Description

Low Back Pain

Low back pain is an important health problem due to its high incidence.

The rate of those who have had severe back pain at least once in
their lifetime is 75-85%. It is the most common reason for referral to primary
care physicians in the adult population.

The waist area is the center of gravity of the body and is
affected by almost all body movements. Therefore, it is a region subject to
constant and repetitive strains.

Causes of Low Back Pain

Causes of low back pain can be divided into mechanical and
degenerative causes, and inflammatory causes.

Mechanical and degenerative causes

They constitute approximately 95% of all back pain. Mechanical
reasons; Lumbarization, sacralization, lumbar lordosis increase, disc hernias,
trauma and back pain due to weak muscles.

Degenerative reasons are the aging of tissues and calcification due to other
reasons.

Mechanical and degenerative low back pain; In general, pain that decreases with
rest, increases with movement, often decreases with heat, increases with cold,
increases or decreases depending on the position, and short-term stiffness in
the morning is observed. There is no deterioration in blood tests.

Inflammatory causes of low back pain

Inflammatory involvement is expressed by the term. Inflammatory
rheumatism (Ankylosing Spondylitis), causes of infection (Brucella,
tuberculosis), cancer-related involvement are among the inflammatory causes.

Pain increases with rest in back pain due to inflammatory
reasons. Pain increases at night and decreases when you get out of bed and
move. Pain increases with heat applications. There are impairments in the tests
(such as sedimentation, CRP) in blood tests that show inflammation.

How to Treat Low Back Pain

Medication and rest

In degenerative and mechanical low back pain, it may be
necessary to use anti-inflammatory drugs and cortisone in the acute period. Simple
pain relievers may be sufficient in the chronic period. A few days of full bed
rest is sufficient for acute (newly started) low back pain. After resting, the
patient should gradually move to normal daily movements over time.

Exercise and Physical Therapy

Strengthening the muscles and maintaining a certain degree of
flexibility is extremely important in meeting the loads transferred to our
lumbar vertebrae. Providing these requires some exercises. What should not be
forgotten in this regard is that all kinds of exercises may not be suitable for
every patient. The type of the exercises will change depending on whether the
disease is acute or chronic, the form of the disease, the physical and social
needs and age of the patient. In other words, exercises should be determined
according to the patient. Exercises should be given to the patient by his
physician.

Various physical therapy applications (superficial heaters, deep
heaters, analgesic currents, traction methods) can be applied to patients with
low back pain. The effects of these applications are used to relieve pain,
relax muscles, regenerate tissue and accelerate the repair process. The form
and duration of physical therapy applications should be prescribed according to
the characteristics of the patient and the disease.

Is Surgery Necessary in Low Back Pain?

Surgical treatment in patients with low back pain is a necessary
treatment method in cases where multiple nerve roots are affected at the same
time and the nerves leading to the bladder are affected and in cases with known
cauda equina syndrome in medicine, there is progressive loss of strength in the
foot or leg. The situation should be evaluated very well in operations
performed only to relieve pain.

Various complementary medicine treatment methods can also be
used to get relief from low back pain. These; acupuncture, spinal manipulation,
meso, PRP, prolotherapy and ozone.

Rules to Be Applied for The Protection of Low Back Pain

•     patient should not stay in the same position for a long time. The sitting and standing time should not exceed 45 minutes.
•     When sitting, a pillow supporting the waist should be used.
•     Care should be taken to crouch down and do the work on the ground.
•     The waist area should be protected from sweaty and cold
•     Orthopedic mattress should be used for sleeping.
•     The most appropriate position is to bend forward in the lateral position, pull the legs towards the abdomen and lie down.

Neck Pain

Neck pain is a very common health problem and can be seen in
people of all sex and age. Although neck pain is less common than waist pain,
neck pain is seen in one third of the population. Most of them recover
spontaneously in a short time and mildly. Rarely, it may be very painful or
even severe enough to cause disability.

Neck pain can also spread to the back of the head, shoulder
circumference, arm and front of the chest. Along with neck pain, numbness in
the arm and hand, dizziness, instability and headache can be seen.

The incidence of neck pain increases with age. Tensions in daily
life and work stress increase neck pain. It has been found that there is a
relationship between neck pain and the patient’s work. Pain is more in those
who work at work. Working in a fixed position for a long time (desk workers,
assembly workers, musicians) also increases neck pain.

A specific cause cannot be found in most of the acute neck
pains, but 95% of them are due to mechanical reasons.

Causes of neck pain;

1- Depends on bone structures

•      Congenital: Torticollis, Klippel-Feil syndrome
•      Traumatic: Fractures, slips, hernias
•      Calcifications, channel stenosis
•      Rheumatic: Ankylosing spondylitis, rheumatoid arthritis, polymyositis, polymyalgia rheumatica
•      Tumors
•      Infections

2- Depending on soft tissues

•      Posture disorders
•      Fibromyalgia and myofascial pain syndrome
•      Nerve and vascular problems

3- Reflected pains

4- Endocrinological and metabolic

•      Osteoporosis
•      Parathyroid disease
•      Paget’s disease

5- Psychological

How are neck pains classified according to duration?

