Exercises to strengthen the lower back muscles. Quadratus lumborum syndrome causes, symptoms, treatment and prevention methods Back muscles pillars
Lower back pain is one of the most common problems, which, according to statistics, affects every third adult. If you do not deal with pain in the back and lower back in time, you can subsequently earn serious spinal disease . We offer you a selection of effective exercises for lower back pain to relax and strengthen muscles, as well as to increase flexibility and mobility of the spine.
Lower back pain: what causes it and what to do?
Most common cause The occurrence of lower back pain is a sedentary lifestyle and poor development of corset muscles, which are not able to support the spine. In addition, the cause may be various pathologies, excessive stress, or simply a sudden awkward movement that provoked pain. Most of these problems can be neutralized with lower back exercises.
What can cause lower back pain:
- staying in one position for a long time;
- weak back and core muscles;
- excessive loads or non-compliance with exercise technique;
- hypothermia of the body;
- curvature of the spine;
- osteochondrosis;
- large excess weight;
- improper diet and vitamin deficiency.
To prevent lower back pain from becoming a cause serious problems with the spine, it is necessary to perform special exercises for the lower back , which will help relieve discomfort, reduce pain, improve the health of the body and serve as a good preventive measure. It is not for nothing that the basis of rehabilitation after back injuries is physical therapy and gymnastics for the spine.
Why it is useful to perform exercises for the lower back:
- Pain in the lower back is reduced by stretching and relaxing the muscles
- Strengthens the spine and increases its flexibility
- Blood circulation increases, which saturates the joints and vertebrae with nutrients
- Strengthens the corset muscles that support the spine
- Posture improves
- Improves the functioning of the heart and lungs
- Hormonal levels are normalized
- The risk of hernia, osteochondrosis and other pathologies is reduced
- Improves the functioning of the pelvic and abdominal organs
A set of exercises for lower back pain should include: muscle stretching exercises Andmuscle strengthening exercises . During exacerbations, tension is observed in the muscles, so first of all they need to be relaxed - for this, a stretching routine is performed (traction) muscles. To prevent lower back pain, it is necessary to strengthen the muscles. When strengthening the back muscles, the load on the spine decreases, since a significant part of the load is taken on by the muscle corset.
Rules for performing exercises for the lower back
1. Do not force the load and overload the lower back with exercises in order to achieve the goal faster. Start with light loads, gradually increasing the duration of exercise.
2. Exercises for the lower back should be done with the load and amplitude that is comfortable for you. Do not make sudden jerks or movements while performing exercises for the lower back, so as not to aggravate the problem.
3. One or two workouts will not help solve the problem; try to perform a set of exercises for the lower back on an ongoing basis. It will be enough to train 3 times a week for 15-20 minutes.
4. If you have a cold floor or cold weather outside, then dress warmly and lay a rug or blanket on the floor to prevent your lower back from getting cold.
5. Perform exercises on a hard surface: a bed or soft mat will not work. During exercises lying on your back, your lower back should be pressed to the floor.
6. Don’t forget about breathing while performing a set of exercises for lower back pain. The training should be accompanied by deep, even breathing; perform each static exercise on 7-10 breathing cycles.
7. If during some exercises you feel discomfort in the lower back or spine, then it is better to skip such exercises. If during the exercise you feel acute pain, then in this case it is better to stop training altogether.
8. You should not perform the proposed set of exercises for the lower back during pregnancy, after a spinal injury or with chronic diseases. In this case consultation with a doctor is required.
9. Remember that if you have any chronic disease, then a set of exercises for the lower back must be selected individually. For example, for scoliosis, exercises to straighten the spine are indicated, and for osteochondrosis and hernia, exercises to stretch it.
10. If discomfort in the lumbar region does not go away within a few weeks, consult a doctor. Lower back pain may be a sign of a serious illness. The sooner you begin the treatment process, the easier it will be to avoid irreversible consequences.
Exercises for lower back pain: stretching
We offer you stretching exercises for the lower back muscles, which are suitable for eliminating painful spasms and as a preventive measure. Stay late in every pose20- 40 seconds , you can use a timer. Remember to do exercises on both sides, right and left. If any exercise gives you discomfort or pain, then interrupt it; the workout should not bring discomfort.
From a position on all fours, move your buttocks back and up, stretch your arms, neck and back in one line. Imagine that your body has formed a slide: try to make the top higher and the slopes steeper. You can simplify the position a little by bending your knees and lifting your heels off the floor.
Allie The Journey Junkie
Take a lunge position, lower the knee of one leg to the floor and move it as far back as possible. The second leg forms a right angle between the thigh and shins. Stretch your arms up, feel a pleasant stretch in your spine. Hold this position and then move into pigeon pose.
From the lunge position, lower yourself into pigeon pose. Cover the left heel with the right pelvic bone. You can deepen the position by moving your left shin slightly forward. Pull your pelvis towards the floor. Place your forearms on the surface or lower your body to the floor or pillow - take a comfortable position, focusing on your flexibility.
After pigeon pose, return to a low lunge and repeat these 2 exercises on the other leg. You can use yoga blocks or books:
To perform this very effective lower back exercise, sit in a sitting position with your legs extended in front of you. Cross your leg over your hip and rotate your body in the opposite direction. This exercise not only allows you to stretch the muscles of the back and lower back, but also gluteal muscles.
5. Seated bends
Remaining in the same position, gently lower your back towards your feet. It is not necessary to make a full fold; it is enough to just slightly round your back to stretch the spine. In this case, it is advisable to lower your head on some support. You can bend your knees or spread your legs slightly to the side - choose a position that is comfortable for you.
6. Bending in the lotus position
Another very useful exercise for lower back pain is bending in the lotus position. Cross your legs on the floor and bend first to one side, holding for 20-40 seconds, then to the other side. Try to keep your body straight, your shoulders and body should not move forward.
7. Leg raise with a strap (towel)
Now let's move on to a series of exercises for the lower back while lying on the floor. Use a strap, tape, or towel to pull your straight leg toward you. During this exercise the back remains pressed to the floor, the lower back does not bend. The other leg remains straight and lies on the floor. If you cannot keep your leg extended and pressed to the floor, you can bend it at the knee. Stay in this position for a while and move to the other leg.
By analogy, perform another effective exercise for the lower back. Lying on your back, bend your leg and pull your knee toward your chest. When performing this simple exercise, the lumbar muscles are stretched very well and painful spasms are reduced.
9. Bent leg raise
This fitness exercise is very often used to stretch the muscles of the buttocks, but it is best suited for stretching the lumbar muscles. Lying on your back, bend your knees and lift them so that your hips and body form a right angle. Grab the thigh of one leg with your hands and place the foot of the other leg on your knee. Hold this position. Make sure your lower back is pressed firmly to the floor.
Another nice relaxing exercise for the lower back is the happy child's pose. Lift your legs up, bending your knees, and grab the outside of your feet with your hands. Relax and stay in this position. You can sway a little from side to side.
Now let's move on to an exercise for the lower back, which involves twisting the spine. Lying on your back, turn your arms and crossed legs to one side. The body seems to form an arc. In this exercise, a large amplitude is not important; you should feel a slight stretch in the lumbar spine. Hold this position for 30-60 seconds and turn to the other side.
12. Lying Back Twist
Another very useful and important exercise for the lower back, which will help relieve pain in the sacral area. Lying on your back, slowly rotate your pelvis and move your leg to the side, throwing it over the thigh of the other leg. The lower back lifts off the floor, but the shoulders remain on the floor.
Another simple exercise for lower back pain. Lie on your stomach and move your leg bent at the knee to the side. The other leg remains extended, with both legs pressed to the floor.
Get on your knees and spread your legs to the side or close them. Exhale and slowly bend forward between your thighs and lower your head to the floor. This relaxing lower back exercise will make your entire body feel lighter, especially your back. This is a resting pose, you can stay in it even for several minutes.
You can also turn first to one side, then to the other, this will help to better stretch the lumbar muscles.
Lie on your back again and place a small pillow under your hips and knees, with your feet touching the floor. Relax in this position for a few minutes.
Exercises for lower back pain: strengthening muscles
Thanks to the proposed exercises, you can improve the mobility of the spine and get rid of discomfort in the lumbosacral region. In addition, you will strengthen your muscle corset, which will be an excellent prevention of lower back pain. Therefore, if you are often bothered by lower back pain, then be sure to take note of these exercises. Please note that it is not recommended to perform exercises to strengthen muscles during exacerbations.
Cat is one of the most useful exercises for the lower back and back in general. As you exhale, round your back, push your shoulder blades as high as possible and draw in your chest. As you inhale, bend well in the lumbar region, pointing the crown of your head toward your tailbone, and open your chest. Perform 15-20 repetitions.
Here and below, photos from the YouTube channel are used: Allie The Journey Junkie
In a standing position on all fours, while inhaling, we stretch our leg back, and while exhaling, we group ourselves, pulling our forehead to our knee. Try not to touch the floor with your foot. Perform 10-15 repetitions on each side.
3. Raising arms and legs on all fours
Remaining in a standing position on all fours, grab the opposite leg with your hand and bend at the lumbar region. The stomach is tucked, the muscles of the buttocks and legs are tense, the neck is free. Stay in this position for 30 seconds, maintaining balance.
Get down on your stomach and take a lying position. Bend your elbows and spread them to the sides. Lift your body up, lifting your chest off the floor. Try to lift your body while keeping your neck neutral. Hold in the upper position for 5-10 seconds and return to the starting position. Complete 10 reps.
A similar exercise to strengthen the lumbar region, only in this version the hands are behind the head, which complicates the position. Both of these lower back exercises are variations of hyperextension, but without the use of additional equipment. Also do 10 reps.
Remaining in a lying position on your stomach, alternately lift your opposite arms and legs up. Movements of the arms and legs should be as synchronous as possible. Stay in the extreme position for a few seconds, try to perform the exercise efficiently. Do not mechanically swing your arms and legs. Repeat the exercise on each side 10 times.
Take your hands back and clasp them together. At the same time, lift your shoulders, chest, shins and knees off the floor, forming an oblong boat with your body. The exercise is not easy, so first try to hold this position for at least 10-15 seconds. You can do several short approaches.
While lying on your stomach, move your arms back and grab your feet with your hands. The thighs, stomach, chest and forehead remain on the floor. Keep your shoulders away from your ears and don't strain your neck. Stay in this position for 20 seconds.
You can also do this version of this exercise for the lower back while lying on your side:
While lying on your stomach, lift your shins up and lift your knees off the floor. Grab your ankles from the outside with your hands of the same name. Bend over as much as possible, lifting your hips and chest off the floor, placing your body weight on your stomach. Imagine that your legs and torso are the body of a bow, and your arms are a stretched bowstring. This exercise for strengthening the lower back is quite complex, so you can gradually increase its amplitude and execution time (you can start with 10 seconds).
From a lying position on your stomach, lift your body, leaning on your forearms and bending in your lower back and thoracic back. Stretch your neck, lower your shoulders, relax your neck and aim the top of your head up. Hold the position for 20-30 seconds. Sphinx pose also helps improve your posture.
If you feel uncomfortable doing this exercise or have lower back pain, you can do an alternative with pillows:
From a lying position on your stomach, lift your body, leaning on your hands and bending in your lower back and thoracic back. Straighten your arms, stretch your neck, aim your head up. Stay in the cobra for 20-30 seconds. You can spread your arms wide, this will make it easier to maintain the position. If you feel discomfort or pain in the lower back, do not perform this exercise.
Take a lying position on your back, legs bent at the knees. Lift your pelvis up, tensing your stomach and buttocks. Hold in the upper position for 5-10 seconds and return to the starting position. This exercise is useful not only for the lower back, but also for strengthening the buttocks and abs. Repeat the bridge 15-20 times.
13. Table pose
Table pose is another effective exercise for the lower back. Take a table pose and stay in this position for 20-30 seconds, repeat in 2 sets. Please note that the hips, stomach, shoulders, and head should be on the same line. The shins and arms are perpendicular to the body. This exercise also opens up the shoulder joints well.
