Under the human back, it is customary to mean the back surface of the body from the waist to the neck.

There are many muscles in this area, the functions of which are:

• support, stretching and rotation of the spine;
• rib movement

The major back muscles can be classified into the following groups:

1. Upper department. Fundamental to this muscle complex- triangular trapezius muscle. It starts at the base of the skull, is attached to the shoulder blade on one side and the collarbone on the other, runs along the entire length of the back. This superficial muscle, under it are three more internal ones: the muscle that lifts the scapula, as well as the small and large rhomboid muscles, which attach the scapula to the spine.
2. Middle department. The largest muscle of this part of the back is called the latissimus dorsi. At the sacrum, it has the shape of a fan, and then narrows and attaches to humerus at the top.
3. In the lower back are the muscles that are responsible for upright walking - they run along the spine. They support the kidneys, provide stability to the spinal column, and form the necessary bend.

Also, the muscular frame can be divided into the following groups:

• deep - transverse-spinous, three-layer: rotators, multifidus and semi-spinous muscles, which are already almost under the skin;
• superficial - already described latissimus dorsi lower back, square - lower back, flexors-extensors of the spine and a complex complex of trapezius muscles.

Since a person’s back has an increased amount of load, doctors often hear complaints that it hurts. Which doctor should I contact if my back muscles hurt? What to do if the pain crept up suddenly?

Sore back muscles

Therapists, neurologists, surgeons and even orthopedists are “responsible” for back pain. It all depends on the nature of the pain, on its characteristics and on which area of ​​the back the problem area is located.

Sometimes the pain has a reflected character, and the back hurts due to innervation internal organs.

If we consider only muscle pain, then their most common causes are:

• overvoltage;
• diseases of the musculoskeletal system in general and the spine in particular: spondylitis, Bechterew's disease, protrusions - intervertebral hernias;
• myositis;
• arthritis;
• arthrosis;
• trauma;
• diseases of the internal organs.

The back can hurt due to congenital pathologies, for example, when one leg is shorter than the other, there are articular anomalies, flat feet and similar defects. That is why you should not take back pain lightly and self-medicate by rubbing yourself with warming agents or endlessly massaging. Such neglect of one's own health will only aggravate the condition and may lead to disorders. nervous system, dysfunction of the kidneys, other internal organs, and even partial paralysis.

Why does back pain occur?

When overexerted, muscle fatigue occurs, lactic acid is produced. Muscles swell, harden, edema appears. If you run your finger along the spine, you can feel the swollen bump. If you give yourself a rest, the pain will go away on its own in a few days.

It should not be thought that overvoltage can only be caused by increased physical activity. It can provoke uncomfortable posture during sleep or a permanent sitting position.

The most common disease of the spine is osteochondrosis. Degenerative changes occur in the spinal column, and the body tries to redistribute the load in order to reduce pressure on the nerve fibers and eliminate pain. Since the load is redistributed, the muscles that should not be involved are overstressed, they themselves put pressure on the spine and exacerbate pathological changes. Thus, spondylitis develops, which is one of the most painful stages of osteochondrosis.

Degeneration of the spine provokes the formation of intervertebral hernias - protrusions. During this disease, the nerve roots are pinched.

With the introduction or activation of an infectious agent, another muscle disease develops - myositis. The "push" to an acute painful process is a decrease in immunity caused by an exacerbation of the condition, the influence of external factors - for example, hypothermia, a new infectious process.

The infectious agent also causes a very painful phenomenon - intercostal neuralgia. During it, the pain is so acute that patients cannot forget about it even for a minute.

If the infection is not eradicated, the muscles may atrophy.

Arthritis and arthrosis are diseases of the joints, but when they appear, a person tries to take a comfortable position in order to reduce pain. The load on the muscles becomes unnatural, and muscle fatigue leads to overstrain.

Any mechanical injury can cause severe pain, and even strains of the back muscles.

A common symptom of a disease of the internal organ is swelling in the affected area. Enlarged organs begin to put pressure on the surrounding tissues, pinching the nerves passing through them.

In diseases of the gynecological and urinary systems, muscle pain occurs in the lumbar spine; in inflammatory processes of the digestive organs, the pain can be pinpoint and girdle.

The feeling that "pricks and cuts" between the shoulder blades can be a symptom of diseases of the respiratory system.

The main cause of a disease of the human spine is associated with periodic spasms of small lateral and transverse, so-called medial, muscles located in the lower back. By the way, this whole series of muscles can be in a spasmodic state for more than one year, from time to time provoking muscle blockades of individual discs located between vertebral bones which can cause pain in the back muscles.

That is why muscular blockage of the disc can develop not at all due to the function of dystrophy and bulging of the intervertebral disc circle and not due to bony growths located next to the vertebrae. In this case, the back muscles hurt in a person, these pains can be eliminated by observing the mode of movement and by applying proper treatment massage.

