This material is intended for people without medical training who want to know more about osteochondrosis than is written in popular publications and on the websites of private clinics. Patients ask doctors of various specialties questions that characterize a complete misunderstanding of the topic of osteochondrosis. Examples of such questions are: "Why does my osteochondrosis hurt? "", "Congenital osteochondrosis was discovered, what should I do? " Perhaps the apotheosis of such illiteracy can be considered a fairly common question: "Doctor, I have the first signs of chondrosis, how scary is it? "This article is intended to structure the material about osteochondrosis, its causes, manifestations, methods of diagnosis, treatment and prevention, and to answer the most frequently asked questions. Since we, without exception, are all patients with osteochondrosis, this article will be useful to everyone.
What is Osteochondrosis?
The name of the disease is scary if it is not clear. The medical suffix "-oz" means proliferation or enlargement of a tissue: hyalinosis, fibrosis. An example would be liver cirrhosis, in which the connective tissue grows and the functional tissue, the hepatocytes, decreases in volume. It can lead to an accumulation of pathological protein or amyloidThis storage disease is then called amyloidosis. This can lead to a significant enlargement of the liver due to fatty degenerationFatty hepatosis is called.
Well, it turns out that with intervertebral osteochondrosis, the cartilage tissue of the intervertebral discs increases in volume, because "chondros, χόνδρο" translated from Greek into Russian means "cartilage"? No, chondrosis, more precisely osteochondrosis, is not a storage disease. In this case, there is no real growth of the cartilage tissue; it is simply a change in the configuration of the intervertebral discs under the influence of long-term physical activity, and we examined what happens in each individual disc above. The term "osteochondrosis" was introduced into the clinical literature by A. Hilderbrandt in 1933.
How does the biomechanics of a dehydrated disc change shape? Due to excessive stress, their outer edges swell, crack, protrusions form and intervertebral hernias or cartilage nodules appear that protrude beyond the normal contour of the intervertebral disc. That is why chondrosis is called chondrosis, because cartilage nodules - hernias - arise where there should be no cartilage, namely behind the outer contour of a healthy intervertebral disc.
The edges of the vertebrae adjacent to the intervertebral 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 aging of the intervertebral discs. None of us are surprised that the face of a 20-year-old girl is slightly different from her face at the age of 70, but for some reason everyone believes that the spine and its intervertebral discs do not undergo the same pronounced temporary 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 seen as the way a person moves: walking upright. Of all mammals, humans are the only species on earth that walk on two legs and only move around that way. Osteochondrosis became the scourge of humanity, but we freed our hands and created civilization. Thanks to upright walking (and osteochondrosis), not only have we mastered the wheel, the alphabet and fire, but you can also sit at home in the warmth and read this article on your computer screen.
Man's closest relatives, the higher primates - chimpanzees and gorillas - sometimes stand on two legs, but this method of movement is an auxiliary method for them, and most often they still move on four legs. In order for osteochondrosis to disappear, as well as the intensive aging of the intervertebral discs, a person needs to change the way he moves 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. Your spine does not absorb long-term static and shock vertical loads because it is in a horizontal state. If humanity goes to sea like Ichthyander and the natural mode of transportation is diving, osteochondrosis will be defeated.
The upright posture forced the human musculoskeletal system to evolve towards protecting the skull and brain from shock loads. But intervertebral discs – elastic cushions between the vertebrae – are not the only method of protection. A person has a springy arch of the foot, cartilage of the knee joints, physiological curvatures of the spine: two lordoses and two kyphosis. All this allows you not to "shake off" your brain even while running.
Risk factors
However, doctors are interested in the risk factors that can be modified to avoid complications of osteochondrosis, which lead to pain, discomfort, limited mobility and reduced quality of life. Let's consider these risk factors that are so often ignored by doctors, especially in private medical centers. After all, it is much more profitable to constantly treat a person than to reveal 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 no longer be resilient and the shock is transmitted upwards to the spine without softening. The intervertebral discs are put under a lot of stress and collapse quickly;
- Overweight and obesity – needs no comment;
- improper lifting and carrying of heavy objects with uneven pressure on the intervertebral discs. For example, if you lift a bag of potatoes and carry it on one shoulder, the heavy load will fall on one edge of the slices and may be excessive.