An excellent strengthening exercise for the corset muscles is the plank. Take a push-up position, your body should form one straight line. The arms are positioned strictly under the shoulders, the stomach and buttocks are tucked. Stay in this position for 20-30 seconds. You can repeat the exercise in 2-3 approaches.
From the plank position, assume the “low plank” position – resting on your forearms. The body maintains a straight line, the buttocks do not rise up, the back remains straight without bends or deflections. Stay in this position for 20-30 seconds. You can also repeat the exercise in 2-3 approaches. After doing the planks, lower yourself into child's pose and relax for 1-2 minutes.
Thanks again to the YouTube channel for the images. Allie The Journey Junkie.
7 videos for lower back pain in Russian
We offer you a selection of videos for the back in Russian that will help you get rid of lower back pain at home, strengthen the back muscles, restore lost mobility of the spine. The workouts last from 7 to 40 minutes, so everyone can choose a suitable video for lower back pain.
1. Improvement of the lumbosacral spine (20 minutes)
2. Exercises for the lower back (7 minutes)
3. How to get rid of lower back pain and strengthen it (14 minutes)
4. Restoration of functions in the lumbosacral region (17 minutes)
5. Exercises for the lower back (40 minutes)
6. Mini-complex for the lower back in the subacute period (12 minutes)
7. Exercises for the lumbar spine (10 minutes)
In addition to the presented exercises for the lower back, an effective means for preventing back pain are Pilates workout . Pilates helps strengthen the postural muscles that support the spine, which will help you avoid back problems.
Be sure to check out:
Muscular system of the back- complex education.
This is an interweaving of muscles, fascia, and ligaments responsible for the vertical position, adduction of the limbs, and movements of the torso.
Strong muscles compensate for pathological changes in the spine.
Almost all middle-aged and older people are already familiar with muscle pain in the back.
What muscles form posture and what diseases can affect them?
Superficial muscles
The back muscles attached to the bones of the shoulder girdle are called superficial. They are arranged in two layers.
Layer one
M. trapezius, trapezius muscle
It resembles a flat figure, the upper side of which forms the lateral cervical triangle, the lower lateral side crosses the scapula laterally. Insertion points: acromial end of the clavicle, acromion, spine of the scapula.
It starts from the occipital protrusion, from the edge of the nuchal occipital bone, ligaments - nuchal, supraspinous, CVII, thoracic vertebrae. Contraction of all parts of the muscle pulls the scapula towards the spine . Upper beams m. trapezius raise the scapula, the lower ones lower it. Together, rotate the scapula in a vertical plane.
Latissimus muscle, m. latissimus dorsi
The upper side of the muscle triangle is hidden under the lower part of the m. trapezius. The lower one forms the lateral side of the lumbar triangle. A powerful muscle responsible for adducting, turning inward, lowering the arm, pulling the torso towards the arms (when swimming, climbing, pulling up) has a thorough beginning.
From all lumbar, spinous processes of the lower 6 thoracic vertebrae. From the median sacral and iliac crests. Additionally from above to m. latissimus dorsi muscle bundles are attached, starting from the lower 4 ribs and the angle of the scapula. Crest of the lesser tubercle humerus- place of attachment.
Video: "Classification of back muscles"
Second layer
Mm. rhomboidei minor et major - rhomboid minor and major muscles
They can merge into one. M. rhomboidei minor starts from the lower part of the nuchal ligament, spinous processes of CVII, TI, and supraspinous ligament. Large - from the spinous processes of TII - V. The place of muscle attachment is the lateral edge of the scapula.
Only m. rhomboidei minor is attached above the level of the spine, and major - from the level of the spine to the lower angle of the scapula. M. rhomboidei are located deeper than m. trapezius. They bring the scapula towards the spine, moving upward .
M. levator scapulae, muscle that lifts the scapula
Performs the function according to the name . At the same time, it brings the scapula closer to the spine and tilts the neck (with the scapula fixed). Start m. levator scapulae - posterior tubercles of the transverse processes of the 4th or 3rd upper cervical vertebrae. Attached to the side of the shoulder blade.
The serratus posterior muscles stand apart in the classification.:
- M. serratus posterior superior - serratus posterior superior muscle responsible for raising the ribs. It is located in front of mm. rhomboidei. Origin - the lower part of the nuchal ligament, spinous processes of the VI-VII cervical, I-II thoracic vertebrae. Attachment - posterior angular surface of ribs II-V, with separate teeth.
- M. serratus posterior inferior - the lower serratus posterior muscle lowers the ribs. Lies in front of m. latissimus dorsi. Starts from the spinous processes ТXI – XII, LI-II. It is attached to the 4 lower ribs with separate teeth.
Video: "Superficial back muscles"
Deep muscles
The deep back muscles are represented in three layers.
Surface
M. splenus capitus - splenius capitis muscle
Extends the neck and head, contracting on both sides . Turns his head, contracting on one side. Origin: nuchal ligament below CIV, CVII, upper (3rd or 4th) thoracic vertebrae. Muscle bundles pass upward and are laterally attached to the mastoid process temporal bone and the rough area under the lateral segment of the superior nuchal line of the occipital bone.
M. sprlenius cervicis - splenius muscle of the neck
Extends the neck while simultaneously contracting . Unilateral contraction of the muscle turns the neck. Starts from the spinous processes TIII-IV. It is attached to the posterior tubercles of the transverse processes of the 3 upper cervical vertebrae. Located in front of m. trapezius.
M. erector spinae, erector spinae muscle - strengthened
Responsible for keeping the body upright . Stretches from the sacrum to the base of the skull. Triples at lumbar level – m. iliocostalis (iliocostal), m. longissimus (longest), m. spinalis (spinous). Attached to the ribs, vertebrae, and base of the skull.
Average
M. Transversospinalis - transverse spinalis muscle
Responsible for straightening the body, bending, and rotating the spine . The muscle is divided into parts that spread across different groups of vertebrae - m. semispinalis (semispinalis), mm. multifidi (multipartite), mm. rotatores (rotators). These muscle groups rotate the spine, move the head, and control breathing movements.
Deep
Mm. interspinales cervicis, thoracis et lumborum - interspinous muscles of the neck, chest and lower back
Participate in the extension of the departments corresponding to the name . The spinous processes unite each other. Down from the second cervical vertebra. These muscles are poorly developed in the thoracic spine or may be absent.
Mm. intertransversarii lumborum, thoracis et cervicis - intertransverse muscles of the lower back, chest, neck
Responsible for the inclination of the homonymous parts of the spinal column . These are short muscle bundles between the transverse processes of adjacent vertebrae.
Mm. Suboccipitales - suboccipital muscles
They are located deep under the superficial muscles. They enclose the vertebral artery, the posterior branches of the spinal nerve CI, the arch of the atlas and the atlanto-occipital membrane in a triangular space. Responsible for head movements - throwing back, bending, rotating .
Video: "Deep back muscles"
What diseases of the back muscles are there?
Did you know that...
Next fact
There are many names for muscle diseases. Almost always they correspond to the mechanism of the pathological process. In addition to the name “myalgia,” which refers to muscle pain due to overexertion.
Muscle inflammation after hypothermia, infection, manifested by pain – myositis. Adhesive fibrous process in the muscles, a consequence of advanced myositis - fibromyositis. Adhesions between muscle tissues, due to thickened lymph released and accumulated around the inflammatory focus - neurofibromyositis.
The blood vessels that innervate and supply the muscle become fused with it during inflammation. Therefore, any influence on the muscle - temperature, static tension causes pain in it.
Muscle pain in the lumbar and sacral region may be a reaction to hysteria. The symptom of herpes zoster is unilateral lower back pain. Any functional changes in the spine are reflected in the condition of the muscles, which try to compensate for the incorrect position of the spinal column by straining.
A constant pathological effect on the muscle forms trigger (sensitive) points, triggering an inadequate pain response at the level of the central nervous system.
Types of myositis and fibromyositis:
Lumbago (myositis, fibrositis) – muscle disease at the level of TXII, LV vertebrae. The pathology is caused by a convulsive spasm of the deeply embedded intervertebral muscles. Trigger areas: medial edge of the erector erector muscles, iliac crest, sacroiliac joint.
A characteristic symptom, in addition to pain, is scoliosis in the affected area, low-grade fever. Lumbago must be differentiated from a tumor of the spinal cord and spine, myelitis. If the patient has muscle pain, fever, eosinophilia, diarrhea, swelling of the skin, then trichinosis cannot be ruled out.
Myositis of the lumbar muscles has a long-term cure with passive treatment. Its chronic form does not manifest itself with such severe pain as with lumbago. The pain is aching and irritating to the patient. Adjoining fibrositis maintains the pain syndrome.
Pathological conditions that cause pain in the back muscles due to traumatic injury, overexertion, hypothermia:
- Ligament sprain. Causes: falls, sports injuries, heavy lifting. The longitudinal and interspinous ligaments of the spine are damaged. Most often the area TVII – TVIII.
- Torticollis. Torsion dystonia with involuntary contraction of the neck muscles is manifested by rotational deformity. It can be congenital or acquired.
- Scapular-costal syndrome– defeat m. levator scapulae. Pain in the neck, shoulder blade, shoulder joint. The trigger zone is where the muscle attaches. When moving the blade, a crunching sound is heard. The disease affects the levator scapulae muscle, adjacent muscles, fascia, and ligaments.
- Myofasciculitis of the trapezius muscle. In case of injury or hypothermia, it has an acute onset. With the development of burning, boring pain at the slightest movement in the cervical and thoracic region. On palpation at the site of muscle attachment there is an acute pain response. The patient has difficulty choosing a position in bed. Prolonged exposure to low temperatures can cause gradual development of pathology. It is accompanied by a feeling of heaviness along the muscle, a dull aching pain that intensifies with static and dynamic loads and radiates to the intercostal spaces. Small painful lumps may migrate under the skin during massage. Painful manifestations of myofasciculitis are often confused with heart pain.
- Myofasciculitis of the rhomboid muscles. Pain in the area of the dorsum of the forearm increases gradually. Intensifies when turning the head and arms. By palpation, pain is determined at the medial edge of the scapula and spinous processes.
- Myofasciculitis of the serratus muscle. Manifestations: heaviness, cerebral (dull, aching) pain at the CV-CVII level. Intensifies at night after exercise.
- Myofasciculitis m. latissimus dorsi. The symptoms are similar to those listed above.
Video: "10 facts about the back muscles"
Conclusion
- Muscular system of the spine formed by muscle groups at the superficial and deep levels. Strengthening muscles helps prevent diseases caused by injuries, overexertion, and infections. If exercise does not prevent the development of pathology, it does make the response of the muscular system less severe for the patient.
- You should take your body seriously avoid hypothermia. Respond in a timely manner to the initial pain symptoms of the back muscles.
- You need to look for the cause of the disease together with a specialized specialist. The names of diseases usually correspond to their pathogenesis.
- Ignoring the disease contributes to irreversible adhesions between muscles, nerves, blood vessels. Such pathologies make the patient hostage to pain, limit movement, and require long-term treatment.
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Anatomy of the back muscles. What are the back muscles and what are they responsible for?
Chiropractor, Neurologist, Osteopath
Engaged in the diagnosis of patients in the field of traumatology and orthopedics. Reads x-rays, and also carry out conservative treatment osteochondrosis and protrusion of spinal discs using manual therapy.
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Proximal attachment. The medial half of the XII rib and the transverse processes of the lumbar vertebrae LI-L4.
Distal attachment. The superior posterior region of the iliac crest.
Function. Unilateral action: tilts the spine in its direction; pulls the 12th rib downwards. Bilateral action: straightens the spine in the lumbar region; participates in forced exhalation, for example, when coughing.
Palpation. The quadratus lumborum muscle is very often the cause of the development lumbar pain, but almost as often its role as a source of malaise is overlooked.
