February 7, 2011

Abdominal syndrome (pseudovisceral pain). Abdominalgic syndrome is characterized by the presence of a focus of neurodystrophic lesions in the muscles of the anterior abdominal wall and occurs in patients with pathology of the lower thoracic and lumbar spine. There are three clinical variants of abdominalgia: thoracic, lumbar and lumbar-thoracic. In the thoracic variant, patients are concerned about pain in the upper and middle sections of the anterior abdominal wall. Myofascial trigger points are found in the rectus and external oblique abdominal muscles, predominantly at the epi- and mesogastric level. In the lumbar version, complaints are reduced to pain in the lower abdomen.
Extravertebral neuromyodystrophic manifestations are localized in the iliac-inguinal, suprapubic and umbilical regions. Patients with the lumbar-thoracic variant are concerned about diffuse, diffuse pains in various areas of the anterior abdominal wall and often unsharply expressed vegetative disorders (nausea, urinary disorders, stool, etc.). Visceral manifestations are due to vertebrovisceral and motor-visceral reactions. The course of this variant of abdominalgia is characterized by more frequent and prolonged exacerbations compared to the thoracic and lumbar variant. Local muscle hypertonicity and zones of neuromyodystrophy are usually multiple and are found in different parts of the muscles. abdominals(Fig. 2.110).
The most painful areas of seals are localized in the rectus abdominis muscles: in the upper portion (especially in the inner third of the costal arch), at the navel and at the point of attachment of the muscles to the pubic crest. Zones of neuromyodystrophy are usually located symmetrically, although clinical manifestations are more pronounced on one side. The defeat of the oblique muscles of the abdomen is predominantly unilateral, often on the right. When peripheral neural structures are involved in the process, hypoesthesia of the umbilical, lateral, or iliac-inguinal regions, as well as a change in abdominal reflexes, are revealed. At the same time, the tone and strength of the abdominal muscles are reduced.
Syndrome of the square muscle of the lower back. This syndrome is characterized by dull or aching pains in the upper lumbar region, radiating to the lateral parts of the abdomen.
Palpation examination reveals painful areas of myofibrosis in the area of ​​​​attachment of the square muscle of the lower back to the transverse processes of the three upper lumbar vertebrae and the XII rib.
Multipart triangle syndrome. The syndrome described by J. Livingston in 1943 is caused by a lesion of the multifidus muscle. The authors consider the process as a reflex tendomyosis of the muscle in response to irritation in the region of the lumbar intervertebral joints, the sacroiliac junction, and, especially often, due to anomalies in the lumbosacral region, which leads to non-physiological unilateral muscle tension.
The clinical picture is characterized by acute pain in the area between the spine and the iliac wing. Pain may radiate to the buttocks and groin, upper part hips. They are aggravated by rotation and straightening of the body. Palpation of the multifidus muscle is compacted and painful.
Mostly the syndrome occurs by reflex mechanisms in patients with lumbar osteochondrosis, in the presence of pathology of the lumbosacral joint, vertebral static disorders.
Lumbago and lumbago.
Lumbago to this day is a collective, vague concept, the essence of which is interpreted differently. The concept of lumbago currently includes a large area of ​​damage to the muscles, nerves and joints of the lumbosacral region.
Lumbago (lumbar backache) - acutely occurring severe pain in the lower back, and lumbalgia - subacute and unsharp pain.
Lumbar shooting. The onset is sudden, during an awkward movement, heavy lifting, with prolonged static stress. In some cases, the attack occurs during cooling, more often during work or rest in a draft. The onset of an attack is described as a push, a "rupture", as a piercing stabbing pain, as a blow electric current, lightning, as squeezing or bursting, boring, braining, sometimes with a burning tinge, or with a feeling of cold spreading along the lower back. Quite often the patient at the same time "breaks through sweat". Pain is experienced in deep tissues, sometimes accompanied by a crunching sensation. They spread throughout the lower back or in its lower sections, often symmetrically. Sometimes they can radiate to the sides, iliac region, buttocks, upper thighs.
Pain intensity can last from 30 minutes to several hours. Patients often freeze in the position in which they were caught by the attack. They cannot unbend if they leaned over to lift a weight, stand up if an attack caught them in a sitting position, take the next step if the pain arose during an awkward movement. In the supine position, the pain decreases, increases when trying to turn in bed, when coughing, sneezing, and sometimes in stressful situations.
The clinical picture of the process is characterized by reflex tension of the lumbar muscles. This muscle tension also determines protective postures, as well as fixed changes in the configuration of the lumbar spine (kyphosis, hyperlordosis, scoliosis). Painful dense rollers are determined by palpation. Lumbar backache lasts an average of 5 to 12 days, responds well to treatment.
Lumbalgia begins gradually or subacutely (within 1-2 days), aching pains in the lower back appear and gradually intensify, mainly in its lower sections. These pains, which often occur in the morning, may disappear or decrease after walking, warming up. They are aggravated by prolonged sitting, standing, after work, torso tilts. In bed, patients take a position that relieves pain.
Being in a bent position, patients hardly unbend, for which they sometimes use an auxiliary technique: they put a hand on the lower back and put pressure on it. It is difficult for them to wash their faces, brush their teeth, iron them because of the synergistic tension of the lumbar muscles. Increased pain in this position is especially facilitated by the phenomena of neuroosteofibrosis in the interspinous and sacrospinous ligaments, as well as in the capsule of the sacroiliac joint. Patients are often forced to change their position, leaning on the palms of their outstretched arms, moving to the front of the seat or, conversely, pressing against the back of the chair with their entire body. Earlier than usual in a standing or sitting position, there is a feeling of fatigue in the lower back.
