What is osteochondrosis of the lumbar spine?

Osteochondrosis of the lumbar region is a pathology of the musculoskeletal system, accompanied by degenerative-dystrophic changes in bone tissue and impaired functioning of the five lower vertebrae (from 20 to 24). The disease causes discomfort to the patient and is characterized by specific symptoms – pain, stiffness of movement. Osteochondrosis of the lower back occurs in waves, with periods of exacerbations and remissions. According to statistics, this form is one of the most common. Pathology left unattended often leads to irreversible changes and a significant deterioration in the quality of life. However, with a competent integrated approach, osteochondrosis can be successfully treated.

Main causes of pathology

There is no exact data on why degenerative-dystrophic changes in the spinal column are triggered. It is assumed that the starting mechanism for the development of pathology is premature age-related changes in the joints. They can be genetically determined - transmitted by inheritance, but most often they initially manifest under the influence of unfavorable factors.

The main one among them is considered to be improper distribution of the load on the spine. Osteochondrosis of the lumbosacral spine can develop with:

• wearing high-heeled shoes;
• carrying a bag or backpack on one shoulder without alternating;
• sleeping or resting for a long time in an uncomfortable position;
• sedentary work;
• lifting weights.

Those at risk for the development of osteochondrosis include elderly people who are characterized by natural destructive changes in cartilage and bone tissue, professional athletes who train daily and intensively, pregnant women, whose center of gravity shifts as the fetus grows and the load on the lower back increases significantly, office workers, forced to spend a lot of time in a sitting position.

In addition to external risk factors, doctors also call a group of internal ones. These include:

• previous injuries to the musculoskeletal system;
• curvature of the spine;
• flat feet;
• congenital dislocation or subluxation of the hip joint;
• autoimmune disorders;
• inflammation of joint tissues;
• pathologies of the circulatory system;
• endocrine diseases;
• obesity.

Osteochondrosis of the lower back can also be provoked by intoxication and prolonged dehydration, bad habits, calcium deficiency, and any mechanical effects on the lower back - bruises, blows, falls.

Osteochondrosis of the lumbar spine: symptoms

The pathology affects not only the bone tissue itself, but also the entire spinal motion segment - vertebrae, intervertebral discs, ligaments, surrounding soft tissues, blood vessels and nerve endings. Osteochondrosis of the lumbar spine develops, the symptoms of which become obvious with significant damage, gradually and slowly. In the early stages it is moderate discomfort during exercise, in the later stages it is acute unbearable pain. Clinical signs are pronounced in the acute stage. During the period of remission, they fade away, and in the early stages this happens even without treatment.

Osteochondrosis of the lumbar spine - symptoms:

• pain in the affected area of the spinal column;
• irradiation of pain upward to the area of the shoulder blades or down to the pelvis and hip joints;
• persistent feeling of tension in the lower back;
• difficulty bending and turning the body;
• slouch;
• lameness;
• muscle weakness or, conversely, increased tone;
• tingling sensation.

Not all of the described symptoms are always present at once. Pain may be associated with limited mobility, but not muscle weakness or numbness. Any of the signs discussed above will be a reason to consult a doctor.

Stages of the disease

The intensity of the symptoms that accompany osteochondrosis of the lumbosacral spine directly depends on the degree of development of the pathology. There are four of them in total.