To localize the quadratus lumborum muscle, the following structures must be identified:
. The XII rib is the lowest and shortest of the ribs. Its free anterior edge is located posterior to the midclavicular line at the same level as the body of the L2 lumbar vertebra.
. Transverse processes of vertebrae LI—L5.
. The iliac crest lies on the same horizontal line with the articulation of the L4-L5 vertebrae.
When palpating the quadratus lumborum muscle, the patient should lie on his stomach. Gently palpate the area between the 12th rib and the iliac crest. The pressure should not be directed deep into the body, but obliquely and medially towards the transverse processes of the lumbar vertebrae. Imagine the location of the quadratus lumborum muscle and your hand will locate its lateral aspect.
Pain pattern. With superficial trigger points, pain is felt along the lateral border of the iliac crest and up to the greater trochanter of the femur. Deep trigger points cause pain in the sacroiliac joint and deep in the buttocks. Due to deep lower back pain, the patient may lose the ability to stand with a straight spine or walk. Pain can be caused by trying to turn over on the other side in bed. Trigger points can cause leg shortening that is noticeable to the eye.
Causal or supporting factors.
Excessive load when lifting weights with your back bent at the waist; prolonged and repeated stress.
Satellite trigger points. The gluteus minimus and medius muscles, the piriformis muscle and the paravertebral muscles of the thoracic and lumbar regions.
Affected organ system. Genitourinary system.
Associated zones, meridians and points.
Dorsal zone. Bladder foot meridian tai yang. BL 21—24, 51, 52.
Stretching exercises.
1. Lying on your back with your knees bent and feet flat on the floor, cross the leg of your uninjured side over the other. With your “upper” foot, gently press down on your lower foot, lowering it toward the floor. Fix the pose until the count is 15-20.
2. Stand with your back to the wall, approximately 30 cm from it. Without lifting your feet from the floor, turn top part body and place your palms against the wall. Fix the pose until the count is 15-20.
3. In a standing position, cross your legs like this. so that the leg of the injured side is in front, transfer your body weight to it. Raise both arms in front of your head and grasp the wrist of the affected side. Pull sideways to the uninjured side.
Strengthening exercise. Since the quadratus lumborum muscle is a postural muscle, strengthening exercises are generally not necessary.
D. Finando, C. Finando
The lumbar spine supports most of the body. Approximately 80% of adults experience low back pain at some point in their lives. Muscle atrophy caused by a sedentary lifestyle is common, especially if you work in an office and lead a relatively sedentary lifestyle. To strengthen your lower back, start with a regular exercise program that includes strength training, stretching, and aerobic or cardiovascular exercise.
Steps
Do exercises to strengthen your back
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Bridge your hips. Hip bridges also help strengthen the lower back and core muscles that support the spine, leading to a reduced risk of lower back pain. For this exercise, lie on your back with your knees bent and your feet flat on the floor, just like you would for a pelvic squeeze.
- Lift your hips toward the ceiling, keep your knees bent, and engage your core. Stop when your hips are level with your knees so that you can draw a straight line (or bridge) from your knees to your shoulders.
- Hold the position for 5-10 seconds, breathing deeply, then lower to the floor. Perform 10 repetitions.
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Do the "Floor Swimming" exercise. For this exercise, also known as "Superman", you need to lie on the floor, face down, legs extended back and arms in front of your head.
- If you are already lying on your back, roll over onto your stomach. Raise your arms above your head and stretch your legs behind you.
- Raise your legs a few centimeters, and then take turns doing swings. You can also raise your left leg and right arm at the same time, then lower them and raise your right leg and left arm.
- Do 10 to 20 repetitions.
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Squeeze your pelvic muscles. This exercise helps strengthen the muscles at the base of your abdominal cavity, as well as the muscles around your lower back. Learning to contract these muscles will help strengthen them so that you are less prone to lower back problems.
- To perform this exercise, lie on your back with your knees bent and feet flat on the floor. Your feet should be approximately hip-width apart.
- Press the arch of your lower back toward the floor and hold for 5-10 seconds, breathing deeply, then lower yourself. Do 10 repetitions of this exercise.
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Hunting dog pose. Hunting dog pose helps stretch and strengthen the lower back and improve balance. When starting this exercise, get on all fours, knees directly under your hips, wrists under your shoulders.
- Extend your left arm forward and your right leg back, making a straight line from your toes to your heel. Keep your back straight, hold for two to three seconds, then return to the starting position and do the same with the other side.
- Do 10 to 20 repetitions of this exercise on each side. Keep your back straight and still, and do not raise your head or heel higher than your back.
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Add lunges. Lunges, when performed correctly, are an excellent exercise for strengthening the lower back. To start, stand with your feet approximately hip-width apart. Make sure there are a few tens of centimeters of space in front of you.
- Step forward with your right foot, lowering and bending your left knee. There should be a straight line from the top of your head to your left knee - do not lean forward towards your right leg. Bend your left knee at a right angle so that your knee is directly above your ankle and your thigh is parallel to the floor.
- Hold the lunge for a few seconds, then return to the starting position and repeat with your left foot in front. Perform 5 to 10 repetitions on each side.
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Engage your core as you perform a plank. Since the lower back muscles are part of the abdominal muscles of the torso, you cannot strengthen your lower back without focusing on your core muscles.
- Lie on your stomach and stretch your legs behind you. Rise up using your hands and toes so that there is a straight line from the top of your head to your toes.
- If you haven't done a plank before, you can modify the exercise by doing it from your knees and elbows, or toes and elbows, so that your upper body rests on your forearms instead of your wrists.
- Side planks work the side muscles of the core. Rise onto your forearm, ankles on top of each other. Make sure your elbow is directly under your shoulder.
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Use a stability ball to increase the difficulty. With a little practice, this exercise won't be so difficult anymore. The exercise ball adds an element of balance, which makes the muscles work harder.
- For example, if you place your feet on an exercise ball to do a bridge, both performing the exercise and maintaining the position will become much more difficult.
Stretch your lower back
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"Cat-cow" for warming up. The cat-cow exercise is taken from yoga and involves changing the position from "cat" to "cow" while synchronizing movements and breathing. If you do the cat-cow exercise regularly, it will make your spine more flexible.
- To begin, get on all fours with your back straight. Your wrists should be directly under your shoulders and your knees should be directly under your hips.
- As you inhale, lower your belly toward the floor and lift your chest and pelvis toward the ceiling so that your back arches into a cow position.
- As you exhale, round your back toward the ceiling, tucking your tailbone and lowering your chin toward your chest. Repeat this cycle of inhalation and exhalation 10 to 20 times. Breathe slowly and deeply, in through your nose and out through your mouth.
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Increase blood flow with Sphinx pose. Sphinx pose helps increase blood flow to the lower back, which helps heal lower back problems and build muscle. To start, lie on your stomach with your legs extended behind you.
- Rise up on your forearms, elbows directly under your shoulders. Press your feet and palms into the floor, pressing against your pubic bone until you feel your lower back muscles engage.
- Hold the position for 1-3 minutes, inhaling deeply through your nose and exhaling through your mouth.
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Stretch your hamstrings by doing downward-facing dog. Downward-facing dog is a classic yoga pose that stretches the entire body and provides mental peace and improved concentration. Stretching the hamstrings, in particular, helps strengthen the lower back.
- Get on all fours on the mat, knees directly under your hips. The wrists can be directly under the shoulders or slightly in front. Focus on your breathing, inhaling slowly and deeply through your nose and exhaling through your mouth.
- As you exhale, lift your hips toward the ceiling, straightening your arms in front of you until your body forms an inverted “V.” The shoulders are rounded, the neck is relaxed.
- Inhaling, push your hips even higher toward the ceiling, transferring the weight from your wrists to your hands. On your next exhale, focus on your legs, reaching down toward your heels to stretch your hamstrings. Continue to remain in this pose for 10-20 cycles of inhalation and exhalation, then lower back to all fours.
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Do a knee crunch. Twisting the knees effectively stretches and strengthens your entire core and lower back, while rotating movements activate and strengthen your spine. First, lie on your back on the mat, straighten your legs.
- Extend your arms out to the sides from your shoulders so that your body forms a "T" on the floor. Then bend your knees towards your chest.
- As you exhale, lower your knees to the right on the floor, your shoulders should be pressed to the mat, that is, you are twisting from the lower back.
- Inhale and bring your legs back to center, then on your next exhale, lower your knees to the left. Repeat 5-10 times in each direction.
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Lie down in child's pose. Child's pose is a classic yoga pose at the end of classes, which also gives a good stretch for the lower back. You can get into this position on all fours—simply lower your hips back and rest your torso on your thighs with your arms extended in front of you.
- If you are flexible enough, you can rest your forehead on the mat. But you should not bend further than the line that is comfortable for you.
- You may find this pose more comfortable if you open your knees slightly.
- Since child's pose is meant for rest, you can lie there for as long as you want, breathing deeply.
Do aerobic exercise
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Go for walks regularly. Walking is an easy and inexpensive way to get active. Taking short walks of 15-20 minutes most days of the week will help strengthen both your lower back and your overall body.
- Try going for walks with a friend, this will motivate you and make your walks more enjoyable. If you're walking alone, you can listen to music, a podcast, or an audiobook.
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Ride your bike. If your lower back pain is so severe that you find it easier to sit than stand, cycling will become a good option cardiovascular training. An indoor exercise bike will be a better option than riding on bumpy, uneven terrain. If you have the opportunity to go to the pool and swim for 20-30 minutes, 2-3 days a week, this is a great way to strengthen your entire back. To avoid worsening any back problems, take a course or hire a trainer to improve your skills.
- Swimming is low-impact and the water keeps you hydrated, making it a great activity if you have joint problems or are overweight.
- If swimming is new to you, start slowly with 10-minute swims. Every week or so, increase your time in the water by five minutes each time until you're swimming for half an hour each session.
- If swimming isn't your thing, walking or jogging in the water provides some resistance, which helps strengthen your legs and lower back without having to worry about breathing.
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Buy a pedometer. You should try to walk at least 10,000 steps throughout the day. A pedometer attached to your belt measures your steps. Some models also connect to the internet and have apps that let you track your progress over time.
- Choose an easy-to-use pedometer that will help you reach your goals. You can purchase a very simple model or one with many additional functions.
- If being active is new to you, start by setting small goals and working towards 10,000 steps. Incorporate walking breaks into your daily routine, such as parking away from the entrance when shopping or taking the stairs instead of using the elevator.
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Maintain an active lifestyle. Sitting for long periods of time can lead to atrophy of the lower back muscles. Preventing this is simple - get up and walk around every 30 minutes or so. If possible, try to reduce the total number of hours you spend sitting.
- For example, if you sit most of the time at work, try doing something while standing when you get home instead of slumping on the couch and watching TV.
- You can also purchase (or ask your boss to purchase) a standing desk so that you can stand for periods of time during the workday.
Warnings
- If you already have lower back pain, talk to your doctor before trying any back strengthening exercises. Your physical therapist may prescribe specific exercises to help relieve your pain without making your injury or disease worse.
Back pain can occur for a variety of reasons, ranging from banal sprains of muscles and ligaments to such serious diseases as malignant tumors. Pain in the back may indicate pathology of the spine, intervertebral discs, spinal cord, nerves or blood vessels, as well as the skin. In some cases, pain is a consequence of acquired or congenital curvature of the spine. It is worth noting that, according to the World Health Organization, back pain is the most common reason for which medical advice is sought.
Anatomy of the back area
The back is formed by the spinal column, the posterior and lateral parts of the ribs and the muscles of the scapular and lumbar region. Very strong back muscles allow you to hold, tilt and rotate the entire body, and are also involved in the movements of the upper limbs. The upper border of the back runs along the spinous process ( unpaired process of the vertebra, extending from the posterior surface of the vertebral arch along the midline) of the last seventh cervical vertebra, as well as along the acromial processes ( processes of the scapula). The bottom border is a line that is limited by the crests of the iliac bones ( superior ilium) and sacrum. The lateral borders are the posterior axillary lines. In the back, there are a paired scapular, subscapular region and an unpaired vertebral region, which corresponds to the contours of the spinal column and the lumbar region.
