home in the warmth and read this article on your computer screen.
Man's closest relatives, higher primates - chimpanzees and gorillas, sometimes climb on two legs, but this method of movement is additional to them, and often they still move on four legs. In order for osteochondrosis to disappear, such as intensive aging of the intervertebral discs, a person needs to change the way they move and remove the constant vertical load from the spinal column. Dolphins, killer whales and whales do not have osteochondrosis, and dogs, cows and tigers do not. Their spines do not receive static vertical loads and long-term shocks, because they are in a horizontal state. If humans go to sea, like Ichthyander, and the natural way of movement is scuba diving, then osteochondrosis will be defeated.
Upright posture forces the human musculoskeletal system to evolve to protect the skull and brain from shock loads. But the disc - the elastic pad between the vertebrae - is not the only method of protection. A person has elastic foot arches, knee joint cartilage, physiological curves of the spine: two lordosis and two kyphosis. All this allows you not to "shrink" your brain even while running.
Risk factors
But doctors are interested in risk factors that can be modified and avoid the complications of osteochondrosis, which cause pain, discomfort, limited mobility and reduce the quality of life. Let's consider this risk factor, which is often ignored by doctors, especially in private medical centers. After all, it is more profitable to constantly treat someone than to show the cause of the problem, solve it, and lose the patient. Here they are:
- the presence of longitudinal and transverse flat feet. Flat feet cause the arch of the foot to stop jumping, and the shock is sent up into the spinal column without softening. The intervertebral disc undergoes significant pressure and quickly collapses;
- overweight and obesity - no comment needed;
- lifting and carrying heavy objects improperly, with uneven pressure on the intervertebral disc. For example, if you lift and carry a bag of potatoes on one shoulder, then a strong load will fall on one edge of the disk, and it can become redundant;
- physical inactivity and a sedentary lifestyle. It was said above that when sitting the maximum pressure on the disc occurs, because a person never sits straight, but always "slightly" bent;
- chronic injuries, slipping on ice, intense weight lifting, contact martial arts, heavy hats, hitting your head on low ceilings, heavy clothing, carrying heavy bags in your hands.
Risk factors that can affect everyone have been listed above. We deliberately do not list diseases here - connective tissue dysplasia, scoliotic deformation, which changes the biomechanics of movement, Perthes disease, and other conditions that worsen and aggravate the course of physiological osteochondrosis and lead to complications. This patient was treated by an orthopedic specialist. What are the common symptoms of complicated osteochondrosis, for which the patient turns to the doctor?
General symptoms
The symptoms that will be described below exist outside of localization. These are common symptoms and can exist anywhere. These are pain, movement disorders and sensory disturbances. There are also vegetative-trophic disorders, or specific symptoms, for example, urinary disorders, but less often. Let's take a closer look at these signs.
Pain: muscular and radicular
Pain can be of two types: radicular and muscular. Radicular pain is associated with compression, or pressing on the protrusion or herniation of the intervertebral disc of the corresponding root at this level. Each nerve root consists of two parts: sensory and motor.
Depending on where exactly the hernia is directed and the portion of the root that has been compressed, there may be either sensory or motor disturbances. Sometimes both disorders occur simultaneously, expressed to varying degrees. Pain also belongs to sensory disorders, because pain is a special and specific feeling.
Radicular pain: compressive radiculopathy
Radicular pain is common to many; it is called "neuralgia". The swollen nerve root reacts strongly to any shock, and the pain is very sharp, similar to an electric shock. He shoots either in the arm (from the neck) or in the leg (from the lower back). The sharp and painful impulse is called lumbago: in the lower back it is lumbago, in the neck it is cervicago, a rare term. Such radicular pain requires forced, analgesic, or antalgic postures. Immediate radicular pain occurs when coughing, sneezing, crying, laughing, or straining. Any shock to the swollen nerve root causes increased pain.
Muscle pain: myofascial-tonic
But an intervertebral hernia or disc defect may not compress the nerve root, but when it moves, it injures nearby ligaments, fascia, and deep back muscles. In this case, the pain will be secondary, painful, permanent, stiffness in the back will occur, and such pain is called myofascial. The source of this pain is no longer nerve tissue, but muscle. Muscles can respond to any stimulus in only one way: contraction. And if the stimulation is prolonged, the muscle contraction will turn into a constant spasm, which will be very painful.
A vicious circle is formed: the spasmodic muscle cannot be well supplied with blood, it becomes deprived of oxygen, and it does not release lactic acid, that is, the result of its own vital activity, into the venous capillaries. And the accumulation of lactic acid again leads to increased pain. It is this kind of chronic muscle pain that significantly worsens the quality of life and forces the patient to undergo long-term treatment for osteochondrosis, although it does not prevent him from moving and does not force him to lie in bed.
The characteristic symptoms of such secondary myofascial pain will be increased stiffness in the neck, lower back or thoracic spine, the appearance of dense and painful muscle lumps - "rollers" next to the spine, that is, paravertebral. In such patients, back pain worsens after several hours of "office" work, with prolonged immobility, when the muscles are practically unable to work and are in a state of spasm.