Persons engaged in active work fall ill physical activity often sporty. After a long period of discomfort in the lower back, they can often develop various types of lumbodynia. Subsequently, the intensity of the pain increases, they become constant, remaining at rest, aggravated by coughing, sneezing. Protective postures and changes in the muscles approach those described in lumbago. The range of motion in the lumbar region is limited, especially the forward bend. If normally the torso inclination (with respect to the vertical) averages 70°, with lumbodynia this angle averages 37.5°; when you try to increase the inclination, pain in the lower back sharply intensifies. These movements are less limited during extension (normal - 28.5 °, with lumbodynia - an average of 20.5 °). Side bends are even less limited.
The symptoms of "tension" in lumbago are clearly expressed, although the accompanying lumbar pain is weaker than in lumbago. But the area of ​​distribution of pain is wider: often they are felt in the buttock and in the popliteal fossa. The prevalence of pain on one leg can be considered a harbinger of future lumboischialgia.
If with lumbago the entire lumbar region is painful, and intensive palpation of typical pain points is difficult, then patients with lumbodynia manage to relax the lumbar muscles. This allows you to determine the painful points of the lower lumbar intervertebral joints, sacroiliac joints, interspinous and ileolumbar ligaments, spinous processes, and in some cases, the Shkolnikov-Osna points.
Soreness of the fibrous tissues of the sacroiliac joint is caused by their stretching. Gate's technique: pain occurs with forced flexion of the hip in the hip joint with a bent knee joint in a patient lying on his back. Bonnet's symptom: pain in the articulation area when turning the hip inward with the leg bent at the knee joint. Symptom Consistent: pain in the articulation area when throwing one leg over the other in a sitting position. Ferguson's symptom: the patient is asked to slowly stand on a chair, first with a healthy, and then with a diseased leg, leaning on the doctor's hand, then go down from the chair, starting with a sore leg. In this case, if the joint is affected, severe pain occurs. Larrey's symptom: pain in the articulation region that occurs when the patient quickly sits down. Symptom Volkmann-Eriksen: pain in the articulation area with pressure on the crest of the sacrum.
Glutalgia. Glutalgic syndrome includes damage to the small and middle gluteal muscles.
In the syndrome of the small gluteal muscle, pain occurs at rest, but more often at the time of tension or, especially, tension of the muscle when moving in bed, walking, getting up from a chair, throwing one leg over the other (symptom of Compliance). On the side of the syndrome, the hip joint is slightly elevated. In this case, the "shortening" of the corresponding leg is prevented by a compensatory tilt of the pelvis. Passive muscle tension - adduction of the bent hip - leads to pain in this muscle.
The tension of the gluteus maximus muscle is not accompanied by compression of any large nerve trunk, there are no phenomena of prolapse in the zone of certain nerve formations.
Palpation in the affected muscle can reveal areas of neuromyofibrosis (Fig. 2.111), with vibration tapping of which pain may appear along the anteroexternal surface of the thigh, radiating to the knee and peroneal zone of the lower leg.
When the gluteus medius muscle is affected, pain occurs or intensifies at the time of its tension and tension, changes in body position when walking and standing, especially in conditions of rotation of the thigh inward and bringing it in, with supination of the foot. Palpation in the gluteus medius muscle reveals an algic or trigger stage of myofibrosis, pain in the places of its attachment to the iliac crest.
Piriformis Syndrome. Pathological tension of the piriformis muscle with compression of the L5 or S1 root, as well as with unsuccessful injections medicinal substances leads to compression sciatic nerve(or its branches with a high discharge) and the vessels accompanying it in the piriform space.
The clinical picture of the piriformis syndrome consists of local muscular symptoms and compression of the sciatic nerve.
Local pains include aching, pulling, aching pain in the buttock, sacroiliac and hip joints. It increases when walking, in a standing position, when adducting the hip, as well as when squatting down, decreases in a prone position, sitting with legs apart. With good relaxation of the gluteus maximus muscle, a dense and painful piriformis muscle is felt under it. It is also painful when stretched (symptom of Bonnet-Bobrovnikova). With percussion at the point of the piriformis muscle, pain appears along rear surface legs (Vilenkin's symptom).
The clinical picture of compression of the vessels and the sciatic nerve in the subpiriform space is formed on the basis of the topographic and anatomical relationships of its greater and peroneal branches with the surrounding structures. Pain during compression of the sciatic nerve is dull, aching in nature with a pronounced vegetative color (feeling of chilliness, burning, stiffness) with irradiation throughout the leg or mainly along the zone of innervation of the greater and peroneal nerves. Provoking factors are heat, weather changes, stressful situations. Sometimes the Achilles reflex, superficial sensitivity in the zone of innervation of the greater and peroneal nerves are reduced. With the predominant involvement of the fibers from which the tibial nerve is formed, the pain is localized in the posterior muscle group of the leg. Pain appears in them when walking, Lasegue's test. Palpation marked tenderness in the soleus and gastrocnemius muscles.
In some patients, compression of the inferior gluteal artery and the vessels of the sciatic nerve itself is accompanied by a sharp transient spasm of the leg vessels, leading to intermittent claudication. The patient is forced to stop, sit down or lie down when walking. The skin of the leg becomes pale. After rest, the patient can continue walking, but the same attack soon repeats. Thus, in addition to intermittent claudication in obliterating endarteritis, its myelogenous and caudogenic genesis, there is also subpear intermittent claudication.
An important diagnostic test is infiltration of the piriformis muscle with novocaine with an assessment of the resulting positive changes. The definitive diagnosis can be established when clinical signs improve as a result of post-isometric piriformis relaxation.