The skin of the scapular region is thick and inactive. In men, this area is usually covered with hair. In some cases, it can lead to boils ( purulent-necrotic lesion of the hair shaft and surrounding tissues). Also in the skin there are a large number of sebaceous glands, which, when the lumen of the excretory covering closes, can become inflamed ( atheroma). Following the skin is dense subcutaneous fat, which has a cellular structure. This is followed by the superficial fascia ( connective tissue membrane) scapular region and its own fascia, which serves as a case for the superficial muscles. In depth, directly next to the scapula, there are two separate fascial sheaths - supraspinatus and infraspinatus.
The skin of the lumbar region is thick and can easily bunch up. Behind it is the hypodermis ( subcutaneous fat) and superficial fascia of the back. A little deeper is the fatty tissue, which also extends to the buttock area, forming the lumbogluteal pad. In this area, two sections are conventionally distinguished - internal and external. The border between these sections runs along the erector spinae muscle.
It is worth considering separately the following structures that make up the back:
- ribs;
- shoulder blades;
- muscles;
- nerve.
Spine
The spinal column is one of the most important elements of the musculoskeletal system. The spine has five segments, including the cervical, thoracic, lumbar, sacral, and coccygeal. Since the back includes only the thoracic and lumbar segments, it is still more appropriate to consider the entire spinal column as a whole.In the spine, movements can occur in all three planes. Flexion or extension occurs around frontal axis, rotation of the body is carried out around the vertical, and tilts of the body to the left and right - around the sagittal axis. Springing movement of the spine is also possible due to the contraction and relaxation of a certain group of back muscles.
The spine at the time of birth has only one natural curve - thoracic kyphosis ( posterior curvature of the thoracic segment). Subsequently, during the first 3 to 4 months, when the child learns to support his head, cervical lordosis is formed ( anterior curvature of the spine). When a child begins to walk, the lumbar spine curves anteriorly, which leads to the formation of lumbar lordosis. Also at the same time, sacral kyphosis is formed. It is thanks to these natural curves - kyphosis and lordosis - that the spine is able to withstand significant loads, acting as a kind of shock absorber. In addition to its supporting function, the spine also performs a barrier function, protecting the spinal cord from various types of injuries. In addition, the spinal column is directly involved in the movements of the head and body.
In the human spine, on average, there are 32 - 34 vertebrae, which are separated from each other by intervertebral discs. There are 5 vertebrae in the lumbar and sacral regions, 7 in the cervical region, and 12 vertebrae in the thoracic region. In turn, the coccyx consists of 3 - 5 vertebrae. Depending on the segment of the spine, the size and shape of the vertebrae may vary slightly.
The following segments are distinguished in the spine:
- Cervical region is the uppermost and most mobile part of the entire spine. Good mobility allows you to perform various movements in the cervical region, and also allows you to tilt and turn your head. Due to minimal loads on the cervical segment, the bodies of the cervical vertebrae are small. The first two vertebrae, called the atlas and epistropheus, are somewhat different in shape from all other vertebrae. Unlike other vertebrae, the atlas does not have a vertebral body, which performs a supporting function. Instead, the atlas has two arches ( back and front), which are connected by lateral bone thickenings. The first vertebra with the help of condyles ( bony projections involved in the articulation of bones) is attached to the foramen magnum in the skull, through which the spinal cord passes. The second vertebra, or epistrophy, has a bony process in the form of a tooth, which is fixed in the vertebral foramen of the atlas with the help of ligaments. It is thanks to this process that the first vertebra along with the head can perform a variety of high-amplitude movements. It is worth mentioning that the transverse processes ( lateral processes extending from the vertebral arch) of the cervical vertebrae there are openings through which the vertebral vein and artery pass. The spinous processes of the cervical vertebrae, which extend back along the midline, have some differences. Most of them are forked. The cervical segment is the most vulnerable part of the spine due to the fact that the vertebrae are small and the muscle corset is not as massive as in other sections.
- Thoracic region consists of 12 vertebrae, which are much more massive than the vertebrae of the cervical segment. The thoracic vertebrae limit the rib cage posteriorly. On the lateral surface of the thoracic vertebrae there are costal fossae to which the heads of the ribs are attached. The long spinous processes of the thoracic vertebrae, which are inclined obliquely downwards, overlap each other in the form of tiles.
- Lumbar represented by 5 massive vertebrae. The bodies of the lumbar vertebrae are very large, since it is the lumbar spine that bears the maximum load. The lumbar vertebrae have costal processes, which are essentially vestigial ribs ( ribs that have lost significance during evolution and are vestigial). The spinous processes of the lumbar vertebrae, unlike the thoracic vertebrae, are directed backward. The last vertebra is tilted slightly forward, as it articulates with the sacrum, which, moving backward, forms physiological kyphosis. It is worth noting that, unlike the thoracic segment of the spine and sacrum, the lumbar region has increased mobility. It is the lumbar region that allows you to tilt the body to the right and left, bend and unbend the body, and also combine tilt and rotation of the body. These high-amplitude movements are carried out thanks to strong muscles.
- Sacral section at the time of birth it consists of 5 separate vertebrae, which by the age of 18 - 25 gradually form and make up a single bone. The sacrum is a bone that is part of the pelvis and has a triangular shape. On the anterior surface of the sacrum there are four parallel horizontal lines, which, in fact, are the places where the vertebrae fuse with each other. On the sides of these lines there are small holes through which nerves and arteries pass. On the posterior surface of the sacrum there are 5 bony ridges, which are the fusion of the spinous and transverse processes. The lateral surfaces of the sacrum articulate with the ilium and are strengthened by strong ligaments.
- Coccygeal region represented by 3 - 5 small vestigial vertebrae fused to each other. The shape of the tailbone resembles a curved pyramid. The coccyx is more mobile in women, since during childbirth it is able to deviate somewhat posteriorly, thereby enlarging the birth canal. Although the coccyx is a rudimentary segment of the spine, it still performs a number of quite important functions. Ligaments and muscles are attached to the coccyx, which are directly involved in the functioning of the large intestine and genitourinary system. The coccyx also performs an important function in distributing physical activity. So, for example, if the body is tilted forward, then the support is the ischial tuberosities, as well as the lower branches of the ischial bones. In turn, if the body is tilted slightly back, the load is partially transferred to the tailbone.
The spinal column is supplied with blood from the branches of the aorta, which pass along or near the vertebral bodies ( the cervical spine is supplied by branches of the subclavian artery). The main arteries are the intercostal and lumbar arteries, which supply blood not only to the anterior and posterior parts of the vertebrae, but also to some of the back muscles. In addition, the posterior branches of these arteries penetrate the spinal canal ( spinal arteries), where the spinal cord is located. In turn, the spinal arteries are divided into anterior and posterior, which communicate with each other and form a network of anastomoses ( anastomosis between vessels). This network supplies arterial blood to the spinal cord, vertebral bodies and cartilage tissue of the intervertebral discs.
The outflow of blood from the spine is carried out through four venous plexuses, which anastomose with each other ( connect). At the base of the skull, these plexuses communicate with the occipital venous sinus, which is one of ten venous collectors that collect blood from the veins of the brain. It is worth noting that the veins of the spine do not have valves, and depending on the pressure, blood can move through them in both directions. This difference, however, significantly increases the likelihood of tumor metastasis ( penetration of cancer cells into other tissues) into the spine.
From the cervical spine, lymph flows into the deep lymph nodes neck, upper part thoracic- into the lymph nodes of the posterior mediastinum. In the lower thoracic segment, the outflow occurs into the intercostal lymph nodes, and then into the thoracic lymphatic duct. The outflow of lymph from the lumbar and sacral segments occurs in the lymph nodes of the same name.
Ribs
There are 12 pairs of ribs in the human chest. The number of ribs corresponds to the number of thoracic vertebrae. The rib is a paired flat bone that has an arched shape. The greater curvature of the ribs provides greater mobility. In turn, curvature depends on age and gender.Each rib consists not only of a bone part, but also of a cartilage part. The bony part of the rib has a body, a neck and a head. The body of the rib is the longest part and forms the angle of the rib approximately halfway through, deviating towards the sternum. On the posterior edge of the rib there is a neck, as well as a head, which articulates with the corresponding thoracic vertebra. The anterior edge of the bony part of the rib has a small fossa, to which the cartilaginous part is attached. It is worth noting that the upper 7 pairs of ribs are directly connected to the sternum, and they are called “true”. The next 3 pairs of ribs are attached with their cartilaginous part to the overlying ribs and are not directly attached to the sternum. The anterior ends of the lower two ribs are located in the abdominal muscles and are called “oscillating.” The lower edge of the ribs bears a groove in which intercostal nerves and vessels pass ( under the lower edge of the rib there is a vein, followed by an artery and a nerve). It is worth noting that this neurovascular bundle is covered in front and behind by intercostal muscles.
The first two ribs are somewhat different in structure from the other ribs. The first rib is the shortest of all and the widest. On the upper surface of this rib there are grooves in which the subclavian artery and vein pass. Also next to the groove there is a tubercle of the anterior scalene muscle, to which this muscle is attached. On the second rib is the tuberosity of the serratus anterior muscle.
Shoulders
The scapula is a flat triangular bone that is part of the shoulder girdle ( along with the collarbone and humerus ). There are three rather large formations in the scapula - the scapular spine, the acromion and the coracoid process. The scapular spine is a triangular shaped bony plate that runs along the posterior surface of the scapula and divides the scapula into the infraspinatus and supraspinatus fossa. The scapular spine ends with the acromion - the humeral process. The acromion is a massive triangular process that is located above the glenoid cavity of the scapula and connects to the collarbone. Also, part of the muscle bundles of the deltoid muscle is attached to the acromion. It should be noted that the scapula performs an important musculoskeletal function, since more than 15 different muscles are attached to it.In total, the following surfaces are distinguished in the blade:
- Front surface(ventral) is directly adjacent to the ribs and is concave. This surface is essentially represented by the subscapular fossa. The inner part of this fossa is lined with ridges, which are necessary for the attachment of the tendons of the subscapularis muscle. In turn, the small outer part of the subscapularis fossa serves as a bed for the subscapularis muscle. In the upper part of the subscapular fossa, the bone bends slightly and forms the subscapular angle. It is thanks to this shape that the blade has good strength.
- Rear surface The scapula is divided into two unequal parts by a large bone formation in the form of a ridge ( spine of the scapula). Unlike the front surface, the rear surface is convex. The part that is located below is called the infraspinatus fossa, and the part above is called the supraspinatus. The infraspinatus fossa is several times larger than the supraspinatus and is the site of attachment and also the bed for the infraspinatus muscle. The supraspinatus fossa serves as the attachment site for the supraspinatus muscle.
Muscles
The skeletal muscles of the back provide active movements not only in the thoracic and lumbar segments, but also participate in turns and tilts of the entire body and neck, participate in the act of breathing due to the attachment of muscle bundles to the ribs, penetrate into the pelvis, and allow movements in shoulder girdle.The following skeletal muscles are distinguished in the back:
- Trapezius muscle It is a flat and rather wide triangular muscle, which is located on the surface and occupies the back of the neck, as well as the upper back. This muscle with its apex is attached to the acromion of the scapula, while the base of the muscle faces the spinal column. Contraction of all trapezius muscle bundles brings the scapula closer to the spine. If only the upper muscle bundles contract, then the scapula rises, and if only the lower ones, it moves down. With fixed shoulder blades, contraction of both trapezius muscles leads to extension and tilt of the head back, and with unilateral contraction, it tilts the head in the corresponding direction.
- Latissimus dorsi muscle is a massive muscle that occupies almost the entire lower back. The muscle originates from the last five thoracic vertebrae, all lumbar and sacral vertebrae, from the upper part of the iliac crest, from the superficial layer of the thoracolumbar fascia, as well as from the lower four ribs and is attached to the humerus. The upper muscle bundles are directed laterally and form the posterior wall of the axillary cavity, while the lower bundles are directed sideways and upward. The latissimus dorsi muscle is involved in inward rotation of the arm. If the upper limb is fixed, the muscle brings the body closer to it and slightly expands the chest.