- physical inactivity and a sedentary lifestyle. It was said above that the maximum pressure on the intervertebral discs occurs when sitting, since a person never sits straight, but always bends "slightly";
- Chronic injuries, slipping on ice, intense weight lifting, contact martial arts, heavy hats, headbutting low ceilings, heavy clothing, carrying heavy bags in hands.
The risk factors that can affect any person have been listed above. We deliberately do not list diseases here – connective tissue dysplasia, scoliotic deformity that changes the biomechanics of movement, Perthes disease and other diseases that aggravate and worsen the course of physiological osteochondrosis and lead to complications. These patients are treated by an orthopedist. What are the most common symptoms of complicated osteochondrosis that cause patients to contact a doctor?
General symptoms
The symptoms described below occur outside the localization. These are common symptoms and can occur anywhere. These include pain, movement disorders and sensory disorders. There are also vegetative-trophic disorders or specific symptoms, for example urinary tract diseases, although they are much rarer. Let's take a closer look at these signs.
Pain: muscle and root pain
There are two types of pain: radicular and muscular. Radicular pain is associated with compression or pressure on a protrusion or herniation of the intervertebral disc of the corresponding root at that level. Each nerve root consists of two parts: the sensory and the motor.
Depending on where exactly the hernia goes and which part of the root has been compressed, either sensory or motor disorders can occur. Sometimes both disorders occur at the same time and manifest themselves to different degrees. Pain is also a sensitivity disorder because pain is a special, specific feeling.
Radicular pain: compression radiculopathy
Radicular pain is familiar to many; it is called "neuralgia. " The swollen nerve root reacts violently to any shock 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, painful oneImpulse is called lumbago: In the lower back it is called lumbago, in the neck it is called cervicago, a less common name. Such radicular pain requires a forced, pain-relieving or antalgic positionPain occurs immediately when coughing, sneezing, crying, laughing or exerting yourself. Any shock to the swollen nerve root results in increased pain.
Muscle pain: myofascial-tonic
However, an intervertebral hernia or disc defect may not compress the nerve root, but rather injure the surrounding ligaments, fascia, and deep back muscles during movement. In this case, the pain is secondary, aching, permanent, there is stiffness in the back, and this pain is called myofascial. The source of this pain is no longer the nerve tissue, but the muscles. A muscle can only respond to any stimulus in one way: contraction. And if the stimulus lasts longer, the muscle contraction will turn into a constant spasm, which will be very painful.
A vicious circle arises: the spasmodic muscle cannot receive a good blood supply, there is a lack of oxygen and it poorly drains lactic acid, i. e. the product of its own vital activity, into the venous capillaries. And the accumulation of lactic acid, in turn, leads to increased pain. It is these muscular, chronic pains that significantly worsen the quality of life and force the patient to undergo long-term treatment for osteochondrosis, but do not prevent him from moving and do not force him to lie in bed.
A characteristic symptom of such secondary myofascial pain is increased stiffness in the neck, lower back or thoracic spine, as well as the appearance of dense, painful muscle bumps - "rolls" next to the spine, i. e. paravertebral. In such patients, back pain worsens after several hours"Office" work with prolonged immobility, when the muscles are practically no longer able to work and are in a state of spasm.
Diagnosis of osteochondrosis
In typical cases, osteochondrosis of the cervical and cervical-thoracic spine occurs, as described above. Therefore, the main phase of diagnosis was and remains to identify the patient's complaints and determine the presence of accompanying muscle spasms by simply palpating the muscles along the spine. Is it possible to confirm the diagnosis of osteochondrosis by X-ray examination?
