This material is intended for people without a medical degree who want to know more about osteochondrosis than can be found 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: "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, you have the initial signs of chondrosis, how scary is it? "This article is about osteochondrosis, its causes, manifestations, methods of diagnosis, treatment and prevention, as well as answers to the most frequently asked questions. Since we are all osteochondrosis patients without exception, this article will be useful for everyone.
What is osteochondrosis?
The name of the disease is scary if not clear. The medical suffix "-oz" means proliferation or enlargement of certain tissues: hyalinosis, fibrosis. An example of this is cirrhosis of the liver, when the connective tissue grows and the functional tissue, the hepatocytes, decreases in volume. Pathological protein or amyloid accumulation may occur, which should not normally be present. This storage disease is then called amyloidosisdue to fatty degeneration, which is called fatty hepatosis.
Well, it turns out that in the case of intervertebral osteochondrosis, the volume of the cartilage tissue of the intervertebral discs increases, because "chondros, χόνδρο" translated from Greek to Russian means "cartilage"? No, chondrosis, more precisely osteochondrosis, is not a storage disease. In this case, the real growth of the discs does not occur, we are only talking about the change in the configuration of the intervertebral discs as a result of many years of physical activity, and we have examined what happens in each disc above. The term "osteochondrosis" was introduced into the clinical literature by A. Hilderbrandt in 1933.
How does the biomechanics of a desiccated disc change its shape? As a result of excessive load, their outer edges swell, crack, protrusions develop, then intervertebral hernias, or cartilaginous nodules extending beyond the normal contour of the disc. That is why chondrosis is called chondrosis, because cartilaginous nodules - hernias - arise where cartilage should not be, behind the outer contour of a healthy disc.
The edges of the vertebrae, which are located next 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 discs. None of us are surprised that the face of a 20-year-old girl will be a little different than at 70, but for some reason everyone believes that the spine, intervertebral discs, do not go through the same pronounced transition period. changes. Dystrophy is a nutritional disorder, and degeneration is a violation of the structure of the intervertebral discs, which follows a long dystrophy.
Causes and complications of osteochondrosis
The main cause of uncomplicated, physiological osteochondrosis is the way a person moves: straight walking. Humans are the only species on earth that walks on two legs among all mammals, and this is the only mode of locomotion. Osteochondrosis became a scourge of humanity, but we freed our hands and created civilization. Thanks to straight walking (and osteochondrosis), not only did we create the wheel, the alphabet and fire, but you can sit at home in the heat and read this article on your computer screen.
Man's closest relatives, the higher primates - chimpanzees and gorillas - sometimes rise on two legs, but this mode of movement is helpful for them, and they still move on all fours most of the time. In order for osteochondrosis to disappear, as an intensive aging of the intervertebral discs, a person must change his movements and remove the constant vertical load on the spinal column. Dolphins, killer whales and whales do not suffer from osteochondrosis, and dogs, cows and tigers do not. Their spine does not absorb long-term static and shock-like vertical loads, as it is in a horizontal state. If humanity goes to sea like Ichthyander, and the natural way of movement is diving, then osteochondrosis can be overcome.
The upright posture forced the human musculoskeletal system to protect the skull and brain from shock loads. But the discs — the flexible cushions between the vertebrae — aren't the only defense. Humans have elastic foot arches, cartilage in their knee joints, and physiological curves of their spine: two lordosis and two kyphosis. All this allows you not to "shake off" your brain while running.
Risk factors
However, doctors are interested in risk factors that can be modified and avoid the complications of osteochondrosis, which cause pain, discomfort, limited mobility and reduced quality of life. Consider these risk factors that are often overlooked by doctors, especially in private medical centers. After all, it is much more rewarding to treat a person continuously than to point out the cause of the problem, solve it and lose the patient. Here they are:
- the presence of longitudinal and transverse flat feet. Because of flat feet, the arch stops springing and the shock is transmitted upwards towards the spine without softening. Intervertebral discs experience significant stress and quickly collapse;
- overweight and obesity - no comment required;
- improper lifting and transportation of heavy objects, with uneven pressure on the intervertebral discs. For example, if you lift and carry a bag of potatoes on one shoulder, the intense load falls on one edge of the discs and can be excessive;
- physical inactivity and sedentary lifestyle. It was said above that the maximum pressure on the discs is reached while sitting, since a person never sits straight, but always bends "slightly";
- chronic injuries, slipping on ice, intense weight lifting, contact martial arts, heavy hats, hitting low ceilings, heavy clothing, carrying heavy bags.