1. First stage. The first structural and functional changes begin. Intervertebral discs dry out and may become cracked. Symptoms at this stage are minor. Many patients mistake them for fatigue after a day of work, wearing uncomfortable shoes or exercising. The key signs of early osteochondrosis are mild discomfort in the lower back, which increases with bending and turning. Mild pain is possible, which will subside on its own after rest.
2. Second stage. The height of the intervertebral discs decreases, the bone structures come closer together. This provokes a new round of symptoms – stiffness when moving and pain. The pain becomes prolonged and intense, and can radiate to the pelvis and legs.
3. Third stage. At this stage, the vertebrae become deformed. Protrusions form - intervertebral discs bulge into the spinal canal area, but the fibrous rings remain intact. The main symptoms are intense pain, disturbing even at rest, decreased sensitivity, crunching and clicking when moving, tingling and numbness of the lower back.
4. Fourth stage. Pathological changes continue to progress. The functions of the vertebrae are lost. Hernias form. Osteophytes—bone growths—are formed. Blood vessels may be pinched and nerve fibers pinched. Against the backdrop of deteriorating blood circulation, the functioning of the pelvic organs is disrupted. In men, the risk of erectile dysfunction increases, in women, disruptions in the menstrual cycle are observed. Advanced osteochondrosis is manifested by sharp lumbago in the lower back, lameness, impaired mobility up to complete immobility, and increased temperature.

If you are concerned about lumbar osteochondrosis, its treatment will directly depend on the stage at which the disease is diagnosed. In the early stages, the doctor has many more recovery methods and techniques in his arsenal. Detection of degenerative-dystrophic changes in the initial stages makes it possible to treat the pathology conservatively, without resorting to surgical intervention.

Forms of pathology

The division into forms is based on the characteristics of the pain syndrome that always accompanies osteochondrosis of the lumbar sacral spine. There are three in total:

1. Lumbago. This is an acute shooting pain that makes it impossible to move. The causes of pain can be pinched nerves or muscle spasms.
2. Lumbodynia. This is a long-term, aching pain. It is characteristic of the stage of formation of protrusions and hernias. Also, discomfort may be associated with sprained ligaments.
3. Sciatica. This is severe pain that radiates to the pelvic area. The patient complains of pain when walking, sitting, or changing body position.

Two more forms of pathology are distinguished depending on the accompanying symptoms. The patient may be diagnosed with:

1. Radiculopathy. Accompanied by compression of nerve endings due to deformation of the vertebrae. With this form of the disease, sensitivity decreases and the affected area goes numb. Soreness and tingling sensation are expressed. Possible decrease in muscle tone, impaired reflexes, tingling in the legs.
2. Discogenic lumbar osteochondrosis. This is a serious condition in which the patient is limited in movement. His lower back and limbs are numb. Other symptoms are general weakness, fever, involuntary urination, and if the disease is prolonged, weight loss.

Danger of spinal disease

Left untreated, osteochondrosis is fraught not only with unbearable pain and stiffness of movement, but also with a number of pathologies that can develop against its background. The most common complications:

• intervertebral hernia;
• inflammation of the sciatic nerve;
• radiculitis;
• paresis.

In order to prevent concomitant pathologies, it is necessary to begin treating osteochondrosis immediately from the moment of detection. With a competent approach to therapy, it is possible to stop or significantly slow down the destruction of bone and cartilage tissue.

Methods for diagnosing pathology

Osteochondrosis of the lumbar sacral spine must be differentiated from other pathologies of the musculoskeletal system, which can occur with similar symptoms. The primary stage is a consultation with a neurologist, orthopedist or surgeon. The doctor clarifies complaints, collects anamnesis, conducts a physical examination, paying attention to the characteristics of the patient’s posture and posture, the nature of his work activity, bad habits, and concomitant diseases.

For the most accurate diagnosis, instrumental techniques are used:

• MRI;
• radiography;
• myelography with contrast agent;
• multislice CT.

Each of the diagnostic procedures allows the doctor to assess the condition of the lumbar and sacral spine at the current moment. The images clearly show structural changes in the vertebrae, indicating the stage of osteochondrosis. Based on the data obtained, the specialist makes a decision on the tactics for further management of the patient.

Laboratory diagnosis is not of key importance, however, studies may be recommended if indicated. In particular, if lumbar osteochondrosis is diagnosed, treatment may be prescribed based on the results of blood tests. They are necessary to clarify the intensity of inflammatory processes in the muscle fibers adjacent to the spinal column.

Lumbar osteochondrosis: treatment

The fight against pathology is carried out under the supervision of a neurologist and begins after a comprehensive diagnosis, when the degree and extent of tissue damage is determined. Modern medicine offers a number of effective conservative methods. If their use does not lead to the expected result, doctors resort to surgery.