Pelvic floor syndrome (coccygodynia). In addition to the vertebral lesion in the occurrence of myodystrophic changes in the muscles of the pelvic floor important role belongs to pathological impulses from the affected pelvic organs. Patients are concerned about pain in the sacrococcygeal region, perineum, spreading to the gluteal region, back or inner thigh. Unpleasant sensations are intensified due to static-dynamic effects, cooling, exacerbations of diseases of internal organs, during the act of defecation, at the time of rising, in the premenstrual and menstrual periods. With an objective examination, increased pain causes displacement of the coccyx and mechanical pressure on it. For diagnosis, in addition to the usual palpation, a perrectal examination is used. This determines the tension and soreness of the muscles and ligaments of the pelvic floor (coccygeal, internal obturator, levator anus, etc.), as well as flexion and abduction of the coccyx. X-ray examination confirms the displacement of the coccyx and reveals signs of osteochondrosis of the lower lumbar SMS and the sacrococcygeal joint. Due to the peculiarities of localization of pain sensations, patients often undergo long-term, repeated treatment by therapists, gynecologists, urologists, proctologists, etc. about, allegedly, diseases of the pelvic organs that they have. Unfortunately, there are frequent cases when only the failure of this treatment prompts the doctor to think about a possible lesion of the musculoskeletal apparatus of the pelvis. Diagnosis is greatly facilitated in the stage of exacerbation of the disease, when not only all of the above symptoms are aggravated, but there is also an active vertebral process.
Iliopsoas syndrome (iliopsoalgia). The development of this syndrome is observed with pathological tension of the iliopsoas muscle. In the recognition of iliopsoalgia, characteristic clinical signs help. Tonic and neurodystrophic phenomena in the iliopsoas muscle can appear against the background of lumbar vertebral or pelvic pathology of various etiologies (inflammatory, oncological, dystrophic). Manifestations of clinical manifestations contribute to diseases of the intestine or kidneys. The implementation of exacerbation is usually due to physical overload. Patients complain of bursting pains in the lumbar region, which then appear in the groin or in the lower part of the buttocks. Pain intensifies in the position on the stomach, when walking, hip extension, turning the body in the "healthy" direction. When walking or standing, the patient is tilted forward or to the affected side. Leaning back is not possible, but forward is easily possible. Patients prefer to lie on their back or on their side with a bent leg, which is due to ilio-lumbar myopically. This also explains the fixed lumbar deformity, more often by the type of kyphosis. If the tonic activity of the muscle forms hyperlordosis, then the most unfavorable S-shaped curvature of the spine in the sagittal plane occurs. Patients can hardly walk, prefer to sit or lie only on their side. Spontaneous pain in the groin and lower back appears or increases with hip extension (Wassermann's symptom, currently considered as a test for stretching the lumboiliac muscle). Characterized by soreness of the muscle and its tendon immediately below the middle of the pupart ligament or the place of its attachment to the lesser trochanter. This zone of neuromyofibrosis is palpated in the lower outer gluteal quadrant. Sometimes it is possible to palpate the painful muscle through a relaxed abdominal wall(an analogy with the Shkolnikov-Osn symptom). The neural symptom complex initially includes pain, and then paresthetic phenomena along the anterior and inner surfaces of the thigh, and sometimes the lower leg. There are complaints of a slight decrease in strength in the leg, more often noted when walking. Hypesthesia or hyperpathy is determined below the pupart ligament in the anterior-medial parts of the thigh and, rarely, the lower leg. Possible hypotension, hypotrophy of the quadriceps muscle, decreased knee jerk. On radiographs in direct projection, an increase in the density of the shadow of the psoas major muscle on the diseased side is sometimes caught. Needle EMG in the zone of muscle exit from under the pupart ligament shows an increase in spontaneous activity during hyperextension in the hip joint and a decrease in amplitude with maximum effort on the affected side.
The course is usually chronically recurrent, progredient-regredient. The exacerbation stage is delayed for more than a month. The regression of the disease is protracted. Remission is incomplete.
Muscular syndromes in the leg area are formed not only under the influence of impulses from the damaged spine, but also under the influence of secondary (postural and vicarious) mechanisms. In the process of formation of reflex or compression-neural syndromes, decompensation may occur in one or another part of the body. In order to adapt to activity in these new conditions, the body, as it were, mobilizes adjacent departments, systems, and tissues. In the course of this adaptive activity, overloads often occur in these systems and tissues. They are muscles, joints, blood vessels, visceral and other organs. In conditions of back-breaking work, disadaptation occurs in them. Myoadaptive overload syndromes are divided into postural and vicarious. The first are formed due to adaptation to new postural changes. So, for example, in the presence of vertebral syndrome, a relationship was revealed, on the one hand, between the degree of tension in the legs and the localization of pain, and, on the other hand, between the degree of vertebral deformity and its nature: the more pronounced the deformity, the stronger the tension in the muscles of the legs. In kyphosis, the muscles of the anterior thigh group and rear group lower leg, with hyperlordosis - the posterior thigh muscle group and the anterior leg muscle group. With scoliosis on the supporting leg, tension develops in the hip abductors and foot arches, and on the non-supporting leg, in the hip adductors and pronators of the foot. Vicarious (myoadaptive) manifestations are also formed in response to compression syndromes in order to adapt to the conditions of prolapse. So, for example, when the function of the gastrocnemius muscle (S1 root) is lost, vicarious hypertrophy occurs in the anterior tibial muscle (L5 root).
Thus, taking into account postural and vicarious muscle overloads allows us to trace and comprehend the sequence of involvement of muscles and fibrous tissues in the course of the formation of syndromes. In this case, both types of overloads, as a rule, are mutually intertwined or follow each other.