Causes of pain

The initial pathological syndrome occurs due to the strong tension of this muscle group (a sharp turn of the torso, exorbitant flexion of the spine, prolonged cooling of the back, infectious cases of diseases, prolonged immobile muscle strain, which occurs due to a long sitting incorrect position of a person at the table, when carrying weights on one and the same shoulder, etc.). If the load exceeds the norm of back muscle tension, this can cause prolonged, reflexively fixed tension and spasm of this muscle group.

For a long period, the intervertebral plates can remain in a compressed position, sometimes they can protrude through the vertebrae, pressing on the nerves and provoking pain irritations of varying intensity. With strong pressure on the intervertebral plates, they take on a flat look and bulge to the sides. The discs then find empty spaces and press on the empty spaces, at which point the person may experience acute back pain. It is important in such a situation to consult a doctor in time to start timely treatment. For many diseases can be cured if the disease was noticed in time and treatment was prescribed, this also applies to pain in the back muscles.

The roots in the spinal cord and the autonomic nerves are most exposed to pressure; with constant contact with neighboring organs, they are irritated. This process creates a contraction of all the muscles of the back (interspinous, intervertebral, intertransverse and other small muscles of the back), which increases the already existing pressure on the round discs, and in the meantime they further irritate the roots spinal cord, this creates a vicious cycle that blocks the vertebral segment. Ultimately, pain develops as they strain to secure the injured part of the body.

Spasmodic muscles pinch the nerve cords and nearby blood vessels, which subsequently leads to a disruption in the supply of power and failures in the energy-information system both in the tissues of the back muscles and throughout the human body. Since the innervation and supply of nutrition to the internal organs is carried out due to the squeezed vessels and nerves, various disorders can occur in these organs.

A case from practice: clamping of the vagus nerve in the neck, the expected signals to rest cannot pass through its channel to the liver, as a result, chronic compression and irritation develops in the gallbladder.

Description of spasmodic processes

With a spasm of the back muscles, a mechanism of accumulation in the muscle fibers of lactic acid occurs, which is the oxidation product of the remains of a glucose-containing liquid in a situation of oxygen starvation. Significant accumulations of lactic acid substances in muscle tissues along the spine suggest the occurrence of sudden pain in the lumbar region and the entire back. With appropriate relaxation of the muscles of the back, the patency of the vessels begins to work in the usual mode, then the leaching of accumulations of products of lactic acid deposits from the muscles of the back under the pressure of blood stagnation is restored, and gradually the pain in the muscles subsides. Regular compression of the spinal nerve endings leads to a partial loss of the sensitive functions of individual internal organs. In addition, compression of blood vessels is fraught with tissue edema and back pain.

Special exercises allow you to relieve muscle pain, increase the intervertebral lumen, reduce pressure on nerve endings, and improve blood flow. This leads to an increase in the metabolic process in the intervertebral joints, adjacent tissue fibers and in the articular pockets, as well as in the ligamentous apparatus of the joints. After regular exercises, the curvature of the vertebrae is removed, the immobility of the articular parts disappears, and back pain is dulled. This whole process leads to the speedy resumption of all functions of the musculoskeletal system from injuries, various diseases of the joints, and also has a positive trend when a person has a cold in the muscles, in case of nervous overstrain and constant stressful situations that lead to the development of the disease.

At the moment of muscle compression, a sudden contraction of the tissue that is inside can occur. muscle mass. As a rule, such spasms appear at the moment of fast clumsy turns or with a sharp movement of the back muscles that are in a tense position.

Rapid straightening of the torso after a long period of immobility, for example, can result in stretching of the muscles of the back and the onset of shooting pain in the back. In response, a reaction will follow in the form of an instant contraction of the dorsal muscle tissues. At this moment, a kind of protective shield will be formed, which will protect the spine from possible irritation.

The next exacerbation of pain leads to an increase in muscle tension. As the muscle pain subsides, the spasm condition begins to subside.

Groups of people at risk of spasms

Since the muscles of the back and neck are constantly in a tense state, they are most often at risk of undergoing spasm. They also subtly react to the most insignificant loads. Sometimes a rather weak draft, and a person has a feeling of stiffness in the muscles of the cervical region, since they are in constant tension all the time when a person is in a sitting position at the table.

Particularly at risk are citizens involved in construction, agriculture and those whose activities are associated with constant being on the street. Unexpected pains in the muscles of the spasmodic property of the entire neck and back, simultaneously with signs of numbness of the skin surface, accompanied by an unpleasant tingling or strong relaxation of the muscles, signal the destruction intervertebral discs or nerve disease.

Osteochondrosis of the spine and muscular blockage of the discs are two different diseases that occur independently of each other.

These diseases require special treatment. In fact, the main cause of pronounced acute pain in the lower back is usually the rapid compression of the small, deep longitudinal muscles of the back, which contributes to their reflex compression and blocking of the intervertebral disc circles located in this place. Against this background, there are sharp muscle pain and concomitant back pain. However, a small disc herniation and various growths of the vertebrae cannot lead to pain.

That is why the diagnosis of “sciatica” or even “osteochondrosis” does not reflect the full picture of the pathological actions that occur during spasms, and it is best to call them fibromyalgia - back pain.

What causes recurring back pain?