Diagnosis of osteochondrosis
In normal cases, osteochondrosis of the cervical spine and cervical-thoracic occurs as described above. Therefore, the main stage of diagnosis is and remains the identification of the patient's complaints, establishing the presence of concomitant muscle spasms using simple palpation of the muscles along the spinal column. Is it possible to confirm the diagnosis of osteochondrosis using an x-ray examination?
"X-ray" of the cervical spine, and even with functional tests for flexion and extension, does not show the cartilage, because their tissue transmits X-rays. Despite this, based on the location of the vertebrae, one can make a general conclusion about the height of the intervertebral disc, the general straightening of the physiological curvature of the neck - lordosis, as well as the presence of marginal growth on the vertebrae by extension. irritation of its surface by a fragile and dehydrated intervertebral disc. Functional testing can confirm the diagnosis of instability in the cervical spine.
Since the disc itself can only be seen using CT or MRI, magnetic resonance and x-ray computed tomography are indicated to clarify the internal structure of the cartilage and formations such as protrusions and hernias. Therefore, with the help of this method, the diagnosis is made accurately, and the tomography results are an indication, as well as a topical guide, for the surgical treatment of hernia in the department of neurosurgery.
It should be added that no other research methods other than imaging, except for MRI or CT, can show a hernia. Therefore, if you are given a fashionable "computer diagnosis" of the whole body, if a chiropractor diagnoses you with a hernia by running his fingers along your back, if a hernia is detected based on acupuncture, special extrasensory techniques, or a honey Thai massage session, thenyou can immediately assume this level of diagnosis is completely illiterate. Complications of osteochondrosis caused by protrusion or hernia, compression, muscle, neurovascular, can be treated only by looking at the condition of the intervertebral disc at the appropriate level.
Treatment of complications of osteochondrosis
Let's repeat once again that it is impossible to cure osteochondrosis, like planned aging and disk dehydration. You can't let things get complicated:
- if there are symptoms of narrowing of the height of the intervertebral disc, then you need to move correctly, do not gain weight and avoid the appearance of protrusions and muscle pain;
- if you already have a protrusion, then you need to be careful not to let it break the fibrous ring, that is, not to turn the protrusion into a hernia, and to avoid the appearance of the protrusion at several stages;
- if you have a hernia, then you need to monitor it dynamically, do a regular MRI, avoid increasing its size, or carry out modern minimally invasive surgical treatment, because all conservative methods to treat the exacerbation of osteochondrosis, without exception, leave the hernia in place. and eliminate only temporary symptoms: inflammation, pain, shooting and muscle spasms.
But with the slightest violation of the regime, with heavy lifting, hypothermia, injuries, weight gain (in the case of the lower back), the symptoms return again and again. We will explain how you can overcome unpleasant sensations, pain, and limited mobility in the back against the background of exacerbation of osteochondrosis, and existing protrusion or hernia, secondary to social tonic syndrome.
What to do during an exacerbation?
Since there is an attack of acute pain (for example, in the lower back), then you need to follow the following instructions at the pre-medical stage:
- completely eliminate physical activity;
- sleeping on a hard surface (orthopedic mattress or a hard sofa), eliminating the sagging in the back;
- it is advisable to wear a semi-rigid corset to avoid sudden movements and "distortion";
- You should place a massage pillow with a plastic needle applicator on your lower back, or use a Lyapko applicator. You need to keep it for 30 - 40 minutes, 2 -3 times a day;
- after this, ointments containing NSAIDs, ointments with bee or snake venom can be applied to the lower back;
- after rubbing, on the second day you can wrap your lower back in dry heat, for example, a belt made of dog fur.
A common mistake is to warm up on the first day. This can be a heating pad, bathing procedure. At the same time, the swelling only increased, and the pain along with it. You can warm up only after the "highest pain point" has passed. After this, the heat will increase the "absorption" of the swelling. This usually happens in 2-3 days.
The basis of any treatment is etiotropic therapy (elimination of the cause), and pathogenetic treatment (affecting the mechanism of the disease). It is accompanied by symptomatic therapy. For vertebrogenic pain (caused by problems in the spine), things go like this:
- To reduce muscle and spinal swelling, a salt-free diet and limiting the amount of fluid consumed are indicated. You can also give mild potassium-sparing diuretic tablets;
- in the acute phase of lumbar osteochondrosis, short-term treatment can be carried out with intramuscular "injections" of NSAIDs and muscle relaxants: daily, 1. 5 ml intramuscularly for 3 days, 1 ml also intramuscularly for 5 days. This will help relieve swelling of nerve tissue, eliminate inflammation, and normalize muscle tone;
- in the subacute period, after overcoming the maximum pain, "injections" no longer need to be taken, and attention should be paid to restorative agents, for example, modern drugs of group "B". They effectively restore impaired sensitivity, reduce numbness and paresthesia.
Physiotherapeutic measures continue, the time has come for exercise therapy for osteochondrosis. Its task is to normalize blood circulation and muscle tone, when swelling and inflammation have subsided, but muscle spasms have not been completely resolved.
