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Douleurs du dos

CETTE SECTION EST EN COURS DE TRADUCTION, REVENEZ PROCHAINEMENT SUR LE SITE!

By Dr Dan Laptoiu, MD, Bucharest, Romania

The injury
In the general population two-thirds of adults will experience low back pain at some point in their life and athletes are no exception. Pain in the lower back is very vommon among both active and inactive people.It can connect to problems related to the structure of the back - as intervertebral discs, joints, connective tissue, or it can come from conditions unrelated to the back - for example pregnancy, head injuries, diseased internal organs.

Most back pain problems are caused by:

  • overloaded connective tissue - myofascial pain, which accounts for about 75% of cases
  • disc degeneration - herniation
  • facet joint syndrome - arthritis of the spine

       

          

What exactly is a lumbar sprain?
Unfortunately, there is no test to accurately diagnose a lumbar sprain, because there is no anatomical or pathological abnormality that can be reliably found in patients with “lumbar sprains”. In the spine the condition characterizes pain coming from the muscles and the connective tissue between the muscles (fascia). When the back or neck is not functioning properly, the muscles surrounding the weak or injured area go into spasm to protect the spine. If the spasm perisists, the muscles become tight and painful.

Even MRI scans are not only unnecessary for most patients with low back pain, but may also be misleading and confusing. There is a study where two-thirds of healthy volunteers without back pain have abnormalities on MRI. Thus, finding an abnormality with MRI is very common and often has nothing to do with the back pain. For most patients with low back pain, X-ray, MRI, and other imaging studies are just not needed.

However, it is important to note that there are certain warning signs and symptoms, and other circumstances, that may indicate more significant disease necessitating further evaluation. These include bladder or bowel dysfunction, muscle weakness or numbness in the legs, sciatica (pain down the back of one or both legs), persistent or prolonged pain (e.g., weeks), weight loss, and fever.

Why does the back pain persists?
The spine was designed to work in harmony with the overlying muscles. If parts of the spine are not functioning properly, the chain is disrupted and other parts must compensate and work harder, particularly other muscles.

As this process is repeated, muscles become tighter and more restricted and the myofascial pain cycle spreads. it is common for the pain to begin in the low back and spread to the neck. Irritated nerves from an undiagnosed disorder of the spine are sometimes responsible for the persistent pain. A thorough evaluation is necessary to be able to treat an underlying problem which is causing the more painful myofascial pain.

If the pain persists with the following treatment suggestions for more than 3 days please seek qualified medical care.

For runners certain situations may predispose to acute or recurrent lumbar sprain/strain. These include weak abdominal muscles, tight muscles/poor flexibility (e.g., hamstring, calf, back without proper warming exercices), poor posture (standing, sitting, or running). Discussion was held on the vibrations send in the back during jogging on hard surfaces without proper sport shoes. Some examples of poor running posture are, hunched or stooped-over position, too much curvature in the low back (butt sticks out with excess arching of the lumbar spine), and pelvic tilt (anterior or lateral). Triathletes have the added complication of the bicycle. Improper fit of the bike, such as handlebars too low or too far forward (or saddle too far back) contribute to back problems. The “aero” position is well known for its ability to apply extra stress to the low back and neck. For all types of athletes training errors may compound the problem.

Not to be overlooked is the contribution of the work place environment (e.g., ergonomics of computer workstation).

Treatment for low back pain may consist of several indications as follows:

  • Bed rest - total bed rest on a firm mattress may help in the acute, severe back problems. With respect to activity, do what you feel you are capable of. Neither absolute bed rest nor aggressive back exercise regimens are helpful. The position is crucial: either lie on your back with a pillow under your calves or lie on your side with knees pulled up to your chest and a pillow held lenghtwise between your calves.
  • Ice/heat and massage - To reduce the pain of early muscle spasm, use ice and light massage with antiinflammatory ointment. To reduce the later stiffness apply moist heat like whirlpool, baths.
  • Medicine - Non-steroidal antiinflammatory drugs (NSAIDs) can help with pain and mobility in the short-term. A muscle relaxant may be added in order to reduce spasm.
  • Rehabilitation exercises following lumbar sprain/strain should highlight and correct muscle weakness, imbalance, and inflexibility. Proper muscle function can help prevent the problem from returning. Back strengthening and stability exercises should be a routine part of the training schedule for anyone who has had recurrent low back problems. Some useful ones are, sit-ups, back extensions, hamstring curls, and quadriceps and gluteal strengthening routines, such as lunges, squats, knee extensions, and leg press. NOTE: check with your doctor first, and then get qualified instruction for proper resistance training technique. Poor technique is the most frequent cause of injury during resistance (weight) training.
  • Physical therapy and spinal manipulation are of limited benefit in most patients. Traction is sometimes used to relieve either pressure on discs or muscle spasm.
  • A brace can be prescribed to help support your back and relieve pain.

Finally, keep in mind that although the first few days are the worst, recovery is usually rapid (approx. 90% of patients are well within two weeks).

Change your lifestyle:

  • avoid heavy lifting
  • when you bend down to pick thigs keep back straight and knees bent
  • avoid bending over for a long time and losing the natural inward curve that creates a hollow in the low back
  • when you have back pain it's wise to avoid teamsports or strenous one-on-one contests that can jar ot twist your back
  • when pain is severe  eliminate sports until you can get doctor's advice

Sports that are easy for your back:

  • walking and swimming to begin with
  • later cycling in an erect position (do not round your back - preferably stationary bike)

Sports that are questionable:

  • jogging
  • golf
  • skiing
  • hockey
  • baseball

Sports that are hard on your back:

  • racquet sports
  • bowling
  • basketball
  • volleyball
  • running fast or downhill

Diving - to be avoided at all times

 

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