Lumbar osteochondrosis: treatment with physiotherapy methods

All physiotherapeutic techniques are good because they affect the sacral and lumbar spine in a comprehensive manner. This approach allows you to cope with pain, reduce inflammation, and restore normal blood circulation.

When osteochondrosis of the lumbar spine progresses, treatment should be comprehensive. Patients with complaints are prescribed:

• electrophoresis - exposure of the problem area to constant electrical impulses with the possibility of using medications for external use;
• diadynamic therapy - a variant of electrotherapy using pulsed currents;
• magnetotherapy – treatment with alternating or static magnetic fields;
• ultrasound therapy - the influence of high-frequency sound waves;
• shock wave therapy - exposure to low-frequency acoustic impulses;

It is important to consider two nuances. First, the effect of physiotherapeutic treatment is noticeable only after a course of procedures, the duration of which is selected individually for each patient. The second is that physiotherapy as an independent method works for osteochondrosis of initial degree. For large-scale lesions, it is recommended as an auxiliary technique in addition to medical and surgical treatment.

Lumbar osteochondrosis: treatment with medications

Pharmacotherapy for lesions of the lumbar and sacral spine is aimed at relieving acute pain and suppressing inflammatory processes. The method is relevant in the acute stage, when symptoms interfere with a full life.

How to treat lumbar osteochondrosis with medications is always decided individually. A neurologist can prescribe drugs from different pharmacological groups. Basic:

• NSAIDs (systemic and local) to suppress inflammation in the vertebrae and adjacent tissues;
• muscle relaxants to relieve muscle spasms;
• angioprotectors to improve blood circulation;
• chondroprotectors to protect the cartilage tissue of the intervertebral discs from destruction;
• B vitamins to improve nerve conduction;
• analgesics for sharp shooting pains that limit mobility.

Exercise therapy as a method of treating pathology of the sacral and lumbar regions

Intense training for osteochondrosis is strictly prohibited, but you cannot completely give up physical activity. On the contrary, exercises of moderate strength and duration help restore blood circulation and reduce pain.

How to treat osteochondrosis of the lumbar spine with exercise therapy:

1. Work out with an instructor. The trainer will show you which exercises are allowed in a particular situation and make sure they are performed correctly. Even the most minor flaws in technology can significantly reduce the effectiveness of training or even cause harm.
2. Prepare carefully for the lesson. Before exercise, it is recommended to warm up the muscles - you can gently massage the lower back and sacrum.  
3. Strictly dose the load. The lower back is a vulnerable area. To avoid overexertion, you need to monitor the duration of classes. Their optimal duration is no more than 20 minutes.
4. Gradually increase the intensity of exercise. For beginners without experience, simple exercises and short programs are suitable. For those who have already been doing exercise therapy for some time, you can move on to more complex options.
5. Remember to be regular. A one-time workout will not bring visible improvements. Pain in the lumbar and sacral spine decreases if the patient engages in exercise therapy on a regular basis - optimally twice a week.
6. Consider contraindications. Physical therapy has proven itself to be a safe method of helping with osteochondrosis, but there are limitations. You should stop exercising if you feel unwell: fever, weakness, or rising temperature.

Lumbar osteochondrosis, the treatment of which should take into account the period of the disease, will not bother you if all the rules are strictly followed.

1. In the acute period. Only smooth and slow movements are allowed. If the pain increases during exercise, you need to stop and give your joints a rest.
2. In the subacute period. The pain syndrome subsides, mobility is restored, so you can slightly increase the intensity of training and increase its duration. But, in order to avoid deterioration, you need to carefully monitor your well-being.
3. In remission. We allow the full range of exercises for pathologies of the lumbar spine, but it is important to remember that overexertion is fraught with a new exacerbation of the disease.

If lumbar osteochondrosis is diagnosed with mild or moderate severity, treatment with physical education can also take place at home. After the exercise technique has been perfected under the supervision of an instructor, it is not prohibited to repeat the exercises at home. For training you will need a gymnastic mat, a roller and a ball.