In an "X-ray" of the cervical spine and also in functional tests for flexion and extension, cartilage cannot be seen because their tissue allows X-rays to pass through. Nevertheless, based on the position of the vertebrae, general conclusions can be drawn about the height of the intervertebral discs and the general straightening of the physiological curvature of the neck- Lordosis - as well as the presence of marginal growths on the vertebrae with prolonged irritation of their surfaces due to fragile and dehydrated intervertebral discs can lead to the diagnosisConfirm instability of the cervical spine.
Since the intervertebral discs themselves are only visible using CT or MRI, magnetic resonance imaging and X-ray computed tomography are indicated to clarify the internal structure of cartilage and formations such as bulges and hernias. Thus, with the help of these methods, an accurate diagnosis is made, and the tomography result is an indication and even an actual guide for the surgical treatment of an inguinal hernia in the neurosurgical department.
It should be added that no other examination methods other than imaging, except MRI or CT, can show an inguinal hernia. So if you get a trendy "computer diagnosis" of the whole body, if a chiropractor diagnosed you with a hernia by running his fingers along your back, if a hernia was diagnosed based on acupuncture, a special psychic technique, or. . . If you do a session of honey Thai massage, you can immediately consider this diagnosis to be completely illiterate complications of osteochondrosis caused by bulging or hernia, compression, muscle orNeurovascular complications caused can only be treated by assessing the condition of the intervertebral disc at the correct level.
Treatment of complications of osteochondrosis
We repeat once again that it is impossible to cure osteochondrosis like planned aging and dehydration of the intervertebral disc. You just can't let it complicate things:
- If symptoms of narrowing of the disc height appear, you need to move properly, not gain weight and avoid the appearance of protrusions and muscle pain.
- If you already have a lead, you need to be careful not to tear the fiber ring, i. e.
- If you have a hernia, you need to monitor it dynamically, do regular MRIs, avoid enlargement or use modern minimally invasive surgical treatment, since all conservative methods of treating exacerbation of osteochondrosis without exception leave the hernia in place and eliminate only temporary onesSymptoms: Inflammation, pain, stinging 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 always return. We describe how to deal with unpleasant sensations, pain and limited mobility in the back against the background of exacerbation of osteochondrosis and an existing bulge or hernia as a result of social tonic syndrome.
What to do during an exacerbation?
Since an acute attack of pain has occurred (for example, in the lower back), you must follow the following instructions at the premedical stage:
- completely eliminate physical activity;
- sleep on a hard mattress (orthopedic mattress or hard sofa) to avoid sagging your back;
- It is advisable to wear a semi-rigid corset to avoid sudden movements and "distortions".
- You should place a massage pillow with plastic needle applicators on your lower back or use a Lyapko applicator. You need to keep it for 30 to 40 minutes two to three times a day.
- after that, ointments with NSAIDs, ointments with bee or snake venom can be rubbed into the lower back;
- After rubbing, on the second day, you can wrap your lower back in dry heat, for example with a belt made of dog hair.
A common mistake is not warming up on the first day. This can be a heating pad or bath procedures. At the same time, the swelling increases and with it the pain. Only when the "highest point of pain" has passed can you warm yourself. After that, heat promotes the "absorption" of the swelling. This usually happens in 2-3 days.
The basis of every treatment is etiotropic therapy (elimination of the cause) and pathogenetic treatment (influence on the disease mechanisms). It is accompanied by symptomatic therapy. Vertebrogenic pain (caused by problems in the spine) looks like this:
- To reduce swelling of the muscles and spine, a salt-free diet and limiting fluid intake are indicated. You can even give a tablet of a mild potassium-sparing diuretic;
- 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 the nervous tissue, eliminate inflammation and normalize muscle tone.
- In the subacute phase, after the maximum pain has been overcome, no more "injections" should be carried out and attention should be paid to strengthening agents, for example modern drugs from 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 already subsided, but muscle spasm has not yet completely subsided.
