This material is intended for people without medical education who want to know more about osteochondrosis than is written in popular publications and on the websites of private clinics. Patients ask questions to doctors of various specialties that characterize a complete misunderstanding of the topic of osteochondrosis. Examples of such questions include: "why does osteochondrosis hurt me? ", "Congenital osteochondrosis was detected, what should I do? "Perhaps the apotheosis of such illiteracy can be considered a fairly common question: "Doctor, I have the initial signs ofchondrosis, how scary is it? "This article aims to structure the material about osteochondrosis, its causes, manifestations, methods of diagnosis, treatment and prevention andto answer the most frequently asked questions. Since all of us, without exception, are patients with osteochondrosis, this article will be useful for everyone.
What is osteochondrosis?
The name of the disease is scary when it is not clear. The medical suffix "-oz" means the spread or enlargement of certain tissues: hyalinosis, fibrosis. An example would be cirrhosis of the liver, when the connective tissue increases and the functional tissue, hepatocytes, decreases in volume. There may be an accumulation of pathological proteins, or amyloid, which should not normally be present. This storage disease will then be called amyloidosis. There may be significant enlargement of the liver due to fatty degeneration, which is called fatty hepatosis.
Well, it turns out that with intervertebral osteochondrosis, the cartilage tissue of the intervertebral discs increases in volume, because "chondros, χόνδρο" translated from Greek to Russian means "cartilage"? No, chondrosis, or, more precisely, osteochondrosis is not a storage disease. There is no real growth of cartilage tissue in this case, we are only talking about a change in the configuration of intervertebral cartilage discs under the influence of many years of physical activity, and we have examined above what happens in each individual disc. The term "osteochondrosis" was introduced into the clinical literature by A. Hilderbrandt in 1933.
How does biomechanics change the shape of a dehydrated disc? As a result of excessive load, their outer edges swell, rupture and form protrusions and then intervertebral hernias or cartilaginous nodes that protrude beyond the normal contour of the disc. This is why chondrosis is called chondrosis, as cartilaginous joints - hernias - arise where cartilage should not be, behind the outer contour of a healthy disc.
The ends of the vertebrae, which are attached to the disc, also hypertrophy, forming coracoids or osteophytes. Therefore, such a mutual violation of the configuration of cartilage and bone tissue is collectively called osteochondrosis.
Osteochondrosis refers to dystrophic-degenerative processes and is part of the normal, normal aging of the intervertebral discs. 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, are not subjected to the sametemporarily highlighted. the changes. Dystrophy is a nutritional disorder and degeneration is a violation of the structure of the intervertebral discs that follows a long period of dystrophy.
Causes of osteochondrosis and its complications
The main cause of uncomplicated, physiological osteochondrosis can be considered the way a person moves: walking straight. Man is the only species on earth that walks on two legs among all mammals, and this is the only way of locomotion. Osteochondrosis became the scourge of humanity, but we freed our hands and created civilization. Thanks to walking straight (and osteochondrosis), we not only created the wheel, the alphabet and mastered fire, but you can also sit at home in warmth and read this article on your computer screen.
The closest relatives of humans, the highest primates - chimpanzees and gorillas, sometimes get up on two legs, but this method of movement is helpful for them, and more often they still move on four legs. In order for osteochondrosis to disappear, like intensive aging of the intervertebral discs, a person must change the way of movement and remove the constant vertical load from the spine. Dolphins, killer whales and whales do not have osteochondrosis, and dogs, cows and tigers do not have it. Their spine does not receive long-term vertical static and shock loads, as it is in a horizontal position. If humanity goes to sea, like Ichthyander, and the natural mode of movement is scuba diving, then osteochondrosis will be defeated.
Upright posture forced the human musculoskeletal system to evolve to protect the skull and brain from shock loads. But the discs — the elastic cushions between the vertebrae — aren't the only method of protection. A person has an arch of the foot, cartilage of the knee joints, physiological curves of the spine: two lordosis and two kyphosis. All this allows you not to "shake" your brain even while running.