When a person is plagued by periodic muscle spasms, they are usually accompanied by unwanted negative emotions, and this ultimately causes a similar attitude towards others and towards life itself. Physical and moral pain, constantly accompanied by immobile tension in some positions of the spine, regular emotional overload can manifest itself both separately and together with other processes.

The blockages and compression provoked by them will also cover other parts of the body, especially the lower back will suffer.

Therefore, in such situations, special treatment and stretching of the muscles is necessary, alternating with isometric tension and relaxation of the longitudinal muscles of the back, which perfectly removes spasms and blockages of certain muscle tissues. Timely intervention and treatment of compression can prevent the development of the disease, which is especially true when the back muscles hurt.

All sorts of injuries, injuries or mental stress lead to constant pressure on the muscles of the back, and for a long time can program the brain for constant pain in the muscles. And when a person undergoes special treatment for a disease that causes muscle pain, his nerve endings can send the same signals to the spinal cord that were sent before. Once the healing process has begun, the brain will need additional income signals from the movements of the compressed spinal muscle, which can break the vicious cycle. The following symptoms, which are often encountered by people who have begun treatment for the disease spinal muscles, muscle amnesia. When you get a back injury, the natural tendency is to limit the movement of the injured back muscle in every possible way.

Ways to treat spasms

Many people have a question: what to do when the back muscles hurt? The answer is simple - you need to reduce the load on the spine and exercise therapeutic gymnastics. Muscle exercises, in the form of motionless and dynamic exercises, with the help of tension and relaxation internal muscles, will help to re-educate and combine this muscle group into the desired interaction with the rest of the muscles of the human body.

get busy special exercises, alternating tension and relaxation of all types of muscles, starting with lower muscles, reaching facial muscles faces. It should be noted that during a prolonged exhalation of air, the entire complex of the parasympathetic nervous system begins to function actively, which is responsible for its relaxation. Start relaxing the spasmodic area muscle tissue one of the following options:

• on inhalation - we strain the whole body, on exhalation - we relax;
• after that, inhale without any tension of the body, then on a calm exhalation, we mentally feel complete peace in the injured area of ​​the body;
• apply maximum tension: the injured part of the body must be strained with all its might and the muscles should be held in this position for twenty to thirty seconds, as far as your the physical state, then relax with a slow exhalation of air;
• passing through the squeezed area the thought of excellent bodily well-being, we feel emotional pleasure.

You can use a gentle massage using pieces of ice. Slowly running a piece of ice over the sore spot around the spasm, we dull the pain. Positive impact will be achieved after some time. Initially, pieces of ice will constrict the blood vessels, then the channels of the vessels will begin to expand, helping to relax the muscles.

It is the back, especially her lumbar, bears the maximum physical load. This vast anatomical region, extending from the back of the head to the sacrum, contains large arrays of muscles. And, of course, various diseases and pathological processes in the muscles of the back almost always will be manifested by myalgia or other diseases.

Anyone who is forced to stay in a non-physiological, monotonous position for a long time that causes static muscle tension (driving a car, working at a computer, air travel) or experiencing muscle overload(playing sports, working in a summer cottage, lifting heavy things), sooner or later begins to feel back muscle pain. Pain is a kind of signal of the body about trouble.

Pain in the muscles of the back with diseases

Musculoskeletal pain is a manifestation myalgia(pain in the muscles of the back) in diseases of the spine, causes of development: diseases and diseases of the spine. The cause of pain in the back muscles is the constant load on muscular apparatus and as a result of this - his overwork, joining subsequently oxygen starvation due to a mismatch between the oxygen consumption by the muscle and the blood flow to it.

The main diseases leading to the occurrence muscular-fascial pains:

osteochondrosis of the spine (in the first place among other reasons);

• herniated intervertebral discs.

There are a number of predisposing mechanical factors, which include the following:

short leg syndrome. This is the most common cause of scoliosis. The insidiousness of the pathology lies in the fact that most doctors either do not have a proper idea about it, or do not attach significant importance to it, considering the shortening of one of lower extremities by 5-6 mm as a relative norm.

It should be noted that the difference in the length of the legs of 3-4 mm in a child already at an early age leads to abnormal growth and position of the pelvis, its rotation around its axis and curvature. spinal column. If the difference in leg length is not diagnosed and adequate treatment is not started in time, then with age it only progresses, aggravating the concomitant changes in the musculoskeletal system especially the spine.

Reducing the size of half of the pelvis. The patient sits, leaning in the direction on which the height of his pelvis is reduced. Accordingly, the muscular apparatus on this side is constantly experiencing intensive loads. It should be noted that a decrease in the size of the pelvis is detected in patients most often in combination with shortening of the lower limb.

Elongated second metatarsal bone. Such a foot is called "Greek". As a result, the function of the foot as a shock absorber is significantly impaired. They experience excessive loads and overwork the muscles, first of the foot, then the lower leg, thigh, and finally lumbar spine. Subsequently, the pain syndrome develops in the above areas.

Short shoulders. A rather rare pathology. It manifests itself in a decrease in the length of the shoulder in relation to the length of the body. As a result, tension is experienced by the muscles of the shoulder girdle. Trigger points located in the trapezius muscle and in the levator scapula are activated.