Modern exercise therapy and rehabilitation rooms are equipped not only with traditional accessories, but also with special medical simulators. They help you recover from illness gently and safely, and also make activities more fun and interactive. For example, the neuromuscular rehabilitation system turns rehabilitation into an exciting competition with oneself. The patient stands on a moving platform and performs the exercises presented on the screen. Another important advantage of the simulator is the ability to track even the slightest progress in the patient’s condition. The system evaluates the result of each exercise performed, and the doctor can see the progress from training to training. Knowing one's success also motivates patients to try harder and not give up.

Manual therapy

Good results can be achieved if you supplement exercise therapy and medication for lumbar pathology with manual therapy. The method allows:

• eliminate hypertonicity of muscle fibers;
• relieve pain;
• restore blood supply in the lumbar and sacrum areas;
• improve the course of metabolic processes.

Manual therapy is an effective way to properly redistribute the load on the spinal column and protect yourself from further destructive changes. The good thing about this method is that it not only relieves pain, but also prevents neurological disorders that often develop against the background of lumbar osteochondrosis.  

Currently, chiropractors combine massage and physical therapy methods, such as tecartherapy. Electromagnetic waves penetrate deep bone tissue and allow you to relieve attacks of pain and quickly restore mobility.  

Surgical methods

Osteochondrosis of the lumbar spine, the treatment of which with medications, physiotherapy and exercise therapy is not always effective, significantly complicates the patient’s life. In some cases, only surgical intervention is applicable to eliminate pain and restore back mobility. Modern methods and technological equipment make it possible to perform minimally invasive operations with a shortened rehabilitation period.

For osteochondrosis, the following intervention methods are relevant:

• endoscopic excision of intervertebral hernia - using microsurgical instruments and a built-in camera;
• transfacet removal of intervertebral hernia - using neurosurgical tube dilators;
• laminectomy – surgical removal of pathologically changed bone processes;
• microdiscectomy – elimination of hernia protrusion.

Direct indications for surgical intervention are recurrent hernias, spinal stenosis, when the spinal canal narrows, and degenerative spondylolisthesis, a pathology in which the vertebrae are displaced relative to each other. In all other cases, if osteochondrosis of the lumbar spine is confirmed, doctors try to carry out treatment using conservative methods.

Disease prevention

Symptoms of osteochondrosis cause inconvenience, and treatment of the pathology can take a long time. It is much more effective to protect the vulnerable lumbar region from overexertion in advance. For preventive purposes it is recommended:

1. Properly organize your workplace during office work. The back of the chair should support the lower back, and the table should be suitable for height.
2. Avoid uncomfortable shoes. The optimal heel height for women is up to 5 cm. It is also advisable to exclude flat soles, as they contribute to foot deformation and flat feet - one of the factors
3. risk of osteochondrosis.
4. Exercise. Lifting heavy objects should be avoided. Swimming, walking, and cardio training are useful if there are no contraindications.
5. Eat a balanced diet. The diet must contain foods that are sources of calcium, phosphorus and B vitamins. These are fish, dairy products, leafy greens, and cereals. These substances are needed to strengthen all elements of the joints and support the nervous system.
6. Make sure you get adequate sleep. It is better to sleep on an orthopedic mattress of medium hardness. It will provide an anatomically correct posture in which the body rests from daily stress.
7. Control body weight. Obesity is one of the provoking factors. If the weight is normal, the load on the spine will be distributed adequately, and the risk of circulatory disorders will be minimized.

The prognosis for patients with osteochondrosis directly depends on the degree of damage to the vertebrae. That is why timely diagnosis is extremely important. If you are worried about lower back pain, and the images reveal destructive processes in the initial stages, you need to start treatment. In the early stages, medications and physical therapy are effective. In later cases, it is rarely possible to do without surgery. Exercise therapy can be used as an additional measure of assistance in any form and at any stage.