Myotherapy techniques for pain in the pelvic girdle and legs

iliopsoas syndrome

The iliopsoas muscle flexes the thigh at the hip joint, rotating it outward. With a fixed hip, it tilts (bends) the body forward. It is the main muscle that bends the body forward. The psoas muscle is attached to the thigh. Reflex contracture of the iliopsoas muscle causes pain in the lower abdomen, often below the groin, which is differentiated by patients as pain in the abdominal cavity and small pelvis. Painful indurations of the muscle palpated by the surgeon through the abdomen can be the source of many diagnostic errors and even inappropriate surgical interventions.

Attention! In case of pain in the abdomen, it is imperative to consult a doctor. Delay in this case can be life-threatening. The exercises suggested below should be performed only after agreement with the attending physician!

Between the muscle bundle of the iliopsoas muscle, the cutaneous femoral nerve can be infringed. In this case, numbness and sensory disturbances occur along the anterolateral surface of the thigh (Bernard-Roth neuralgia).

With a functional limitation of the mobility of the sacroiliac joint, a painful spasm of the iliac muscle is detected in the supine position with the legs slightly bent at the knee joints. If this spasm occurs on one side, then it has a very valuable diagnostic value. You can feel the iliac muscle from the side on the surface of the pelvis. In the presence of spasm, when probing under the fingers, a painful roller is felt. True, it can be quite difficult to feel it in oneself.

All exercises for iliopsoas muscle syndrome should be performed lying on your back, a healthy leg is bent at the knee and hip joints and rests on the couch, the body on the edge of the couch. The affected leg is bent at the knee joint and hangs freely from the longitudinal edge of the couch.

To reduce pain in iliopsoas muscle syndrome, the following myotherapy technique is used, which is performed with one thumb or several fingers, a small pad (knob) of the hand, or the entire palm. When performing this technique, the palmar surface of the phalanx thumb, i.e., the pad of the thumb moves continuously in the longitudinal direction along the front surface of the thigh.

Longitudinal linear stroking

It is performed with the pad of the middle finger on the same side, moving up and down along the irradiation of pain along the front surface of the thigh for 1 minute, 6-15 times.

Cross-lateral stroking

It is performed similarly to the previous one, only in the transverse direction.

Stroking with a "planer"

It is carried out along the front surface of the thigh from the inguinal region down with great effort and back - with less, simulating the work of a planer.

Semi-circular stroking

It is performed with the edge of the thumb near the nail from the inguinal region down along the irradiation of pain. The reception efficiency increases with increasing speed.

Exercise 84 (vibration pinching)

Perform in the same position with two or three fingers folded in the form of tongs. The captured part of the tissue, where the pain zone is located, is shaken, giving it an oscillatory (tremulous) movement: at first light, then more intense.