Kyphosis(anterior curvature) of the thoracic spine. In the common people it is called stoop. Tension is experienced by the muscles of the neck and shoulder regions. In its turn P The causes of kyphosis are mainly hereditary diseases:

Scheuermann-Mau disease;

The stress experienced during prolonged exposure to the wrong uncomfortable posture. Associated with improper organization of the workplace in production, improper design of school furniture.

Block function of one of the joints. It is one of the most important factors in the occurrence of pain in the muscles of the back. Most often, a functional block develops in one of the vertebral segments.

Prolonged compression of the muscle. Factors leading to this can be: the straps of bags and backpacks, tight pressing bra straps, tight clothing collar.

common cause myofascial pain syndromes involving muscles pelvic floor is an gynecological pathology. With the last option chronic pain are felt not only in the lower abdomen, but also in the lower back, sacral region.

Diseases gastrointestinal tract, such as stomach ulcers, often accompanied by myofascial pain syndromes involving the paravertebral muscles.

Very great importance as a provoking factor has a long monotonous position of the body (features of lifestyle, profession). Of the comorbidities, most of those suffering from pain in the back muscles also experience vitamin deficiency(vitamins B1, B6, B12, C, folic acid).

The lack of vitamins in the body contributes to the increase trigger point excitability, since under these conditions there is a violation of metabolic processes in muscle tissue. At characteristics of myofascial pain very great importance is attached to the concept of a trigger point.

trigger point- an area of ​​increased muscle excitability, localized in the area pain. Characterized by the presence of a tense and dense area muscle fibers which can be felt when examining the patient. The trigger point can be located not only in the immediate source of pain (muscle or fascia), but also in other tissues (skin, tendons, periosteum, ligamentous apparatus).

As a rule, the most intense pain is always localized at the trigger point, which, however, has the ability to cause pain in very remote areas of the body. By their nature, pain can be very different:

• repetitive;

  chronic.

Acute pain arise, as a rule, as a result of excessive mechanical loads on the corresponding muscle group.

Other causes of back pain

Approximately 85% of cases of chronic or episodic pain in the back muscles are associated with excessive pain. Even if you do not play sports, do not carry heavy loads and do not dig in the beds all day long, your back muscles still experience daily overstrain. When you sit, for example, in front of a monitor, it is they who have to support the bulk of your body. Therefore, doctors recommend that those who work at the table sit as "deeper" as possible in a chair, leaning on its back.

Back muscle injuries: stretching followed by muscle spasm during a sudden, unsuccessful turn, throw, jump is a common cause of trigger activation. Shots in basketball, serve in tennis, throwing a spear or a shot adversely affect unheated, unprepared muscles.

Back muscle injury

Direct muscle contusion can activate triggers that remain active after the hematoma has regressed.

Myositis of the back muscles(inflammatory process) - a common cause of pain in the muscles of the back. The disease is characterized by a long course. Pain in the muscles of the back, mostly aching. The muscles are compacted, painful when palpated and stretched. In patients with chronic infections and metabolic disorders, myositis of the back muscles can be combined with pain in the joints.

Lumbago(from the Latin word lumbus - lower back) - acute pain in the lower back. Lumbago is caused by overexertion of the lumbar region of the back. Lumbago is the result of a sharp movement of the spine, aimed at lifting weights or trying to reach something.

Pain in the muscles of the lower back may also be caused by lumbar intervertebral hernias, displacement of the vertebrae. Factors that increase the likelihood of lumbago can be hypothermia, diseases and injuries of the spine. The reasons for the sudden strong muscle pain low back are usually a prolapse of the intervertebral disc or severe tension in the muscles and ligaments of the lower back.

sciatica due mainly to congenital and acquired changes in the spine and its ligamentous apparatus. Pain in the lumbosacral region with sciatica can be acute or dull, usually on one side, radiates to the buttock, back of the thigh, and the outer surface of the lower leg. It increases with a change in body position, walking, coughing, sneezing, straining. Sometimes pain is combined with sensations:

numbness;

tingling;

goosebumps;

burning, itching.

Intervertebral hernia this is a fairly common problem, more common in people over 40 (although it can be diagnosed at an earlier age). The reason lies in the degeneration of muscle and connective tissues. With age, your spine seems to “settle”, and the vertebrae are pressed closer to each other, the intervertebral discs are flattened and protrude beyond the spinal column. As a result, compression of the nerve roots occurs, leading to acute muscle pain waist and legs.

In a person experiencing pain in the lumbar region, in a state mental stress muscle tension may increase, which is already spasmodic. This increases the pain, which, in turn, can lead to a further increase in spasm. However, many doctors believe that nervous tension or stress are indeed the main cause of pain in the back muscles.

For pain in the muscles of the back, seek help from traumatologist. After the examination, the doctor will recommend treatment for you. You can also contact a massage therapist or chiropractor for additional advice.