Kinesiotherapy (movement treatment) involves doing therapeutic exercises and swimming. Gymnastics for osteochondrosis of the cervical spine is not aimed at the disc at all, but at the surrounding muscles. Its task is to relieve tonic spasms, increase blood flow, and also normalize venous outflow. This leads to a decrease in muscle tone, a decrease in the severity of pain and stiffness in the back.
Along with massage, swimming and acupuncture sessions, the purchase of special orthopedic mattresses and pillows is recommended. Pillows for osteochondrosis of the cervical spine should be made of special materials with "shape memory". Its task is to relax the muscles of the neck and suboccipital region, as well as to prevent blood flow disturbances at night in the vertebrobasilar region.
Autumn is an important stage in the prevention and treatment of home physiotherapy products and devices - from infrared and magnetic devices, to the most common needle applicators and ebonite discs, which are sources of weak electric current during the massage that have a good effect on the patient.
Exercises for osteochondrosis must be carried out after a light general warm-up, on "warming up muscles". The main therapeutic factor is movement, not the degree of muscle contraction. Therefore, to avoid repetition, the use of weights is not allowed; gymnastic mats and gymnastic sticks are used. With their help, you can effectively restore range of motion.
Rubbing in the ointment and using the Kuznetsov implicator continues. Swimming, underwater massage, Charcot shower are indicated. It is during the fading aggravation stage that home magnet therapy and physiotherapy are indicated.
Usually treatment takes no more than a week, but in some cases, osteochondrosis can manifest itself with such dangerous symptoms that surgery may be necessary, and immediately.
About Shants collar
In the initial stage, during the acute stage, it is necessary to protect the neck from unnecessary movement. Shants collars are great for this. Many people make two mistakes when buying this collar. They do not choose it according to their size, which is why it does not perform its function and causes discomfort.
The second common mistake is to wear it for prophylactic purposes for a long time. This leads to weak neck muscles, and only causes more problems. For the collar, there are only two signs where it can be worn:
- the appearance of acute pain in the neck, stiffness and pain spreading to the head;
- if you are going to do physical work while in full health, in which case there is a risk of "straining" your neck and getting aggravation. This is, for example, repairing the car, when you lie under it, or washing the window, when you have to reach out and take an awkward position.
The collar should be worn no more than 2-3 days, as longer wear can cause venous congestion in the neck muscles, in time to activate the patient. An analogue of the Shants collar for the lower back is a semi-rigid corset purchased at an orthopedic salon.
Surgical treatment or conservative measures?
It is advised that every patient, after the development of symptoms, in the presence of complications, undergo an MRI and consult a neurosurgeon. Modern minimally invasive surgery makes it possible to safely remove relatively large hernias, without prolonged hospitalization, without being forced or lying down for several days, without affecting the quality of life, because it is performed using modern video endoscopy, radio frequency, laser technology or using plasmacoldYou can steam part of the kernel and lower the pressure, reducing the risk of getting a hernia. And you can eliminate the defect radically, that is, by getting rid of it completely.
There is no need to be afraid to operate on a hernia; this is no longer the previous type of open operation in the 80s-90s of the last century with muscle surgery, blood loss and a long recovery period. They are more like small punctures under X-ray control followed by the use of modern technology.
If you prefer conservative treatment methods, without surgery, then know that not a single method will allow you to reduce the hernia or eliminate it, no matter what they promise you! Neither hormone injections, nor electrophoresis with papain, nor electrical stimulation, nor massage, nor the use of leeches, nor acupuncture can overcome hernias. Creams and balms, kinesiotherapy, and even the introduction of platelet-rich plasma will not help either. Even traction therapy, or attraction, despite all its benefits, can only reduce symptoms.
Therefore, the motto for the conservative treatment of intervertebral hernia can be the well-known expression "minced meat cannot be retracted. "The hernia can only be eliminated immediately. The price for a modern operation is not so high, because it has to be paid once. But annual treatment at the sanatorium can ultimately cost 10-20 times more than the radical removal of the hernia with loss of pain and restoration of quality of life.
Prevention of osteochondrosis and its complications
Osteochondrosis, including the complicated ones, the symptoms and treatment of which we discussed above, is largely not a disease at all, but only an inevitable manifestation of aging and premature "shrinkage" of the intervertebral disc. Osteochondrosis needs little to not bother us:
- avoid hypothermia, especially in autumn and spring, and falls in winter;
- do not lift loads, and carry loads only with a straight back, in a backpack;
- drink more clean water;
- don't be fat, your weight should match your height;
- treating flat feet, if any;
- do physical exercise regularly;
- engage in a type of exercise that reduces the burden on the back (swimming);
- abandon bad habits;
- replace mental stress with physical activity. After every hour and a half of mental work, it is recommended to change the type of activity to physical work;
- You can regularly do at least an x-ray of the lumbar spine in two projections, or an MRI, to find out if a hernia, if any, is developing;
By following these simple suggestions, you can keep your back healthy and mobile for life.