 
 1- Acute: Lasts less than 1 month.

  
2- Subacute: Lasts 1-3 months.

  
3- Chronic: Lasts longer than 3 months.

What are the diagnostic methods in neck pain?

• The probability of detecting the cause of
  neck pain does not exceed 20% in 20-50 years of age and 12-15% in all
  ages. Therefore, ancillary examination methods are not required during the
  first evaluation in most of the cases.
• Laboratory examinations should be made
  for infections, rheumatic problems, cancers, and common diseases of the
  bone.
• EMG and nerve conduction studies
• It is mostly performed in cases with neck
  pain in the possibility of nerve root compression. It shows which nerve
  root is pressurized and its severity, and it distinguishes muscle and
  nervous system diseases.
• Display methods
• It should not be forgotten that in
  patients with neck pain, none of the more advanced diagnostic examinations
  such as radiography, CT, MRI, EMG or bone scintigraphy can replace history
  and physical examination, and treatment should be planned according to the
  patients’ complaints rather than the results of this examination.

In what situations should imaging examinations be performed?

•     Advanced age
•     Recent trauma
•     Prolonged cortisone use
•     The presence of cancer
•     Presence of infection
•     Having a fever
•     10% weight loss within 6 months
•     Presence of persistent pain
•     Neurological symptoms

What are the treatment principles in neck pain?

In the treatment, first of all, in order to relieve the patient,
a way is followed such as relieving pain and reducing spasm, taking measures to
prevent recurrence and correcting biomechanics to break the vicious cycle of
pain-spasm-pain. The main methods used in treatment are:

Bed rest and neck collar

The patient must first be informed about the possible causes of
his pain and educated about his disease. It has been determined that 2-3 days
of rest is sufficient in acute pain and 7 days of rest in radicular pain, and
resting for more than 1 week leads to loss of motion in joints, soft tissue
shortening, and a decrease in muscle strength and cardiovascular condition.
Therefore, activity arrangements should be made instead of bed rest in acute
neck pain.

The use of the collar should be used for a short time in acute
neck pain that is not caused by trauma and should not exceed 1.5 months.
Exercises should definitely be done, as strength and volume loss may occur in
the neck muscles during long-term use.

Medication

What are the goals of drug therapy?

•     Reduce pain
•     Increasing physical function and movement
•     Restoring sleep patterns that are disturbed by pain and other complaints
•     To improve social life that is impaired due to pain and discomfort
•     To prevent job losses caused by pain and physical inadequacy
•     Combating anxiety, tension and depression due to pain
•     Pain medications, muscle relaxants, antidepressants, corticosteroids, and antiepileptics can be used in neck pain according to the patient’s condition and the patient.

Physical Therapy applications

Physical therapy sessions and exercise programs, which occupy
the most important place in treatment, have been used for many years because
they reduce complaints and can be applied safely.

In physical therapy, currents to reduce pain such as hot
application, TENS or interference, ultrasound, laser, hiltherapy, traction,
cupping therapy, massage, taping, dry needling, trigger point injections,
mobilization and manipulation applications can be performed.

Exercises

What are the main purposes of exercise in neck pain?

•     Providing painless and full range of motion of neck and shoulder movements
•     Providing full strength, endurance and balance of the muscles
•     Prevention of loss of physical function
•     Protection from repetition
•     Providing physical adaptation
•     Facilitating the return of chronic neck pain patients to a more productive life and
  increasing the quality of life

Exercises in the acute period are aimed at reducing pain and
protecting the damaged structures from further damage. In the subacute period,
it aims to restore the functions of damaged and supporting structures. In the
chronic phase, it aims to eliminate psychological problems in recovery and
decrease in physical function.

Joint range of motion, stretching, strengthening, posture,
coordination and aerobic conditioning exercises are beneficial in neck pain.

A reduction in pain threshold and muscle spasm and an increase
in quality of life are achieved with spa treatment.

Is surgical treatment necessary?

Surgical treatment (surgery) is required for the following problems related to the neck.

•     Having a cervical hernia compressing the spinal cord with progressive loss of muscle
  strength, sensation and reflex
•     Tumor or abscess in the spine
•     Symptoms lasting longer than 3 months despite treatment, being unbearable and impairing quality of life
•     Spinal fracture and severe spinal displacement
•     In the presence of serious neurological problems due to compression in the spinal cord

Useful tips for people with neck pain

•     Never lift, pull or push heavy objects. Divide the loads you will be carrying equally on both hands.
•     Do not carry a load with your head. Do not lift loads above head level.
•     Never lift, pull or push heavy objects. Divide the loads you will be carrying equally on both hands.
•     Do not keep your neck constantly tilted forward or in the same position.
•     Do not pinch the phone between the neck and shoulder while talking.
•     While sitting, keep your back straight and lean.
•     If necessary, reinforce your neck with a neck pillow that fits your neck curve.
•     Do not fall asleep with your neck falling apart from the bed.
•     Do not use excessively high pillows.
•     Organize your working conditions and conditions well.
•     Change positions every 30 minutes, especially at the computer and desk.