Back pain is one of the most common complaints that patients present in general medical practice. Often they are caused by osteochondrosis of the spine - a degenerative lesion of the cartilage of the intervertebral disc and reactive changes in the bodies of adjacent vertebrae. Damage to the intervertebral disc develops as a result of its repeated injuries (weight lifting, excessive static and dynamic load, falls, etc.) and age-related degenerative changes. The nucleus pulposus, the central part of the disc, dries out and partially loses its shock-absorbing function. The fibrous ring, located along the periphery of the disc, becomes thinner, cracks form in it, to which the nucleus pulposus is displaced, forming a protrusion (prolapse), and when the fibrous ring is ruptured, a hernia. Currently, drugs have been created that have a structure-modifying effect on cartilage tissue (the old name is chondroprotectors). A typical representative of the group is the drug chondro, prescribed by a course of 4 months (the effect persists for 2 months after cancellation). In the affected vertebral segment, relative instability of the spine occurs, osteophytes of the vertebral bodies develop (spondylosis), ligaments and intervertebral joints are damaged (spondylarthrosis). Hernias of the intervertebral discs are most often observed in the lower lumbar discs, less often - in the lower cervical and upper lumbar, extremely rarely - in the chest. Disc herniations into the vertebral body (Schmorl's hernias) are not clinically significant, disc herniations in the posterior and posterolateral direction can cause compression of the spinal root (radiculopathy), spinal cord (myelopathy at the cervical level) or their vessels.

In addition to compression syndromes, reflex (muscle-tonic) syndromes are possible, which are caused by impulses from receptors in response to changes in the disks, ligaments and joints of the spine - painful muscle spasm. The reflex muscle tension initially has a protective character, since it leads to the immobilization of the affected segment, but in the future this factor becomes the cause of pain. Unlike compression syndromes of osteochondrosis of the spine, which are relatively rare, painful muscle spasms occur during the life of almost every second person.

A classic example of painful muscle spasm is lumbago (lumbar backache), which is characterized by sharp, shooting pain in the lower back, usually developing during physical exertion (lifting weights, etc.) or awkward movement. The patient often freezes in an uncomfortable position, an attempt to move leads to increased pain. Examination reveals back muscle tension, usually scoliosis, flattening of the lumbar lordosis, or kyphosis.

Lumbalgia - back pain - and sciatica - pain in the back and on the back of the leg - develop more often after physical exertion, awkward movement or hypothermia, less often - without any reason. The pains are aching in nature, aggravated by movements in the spine, certain postures, walking. Lumbosciatica is characterized by pain in the buttock, in the posterolateral parts of the leg, which does not reach the fingers. Examination reveals soreness, tension in the muscles of the back and rear group leg muscles, limited mobility of the spine, often scoliosis, symptoms of tension (Lasega, Wasserman, etc.).

At the cervical level, reflex muscular-tonic syndromes can occur: cervicalgia and cervicobrachialgia, which often develop after physical exertion or an awkward movement of the neck. Cervicalgia is pain in the cervical region, which often extends to the back of the head (cervicocranialgia). Cervicobrachialgia is pain in the neck that radiates to the arm. Characterized by increased pain during movements in the neck or, conversely, with prolonged static position(in the cinema, after sleeping on a dense high pillow, etc.). Examination reveals stress neck muscles, there is often a restriction of movement in cervical region, pain on palpation of the spinous processes and intervertebral joints on the side of pain.

With compression of the nerve root (radiculopathy), in addition to painful muscle spasm and mobility restrictions in the spine and limbs, sensitive, reflex and (or) motor disorders are detected in the area of ​​the affected root. At the lumbar level, the fifth lumbar (L5) and first sacral (S1) roots are more commonly affected, less frequently the fourth lumbar root, and very rarely the upper lumbar roots. Radiculopathy of the lower cervical roots are much less common.

Painful muscle spasm also occurs with another fairly common cause of pain in the back and limbs - myofascial pain caused by the formation of so-called trigger zones in the muscles and (or) associated fascia. Myofascial pain is manifested by muscle tension and the presence of trigger points in them, the identification of which is carried out by manual examination of the muscles. Active trigger point- a constant source of pain, aggravated by its palpation in the muscle; a latent trigger point causes pain only when it is palpated. For each muscle, there is an independent myofascial syndrome with a characteristic localization of pain when the trigger zone is irritated, extending beyond the projection of the muscle onto the skin surface. Focal neurological disorders are absent, except for those cases when tense muscles compress the nerve trunk.

It is important to remember that back pain may be the only symptom of spinal cord tumors, syringomyelia, and other spinal cord disorders. Pain occurs during the destruction of the vertebrae and damage to the nerve roots due to infectious processes (tuberculous spondylitis, spinal epidural abscess), neoplasms (primary and metastatic tumors of the spine, multiple myeloma), dysmetabolic disorders (osteoporosis, hyperparathyroidism, Paget's disease). Back pain can be the result of a fracture of the spine, its congenital or acquired deformities (scoliosis, etc.), spinal canal stenosis, spondylolisthesis, ankylosing spondylitis.

It is possible with various somatic diseases (heart, stomach, pancreas, kidneys, pelvic organs, etc.) according to the mechanism of reflected pain.