First, shake the iliac muscle in the presence of a pain point above the inguinal fold, grabbing it with your fingertips and rotating it in the longitudinal or transverse direction. Then the skin, subcutaneous tissue and muscle in the fold are compressed. After that, an oscillatory (vibrating) movement back and forth is reported, pressing and pressing on the painful area. Pressing is carried out with the fingertips (one or more fingers at the same time) or with the tip of the thumb. Next, pain zones are found along the anterior surface of the thigh and sequentially similar methods of myotherapy are performed.

Exercise 85

With swelling of the tissues in the inguinal region and the anterior surface of the thigh, finger pricks are carried out at a very fast pace with the tips of the thumb, index and middle fingers. pain points.

In this case, the swollen tissue is slightly shifted up and down. Usually, pressure on the muscle trigger point during myotherapy is continued until pain appears. As the pain decreases, the pressure is gradually increased. The pressure lasts 1–2 minutes with a force of up to 3 kg. Finger impact on the muscle trigger point is carried out by the type of "screwing" the screw counterclockwise until pain appears and "unscrewing" the screw counterclockwise for 1-2 minutes (cycles of 3-6 seconds).

Pain in the buttocks and hip joint

piriformis syndrome

The piriformis syndrome has been described in detail by Russian vertebroneurologists. The piriformis muscle is the only muscle that connects the articular surfaces of the sacroiliac joint. It begins on the pelvic surface of the sacrum on the side of the second and fourth pelvic sacral foramen. Representing a flat isosceles triangle, the piriformis muscle passes through the large sciatic foramen and attaches to the greater trochanter of the thigh. It is involved in external rotation, abduction, and partly in hip extension.

The sacral plexus inside the small pelvis lies on the piriformis muscle, between its tendons. Passing through the large sciatic foramen, the piriformis muscle leaves small gaps along the upper and lower edges: suprapiriform and subpiriform openings. The sciatic nerve extending from the sacral plexus passes through the piriform opening, which, together with the vessels surrounding it, can be compressed during spasm of the piriformis muscle.

The clinical picture of the disease is characterized by dull, pulling, tearing, moribund, sometimes with a burning tinge of pain in the buttocks, in the sacroiliac and hip joints. Pain may improve in bed, but worse when walking. When the sciatic nerve is compressed, the pain spreads along the back of the thigh, into the popliteal fossa, to the heel, to the toes. Sometimes it can be felt along the front surface of the lower leg, along the upper surface of the foot to the big toe. There are frequent disturbances of sensitivity throughout the leg, especially in the foot.

Exercise 86 (for piriformis syndrome - for pain in the buttocks, in the sacroiliac and hip joints)

Perform the exercise lying on a healthy side, a healthy leg is straightened, a diseased leg is on top, bent at the knee and hip joints so that the knee rests on a healthy leg. Fingertips upper hand in the middle of the buttock of the sore leg located on top, feel (palpate) the painful zones, moving the muscle masses of the gluteus maximus muscle located above and outside with the middle fingers up, as if first screwing the middle fingers into the middle of the buttock.

Then apply stroking techniques in the longitudinal, transverse-lateral and semicircular directions, pressing and pushing techniques.

After that, choosing the most painful point, half-bent middle or index finger brushes to put pressure on it until pain appears.

As the pain decreases, gradually increase the pressure of the finger. Press for 1-2 minutes with a force of 3 to 6 kg. Repeat the exercise 3-6 times.

Pain in the lumbosacral region, in the outer part of the thigh, along the anterior outer part of the lower leg, sometimes radiating to the outer ankle

iliotibial tract syndrome

The iliotibial tract somewhat abducts, flexes, rotates the thigh inward and is involved in keeping the knee in a straightened position.

The clinical picture of the lesion of the ilio-tibial tract is characterized by pain in the lumbosacral and acetabular regions, the outer part of the thigh along the ilio-tibial tract, along the anterolateral part of the leg, sometimes radiating to the outer ankle. The main starting zone of pain is located in the upper outer parts of the thigh anterior to the greater trochanter of the thigh, the other is in the region of the small and middle gluteal muscles.

Exercise 87 (with iliac-tibial tract syndrome - pain in the lumbosacral region, the outer part of the thigh, along the anterior outer part of the lower leg, sometimes with irradiation to the outer ankle)

The exercise is performed lying on a healthy side, the diseased leg lies on a healthy one, lower hand placed behind the head. First, with the fingertips of the upper hand, carefully feel (palpate) the muscles of the outer surface of the thigh to identify the most affected areas, highlighting the most painful (starting point) from them.

Then, with the side surface of the palm, carry out a longitudinal linear stroke, moving up and down the side surface of the thigh for 1 minute, 6-15 times.

Then carry out stroking with a “planer” in the longitudinal direction up or down, with great effort in the direction where pain is caused, 1 minute, 6–15 times.

After that, with the edge of the thumb or middle finger near the nail, conduct a semicircular stroking, as if “twisting” and “unscrewing” the screw counterclockwise, for 1 minute, 6-15 times.