- Rhomboid major muscle passes directly under the trapezius muscle and is shaped like a diamond. This muscle is located between the shoulder blades. The rhomboid major muscle originates from the spinous processes of the first four thoracic vertebrae, moving obliquely downwards, muscle bundles are attached to the inner edge of the scapula. Contraction of the muscle leads to adduction of the scapula to the midline. When only the lower muscle bundles contract, the lower angle of the scapula rotates inward.
- Rhomboid minor muscle, like the rhomboid major muscle, is located under the trapezius muscle ( second layer of muscle). This diamond-shaped muscular plate originates from the two lower cervical vertebrae. Going obliquely down, the muscle is attached to the inner edge of the scapula. The rhomboid minor muscle brings the scapula closer to the spine.
- The levator scapulae muscle is an elongated and thickened muscle plate that is located under the trapezius muscle in the lateral region of the back of the neck. This muscle originates from the transverse processes of the first four cervical vertebrae and, moving obliquely downward, is attached to the inner edge and upper corner of the scapula. The muscle raises the upper corner of the scapula, and also slightly rotates and shifts the lower corner of the scapula towards the spine. With the shoulder blade fixed, tilts the neck in the appropriate direction.
- Muscles that lift the ribs located only in the thoracic region. These muscles originate from the transverse processes of the thoracic vertebrae. These muscles are attached to the underlying ribs. It is worth noting that there are short muscles that lift the ribs, which go directly to the underlying rib, as well as long ones, which extend over one rib. During contraction, these muscles raise the ribs, which helps increase the volume of the chest ( are one of the main muscles involved during inhalation).
- Serratus posterior superior belongs to the third layer of the superficial back muscles. This muscle begins from the two lower cervical and two upper thoracic vertebrae. Moving obliquely downwards, the superior serratus posterior muscle attaches to ribs 2–5. Since the muscle is attached to the ribs, its main function is to participate in the act of breathing.
- Serratus posterior inferior located on the border of the thoracic and lumbar back. This muscle begins from the spinous processes of the three upper lumbar vertebrae and the two lower thoracic vertebrae. The muscle bundles move obliquely upward and are attached to the last four ribs. This muscle pulls the lower ribs down.
- Erector spinae muscle- the longest and most powerful skeletal muscle in the entire back. The muscle lies in a groove formed by the transverse and spinous processes of the vertebrae. One end of the muscle is attached to the sacrum, the spinous processes of the last two lumbar vertebrae and the iliac crest. Directing vertically upward, this muscle is divided into three separate muscle bundles - the spinalis muscle, longissimus muscle and the iliocostalis muscle. If a bilateral contraction of the erector spinae muscle occurs, this leads to extension of the entire spinal column and fixation of the entire torso in a vertical position. With unilateral contraction, the spinal column tilts in the corresponding direction. In addition, due to the fact that several muscle bundles are attached to the ribs, this muscle can also take part in the act of breathing.
- Teres major muscle is a flat and elongated muscle that originates from the lower angle of the scapula, extends outward and attaches to the humerus. The teres major muscle brings the shoulder toward the body and also pulls it back.
- Teres minor muscle is an oblong muscle, which in shape resembles a rounded cord. The teres minor muscle originates from the outer edge of the scapula. Moving laterally, the muscle passes into a tendon, which is woven into the posterior surface of the shoulder capsule and attached to the humerus ( To greater tubercle ). Abductor teres minor ( supination) the shoulder away from the body and retracts the capsule of the shoulder joint.
- Infraspinatus muscle has a triangular shape and fills the entire infraspinatus fossa of the scapula. Moving to the side, the muscle bundles converge into a tendon that attaches to the humerus. The infraspinatus muscle externally rotates the shoulder and also pulls back the joint capsule of the shoulder joint.
- Supraspinatus muscle is a triangular-shaped muscle that completely covers the supraspinatus fossa of the scapula. Muscle fibers passing under the brachial process ( acromion), are directed towards the humerus. The muscle is attached to the posterior surface of the articular capsule of the shoulder joint. Contraction of the supraspinatus muscle retracts the joint capsule and prevents it from being pinched.
- Subscapularis muscle- a flat, triangular-shaped muscle that almost completely fills the subscapular fossa. The muscle is divided into separate muscle bundles by connective tissue layers. The subscapularis muscle has a deep and superficial layer. In the first layer, muscle bundles originate from the costal ( ventral) surface of the scapula, in turn, the superficial bundles begin from the subscapular fascia, which is attached to the edge of the subscapular fossa. The subscapularis muscle attaches to the humerus ( to the crest of the lesser tubercle). It should be noted that this muscle, heading towards the humerus, passes into a tendon, which fuses with the articular capsule of the shoulder joint in its anterior part. Thanks to this, the muscle is able to bring the shoulder to the body.
- Intertransverse muscles are deep short muscle bundles that are stretched between the transverse processes of two adjacent vertebrae. The intertransverse muscles are present in the cervical, thoracic and lumbar regions. The main function of these muscles is to hold the spine. Unilateral contraction leads to an inclination of the spinal column in the corresponding direction.
- Interspinous muscles also located in close proximity to the spine. These short muscles are stretched between the spinous processes of adjacent vertebrae in the cervical, thoracic and lumbar regions. The interspinous muscles take part in straightening the spine and holding it in a vertical position.
- Quadratus lumborum muscle It is a flat quadrangular muscle bundle. The quadratus lumborum muscle originates from the transverse processes of all lumbar vertebrae, the iliac crest, as well as from the iliopsoas ligament and is attached to the last rib and the transverse processes of the first and second lumbar vertebrae. Bilateral contraction of the quadratus lumborum muscle leads to extension of the spine, and unilateral contraction causes the torso to tilt in the corresponding direction.
- Psoas major muscle It is a long and fusiform muscle. The most superficial muscle bundles are attached to the lateral surfaces of the four upper lumbar vertebrae, as well as to the last thoracic vertebra. Moving down, the psoas major muscle narrows somewhat. In the pelvic cavity, this muscle connects with the iliacus muscle, which leads to the formation of the common iliopsoas muscle. This muscle is involved in flexion and outward rotation of the thigh. In addition, the psoas major muscle allows flexion of the lower back when the lower limb is in a fixed position.
- External oblique muscle located on the front and side surfaces of the abdomen, and also partially extends to the chest. The external oblique abdominal muscle originates from outer surface seven lower ribs. This muscle is attached to the ilium, a connective tissue structure that runs along the midline of the abdomen ( white line) and to the articulation of the two pubic bones ( pubic symphysis). Bilateral contraction of the external oblique muscle slightly flexes the spine and lowers the lower ribs. In turn, unilateral contraction leads to rotation of the torso in the opposite direction.
- Internal oblique muscle located directly under the external oblique muscle of the abdomen. This muscle is a muscle-tendon plate, which originates from the iliac crest, thoracolumbar fascia and inguinal ligament. Moving in a fan-like fashion, the internal oblique muscle attaches to the lower ribs and is woven into the linea alba. With a bilateral contraction, the spine flexes, and with a unilateral contraction, the body rotates in the appropriate direction. In the event that rib cage fixed, the internal oblique muscle of the abdomen raises the pelvic bones.
Nerve
The nerves of the back are represented by the spinal nerves. Each such nerve consists of motor and sensory nerve fibers. The first are centripetal fibers that carry impulses from the brain through the spinal cord to muscle tissue and some glands. While the sensitive fibers are centrifugal. Receiving impulses from peripheral tissues, as well as from organs, these nerve fibers ( nerve cells and their processes) conduct them to the central nervous system.Spinal nerves are formed from the following nerve tissues:
- anterior roots, in fact, formed by the main processes of nerve cells ( axons), which are located in the anterior part of the spinal cord ( in the anterior horns). These processes unite to form filaments, which, in turn, form the anterior or motor root. The anterior roots contain nerve fibers that conduct motor impulses to the smooth and skeletal muscles. It is worth noting that when leaving the spinal cord, the roots depart in different ways. In the cervical segment of the spinal cord, the roots extend from it almost horizontally, in the thoracic region they are directed obliquely and downward, and in the lumbar and sacral regions they extend downward.
- Posterior roots, unlike the anterior ones, are formed by the axons of nerve cells, which conduct sensitive impulses from various organs and tissues to the spinal cord, and then to the brain. It is worth noting that the dorsal roots, connecting with the anterior roots, form the spinal ganglion. This node then sends out fibers to form the spinal nerve.
The spinal nerves of the thoracic segment have four separate branches. One of these branches is represented by the intercostal nerves.
The following branches are distinguished in the thoracic nerves:
- Connective nerves are directed to the node of the sympathetic trunk ( part of the autonomic nervous system that is activated by stress) and connect with it ( anastomose).
- Shell branch enters the spinal canal and goes to the dura mater ( connective tissue membrane that covers the spinal cord and brain).
- Posterior branch, in turn, is divided into two branches - internal and external. The internal branch sends muscle branches to some of the chest muscles ( transverse spinalis, semispinalis and rotator cuff muscles), and the cutaneous branch innervates the skin, which is located above these muscles. The external branch also has a muscular and cutaneous branch. The first branch innervates the iliocostal muscle, as well as some muscles of the chest and neck. The second branch penetrates the skin, which corresponds to these muscles.
- Anterior branch The thoracic spinal nerves are represented by intercostal nerves. Their number fully corresponds to the number of ribs. The intercostal nerves enter the neurovascular bundle, which is also represented by an artery and a vein. The first six intercostal nerves reach the sternum, and the lower two are directed into the wall of the abdominal cavity ( to the rectus abdominis muscle).
The intercostal nerves innervate ( carry out nervous regulation) muscles that are located in the wall of the abdominal and thoracic cavity ( transverse pectoral muscle, subclavian muscle, levator ribs, external and internal intercostal muscles and the upper portions of some abdominal muscles), as well as some back muscles ( serratus posterior superior, inferior, and levator ribs). In addition, the intercostal nerves also innervate the peritoneum ( transparent and thin connective tissue membrane that covers all the organs of the abdominal cavity on top) and pleura ( a membrane of thin connective tissue that covers both lungs and lines the inside of the chest cavity). The first intercostal nerve also takes part in the formation of the brachial plexus. It is worth noting that in addition to connective and muscle tissue, these nerves also penetrate the skin of the lateral and anterior surfaces of the abdomen and chest. In turn, in women these nerves are involved in the innervation of the mammary glands.
What structures can become inflamed in the back?
It should be noted that back pain can occur not only due to inflammation of structures located directly in the back area. For example, with some diseases of the chest and abdominal organs, pain occurs, which can be reflected ( irradiate) in the back. The following tissues and structures may become inflamed in the back area:
- Skin the back may be affected by pyogenic bacteria such as staphylococci and streptococci, causing pyoderma ( purulent skin lesion). In addition to the skin, these microbes infect the hair shafts ( follicles), sweat and sebaceous glands.
- Fatty fiber, located directly under the skin ( hypodermis) or in deeper layers, can also become inflamed and lead to cellulitis ( purulent melting of fatty tissue). Phlegmon most often occurs against the background of purulent damage to the kidneys, pancreas or other structures that are located in the retroperitoneal space or in the abdominal cavity.
- Muscles, as a rule, they become inflamed due to traumatic injury, which can occur after excessive physical effort or with direct exposure to a traumatic factor on muscle tissue ( bruise, crushing, sprain, compression or rupture). The muscles may also become inflamed ( myositis) due to prolonged stay in an uncomfortable position or local hypothermia.
- Ligaments and tendons just like muscles tend to become inflamed after they are damaged. Partial or complete rupture of the ligaments is accompanied by local pain of varying severity ( from weak to extremely strong with complete rupture of the ligament), tissue swelling, as well as limited mobility in the nearby joint.