Examination of a patient with back pain requires care. It is impossible to attribute any back pain to "osteochondrosis" - a condition that is detected by X-ray examination in most middle-aged and elderly people. For neurological manifestations of osteochondrosis of the spine and myofascial pain, painful muscle spasm and limited mobility of the spine are characteristic.

The diagnosis of reflex and compression complications of osteochondrosis is based on clinical data and requires the exclusion of other possible causes of back pain. X-ray of the spine is used mainly to exclude congenital anomalies and deformities, inflammatory diseases(spondylitis), primary and metastatic tumors. X-ray CT or MRI can detect a herniated disc, determine its size and location, as well as detect spinal stenosis, spinal cord tumor.

The diagnosis of myofascial pain is based on clinical findings (detection of painful muscle tension in one or more muscles) and requires the exclusion of other possible causes of pain; differential diagnosis with reflex syndromes (muscular-tonic syndromes) due to osteochondrosis of the spine often causes difficulties; a combination of these diseases is possible.

Treatment of reflex syndromes and radiculopathies due to osteochondrosis is based in the acute period on rest - the patient is advised to avoid sharp bends and painful postures. Prescribed bed rest for several days until the sharp pain subsides, a hard bed (a shield under the mattress), taking centrally acting muscle relaxants, if necessary, also additionally analgesics, non-steroidal anti-inflammatory drugs. To facilitate movement during this period, you should wear a cervical or lumbar corset (fixing belt). You can use physiotherapeutic analgesic procedures, rubbing anesthetic ointments, compresses with a 30-50% solution of dimexide and novocaine, novocaine and hydrocortisone blockades. With the weakening of pain, a gradual increase in physical activity and exercises to strengthen the muscles are recommended.

In the chronic course of reflex syndromes and radiculopathy, manual therapy, reflexology, physiotherapy, and spa treatment can be effective. Surgery(removal of a herniated disc) is necessary in those rare cases when there is compression of the spinal cord or roots of the cauda equina. Surgical treatment is also indicated for discogenic radiculopathy, accompanied by severe paresis, and with a long-term (more than three to four months) lack of effect from conservative treatment and the presence of a large disc herniation. To prevent exacerbations of osteochondrosis, it is recommended to avoid provoking factors (lifting large loads, carrying a heavy bag in one hand, hypothermia, etc.), and regularly engage in therapeutic exercises.

With myofascial pain, it is necessary that the muscle is at rest for several days. As a treatment, you can prescribe muscle stretching exercises (post-isometric relaxation), physiotherapy, reflexology or local injection of anesthetics into trigger zones, compresses with dimexide and anesthetics.

As already noted, both in acute pain and in chronic pain syndromes, the treatment of painful muscle spasm is of great importance. Tonic muscle tension can not only cause pain in itself, but can also cause deformation and limit the mobility of the spine, as well as cause compression of the nerve trunks and vessels passing near. For its treatment, in addition to non-steroidal anti-inflammatory drugs, analgesics (for example, nimulide in the form of a transdermal gel for local therapy or in the form of lingual tablets for acute pain syndrome), physiotherapy and therapeutic exercises, muscle relaxants are used as first-line drugs - drugs that can break the "vicious circle" of pain syndrome.

For the treatment of painful muscle spasm, muscle relaxants are used orally or parenterally. Reducing the reflex muscle tension, muscle relaxants reduce pain, improve motor function and facilitate physiotherapy exercises. Treatment with muscle relaxants begins with the usual therapeutic dose and continues as long as the pain syndrome persists; as a rule, the course of treatment is several weeks. In the course of a number of studies, it was possible to prove that with painful muscle spasm, the addition of muscle relaxants to standard therapy (non-steroidal anti-inflammatory drugs, analgesics, physiotherapy, therapeutic exercises) leads to a faster regression of pain, muscle tension and improved spinal mobility.

As muscle relaxants, mydocalm, baclofen and sirdalud are used. Muscle relaxants are usually not combined with each other. To relieve painful muscle spasms, you can also use diazepam (Seduxen, Relanium) in an individually selected dose.

Baclofen has a muscle relaxant effect mainly at the spinal level. The drug is close in structure to γ-aminobutyric acid (GABA); it binds to presynaptic GABA receptors, leading to a decrease in the release of excisatory amino acids (glutamate, aspatate) and suppression of mono- and polysynaptic activity at the spinal level, which causes a decrease in muscle tone; Baclofen also has a moderate central analgesic effect. It is well absorbed from the gastrointestinal tract, the maximum concentration in the blood is reached 2-3 hours after ingestion. The initial dose is 15 mg per day (in three doses), then the dose is increased by 5 mg every day until the desired effect is obtained, the drug is taken with food. Usual doses for the treatment of painful muscle spasm are 20-30 mg. The maximum dose of baclofen for adults is 60-75 mg per day. Side effects are more often manifested by drowsiness, dizziness. Sometimes there is nausea, constipation, diarrhea, arterial hypotension; caution is required in the treatment of elderly patients.