Above, we have listed the risk factors that can affect all people. We deliberately do not list diseases here - connective tissue dysplasia, scoliotic deformation that changes the biomechanics of movement, Perthes disease and other conditions that aggravate and worsen the course of physiological osteochondrosis and lead to complications. These patients are treated by an orthopedist. What are the common symptoms of complicated osteochondrosis that make patients consult a doctor?
General symptoms
The symptoms described below also exist outside of localization. These are common symptoms and can occur anywhere. These are pain, movement disorders and sensory disturbances. There are also vegetative-trophic disorders or specific symptoms such as 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 pressure of the intervertebral disc protrusion or herniation of the corresponding root at this level. Each nerve root consists of two parts: sensory and motor.
Depending on exactly where the hernia is and which part of the root has been compressed, there may be sensory or motor abnormalities. Sometimes both disorders appear at the same time, expressed to different degrees. Pain also belongs to sensory disorders, since pain is a special, specific feeling.
Radicular pain: compression radiculopathy
Radicular pain is known to many people and is called "neuralgia". The swollen nerve root reacts violently to any stroke, and the pain is very sharp, similar to an electric shock. It shoots into the arm (from the neck) or the leg (from the lower back). Such a sharp, painfulimpulse is called lumbago: lumbago in the lower back, cervicago, a rarer termor requires a pain-relieving posture. Coughing, sneezing, laughing, or straining, radicular pain occurs immediately. Any shock to the swollen nerve root causes increased pain.
Muscle pain: myofascial tonic
But an intervertebral hernia or a disc defect cannot compress the nerve root, but the nearby ligaments, fascia and deep back muscles are injured during movement. In this case, the pain is secondary, aching, constant, back stiffness occurs, 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 is prolonged, the muscle contraction turns into a permanent spasm, which will be very painful.
A vicious circle develops: the spasmodic muscle cannot supply blood well, it is starved of oxygen and poorly removes lactic acid, i. e. the product of its own life activity, into the venous capillaries. And the accumulation of lactic acid again leads to increased pain. It is this type of muscle, chronic pain that significantly impairs the quality of life and forces the patient to undergo long-term osteochondrosis treatment, although it does not prevent him from moving or forcing him to lie in bed.
A characteristic symptom of such secondary myofascial pain is increased stiffness of the neck, lower back or thoracic spine, the appearance of dense, painful muscle lumps - "rollers" next to the spine, i. e. paravertebral. In such patients, back pain occurs after several hours of "office" workit gets stronger with prolonged immobility, when the muscles practically cannot work and are in a spasmodic state.
Diagnosis of osteochondrosis
In typical cases, osteochondrosis of the cervical and cervicothoracic spine occurs as described above. Therefore, the main stage of the diagnosis was and remains the identification of the patient's complaints, establishing the presence of simultaneous muscle spasm by simply palpating the muscles along the spinal column. Can the diagnosis of osteochondrosis be confirmed by X-ray examination?
"X-rays" of the cervical spine, and even functional tests for bending and stretching do not reveal the cartilage, since their tissue transmits the X-rays. Nevertheless, based on the location of the vertebrae, general conclusions can be drawn about the height of the intervertebral discs, the general straightening of the physiological curvature of the neck - lordosis, as well as the presence of marginal growths on the vertebrae, their surface irritation is fragile andby desiccated intervertebral discs. Functional tests can confirm the diagnosis of cervical spine instability.