- Thoracic and lumbar spinal roots most often become inflamed when they are compressed by the vertebrae, pathological bone growths ( osteophytes) or tumor, causing radiculitis. A special case of radiculitis is inflammation of the intercostal nerves, which is manifested by pain along these nerves of varying nature and intensity ( this pathology is also called intercostal neuralgia).
- Vertebrae may be involved in infectious and non-infectious inflammatory process. In some cases, the spinal column may be affected by infections such as tuberculosis or brucellosis ( an infection transmitted from sick animals to people that causes damage to internal organs). Also, the vertebrae may be subject to purulent-necrotic inflammation of bone tissue ( osteomyelitis), which is most often caused by pyogenic bacteria such as streptococci or staphylococci.
- Spinal cord may become inflamed due to an existing infection. With myelitis ( inflammation of the white and gray matter spinal cord) there is a partial loss of motor and tactile sensitivity up to the development of paralysis of the limbs ( lower and/or upper). Also, myelitis can be caused by a serious injury, in which infection occurs and involvement in pathological process one of the spinal cord segments.
Causes of back pain
Back pain can occur due to a number of different pathologies. In some cases, severe pain appears against the background of banal physical strain, which leads to muscle spasm. Athletes most often injure the musculo-ligamentous system. In turn, in older people, in most cases, dystrophic-degenerative processes of the spine are detected. These processes manifest themselves as back pain of varying intensity, limited mobility in the spine, muscle spasms, loss of motor and tactile sensitivity and other symptoms. Causes of back pain
| Name of the disease | Mechanism of back pain | Other symptoms of the disease |
| Pain arising from inflammation of the skin and subcutaneous fat | ||
| Furuncle
(purulent-necrotic inflammation of the hair shaft and tissues around it) | Painful sensations appear due to excessive irritation or destruction of the pain endings, which are located near the hair shaft or follicle. It is worth noting that the most severe pain occurs 72 hours after the formation of a boil. It is on the 3rd - 4th day that purulent melting of the boil core occurs ( central part), in which pain endings are also destroyed. | The general condition, as a rule, is not changed. The only symptom other than local pain is fever. In this case, body temperature can rise up to 38ºС, and sometimes exceed 39ºС. During the period when the core of the boil has undergone melting and rejection, the pain gradually subsides. At the site of the boil, the skin heals by scarring within 2 to 5 days. |
| Furunculosis
(pathological condition, in which boils appear on the skin at various stages of development) | Furunculosis manifests itself as a general malaise with headaches, dizziness, nausea and/or vomiting. In some cases, loss of consciousness may occur against a background of general weakness. Also, with this purulent skin lesion, a fever occurs, in which the body temperature rises to 38.5 - 39.5ºC. | |
| Carbuncle
(acute purulent-necrotic inflammation of the skin and surrounding tissues around several hair follicles) | The mechanism of pain is similar to that of a boil. | A carbuncle is a fusion of several affected hair shafts ( infiltrate). The size of the carbuncle can vary, in some cases it can reach 4 - 6 centimeters in diameter, and sometimes exceed 9 - 10 centimeters. It is necessary to mention that for 8 to 12 days this pathological formation is extremely painful. Subsequently, through several holes through the carbuncle, a purulent-necrotic mass is rejected ( skin is like a sieve). The skin at the site of the carbuncle reveals a fairly deep ulcer, which is also quite painful. Over the next 15 to 20 days, the ulcer heals through scarring. The general condition with carbuncle is similar to that with furunculosis - increased body temperature ( 39.5 - 40ºС), chills, headaches, dizziness, nausea and vomiting. |
| Ecthyma
(a skin disease in which deep damage occurs) | Pain is a consequence of the occurrence of a deep ulcer, which forms on the site of a relatively small abscess or phlyctena. It is the open ulcer that serves as the source of pain. It should be noted that within 3 to 5 days, this ulcer gradually begins to scar, which is manifested by a decrease in pain. | At the onset of the disease, one or several small blisters with purulent contents may appear on the skin ( sometimes the pus may be mixed with blood). Subsequently, this abscess becomes covered with a brown crust, which, when opened, reveals a painful and deep ulcer. |
| Erysipelas
(damage to subcutaneous fat) | Subcutaneous fat becomes inflamed and swells. In turn, tissue swelling compresses the nerves and nerve endings located in nearby vessels and the subcutaneous fat tissue itself. In the bullous form of erysipelas, blisters with colorless liquid form, which then become crusty. Subsequently, the crust falls off and often reveals painful ulcers and erosions. | Within a few hours ( 2 - 4 hours) After the onset of the disease, the affected skin becomes hot to the touch, swollen and painful. Emerging erythema ( reddened segment of skin) has a red-purple color, and is also raised compared to healthy skin ( due to tissue swelling). This disease is also characterized by damage lymphatic vessels and nodes ( lymphangitis and lymphadenitis). |
| Pain resulting from inflammation of muscles, ligaments and deep fatty tissue | ||
| Myositis
(an inflammatory process that is localized in the muscles) | The inflammatory process leads to swelling of the soft tissues. Ultimately, the enlarged muscles compress the nerve endings in the vessels, as well as nearby nerves that are located in the deeper and/or superficial layers. | Myositis is manifested by muscle pain, which intensifies when touched and pressed. Also myalgia ( muscle pain) intensifies during movement or when the weather changes. Sometimes this pathology can lead to redness of the skin over the inflamed muscle tissue. If not treated in a timely manner, myositis leads to disruption of the functional state of the muscles. Also, in rare cases, other nearby muscles may be involved in the pathological process. |
| Tendinitis
(inflammation of the connective tissue of the tendon) | Tendinitis is characterized by a permanent tear of a specific part of the tendon. Since the connective tissue of the tendon contains a large number of pain receptors, depending on the extent of the damage, the pain can be either minor or severe. As a rule, pain occurs when performing movements in the joint adjacent to the tendon. | The skin over the injured tendon may become red and hot to the touch. Tissue swelling may also occur. Sometimes a crunch occurs at the site of inflammation of the connective tissue of the tendon ( crepitus). It should be noted that in some cases, the damaged tendon heals with the formation of dense calcium nodules ( calcifications). |
| Retroperitoneal phlegmon
(purulent melting of the retroperitoneal tissue, diffuse in nature) | Retroperitoneal phlegmon leads to purulent melting of fatty tissue located in the retroperitoneal space. Ultimately, a large accumulation of pus forms, which compresses various structures and tissues ( nerves, muscles, tendons, blood vessels ), in which a large number of pain endings are located. Painful sensations with this pathology are usually pulling and pulsating. | In the first period of the disease, general weakness, loss of appetite, dizziness, headaches, and chills occur. Body temperature can rise to 37.5 - 38ºС. The pain, localized in the lumbar region, gradually intensifies. In some cases, the process can spread beyond the retroperitoneal tissue, causing pain in the sacrum, buttock or abdomen. |
| Pain in the spine | ||
| Osteochondrosis
(dystrophic changes occurring in intervertebral discs) | With osteochondrosis, degenerative changes occur in the intervertebral discs. Ultimately, they lose elasticity, which leads to a decrease in the space between two nearby vertebrae and pinching of the spinal nerves. Compression of nerve tissue leads to cramping and sharp pain. It should be noted that pain with osteochondrosis may intensify against the background of increased mental or physical activity. | Often with osteochondrosis, there is increased sweating of the whole body or hands ( hyperhidrosis). The muscles innervated by pinched spinal nerves gradually lose their functionality and become flaccid and weak ( atrophy). Compression of the lower lumbar spinal nerves, as well as the upper sacral ( these nerves form the sciatic nerve) leads to sciatica ( inflammation sciatic nerve ). |
| Intervertebral hernia | When the peripheral part of the intervertebral disc is damaged, the nucleus of the disc protrudes outward. Ultimately, this nucleus can compress the spinal nerves, causing pain and inflammation of the nerve tissue. These pains may be constant or cramping in nature ( in the form of lumbago). It should be noted that intervertebral hernia is most often formed against the background of osteochondrosis in the lumbar segment of the spine. | Since the hernia occurs precisely in the lumbar spine ( more than 75 - 80% of all cases), this leads to compression of the sciatic nerve, which innervates back thighs and legs, as well as feet. Most often in the lower limb ( as a rule, only one sciatic nerve is compressed) unpleasant sensations such as goosebumps, tingling, and numbness may occur. In addition, weakening of the leg muscles occurs, as well as loss of sensitivity. In rare cases, disturbances in urination and defecation are observed. If an intervertebral hernia occurs in the cervical segment ( approximately 18 - 20% of all cases), then it is possible to increase blood pressure, cause headaches and dizziness, as well as pain that is reflected in the shoulder and arm. In quite rare cases ( in 1 - 3%) a hernia occurs in the thoracic region. In this case, a typical symptom is constant pain in the thoracic segment while working in a forced position. It should be noted that sudden movements, coughing and sneezing often provoke new attacks of pain. |
| Vertebral displacement
(vertebral subluxation) | When the vertebrae are displaced ( spondylolisthesis) compression of the spinal nerves, as well as the spinal cord itself, can occur ( there is a narrowing of the canal in which the spinal cord is located). As a result, a pain syndrome of varying severity occurs with the occurrence of various types of neurological symptoms. | When one of the vertebrae of the lumbar spine is displaced ( occurs most often) symptoms characteristic of inflammation of the sciatic nerve appear. In this case, pain occurs along the nerve fiber, loss of sensation in the back of the leg, and paresthesia ( tingling sensation, numbness, “pins and needles” in the leg), muscle atrophy. If there is a displacement of a vertebra in the cervical spine, which occurs much less frequently, then in this case the main symptoms are headaches, dizziness, and in some cases a stable increase in blood pressure. |
| Vertebral fracture | The direct impact of a traumatic factor on the vertebrae can lead to compression of nerve tissue, spinal cord, blood vessels and other tissues, causing extremely severe pain. | A vertebral fracture, in addition to the occurrence of acute pain in the area of damage, is also characterized by a complete restriction of active movements in the damaged segment, severe muscle tension, and with compression of the spinal cord, serious neurological symptoms can occur, including impairment of cardiovascular and respiratory activity ( if we are talking about a fracture of the upper cervical vertebrae). |
| Spinal tumor
(benign or malignant tumor spine or spinal cord) | Tumor cells, and cancer cells in particular, are able to bind to pain receptors in various tissues ( nervous, connective tissue, muscle tissue, as well as the vascular wall) and cause their stimulation. The more cancer cells come into contact with the pain endings, the more severe the pain syndrome. It is worth noting that pain is the first symptom of a tumor of the spine and spinal cord. This pain is characterized by intensification at night and/or morning ( being in a horizontal position) and some subsidence when moving to a vertical position. | Pain that occurs due to neoplasia ( neoplasm) spine, often reflected in the upper or lower extremities. It is characteristic that the pain is practically not relieved by painkillers. In addition to pain, there is also a violation of the act of urination and defecation, muscle weakness and paresthesia ( the occurrence of a burning sensation, goosebumps, numbness) in the lower and sometimes in the upper extremities, loss of motor function ( paralysis), gait disturbance. In some cases, the lower extremities feel cold and the skin of the extremities becomes cold to the touch and clammy. A fairly large tumor can lead to deformation of the spine, causing scoliosis. |
| Ankylosing spondylitis
(non-infectious inflammation of the spine) | The inflammatory response that occurs in the spinal column leads to the release of large amounts of biologically active substances which are responsible for increasing the pain syndrome. Inflammation is localized not in the vertebrae themselves, but in the intervertebral discs, causing dystrophic changes in them. Ultimately, the load on the muscles and ligaments of the spine increases, which leads to their pathological tension and pain. | At the onset of the disease, pain may occur in only a few vertebrae of the lumbar or sacral spine. Subsequently, the process covers the entire spine, and in some cases spreads to large joints ( hip, knee, ankle and/or elbow). Stiffness in the spine gradually increases, which disrupts normal motor function. In addition, ankylosing spondylitis ( ankylosing spondylitis) has manifestations of an extra-articular nature. Such manifestations include inflammation of the iris of the eyeball ( iridocyclitis), inflammation of the heart sac ( pericarditis), acquired heart valve insufficiency. |
| Scoliosis
(lateral curvature of the spinal column) | The pain occurs due to compression of the spinal nerves by the vertebrae that have undergone scoliotic curvature. Scoliosis also serves as a predisposing factor to the early development of osteochondrosis. | Depending on the amount of curvature of the spinal column, there are 4 degrees of scoliosis. In addition to poor posture, the normal position of the pelvic bones and organs located in the pelvic cavity sometimes changes ( bladder, rectum, uterus and its appendages). |