Risk factors
But doctors are interested in those risk factors that can be modified and avoid the complications of osteochondrosis, which cause pain, discomfort, limited mobility and reduced quality of life. Let's examine these risk factors, which are often ignored by doctors, especially in private medical centers. After all, it is much more useful to constantly treat a person 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 releasing and the shock is transmitted up the spine without being cushioned. Intervertebral discs experience significant stress and quickly collapse;
- overweight and obesity - no comment needed;
- improper lifting and holding of heavy objects, with uneven pressure on the intervertebral discs. For example, if you lift and carry a bag of potatoes on one shoulder, then the intense load will fall on one end of the discs and may be excessive;
- physical inactivity and a sedentary lifestyle. It was said above that it is during sitting that the maximum pressure on the discs occurs, since a person never sits straight, but always bends "a little";
- chronic injuries, sliding on ice, intense weightlifting, contact martial arts, heavy hats, hitting your head on low ceilings, heavy clothing, carrying heavy bags.
Risk factors that can affect any person are listed above. We deliberately do not list diseases here - connective tissue dysplasia, scoliotic deformity, which changes the biomechanics of movement, Perthes disease and other conditions that worsen and aggravate the course of physiological osteochondrosis and lead to complications. These patients are treated by an orthopedist. What are the common symptoms of complicated osteochondrosis, for which patients turn to doctors?
General symptoms
The symptoms that will be described below exist outside the 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 much 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 compression of a 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 which part of the root is compressed, there may be sensory or motor disturbances. Sometimes both disorders occur at the same time, expressed in different degrees. Pain also belongs to sensory disorders, since pain is a special, specific feeling.
Radicular pain: compression radiculopathy
Radicular pain is familiar to many people; The swollen nerve root reacts violently to any stroke and the pain is very sharp, similar to an electric shock. It shoots either in the arm (from the neck) or in the leg (from the lower back). Such a sharp and painful impulse is called lumbago: in the lower back it is lumbago, in the neck it is cervicago, a rarer term. Such radicular pain requires a forced, analgesic or antalgic position. Radicular pain occurs immediately when you cough, sneeze, cry, laugh or exert yourself. Any blow to the swollen nerve root causes increasing pain.
Muscular pain: myofascial-tonic
But an intervertebral hernia or disc defect may not press the nerve root, but when it moves, damage the ligaments, fascia and deep muscles of the back. In this case, the pain will be secondary, aching, permanent, stiffness will appear in the back and such pain is called myofascial. The source of this pain will no longer be the nervous tissue, but the muscles. A muscle can respond to any stimulus in only one way: contraction. And if the stimulus is prolonged, the muscle contraction will turn into a continuous spasm, which will be very painful.
A vicious circle is formed: the spasmodic muscle cannot be well supplied with blood, becomes starved of oxygen and poorly removes lactic acid, that is, the product of its vital activity, in the venous capillaries. And the accumulation of lactic acid again leads to increased pain. It is this type of chronic muscle pain that significantly worsens the quality of life and forces the patient to undergo long-term treatment of osteochondrosis, although it does not prevent him from moving and does not force him to lie in bed.
A characteristic symptom of such secondary, myofascial pain will be increased stiffness in the neck, lower back or thoracic spine, the appearance of dense, painful lumps of muscles - "rolls" near the spine, that isparavertebral. In such patients, back pain intensifies after several hours of "office" work, with prolonged immobility, when the muscles are practically unable to work and are in a state of spasms.
Diagnosis of osteochondrosis
In typical cases, osteochondrosis of the cervical and cervical-thoracic spine occurs as described above. Therefore, the main stage of diagnosis was and remains the identification of the patient's complaints, determining the presence of accompanying muscle spasm using simple palpation of the muscles along the spine. Is it possible to confirm the diagnosis of osteochondrosis using x-ray examination?
An "X-ray" of the cervical spine, even with functional tests for flexion and extension, does not show cartilage, since their tissues transmit X-rays. Despite this, based on the location of the vertebrae, general conclusions can be drawn aboutthe height of the intervertebral discs, the general direction of the physiological curvature of the neck - lordosis, as well as the presence of marginal increases in the elongated vertebrae. irritation of their surfaces by fragile and dehydrated intervertebral discs. Functional tests can confirm the diagnosis of cervical spine instability.