After taking a break and resting for 2-3 minutes, find the most painful area and conduct a vibration technique: grab the most painful areas on the outer surface of the thigh with your fingertips, shake them back and forth and rotate them counterclockwise.

Reception is performed within 1.5-2 minutes. After that, rub with the end of the thumb with slow reciprocating movements with pressure on the most painful area for 1.5–2 minutes.

After the preparatory part, take a break for 2–3 minutes and, having felt the most painful point on the outer surface of the thigh, with a straightened thumb, middle or index finger (“needle finger”), carry out the piercing technique until pain appears.

The reception is repeated 3-6 times every 2-3 minutes until the pain decreases and disappears.

In the absence of allergic reactions, 40 minutes before the exercise, you can use: ascorbic acid (vitamin C) 1000 mg (after meals); glycine 0.3 mg under the tongue; indomethacin (in suppositories) 50 mg; voltaren active 25 mg (after meals).

Pain in the popliteal fossa radiating up and down, sometimes to the ischial tuberosity

biceps femoris syndrome

Spasm of the biceps femoris muscle occurs when the torso is tilted forward, the physiological bending of the lumbar spine is increased forward, two vertebrae slip off (spondylolisthesis), when the posterior edge of the pelvis and the ischial tubercle, where it is attached, rises. When the tendon of the biceps femoris muscle fibers of the peroneal nerve is compressed, when it is still part of the sciatic nerve, a pain syndrome of its lesion may occur with symptoms of prolapse, up to paralysis of the foot. This is especially often observed in people whose work requires squatting, kneeling.

The clinical picture of the defeat of the biceps femoris muscle is characterized by pain, which is localized more often in the popliteal fossa with irradiation up and down, sometimes in the area of ​​the ischial tuberosity. In the biceps femoris, palpation often reveals soreness and seals on the border of the upper and middle third. When the fibers of the peroneal nerve are compressed, pain often with a feeling of numbness, tingling spreads to the lower leg, foot and toes. Soreness and induration can often be identified in the area of ​​the popliteal fossa.

Exercise 88 (with biceps femoris syndrome - pain in the popliteal fossa, giving up and down)

Exercise to perform reclining on a healthy side, leaning on the elbow. First, with the pad of the middle finger of the upper hand, carefully feel (palpate) the popliteal region to identify the most affected areas, highlighting the most painful (starting point) from them.

Then, with the pad of the middle finger, carry out a longitudinal linear stroking, moving up and down the popliteal region and lateral zones for 1 minute, 6-15 times.

Having felt the most painful area, carry out transverse-lateral stroking for 1 minute, 6-15 times.

Then carry out stroking with a “planer” in the longitudinal direction up or down, with great effort in the direction where the pain is caused, for 1 minute, 6–15 times.

After taking a break and resting for 2-3 minutes, take the starting position, find the most painful area and conduct a vibration technique: with the tips of the thumb, index and middle fingers, grab the most painful areas in the popliteal fossa, shake them back and forth and rotate counterclockwise.

Reception is performed within 1.5-2 minutes. After that, rub with the pad of the middle finger with slow reciprocating movements with pressure on the most painful area for 1.5–2 minutes.

After the preparatory part, take a break of 2-3 minutes. Having felt the most painful point in the region of the popliteal fossa, use a straightened middle or index finger (“needle finger”) to carry out a sticking technique until pain appears.

As the pain sensation decreases within 0.5–1 minute, the pressure must be gradually increased. Press for 1-2 minutes with a force of 3 to 6 kg.

Pain in the gluteal muscles radiating to the back of the thigh and lower leg

Syndrome of the middle and small gluteal muscles

The gluteus medius muscle is located under the gluteus maximus muscle and is well palpated under the skin and subcutaneous fatty tissue. Her muscle fibers start from the outer surface of the iliac wing and are attached to the upper part of the femoral head. The anterior fibers of the gluteus medius muscle rotate the thigh inward, the posterior fibers outward, the entire muscle is involved in the abduction of the thigh and in straightening the bent torso. The gluteus minimus is located under the gluteus medius, starts from the outer surface of the iliac wing and is attached to the anterior edge of the femoral head. The gluteus minimus abducts the thigh to the side and straightens the bent torso.

The clinical picture of the defeat of the middle and small gluteal muscles is similar. With both diseases, pain can increase at rest, but more often during tension and muscle spasm: when changing body position, walking, standing, getting up from a chair, when throwing one leg over the other. The area of ​​irradiation of pain in the syndrome of the middle and small gluteal muscles captures the buttock, the back of the thigh and lower leg. With gluteus minimus syndrome, pain can spread along the anterolateral surface of the thigh to the top of the foot to 2-5 fingers (that is, to all fingers except the big one).

The trigger zone for gluteus medius syndrome is located in the upper part of the gluteal region, on the border with the gluteus maximus muscle. The trigger zone for gluteus maximus syndrome is on the middle part of the line connecting the upper part of the ilium and the head of the femur.