| Kyphosis
(curvature of the spine in the anteroposterior direction) | With kyphosis, a wedge-shaped deformation of the vertebrae in the thoracic spine is observed, along with pathological replacement of cartilaginous tissue with connective tissue in the intervertebral discs. Ultimately, the muscular-ligamentous system cannot cope with the load, which leads to overstrain and pain. | Kyphosis leads to impaired mobility of the spinal column. The long course of this pathological condition leads to stooping, and then to hunchback. It should also be noted that with kyphosis the function of the respiratory muscles is impaired ( mostly diaphragm) due to impaired mobility of the chest. |
| Scheuermann-Mau disease
(kyphosis, which occurs during puberty) | The same as for kyphosis. | As a rule, increased fatigue and pain in the lumbar segment occur when performing moderate physical activity. Pain may also occur when sitting for a long time. |
| Spinal tuberculosis
(spinal infection with tubercle bacilli) | Tuberculosis can completely destroy the bone tissue of the vertebrae, leading to pinching of the spinal roots. In addition, tuberculosis can lead to the formation of an abscess ( limited accumulation of pus), which, in turn, is also capable of compressing the spinal nerves. | With tuberculosis, general malaise, muscle weakness and myalgia occur ( muscle pain), low-grade fever ( 37 - 37.5ºС). Pain at the beginning of the disease is usually minor, but as the disease progresses, it becomes more pronounced and sometimes unbearable. In addition, tuberculous lesions of the spine cause poor posture and stiffness in movements both in the spinal column itself and in hip joints (gait disturbance occurs). Due to the fact that the load from the spinal column is transferred to the muscular-ligamentous apparatus, the back muscles gradually atrophy ( loss of function). |
| Brucellosis of the spine(damage to the spine caused by penetration of the causative agent of brucellosis into the body) | Brucellosis most often affects one or two vertebrae. In these affected vertebrae, a decrease in bone tissue density is observed, which triggers a compensatory reaction, during which additional lateral bone growths are formed ( osteophytes). It is osteophytes that most often compress the spinal roots emerging from the spinal cord. | Brucellosis is characterized by an increase in body temperature to 37.5 - 38ºС. Chills and general malaise also appear, which is manifested by headache, dizziness, joint pain, especially in the lower extremities. If treatment is not detected in time and treatment is not started, then damage to the spine by brucellosis can cause purulent lesions of the spine ( osteomyelitis). |
| Spinal osteomyelitis
(purulent inflammation of the vertebrae with involvement of surrounding tissues in the pathological process) | This rather rare pathology leads to purulent lesions of the vertebral bodies. As a result, an accumulation of pus is formed, which can compress the spinal cord, spinal nerves, blood vessels, soft tissues, and fatty tissue, which contain a large number of pain receptors. The pain is most often severe and constant. It is worth noting that pus can melt tissue and penetrate into more superficial layers ( through fistulas). | Osteomyelitis progresses rapidly. Body temperature rises to 39 - 40ºС, tachycardia occurs ( increased heart rate) and hypotension ( lowering blood pressure). Besides, general condition sharply worsens, leading to fainting and convulsions. The pain syndrome is most pronounced at night. |
| Myelitis
(inflammation of the spinal cord) | The inflammatory process, localized in the structures of the spinal cord, leads to tissue swelling. In turn, the swelling compresses nearby blood vessels and nerves, contributing to pain. It is worth noting that back pain with myelitis is most often mild. Neurological symptoms come to the fore. When spinal nerves are involved in the pathological process, diffuse pain appears along the course of these nerve fibers. | Depending on the affected segment of the spinal cord ( as a rule, 1 - 2 segments are affected), as well as the clinical form of this inflammation, the symptoms of myelitis may differ slightly. Acute focal myelitis is characterized by the occurrence of general malaise, fever ( 38.5 - 39ºС), chills, muscle weakness, and sometimes vomiting. Then there is a feeling of numbness and tingling in the legs ( paresthesia), which quickly gives way to a complete loss of movement in the limbs. If the process is localized in the lumbar region, then in this case dysfunction of the pelvic organs occurs. With disseminated myelitis, in addition to the main focus, there are also secondary lesions that are smaller in size. The unevenness of damage to the spinal cord leads to varying degrees of motor, reflex and sensory disorders on both the left and right. There is also a form of myelitis ( neuromyelitis optica), in which partial loss of visual areas occurs, as well as a decrease in visual acuity. In children, myelitis often leads to seizures. |
| Pain in the ribs | ||
| Shingles
(a viral disease caused by herpes zoster, which manifests itself as damage to the skin and nervous system) | After the varicella zoster virus ( herpes zoster) becomes active again ( after the first contact with it, a person gets chickenpox, and then the virus becomes inactive), it moves along the intercostal cells and causes inflammation of the overlying layers, namely the skin. Characteristic rashes appear ( red bubbles with colorless liquid), severe itching and severe pain. Pain is a consequence of strong irritation of pain receptors located in the subcutaneous fat, as well as nerve processes ( axons) intercostal nerves. | Most often, skin manifestations of herpes zoster are preceded by a general malaise of the body ( headache, dizziness, fever, muscle pain), itching, tingling and neurological pain at the site of future rashes. In rare cases, the virus can infect the ophthalmic branch of the trigeminal nerve, leading to destruction of the cornea ( the transparent and most superficial layer of the eye) or cause pathological changes in the ear canal, causing partial or complete hearing loss. |
| Tietze syndrome
(inflammation of the cartilaginous part of the ribs) | This pathology leads to inflammation and swelling of the cartilage tissue of the ribs. The enlarged anterior segments of the ribs are capable of compressing the surrounding tissues in which pain receptors are located. The pain is most often one-sided and acute or increasing. | Usually the cartilaginous segments of the first 5 - 6 ribs are affected. Sudden movements of the body, coughing or sneezing can increase the pain syndrome. Tietze syndrome is characterized by the presence constant pain in the sternum area, which in some cases can bother patients for years. Often the pain is paroxysmal. When palpating the cartilaginous part of the ribs, a painful swelling is detected. Sometimes pain can be reflected along the ribs in the anteroposterior ( sagittal) direction. It is worth noting that, apart from pain in the anterior part of the chest and sternum, there are no other symptoms of this disease. |
| Intercostal neuralgia
(pain caused by compression of the intercostal nerves) | Pinching of the spinal roots of the thoracic spinal cord inevitably leads to pain along the intercostal nerves ( thoracalgia). The pain can be either dull and aching or sharp and piercing. It is worth noting that this pain syndrome is paroxysmal in nature. | An attack of pain leads to difficulty breathing, as a person reflexively stops using the affected side, taking a forced position. In some cases, twitching of the muscles innervated by the intercostal nerves is observed, and the skin becomes red or, conversely, turns pale. Heavy sweating and tingling in the chest may also occur. Sometimes there may be loss of sensation in some parts of the chest. An attack can be caused or intensified by coughing, sneezing, and sudden movements. In fact, intercostal neuralgia is not an independent pathology, but is a manifestation of osteochondrosis of the thoracic spine, scoliosis, and some infectious diseases ( herpes zoster, influenza, tuberculosis), severe fatigue, injury or other reason. |
| Fractured ribs | The pain is caused by the impact of a traumatic factor on various structures of the chest ( bruise, sprain, compression, crushing or rupture). In some cases, bone fragments of the ribs can damage the pleura ( thin connective tissue membrane that covers both lungs and lines the inside of the chest cavity), which contains a large number of nerve receptors. | The pain is most often severe and excruciating. Any movements made in the chest, deep breathing, coughing or sneezing can increase these pain sensations. This is why patients with rib fractures reflexively experience shallow breathing, which, in turn, increases the risk of pneumonia. When palpating the fracture site, a crunching sound is often detected ( crepitus), swelling and deformation of the chest ( sometimes bruising). The skin becomes pale or bluish. If there is a unilateral fracture of the rib or ribs, then a lag in breathing is detected on the affected side of the chest. When the torso is tilted to the healthy side, severe pain usually occurs. |
| Osteosarcoma and osteochondroma of the ribs
(malignant tumors of the ribs, in which the bone or cartilage tissue of the ribs is involved in the pathological process) | Cancer cells are able to bind ( have tropism) with pain endings in different tissues ( connective tissue, muscle, nervous, as well as the vascular wall) and cause them to be overstimulated. There is a direct relationship between the number of cancer cells and the severity of pain ( the more cells, the more pain). One of the features of osteosarcoma is that pain is most pronounced at night and in the morning, when a person is in a horizontal position. | The skin at the site of the lesion becomes swollen. Subsequently, a small network of dilated veins often appears on it ( phlebectasia). The progression of these oncological diseases leads to an increase in the size of the tumor, which, in turn, increasingly compresses the surrounding tissues and increases pain. In addition, anemia occurs ( anemia), muscle weakness, apathy, weight loss. It should be noted that the pain caused by osteosarcoma is practically impossible to relieve ( localization and minimization). |
| Pain in the shoulder blades | ||
| Winged scapula syndrome
(paralysis of the serratus anterior muscle, which causes a painful protrusion of the scapula backwards) | Most often, this pathology develops against the background of injury to the long thoracic nerve. Ultimately, this nerve is unable to send nerve impulses to the serratus anterior muscle, causing its paralysis. Against the background of impaired innervation of the serratus anterior muscle, muscle pain gradually occurs. Sometimes damage to the cervical spinal nerves or brachial plexus can also lead to this disease. The pain is aching in nature. | Typically, pain occurs after muscle weakness occurs. This pain may be reflected in the shoulder or even the forearm. Another symptom is protrusion of the lower edge of the scapula. The presence of this manifestation is detected when the patient presses on the wall with straight arms. |
| Scapula fracture | Compression by a hematoma can cause pain ( accumulation of blood from damaged vessels) surrounding tissues. In some cases, pain from a scapula fracture may be felt in the shoulder joint. This is explained by the fact that when the glenoid cavity of the scapula is fractured, all the blood flows into the cavity of the shoulder joint ( hemarthrosis). | In addition to pain in the scapula area, swelling also occurs, which is a consequence of tissue edema. Often, during movements or when pressing in the area of the scapula fracture, you can hear a crunching sound ( friction of bone fragments). In some cases, displacement of the scapula occurs, which ultimately leads to drooping of the shoulder girdle. In addition, very often there is a limitation in the mobility of the shoulder joint. |
| Osteomyelitis of the scapula
(purulent lesion of the scapula bone) | The accumulation of pus in the subscapular region can lead to compression of the underlying blood vessels and nerves. In some cases, this pathology causes purulent inflammation of the shoulder joint ( purulent shoulder arthritis). The pain can be either moderate or severe. | In addition to pain, there is an increase in body temperature ( up to 37 - 38ºС), chills, general weakness, loss of appetite. Occasionally, increased heart rate may occur ( tachycardia). As a rule, the pain intensifies at night or in the morning, and gradually decreases during the day. |
| Exostosis of the scapula
(osteochondral overgrowth that can compress surrounding tissues) | In some cases, osteochondral neoplasm of the scapula can reach large sizes and, thereby, lead to compression of muscle tissue, blood vessels and nerves. Pain can also occur with malignant degeneration of exostosis ( cancerous tumor). | If exostosis reaches large and very large sizes, then in addition to pain, excessive pressure on the ribs may occur, which, in turn, can lead to their deformation. |
| Tumor of the scapula
(osteochondroma, chondroma, osteoblastoma, osteoma) | Tumor cells have protein molecules on their surface that bind to pain receptors and cause them to be stimulated. Pain at the beginning of the disease may not be much of a concern, but as the tumor grows, the pain increases significantly and is almost impossible to relieve with painkillers. This is due to the fact that there is a direct relationship between the size of the tumor and the severity of the pain syndrome ( the more cancer cells, the more pain). | The skin in the area of the shoulder blade is most often hot to the touch, thinned and swollen. If the tumor is located near the glenoid cavity of the scapula, then a violation of movements in the shoulder girdle occurs. In some cases, pathological fractures may occur, which are associated with loss of bone strength. If the tumor reaches a large size, it can compress the vessels and nerves of the chest, thereby causing severe pain and discomfort. |
In addition to the above reasons, there are a number of pathologies associated with the cardiovascular system, gastrointestinal tract, and respiratory system, which can lead to pain in various areas of the back. That is why, if you experience back pain, you need to consult an experienced doctor who can carry out the correct differential diagnosis and accurately identify the disease.