Since the discs themselves can only be seen using CT or MRI, magnetic resonance imaging and computed tomography x-rays are indicated to clarify the internal structure of the cartilage and formations such as protrusions and hernias. Thus, with the help of these methods, a diagnosis is accurately established, and the tomography result is an indication, even a current guide for the surgical treatment of a hernia in the neurosurgery department.
It should be added that no research method 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 diagnosed you with a hernia by running his fingers along the back, if a hernia was discovered on the basis of acupuncture, a special extrasensory technique or a Thai massage sessionwith honey, then you can immediately consider this level of diagnosis completely illiterate. Complications of osteochondrosis caused by protrusion or hernia, compression, muscular, neurovascular, can be treated only by looking at the condition of the intervertebral disc at the right level.
Treatment of complications of osteochondrosis
Let's repeat once again that it is impossible to cure osteochondrosis, like planned aging and dehydration of the disc. You just can't let things get complicated:
- if there are symptoms of narrowing of the height of the intervertebral discs, then you should move properly, do not gain weight and avoid the occurrence of muscle strains and pains;
- if you already have a protrusion, then you must be careful not to let the annulus fibrosus rupture, that is, not to turn the protrusion into a hernia and avoid the appearance of protrusions at several levels;
- if you have a hernia, then you need to monitor it dynamically, do regular MRIs, avoid increasing its size or perform modern minimally invasive surgical treatment, since all conservative methods of treatment of the exacerbation of osteochondrosis, without exception, they 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, injury, weight gain (in the case of the lower back), the symptoms return again and again. We will describe how you can deal with unpleasant sensations, pain and limited mobility in the back against the background of worsening osteochondrosis and an existing protrusion or hernia, secondary to social tonic syndrome.
What should you do during a tantrum?
Since there was an attack of acute pain (for example, in the lower back), then you should follow the following instructions in the pre-medical phase:
- completely eliminate physical activity;
- sleep on a firm one (orthopedic mattress or firm sofa), eliminating the sagging of the back;
- it is advisable to wear a semi-rigid corset to prevent sudden movements and "distortions";
- You should place a massage cushion with plastic needle applicators on your lower back or use a Lyapko applicator. You should keep it for 30-40 minutes, 2-3 times a day;
- After that, NSAID-containing oils, bee or snake venom oils can be rubbed into the lower back;
- after rubbing, on the second day you can wrap the lower back in dry heat, for example, a belt made of dog hair.
A common mistake is to warm up on the first day. This can be a heating pad, bath procedures. At the same time, the swelling only intensifies, and the pain along with it. You can warm up only after the "highest point of pain" has passed. After that, the heat will increase the "resorption" 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 mechanisms of the disease). It is accompanied by symptomatic therapy. For vertebrogenic pain (caused by problems in the spine), things go like this:
- To reduce swelling of the muscles and spine, a salt-free diet and limiting the amount of fluids consumed is indicated. You can also give a tablet of a mild potassium-sparing diuretic;
- in the acute stage of lumbar osteochondrosis, short-term treatment can be carried out with intramuscular "injections" of NSAIDs and muscle relaxants: every day, 1. 5 ml intramuscularly for 3 days, 1 ml also intramuscularly for 5 days. This will help relieve the swelling of nerve tissue, eliminate inflammation and normalize muscle tone;
- in the subacute period, after overcoming the maximum pain, no more "injections" should be given and attention should be paid to restorative agents, for example, modern drugs of group "B". They effectively restore damaged sensitivity, reduce numbness and paresthesia.
Physiotherapy measures continue, the time has come for exercise therapy for osteochondrosis. Its task is to normalize blood circulation and muscle tone, when the swelling and inflammation have already decreased, but the muscle spasm has not yet been completely resolved.
Kinesiotherapy (movement therapy) involves performing therapeutic exercises and swimming. Gymnastics for osteochondrosis of the cervical spine is not aimed at the discs at all, but at the surrounding muscles. Its task is to relieve tonic spasm, improve blood flow and also normalize venous flow. This is what 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, it is recommended to purchase an orthopedic mattress and a special pillow. A pillow for osteochondrosis of the cervical spine should be made of a special "shape memory" material. Its task is to relax the muscles of the neck and suboccipital region, as well as to prevent the interruption of blood flow at night in the vertebrobasilar region.