Since the discs themselves can only be seen with CT or MRI, magnetic resonance and X-ray computed tomography are recommended to clarify the internal structure of the cartilage and formations such as protrusions and hernias. Thus, with the help of these methods, the diagnosis is accurately established, and the results of the tomography are an indication and even a current guideline for the surgical treatment of the hernia occurring in the neurosurgery department.
It should be added that a hernia cannot be detected with any other research method, except MRI or CT. Therefore, if you receive a fashionable, whole-body "computer diagnosis", if a chiropractor diagnosed a hernia by running his fingers along your back, if a hernia was diagnosed based on acupuncture, a special extrasensory technique, or a session of Thai massage with honey, then you can immediately consider this diagnostic method completely illiteratelevel. Osteochondrosis is caused by protrusion or hernia, compression, muscle, neurovascularits complications can only be treated with an adequate level of vision of the condition of the intervertebral disc.
Treatment of complications of osteochondrosis
Let's repeat once again that it is impossible to cure osteochondrosis, like planned aging and drying out of the disc. You just can't let things get complicated:
- if there are symptoms of a narrowing of the height of the intervertebral discs, you need to move correctly, do not gain weight and avoid the appearance of protrusions and muscle pain;
- if there is already a protrusion, then take care not to break the annulus fibrosus, that is, the protrusion does not turn into a hernia, and avoid the appearance of protrusions at several levels;
- if there is a hernia, it should be dynamically monitored, regular MRI should be performed, its size should be avoided, or modern, minimally invasive surgical treatment should be performed, since all conservative methods of treating exacerbation of osteochondrosis leave the hernia in place without exception. and relieve only temporary symptoms: inflammation, pain, shooting and muscle spasms.
But with the slightest violation of the regime, heavy lifting, hypothermia, injury, weight gain (in the lower back), the symptoms return again and again. We describe how to cope with discomfort, pain and limited mobility in the back against the background of exacerbation of osteochondrosis and secondary protrusion or herniation of social tone syndrome.
What to do during an exacerbation?
Since acute pain has arisen (for example, in the lower back), in the pre-doctor stage, you should follow the following instructions:
- completely eliminate physical activity;
- sleep hard (on an orthopedic mattress or hard sofa), eliminating sagging of the back;
- it is advisable to wear a semi-rigid corset to prevent sudden movements and "distortions";
- Place a massage pad with plastic needle applicators on the lower back or use a Lyapko applicator. It should be used 2-3 times a day for 30-40 minutes;
- after that, ointments containing NSAIDs, ointments with bee or snake venom can be rubbed into the lower back;
- on the second day after rubbing, you can wrap the lower part of the back in dry heat, for example with a belt made of dog hair.
A common mistake is warming up on the first day. It can be a heating pad, bath procedures. At the same time, the swelling only increases, and along with it, the pain. You can apply heat only when the "highest point of pain" has passed. After that, the heat will increase the "absorption" of the swelling. This usually happens within 2-3 days.
All treatment is based on etiotropic therapy (elimination of the cause) and pathogenetic (influencing the mechanisms of the disease) treatment. It is accompanied by symptomatic therapy. For vertebrogenic pain (caused by spinal problems):
- In order to reduce the swelling of the muscles and spine, a salt-free diet and limiting the amount of liquid consumed is recommended. 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 by intramuscular "injection" of NSAIDs and muscle relaxants: 1. 5 ml intramuscularly daily for 3 days, 1 ml intramuscularly for 5 days. This helps to relieve the swelling of nerve tissue, eliminate inflammation and normalize muscle tone;
- in the subacute period, after overcoming the maximum pain, one should no longer take "injections" and pay attention to restorative agents, for example, modern drugs of the "B" group. They effectively restore damaged sensitivity, reduce numbness and paresthesia.
Physiotherapy measures continue, it's time to practice osteochondrosis. Its task is to normalize blood circulation and muscle tone when the swelling and inflammation have passed, but the muscle spasm has not yet completely disappeared.