The most common pathologies that may cause referred back pain
| Name of the disease | Mechanism of pain | Other symptoms of the disease |
| Diseases of the gastrointestinal tract | ||
| Stomach and duodenal ulcers | Excessive exposure to stomach acid, bile, and stomach enzymes ( pepsin) on the mucous membrane of the stomach and duodenum leads to local ulceration ( an ulcer forms). As a rule, pain in these pathologies is localized in the upper abdomen, but sometimes it radiates ( reflected) in the lumbar and/or thoracic segment of the spine, as well as in the left part of the lower back. The intensity of the pain can vary - from slightly aching to “dagger-like”. | Stomach ulcers quite often lead to heartburn and belching. A quickly arising feeling of satiety with food is often replaced by nausea and even vomiting. After eating, heaviness in the stomach may occur. In half of the cases, table disturbance occurs ( constipation). With a duodenal ulcer, “hunger pains” are observed, which appear on an empty stomach and are relieved only after eating or when using medications or substances that reduce acidity ( antacids, antisecretory drugs, soda). In addition, duodenal ulcers are characterized by symptoms such as belching, nausea and vomiting, bloating of the abdomen and intestines, and night pain. |
| Pancreatitis
(inflammation of the pancreas) | Normally, pancreatic enzymes enter the duodenum and only there they become active. In some cases, premature activation of these enzymes occurs in the pancreas itself, which, in turn, leads to inflammation and severe pain. Depending on the affected area, pain may occur in the left or right hypochondrium, in the epigastrium ( the upper part of the abdominal cavity, located below the sternum), and when the entire pancreas is involved in the pathological process - have a girdling character ( the pain radiates, including to the lower back). | Characterized by general malaise, fever ( up to 38 - 38.5ºС), palpitations, shortness of breath, nausea, bloating, abnormal bowel movements ( diarrhea or constipation). The face of a patient with pancreatitis acquires pointed features and also becomes pale. The body becomes covered with sticky sweat, the mucous membranes become dry. In some cases, the skin around the navel and on the lower back becomes bluish, covered with dark blue spots. This is due to the fact that blood during pancreatitis can accumulate under the skin and lead to the formation of these spots ( Mondor's sign). |
| Intestinal obstruction | Painful sensations arise due to intestinal compression of the mesentery, in which nerve trunks and blood vessels are located. The nature of the pain depends on the type of intestinal obstruction ( dynamic, mechanical or mixed). Most often, there is a constant and bursting pain or cramping and severe pain. | The main symptom of intestinal obstruction is pain, which is localized in the abdomen and can be reflected in the lumbar region. In the future, pain may subside, which indicates inhibition of intestinal motility and peristalsis. Often the feeling of nausea is replaced by uncontrollable and repeated vomiting. Obstruction is accompanied by retention of gases and stool, as well as bloating. |
| Diseases of the cardiovascular system | ||
| Myocardial infarction
(one of the manifestations coronary disease hearts) | Death of heart tissue ( necrosis) leads to severe and persistent pain. With myocardial infarction, pain persists for more than 15 minutes ( up to 60 - 70 minutes) and stop either after the use of narcotic painkillers, or independently within a few hours. | The pain is localized behind the sternum, but in some cases it can radiate ( give away) in the shoulder, arm, shoulder blade, stomach or throat. Various arrhythmias also occur quite often. In addition to pain and heart rhythm disturbances, shortness of breath and a dry cough may occur. In some cases, a heart attack is asymptomatic, and sometimes the only sign of a heart attack is cardiac arrest. |
| Angina pectoris
(a disease that manifests itself as short-term pain or discomfort in the heart area) | Pain occurs due to impaired blood supply to the coronary vessels that supply the heart. Unlike myocardial infarction, angina pectoris pain lasts no more than 15 minutes and responds well to treatment with nitrates ( nitroglycerine). | Pain and discomfort with angina pectoris are pressing or burning in nature. Very often the pain is reflected in the shoulder and left arm, neck, lower jaw, upper abdomen or interscapular area. Sometimes shortness of breath, nausea or vomiting occurs. |
| Diseases respiratory system | ||
| Pleurisy
(inflammation of the pleura that surrounds each lung) | Accumulation of pathological fluid in the pleural cavity ( exudate) leads to overstretching of the pleural layers, which contain a large number of nerve endings. Pain also occurs due to friction of the inflamed and rough layers of the pleura against each other. Pain in the chest in some cases can radiate to the scapula area. | Pleurisy is often accompanied by an increase in body temperature ( 38 - 39ºС) and chills. The pain intensifies when coughing, while breathing, shortness of breath appears. The affected half of the chest may lag behind the healthy half when breathing. The accumulation of a large amount of pathological fluid in the pleural cavity can lead to compression of the lung. |
| Pneumonia
(inflammation of the lung tissue) | Pain during pneumonia indicates that the pathological process involves not only lung tissue (there are no pain receptors in the lungs), but also the pleura. The intensity of pain depends on the degree of involvement of the pleura in this inflammatory process. If pneumonia affects only one lung, then the pain is localized in the right or left hypochondrium. With bilateral pneumonia, not only the chest hurts, but also in the area of the shoulder blades. | As a rule, pneumonia with pleurisy begins with chills, followed by fever ( up to 39 - 40ºС). Then appears wet cough with sputum. In addition, there is general malaise, muscle pain, headache, loss of appetite, and drowsiness. In some cases, sputum may contain streaks of blood, which indicates that red blood cells are leaving the bloodstream and entering the lungs ( occurs in the second stage of lobar pneumonia). |
| Lung cancer | As the cancer grows, it can penetrate the bronchi, pleura and nerve tissue, which causes severe pain. The faster the tumor progresses, the stronger the pain. | A dry or wet cough may appear, which is accompanied by sputum or blood. In some cases, cancerous pneumonia occurs, which is manifested by fever, chills, general weakness, and shortness of breath. When a tumor grows into the heart sac, pain occurs in the heart, and if nerves are involved in this pathological process, then neurological symptoms appear ( muscle paralysis, pain along the nerve, etc.). |
| Kidney diseases | ||
| Pyelonephritis
(inflammation of the kidney and pelvis) | The penetration of pathogenic microorganisms into the kidney leads to its inflammation. Subsequently, focal damage to the kidney occurs with the involvement of the intercellular substance in the pathological process. Pyelonephritis leads to tissue destruction ( including nerve endings) and replacing them with connective tissue ( fibrosis). Against the background of a banal infection, the pain can be aching or dull, and if pyelonephritis is a consequence of blockage with a stone ( stone) pelvis or ureter, then a pronounced pain syndrome occurs, which is paroxysmal in nature. | Acute pyelonephritis is manifested by an increase in body temperature to 39 - 40ºС, chills, general weakness, malaise, loss of appetite, headache, sleep disturbance. Nausea and vomiting occur quite often. An increase in the frequency of the urge to urinate is combined with unpleasant sensations during this process. Urine often becomes cloudy ( the presence of protein and bacteria in the urine). Exacerbation of chronic pyelonephritis is also manifested by the above-mentioned symptoms, but this pathological condition is more dangerous. The thing is that chronic pyelonephritis leads to chronic renal failure ( impairment of all renal tissue functions), and may also cause arterial hypertension renal origin ( increased blood pressure). |
| Renal colic | Increased pressure in the renal pelvis ( cavity connecting the ureter to the kidney) leads to acute disorder renal blood supply and the occurrence of severe pain. An attack of pain occurs suddenly. Usually the pain is felt most severely in the lower back ( at the site of projection of the left or right kidney). It is worth noting that an attack of renal colic lasts from a few seconds and minutes to several hours. | The pain syndrome often spreads to the lower abdomen, groin and perineum, as well as to the thighs. Sudden movements can provoke renal colic. Sometimes there is nausea and vomiting, bloating, bowel dysfunction ( diarrhea). If renal colic occurs due to blockage of the ureter by a stone, then an increase in the frequency of the urge to urinate is observed. There is also a cessation of urine output. |
Why does my back hurt in the lumbar region?
Pain in the lumbar region can occur due to a wide variety of reasons. Lower back pain can be caused by injury to the lumbar region, prolonged stay in a very uncomfortable position, physical overexertion, stressful situations, sprained muscles and ligaments, acquired or congenital curvature of the spinal column, etc. Below is a list of the most common diseases that can cause pain in the lower back lumbar region. Pathologies that can lead to pain in the lumbar region are the following:
- Purulent lesion of the skin ( pyoderma). With a local decrease in the protective properties of the skin, pyogenic bacteria such as streptococci and staphylococci can penetrate into it. In this case, a purulent-inflammatory process develops, which leads to the appearance of painful ulcers of various sizes. These diseases are most often accompanied by general malaise, fever, and weakness.
- Strain of the muscles and ligaments of the lower back usually occurs in professional athletes or in untrained people after excessive physical activity. In addition to pain, inflammation and local tissue swelling also occur.
- Osteochondrosis of the spine is a degenerative disease in which the cartilage tissue covering the intervertebral discs gradually breaks down. Ultimately, the distance between the vertebrae gradually decreases, leading to compression ( squeezing) roots of the spinal cord, which are located on the sides of the vertebral bodies. It is the compression of the spinal roots that causes severe pain ( radiculitis).
- Scoliosis is a lateral curvature of the spine ( curvature along the frontal axis). This pathology leads to uneven distribution of the load on the spinal column. Ultimately, the skeletal muscles and ligaments of the lower back are constantly overstrained, which causes pain.
Why does my back hurt during pregnancy?
During pregnancy, women often experience back pain and, in particular, lower back pain. The thing is that during pregnancy, some changes occur in the muscular-ligamentous apparatus of the back. In order to ensure normal passage of the fetus through the birth canal ( pelvic bones), under the influence of a special hormone ( relaxin), ligaments and muscles become looser and less elastic. And this, in turn, increases the load on the spine and intervertebral discs. In addition, during pregnancy there is a shift in the center of gravity, which is manifested by a strong anterior displacement of the lumbar region. In this case, the lower back muscles are constantly overstrained, which ultimately leads to microtrauma and pain. Pain during pregnancy can occur at different stages. Quite often, this symptom occurs at 4-5 months of pregnancy. As the child grows, the pregnant woman's center of gravity shifts more and more, which increases the pain. This is why back pain is worst in the last month of pregnancy. Increased pain also occurs due to the fact that the child begins to compress the lower back from the inside.
If before pregnancy a woman was diagnosed with osteochondrosis of the spinal column ( dystrophic changes in intervertebral discs), then the likelihood that she will experience back pain while carrying a child increases many times over. These pains can also be observed in pregnant women with curvature of the spinal column ( scoliosis or kyphosis), in obese or overweight women and in women with poor back muscle development.
In some cases, back pain may be referred to the back of the thigh, leg, or foot. This symptomatology, as a rule, indicates compression and inflammation of the sciatic nerve ( sciatica). In addition to pain, paresthesia also occurs ( burning, tingling or crawling sensation), sensory impairment and muscle weakness in the leg.