Autumn is an important stage in the prevention and treatment of home physiotherapy products and equipment - from infrared and magnetic devices, to the most common needle applicators and ebonite discs, which are a source of weak electric currents during massage thathave a beneficial effect on the patient.
Exercises for osteochondrosis should be performed after a light general warm-up, on "warmed up muscles". The main therapeutic factor is movement, not the rate of muscle contraction. Therefore, to avoid relapse, the use of weights is not allowed; With their help, you can effectively restore the range of motion.
Rubbing with ointments and using the Kuznetsov implicator continues. Swimming, underwater massage, Charcot shower are indicated. It is during the worsening phase of fading that medications for home magnetic therapy and physiotherapy are indicated.
Usually the treatment lasts no more than a week, but in some cases, osteochondrosis can appear with such dangerous symptoms that surgery may be necessary and urgent.
Around Shants collar
In the early stages, during the acute stage, it is necessary to protect the neck from unnecessary movements. The Shants collar is great for this. Many people make two mistakes when buying this collar. They do not choose it according to their size, therefore it simply does not perform its function and causes a feeling of discomfort.
The second common mistake is keeping it for prophylactic purposes for a long time. This leads to weakening of the neck muscles and only causes more problems. For a collar, there are only two indications under which it can be worn:
- the appearance of acute pain in the neck, stiffness and pain that spreads to the head;
- if you are going to engage in physical work in full health, in which there is a risk that you will "strain" the neck and get a burden. This is, for example, repairing a car, when you lie down under it, or washing windows, when you have to lie down and take awkward positions.
The collar should be worn for no more than 2-3 days, as wearing it longer can cause venous congestion in the neck muscles at a time when it is time to activate the patient. An analogue of the Shants collar for the lower back is a semi-rigid corset purchased in an orthopedic salon.
Surgical treatment or conservative measures?
It is recommended that every patient, after the progression of symptoms, in the presence of complications, undergo an MRI and consult a neurosurgeon. Modern minimally invasive operations make it possible to safely remove rather large hernias, without prolonged hospitalization, without forcing or lying down for several days, without affecting the quality of life, as they are performed using modern video endoscopic, radiofrequency, laser orusing cold plasma. You can vaporize part of the core and reduce the pressure, reducing the risk of 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 hernias, these are no longer the previous types of open operations of the 80-90s of the last century with muscle dissection, blood loss and a long recovery period. They are more like a small puncture under X-ray control followed by the use of modern technology.
If you prefer a conservative method of treatment, without surgery, then know that no single method will allow you to reduce the hernia or eliminate it, no matter what they promise you! Neither a hormone injection, nor electrophoresis with papain, nor electrical stimulation, nor massage, nor the use of leeches, nor acupuncture can cope with a hernia. Creams and balms, kinesiotherapy, and even the introduction of platelet-rich plasma will not help. And even traction therapy, or traction, 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 does not go back". A hernia can only be eliminated immediately. The prices for modern operations are not so high because they have to be paid once. But annual treatment in a sanatorium can ultimately cost 10-20 times more than radical removal of a hernia with the disappearance of pain and restoration of quality of life.
Prevention of osteochondrosis and its complications
Osteochondrosis, including complicated ones, the symptoms and treatment of which we discussed above, for the most part is not a disease at all, but simply a manifestation of inevitable aging and premature "shrinkage" of the intervertebral discs. Osteochondrosis needs little to never bother us:
- avoid hypothermia, especially in autumn and spring, and falls in winter;
- do not lift weights and carry loads only with a straight back, in a backpack;
- drink more clean water;
- do not gain weight, your weight should correspond to your height;
- treat flat feet, if any;
- do physical exercises regularly;
- engaging in types of exercises that reduce the load on the back (swimming);
- giving up bad habits;
- alternation of 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 have at least an x-ray of the lumbar spine in two projections, or an MRI, to know if the hernia, if any, is progressing;
By following these simple recommendations, you can keep your back healthy and mobile for life.