Sirdalud (tizanidine) is an α-2 adrenergic receptor agonist. The drug reduces muscle tone due to the suppression of polysynaptic reflexes at the level of the spinal cord, which may be caused by inhibition of the release of excitatory amino acids and activation of glycine, which reduces the excitability of spinal cord interneurons; sirdalud also has a moderate central analgesic effect. When taken orally, the maximum concentration of sirdalud in the blood is reached after an hour, food intake does not affect its pharmacokinetics. The initial dose of the drug is 6 mg per day in three doses, the average therapeutic dose is 12-24 mg per day, the maximum dose is 36 mg per day. As side effects, drowsiness, dizziness, a slight decrease in blood pressure; caution is required when taking the drug in elderly patients.

Mydocalm (tolperisone) has been widely used for a long time in the treatment of reflex and compression complications of degenerative-dystrophic changes in the spine (osteochondrosis, spondylosis, spondylarthrosis) and myofascial pain. Mydocalm has a predominantly central muscle relaxant effect. A decrease in muscle tone when taking the drug is associated with a depressing effect on the caudal part of the reticular pharmacy and suppression of spinal reflex activity. The drug has a moderate central analgesic effect and a slight vasodilating effect. Reception of mydocalm begins with 150 mg per day three times a day, gradually increasing the dose until the effect is obtained, in adults usually up to 300-450 mg per day. For a quick effect, the drug is administered intramuscularly at 1 ml (100 mg) twice a day or intravenously at 1 ml once a day.

The efficacy and safety of using mydocalm for painful muscle spasm has been proven in a double-blind, placebo-controlled study. At eight study centers, 110 patients aged 20 to 75 years were randomized to receive mydocalm at a dose of 300 mg per day or placebo in combination with physiotherapy and rehabilitation for 21 days. As an objective criterion for the effectiveness of treatment, the pain pressure threshold is considered, measured using a special device (Pressure Tolerance Meter) at 16 symmetrical points of the trunk and extremities. In addition, patients subjectively assessed their condition by the intensity of pain, the feeling of muscle tension and mobility of the spine; the physician also assessed muscle tension and spinal mobility. Before the start of treatment and after its completion, a detailed clinical and laboratory examination was carried out, including ECG, blood pressure measurement, and a biochemical blood test for 16 parameters.

According to research results, the use of mydocalm significantly reduces painful muscle spasm, measured objectively by an instrumental method. The difference between the treatment and placebo groups, which was observed already on the fourth day, gradually increased and became statistically significant on the 10th and 21st days of treatment, which were chosen as endpoints for evidence-based comparison. An analysis of the subjective assessment of the results of treatment given by doctors and patients after its completion (after 21 days) showed that in the group of patients who received mydocalm, the results of treatment were significantly more often assessed as very good, while in the placebo group, the effect was significantly more often absent. According to the subjective assessment of the results of treatment given by patients after its completion (after 21 days), no significant differences were found regarding the tolerability of mydocalm and placebo. The vast majority of patients showed good tolerability of mydocalm. ECG results, biochemical and hematological parameters in the group of patients who took both mydocalm and placebo also did not differ.

It is important to note that more than half (62%) of the patients included in the study received other therapies before the start of the study, and most of them (68%) did not improve. This indicates the effectiveness of mydocalm in the treatment of painful muscle spasm, resistant to other types of therapy.

The introduction of mydocalm parenterally allows you to quickly relieve pain and reduce muscle tension. In case of vertebrogenic muscular-tonic syndrome, intramuscular injection of 100 mg of mydocalm relieves pain after 1.5 hours, and treatment with mydocalm for a week at 200 mg / day / m, and then for two weeks at 450 mg / day orally has a significant advantage over standard therapy; at the same time, mydocalm therapy not only reduces pain, but also relieves anxiety, increases mental performance.

With painful muscle spasm, the advantages of mydocalm, in addition to an effective muscle relaxant and analgesic effect, are the absence of side effects and good interaction with non-steroidal anti-inflammatory drugs, which in many cases allows you to reduce the dose of the latter and, as a result, weaken or even completely eliminate their side effects without reducing the effectiveness of treatment.

An important advantage of midokalm over other muscle relaxants is the absence of a sedative effect and muscle weakness when taking it. This benefit has been proven in a double-blind, placebo-controlled study. The study included 72 healthy volunteers aged 19 to 27 years ( average age- 21.7 years). The study was conducted for eight days, all this time volunteers received 150 or 450 mg of mydocalm per day in three divided doses or placebo in three divided doses by randomization. Neuropsychological studies are carried out in the morning on the first and last (eighth) days of the study before and after taking midokalm after 1.5, 4 and 6 hours or placebo. The results of the study did not show any significant differences in the speed of sensorimotor reactions and the speed of performing various psychological tests 1.5, 4 and 6 hours after taking mydocalm at a dose of 50 or 150 mg or placebo. Similar studies conducted on the eighth day from the start of taking mydocalm also did not show significant differences in comparison with the placebo group. This testifies to the good tolerance of mydocalm and the possibility of prescribing it in cases where, due to the type of activity, the patient needs to maintain the speed of reactions and the ability to concentrate, including when driving a car.