With pathology of the middle and small gluteal muscles, pain appears in them, often extending to the back of the thigh and lower leg.

Exercise #89

The exercise is performed lying on a healthy side so that the knee of the diseased upper leg, bent at the hip joint, leans on the knee of the lower healthy straightened leg. With the pad of the middle finger of the upper hand, carefully feel (palpate) the muscles of the gluteal region in the middle gluteal and anterior outer parts to identify the most affected areas, highlighting the most painful (starting point) of them.

Then, with the pad of the middle finger or the side surface of the palm, carry out a longitudinal linear stroking, moving up and down the buttock and along the side zones for 1 minute, 6-15 times.

Having felt the most painful area, carry out transverse-lateral stroking in the transverse direction for 1 minute, 6-15 times.

Then carry out stroking with a “planer” in the longitudinal direction up or down, with great effort in the direction where pain is caused, 1 minute, 6–15 times. After that, with the edge of the middle finger near the nail, carry out a semicircular stroking, as if “twisting” and “unscrewing” the screw counterclockwise for 1 minute 6-15 times.

After taking a break and resting for 2-3 minutes, take the starting position, feel for the most painful area in the gluteal region and conduct a vibration technique: with the tips of the thumb, index and middle fingers, grab the most painful areas in the gluteal zone, shake them back and forth and rotate counterclockwise .

Reception is performed within 1.5-2 minutes. After that, rub the pad of the middle finger of the upper hand with slow reciprocating movements with pressure on the most painful area for 1.5–2 minutes.

After the preparatory part, take a break of 2-3 minutes. Having felt the most pronounced painful point, use a straightened middle or index finger (“needle finger”) to carry out a piercing technique until pain appears.

As the pain sensation decreases within 0.5–1 minute, the pressure must be gradually increased. Press for 1-2 minutes with a force of 3 to 6 kg.

The reception is repeated 3-6 times every 2-3 hours until the pain disappears completely. In the absence of allergic reactions, 40 minutes before the exercise, you can use: ascorbic acid (vitamin C) 1000 mg (after meals); glycine 0.3 mg (3 tablets under the tongue); indomethacin (in suppositories) 50 mg; voltaren active 25 mg (after meals).

! Attention! Medicines can be used only after consultation with the attending physician!

Pain along the inner surface of the leg, radiating to the groin, and sometimes along the front of the thigh to the inner ankle

Adductor thigh syndrome

The adductor muscle group of the thigh includes the large adductor, long and short adductor and pectus muscles. All three adductor muscles are attached with inside hips. The long adductor muscle, located more superficially, is attached especially widely to this line. Adductor thigh syndrome is more common than abductor syndrome. For example, when shortening one leg - so that the pelvis is located symmetrically (correction by the brain of the vertical position of the body in space), with pathological processes in the hip, knee or ankle joints, fractures of the lower limb, etc.

The clinical picture of damage to the adductor muscles of the thigh is characterized by pain along the inner or anterointernal surface of the leg, radiating to the groin, and sometimes along the front surface of the thigh to the inner ankle. On the inner surface of the leg, often near the groin, one can feel a muscular induration, which is painful when palpated and stretched. As a result, there is a restriction of movement in the hip joint, the posterior sections of the pelvis on the affected side rise, the thigh is slightly bent and adducted, which makes it impossible to rest the foot on the entire foot, but only on the toe.

Exercise 90

Perform the exercise in a sitting position, with the foot resting the sore leg on the thigh of the other leg. Putting the fingertips of the opposite hand on the inner surface of the thigh of the affected side, carefully feel (palpate) the muscles on the inner surface of the thigh to identify the most affected areas, highlighting the most painful (starting point) from them.

Then, with the pad of the middle finger or the side surface of the palm, carry out a longitudinal linear stroke, moving up and down the front-outer surface of the thigh for 1 minute, 6-15 times.

Having found the most painful area, carry out transverse-lateral stroking in the transverse direction, for 1 minute, 6-15 times.

After that, with the edge of the middle finger near the nail, conduct a semicircular stroking, as if “twisting” and “unscrewing” the screw counterclockwise, for 1 minute, 6-15 times.

After taking a break and resting for 2–3 minutes, take the starting position, feel for the most painful area on the inner thigh and conduct a vibration technique: with the tips of the thumb, index and middle fingers, grab the most painful areas on the inner thigh, shake them back and forth and rotate them against hour hand.

Reception is performed within 1.5-2 minutes. After that, rub the tubercle at the base of the thumb on the same side with slow reciprocating movements with pressure on the most painful area for 1.5–2 minutes.

After the preparatory part, take a break of 2-3 minutes. Having felt the most pronounced painful point on the inner surface of the thigh, with a straightened middle or index finger (“needle finger”), carry out a sticking technique until pain appears.

As the pain sensation decreases within 0.5–1 minute, the pressure must be gradually increased. Press for 1-2 minutes with a force of 3 to 6 kg.

