In today world, pain in back is a very common reason for visit a physician and the most common reason for absence from work. Spine diseases, except that create major health problems to the patient, and represent a major social problem: the cost of sick leave, medical treatment and rehabilitation can be very high.

According to epidemiological data, the western countries 50 to 80 percent of adults had lower back pain (lumbar syndrome) throughout life. Lower pain in back can occur at any age but is most common in age group from 35 to 55 years old, equally in both sexes. After menopause is somewhat more common for women, as well as during pregnancy, when 49-76 % of women develop back pain. It is the leading cause of disability in adults aged less than 45 years and the third reason for disability for people aged over 45 years. Approximately 5% of men and 2.5% of women have ishialgia, and back pain is usually localized to the area of the lumbar or cervical spine.

CAUSES OF PAIN

Mostly sedentary lifestyle (especially so called sedentary occupations - such as servants, drivers, etc.), lack of physical activity, poor posture and increasing obesity led to more frequent occurrence of diseases related to locomotory system. Although regular sports activities usually protect people against the common problems of the musculoskeletal system, weight training or excessive athletic activity can lead to spinal problems. As training intensity increases, so does the risk of improperly performed exercises increases.

Back pain is a symptom, not a disease, and its causes can be many and varied. There are approximately 150 different causes for pain in the lower back. The most common reasons are certainly degenerative changes in the area of the disc ("tiles") that lies between the vertebrae and degenerative changes in the small joints between the vertebrae. When advanced process occurs, there is potential appearance of prolapsed disc (discus hernia) in the spinal canal (partial or complete), with the pressure on the nerve roots nerves, while this condition manifests as lumboischialgia or sciatica.

Additionally causes of pain in the lower back may be different congenital and developmental abnormalities, inflammation (eg. rheumatic diseases, infections), trauma, tumors, metabolic disorders (eg. osteoporosis), mechanical causes (bad posture, weakened spinal musculature, scoliosis, unequal length legs, static anomalies of feet, blocked area of the joints of the spine, changes and blocked sacro-illiacar joints), gynecological diseases, diseases of the digestive and urogenital system and psychiatric disorders.

The most common lower back pain is mechanical (even in 90 percent of cases), while inflammatory lower back pain makes one to five percent of all cases of lower back pain.

CLINICAL PICTURE

The clinical picture of acute lumbar or lumbo-sacral syndrome is mainly characterized by sudden onset, the patient often describes a sudden movement or load on the spine after which the pain is felt in the lower back. There is elevated tone of paravertebral muscles (the muscles along the spine), and pain due to the limited mobility of the spine. In the lumbo-sciatica pain spread from areas lumbosacral spine through the back and out soles of your feet.

We distinguish between acute and chronic back pain. The acute pain is when disease duration does not exceed three months, and if the back pain lasts longer than three months or if at least two events acute pain arising in one year, then it can be described as chronic.

Discus hernia or prolapsed disc is one of the more common diseases, and cause pain in all parts of the spine. A herniated disc or more specifically the intervertebral disc prolapse stands for “blowout” of fibrous sheath.

A typical finding in lumbar disc herniation include:

- Pronounced pain in the leg than in the back and amplifies the tension in the
- Pain varies from mild to extremely severe sharp pain in the back or neck
- A feeling of numbness in the legs, paralysis
- A feeling of numbness
- Muscle weakness

When nerve compression of the cervical spine appear similar symptoms as above, but also appear:

- Dizziness of the visual field
- Headaches
- Pain in the neck, arms
- Numbness of the hands

TREATMENT

When treatment is necessary to find a balance between short-term medication, medical gymnastics and tips for eliminating risk factors. In most cases (in about 95%) is applied inoperable TJ. Conservative treatment, which consists of:

1. Paramedics therapy (systemic and local). Principles of pharmacological treatment based on the suppression of pain and inflammation. The first paramedic usually recommended is acetaminophen that relieves pain quickly (and does not cause stomach pain). In some cases, NSAIDs (NSAID) is given which relieves pain and inflammation, and muscle relaxants that help in eliminating the pain by relaxing the muscle spasm. Prescribing is usually short-term, three to seven days. Antidepressants lead to back pain in the release of emotional stress, and may also be helpful in the treatment

2. Resting for 2-3 days on the flat bed in a position that best suits the patient to reduce pain

3. Physical therapy - depending on the recommendation of the physiatrist can apply a full range of procedures and treatments that eliminate the problems caused by back pain: electrotherapy, TENS, thermotherapy (or the application of heat - usually in chronic conditions), cryotherapy (cold or application - in acute conditions), massage, laser, magnetic therapy, acupuncture, traction (stretching certain parts of the body, freeing pain) .... The therapeutical pool is often used for relaxing thermal effect of water and ease of movement due to release pressure on the spine reducing body weight in water.

4. Medical gymnastics – after a resting for two to three days to calm acute pain it is recommended in terms of treatment, but also prevention, to start with targeted medical gymnastics to strengthen the back and abdominal muscles (to prevent another attack of low back pain). In medical gymnastics leading position occupied are isometric exercises and stretching exercises (stretching). Exercise program is individual, which means that it must adapt to the patient, his or her age and sex and condition of the bone, muscle and ligament of the spine. Regular exercise helps strengthen the muscles props spine (back and abdominal muscles). Recommended aerobic exercise can achieve better heart function and the release of endorphins as a natural inhibitor of pain.

Surgical treatment of back pain is performed in cases when pain in back can be only surgically removed. Is indicated in herniation ("jumping" plate between the vertebrae), which caused the development of serious neurological symptoms, such as urinary disorder, express outbursts of movement due to pressure on a nerve root, long-term severe pain that does not improve with conservative therapy, etc. In addition to herniation, surgical treatment is necessary in case of tumors and unstable fractures of the vertebrae.

Even after surgical treatment is extremely important to pay attention to the load on the spine and keep up with continuous exercise.

PREVENTION

The patient should be educated which exercises should be carried out at home (exercising on daily basis at least 10 to 30 minutes), how to properly lift a heavy load (not to encumber the spine), which sports movements avoid (for example, sports that require jumping on hard background, suddenly turning, etc.).

From sports and recreational activities swimming is recommended (the best is backstroke swimming and freestyle). Breaststroke swimming technique is not recommended for people who have back pain. Cycling and walking are also recommended activities.

Ideal or proper seating position is one in which the feet touch a hard surface along its entire length, and the back of the chair should support pushing back. If necessary, the pad should be placed in order to maintain the normal curvature of the back. The knees should form a right angle with your legs and thighs, shoulders should be relaxed, forearms should lean on the handlebars. If you're sitting at a computer, the screen should be placed at eye level and be slightly tilted (10-20 degrees). The fingers and wrist must be relaxed in the position bended for 15 degrees on the keyboard. These small adjustments in posture can significantly reduce the workload and fatigue, as well as the sensation of pain.

Psychotherapy in our community is not as represented, but many studies showed a high percentage of the impact of mental health on the outcome of chronic back pain. In addition, cognitive therapy is often practiced today. It develops skills to deal with the problem of pain and disability. Using these skills can eliminate the occurrence of depression, anxiety and stress.

Despite the different etiology and pathophysiology of diseases and disorders of the spine, for the vast majority of patients is sufficiently conservative, nonsurgical treatment. It is aimed at reducing pain, restoring function, and less frequently to definitely the cause.

CONCLUSION

Back pain is a disease of century for modern civilized society. The right lifestyle choices and daily physical activity in most cases can substantially reduce frequency and intensity of back pain.