Thus, painful muscle spasm is one of the most common causes of back pain (due to reflex syndromes of osteochondrosis or myofascial pain). In such cases, the use of muscle relaxants in combination with various medicines, physiotherapy and therapeutic exercises. IN last years The effectiveness and safety of the muscle relaxant mydocalm, which does not cause a sedative effect and is available in the form for parenteral administration for the purpose of rapid relief of pain, has been proven.

Literature.

1. Avakyan G. N., Chukanova E. I., Nikonov A. A. The use of mydocalm in the treatment of vertebrogenic pain syndromes // Zhurn. nevrol. and psychiatrist. 2000. No. 5. S. 26-31.
2. Parfenov V. A., Yakhno N. N. Neurology in general medical practice. - M., 2001.
3. Parfenov V. A. Mydocalm in neurological practice // Treatment of nervous diseases. 2002. No. 2. S. 10-12.
4. Pratzel H. G., Alken R. G., Ramm S. Efficacy and tolerance of repeated doses of tolperisone hydrochloride in the treatment of painful reflex muscle spasm: results of a prospective placebo-controlled double-blind trial // Pain. 1996 Vol. 67.- P. 417-425.
5. Dulin J., Kovacs L., Ramm S. et al. Evaluation of sedative effects of single and repeated doses of 50 mg and 150 mg tolperisone hydrochloride. Results of a prospective, randomized, double-blind, placebo-controlled trial // Pharmacopsychiat. 1998 Vol. 31. P. 137-142.

V. A. Parfenov, doctor of medical sciences, professor of MMA named after. I. M. Sechenova
T. T. Batysheva, Candidate of Medical Sciences Polyclinic rehabilitation treatment№7 Moscow

Vertebral column. There are a number of other reasons, but these are the leading ones. We propose to consider them in more detail. After all, the treatment of pain in the muscles of the back cannot be effective without the timely and correct elimination of the factors that provoke it.

So, we will start with the fact that your back muscles hurt after significant physical exertion. This may be elementary overwork or exposure to extreme loads with improperly prepared muscle tissue for training. In order to prevent this condition in the future, it is recommended:

• be sure to conduct a full-fledged warm-up with exercises for stretching muscles and tendons;
• observe the water regime (drink a sufficient amount of fluid during periods of intense physical activity, since dehydration of muscle fibers leads to the risk of developing microscopic tears and the accumulation of lactic acid);
• ramp up physical exercise gradually as the muscle fibers are strengthened and prepared;
• engage (at least for the first time) under the guidance of an experienced instructor.

If you already have muscular back pain, then you need to stop physical activity as soon as possible. Apply cold to the affected area for 2 to 3 hours. After that, use special warming ointments that increase peripheral blood circulation. If you are sure that there are no sprains and small muscle tears, then you can apply heat and do warm compresses. Pain in the muscles of the back during sports overload, as a rule, disappears within 3-5 days. If during this period you do not feel better, then you should seek medical help.

In our clinic of manual therapy you can use the services of a professional massage therapist. Therapeutic massage will speed up the recovery process of muscle tissue and prepare it for future physical exertion.

Other causes of back pain

There are other causes of back pain as well. These can be diseases of the spinal column associated with a violation of posture or destruction of the cartilaginous tissue of the intervertebral discs. There are pathologies associated with the deposition of salts, the formation of osteophytes and other etiological factors of deformation.

With osteochondrosis, pain in the back muscles occurs in the acute phase. This is a reflex process of muscle fiber tension, due to which the body tries to compensate for the load and provide relative peace to the affected spine. This causes tension and sharp pain in the muscles that support one or another section of the spine.

Particularly intense muscle pain in the back causes protrusions and herniated discs. These diseases are associated with injuries and infringements of nerve endings. Against the background of this pathogenesis, sciatica and sciatica (inflammation of the nervous tissue) develop. Disturbed innervation and constricted blood vessels in conditions of soft tissue swelling only exacerbate the situation.

Another common cause of muscular back pain is myositis. This disease is characterized by inflammatory processes of aseptic etiology in the foci of muscle tissue. It occurs against the background of exposure to drafts, with exacerbation of certain chronic diseases, muscle injury, for example, upon impact.

With prolonged exposure to traumatic, including infectious factors, neuralgia occurs with soreness of muscle fibers on the intercostal nerve endings. Intercostal neuralgia is characterized by unilateral localization and severe pain, which increases with deep inspiration.

Treatment of muscular back pain

If muscle back pain occurs, treatment should begin with a differential diagnosis of the disease. Depending on the final diagnosis, you can resort to traditional medicine methods, or visit our chiropractic clinic. We offer fast, effective and safe treatment muscle pain in back.

At your service - traction traction of the spine, if the cause of pain in the muscles of the back lies in the instability of the vertebrae, herniated disk or other manifestations of osteochondrosis.

With myositis, sprains and tendon apparatus, intercostal neuralgia, we are ready to offer you therapeutic massage, reflexology, a complex of special exercise. All this together will help to restore health and proceed to further sports training.