Kinesiotherapy (exercise treatment) involves therapeutic exercises and swimming. Gymnastics for osteochondrosis of the cervical spine is aimed not at the intervertebral discs at all, but at the surrounding muscles. Its task is to relieve tonic spasms, improve blood circulation, and also normalize venous outflow. This leads to a reduction in muscle tone, a reduction in pain intensity and stiffness in the back.
In addition to 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 material with "shape memory". Its task is to relax the muscles of the neck and suboccipital region and prevent circulatory disorders in the vertebrobasilar area at night.
Autumn is an important period 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 produce weak electrical currents during massage that have a positive effect on the health of the patient.
Exercises for osteochondrosis must be performed on "warmed up muscles" after a light general warm-up. The main therapeutic factor is movement, not the degree of muscle contraction. Therefore, in order to avoid relapse, the use of weights is not allowed; a gymnastic mat and aGymnastic sticks are not used. With their help you can effectively restore freedom of movement.
Rubbing ointments and using the Kuznetsov implicator continues. Swimming, underwater massage, Charcot shower are shown. At the stage of subsiding exacerbation, drugs for home magnetic therapy and physiotherapy are indicated.
Usually treatment lasts no more than a week, but in some cases osteochondrosis can manifest itself with such dangerous symptoms that urgent surgery may be required.
About Shants' collar
In the early stages, in the acute stage, it is necessary to protect the neck from unnecessary movements. The Shants collar is ideal for this. Many people make two mistakes when purchasing this collar. They do not choose it according to their size, so it simply does not fulfill its function and causes discomfort.
The second common mistake is wearing it for a long period of time for prophylactic purposes. This leads to weak neck muscles and only causes more problems. There are only two indications under which a collar may be worn:
- the appearance of acute pain in the neck, stiffness and pain spreading to the head;
- if you, in full health, do physical work that risks "straining" your neck and aggravating it. This is, for example, repairing a car if you lie down under it, or cleaning windows if you stretch out your hand and feel uncomfortablepositions must be taken.
The collar should not be worn for more than 2-3 days, as prolonged wear may cause venous congestion in the neck muscles at a time when the patient needs to be activated. 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 advisable that every patient undergo an MRI and consult a neurosurgeon after the progression of symptoms and in the presence of complications. Modern minimally invasive operations allow the safe removal of larger hernias, without a long hospital stay, without coercion or lying down for several days, without affecting the quality of life, as they are carried out using modern videoendoscopy, radiofrequency, laser technology or with cold plasma. They can evaporate part of the core and lower the pressure, reducing the risk of a hernia. And you can radically eliminate the defect by eliminating it completely.
There is no need to be afraid of hernia surgery, it is no longer the same as the previous open operations of the 80s and 90s of the last century with muscle dissection, blood loss and a subsequent long recovery period. They are more like a small puncture under X-ray control and subsequent use of modern technology.
If you prefer a conservative method of treatment without surgery, then know that no single method can reduce or eliminate the hernia, 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 treat an inguinal hernia. Creams and balms, kinesitherapy and even the introduction of platelet-rich plasma do not help either. And even traction therapy or traction, despite all its benefits, can only relieve symptoms.
The well-known saying "Minced meat cannot be reversed" can therefore serve as a guiding principle for the conservative treatment of intervertebral hernias. A hernia can only be eliminated in a timely manner. The prices for modern operations are not that high because they have to be paid once. But an annual oneTreatment 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, is largely not a disease, but simply a manifestation of inevitable aging and premature "shrinkage" of intervertebral discs. Osteochondrosis needs little to never bother us:
- Avoid hypothermia, especially in fall and spring, and fall in winter.
- Do not lift weights and only carry loads in your backpack with your back straight.
- drink more clean water;
- Don't get fat, your weight should correspond to your height;
- Treatment of flat feet, if any;
- Do physical exercises regularly;
- performing exercises that relieve strain on the back (swimming);
- give up bad habits;
- Alternation between psychological stress and 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 take at least one x-ray of the lumbar spine in two projections or an MRI to determine whether the hernia, if any, is progressing;
By following these simple recommendations, you can keep your back healthy and mobile throughout your life.