Kinesiotherapy (movement treatment) includes 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 normalize venous outflow. This leads to a decrease in muscle tone, a decrease in the severity of pain and stiffness in the back.
In addition to massage, swimming, and acupuncture treatments, it is recommended to purchase an orthopedic mattress and special pillow. The pillow for osteochondrosis of the cervical spine must be made of a special material with "shape memory". Its task is to relax the neck and suboccipital muscles, as well as to prevent nighttime blood flow disturbances in the vertebrobasilar region.
Autumn is an important station for 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 currents during massage that have a beneficial effect on the patient.
Exercises for osteochondrosis should be performed after a mild general warm-up, on "warmed muscles". The main therapeutic factor is movement, not the degree of muscle contraction. Therefore, in order to avoid a relapse, the use of gym mats and gym sticks is not allowed; with their help, you can effectively restore the range of motion.
The rubbing of ointments and the use of the Kuznetsov implicator continue. Swimming, underwater massage, Charcot shower can be seen. At the stage of worsening of the fading, home magnetic therapy and physiotherapy drugs are indicated.
Treatment usually lasts no longer than a week, but in some cases, osteochondrosis can present with such dangerous symptoms that surgery may be required, and urgently.
From Shants collar
In the initial stage, the acute stage, the neck must be protected from unnecessary movements. The Shants collar is excellent for this. Many people make two mistakes when buying this collar. They are not selected according to their size, which is why it simply does not fulfill its function and causes discomfort.
The second common mistake is to wear it for a long time for prophylactic purposes. This leads to weak neck muscles and only causes more problems. In the case of the collar, it can only be worn based on two indications:
- the appearance of acute pain in the neck, stiffness and pain spreading to the head;
- if you are in full health and will be doing physical work where there is a risk of "straining" your neck and aggravating it. This is for example repairing a car when you lie down or washing windows when you have to reach out and assume awkward positions.
The collar should be worn for no more than 2-3 days, as venous congestion may occur in the neck muscles when the patient has time to activate it. 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, after the progression of symptoms, and in the event of complications, all patients should undergo an MRI and consult a neurosurgeon. Modern, minimally invasive surgeries enable the safe removal of fairly large hernias, without long-term hospitalization, forced or several days of bed rest, without deterioration of the quality of life, since modern video endoscopic, radiofrequency, laser, orusing cold plasma. It can vaporize part of the seed and reduce the pressure, reducing the risk of herniation. And you can eliminate the error radically, that is, by getting rid of it completely.
There is no need to be afraid of hernia surgery, these are no longer the open surgery types of the 80s and 90s of the last century, with muscle dissection, blood loss and the subsequent long recovery period. They are more like a small puncture with an X-ray check followed by the application of modern technology.
If you prefer a conservative, non-surgical treatment method, know that no method can reduce or eliminate the hernia, no matter what they promise! Neither hormone injection, papain electrophoresis, electrical stimulation, massage, the use of leeches, nor acupuncture can deal with a hernia. Creams and balms, kinesiotherapy, and even the introduction of platelet-rich plasma do not help. And even traction therapy, or traction, for all its benefits, can only reduce symptoms.
Therefore, the motto of the conservative treatment of intervertebral hernia can be the well-known expression: "minced meat cannot be turned back". The hernia can only be removed immediately. The prices of modern operations are not so high, because you have to pay once. But the annual sanatorium treatment will eventually cost 10-20may cost several times more than the radical removal of the hernia with the disappearance of pain and restoration of quality of life.
Prevention of osteochondrosis and its complications
Osteochondrosis, including complex ones, the symptoms and treatment of which were discussed above, is mostly 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 fall 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;
- treatment of flat feet, if present;
- do physical exercises regularly;
- practicing types of exercises that reduce the load on the back (swimming);
- giving up bad habits;
- alternation of mental 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;
- At a minimum, you can get regular x-rays of the lumbar spine in two views or an MRI to see if the hernia, if any, is progressing;
By following these simple recommendations, you can keep your back healthy and flexible for a lifetime.