The reception is repeated 3-6 times every 2-3 hours until the pain disappears completely. In the absence of allergic reactions, for better muscle relaxation 40 minutes before the exercise, you can use: ascorbic acid (vitamin C) 1000 mg (after meals); glycine 0.3 mg (3 tablets under the tongue); indomethacin (in suppositories) 50 mg; voltaren active 25 mg (after meals).

Pain and cramps in the calf muscle

Triceps Syndrome

Muscular syndromes with neurological manifestations of the pathology of the spine include the syndrome of the triceps muscle of the lower leg. The triceps muscle of the lower leg consists of the gastrocnemius muscle lying superficially and subcutaneously and the gastrocnemius muscle located in front, closer to the bones of the lower leg, soleus muscle. These muscles perform plantar flexion of the foot.

In connection with the anatomical and functional features of the muscle, convulsions are often observed in it.

Cramps are provoked by sudden plantar flexion of the foot (including at night at rest, when removing shoes, etc.). The duration of convulsive painful contraction is from several seconds to a minute. The defining moment is the brain injury suffered in the past. Convulsive muscle contractions can occur with arterial and venous insufficiency, as a result of detraining in athletes, but never occur with overexertion.

If convulsions occur with a sharp pain in the gastrocnemius muscle, it is necessary to immediately include the gastrocnemius muscle in the work for their disappearance: give it a load with a maximum contraction of the muscle tonic fibers. If this happened in a prone position (often happens during sleep), then it is necessary to bend the foot as much as possible and lean on it, strengthening the weight of the body. If at the same time convulsions with sharp pain do not disappear, then you need to get out of bed and stand on this leg - convulsions with sharp pain will instantly disappear. After 10–20 steps, only traces of the transferred pain will remain, which will disappear after 2–3 minutes.

Exercise 91 (with triceps calf syndrome - pain or cramps on the back of the leg below the popliteal fossa)

Perform the exercise while sitting on the couch so that the foot of the sore leg, bent at the hip and 90 ° at the knee joints, rests on a small bench next to the chair or couch. Putting the pads of the thumbs of both hands on the back of the thigh below the popliteal fossa, carefully feel (palpate) the muscles on the back of the lower leg to identify the most affected areas, highlighting the most painful (starting point) from them.

Then, with the pad of the thumb or middle finger or the side surface of the palm, carry out a longitudinal linear stroke, moving up and down the back of the lower leg for 1 minute, 6-15 times.

Having found the most painful area, carry out transverse-lateral stroking in the transverse direction, for 1 minute, 6-15 times.

Then carry out stroking with a “planer” in the longitudinal direction up or down, with great effort in the direction where the pain is caused, 1 minute 6-15 times.

After that, with the edge of the thumbs near the nail, carry out a semicircular stroking, as if “twisting” and “unscrewing” the screw counterclockwise, for 1 minute, 6-15 times.

After taking a break and resting for 2-3 minutes, take the starting position, feel for the most painful area on the back of the lower leg and conduct a vibration technique: with the tips of the thumb, index and middle fingers, grab the most painful areas on the back of the lower leg, shake them back and forth and rotate them against hour hand.

Reception is performed within 1.5-2 minutes. After that, rub the tubercle at the base of the thumb with slow reciprocating movements with pressure on the most painful area for 1.5–2 minutes.

After the preparatory part, take a break of 2-3 minutes. Having felt the most pronounced painful points in the calf region, use a straightened index finger (“needle finger”) to carry out the piercing technique until pain appears.

As the pain sensation decreases within 0.5–1 minute, the pressure must be gradually increased. Press for 1-2 minutes with a force of 3 to 6 kg.

The reception is repeated 3-6 times every 2-3 hours until the pain decreases. In the absence of allergic reactions, to relax the calf muscle 40 minutes before the exercise, you can use: ascorbic acid (vitamin C) 1000 mg (after meals); glycine 0.3 mg (3 tablets under the tongue); indomethacin (in suppositories) 50 mg; voltaren active 25 mg (after meals).

Syndrome of the iliopsoas muscle (psoas-syndrome)

… the development of this syndrome is observed with pathological tension of the iliopsoas muscle .

ETIOLOGY and PATHOGENESIS

iliopsoas muscle syndrome ( psoas-syndrome) is a secondary reflex vertebrogenic syndrome(against the background of lumbar vertebral pathology) or a variety of muscular-tonic and neurodystrophic syndromes caused directly by muscle damage as a result of trauma, pelvic pathology of various etiologies (inflammatory, oncological, dystrophic), as well as pathology hip joint(fracture of the neck of the femur, arthritis of the hip joint, the initial stage of aseptic necrosis of the femoral head). Iliopsoas syndrome occurs in 30-40% of patients with diseases of the hip joint and as an independent disease in 2.5% (usually in young people).

Manifestations of clinical manifestations contribute to diseases of the intestines, gallbladder or kidneys (see the article "Reflex muscle pain syndromes with nephroptosis (clinic)" in the "vertebrology" section of the medical portal site). The implementation of exacerbation is usually due to physical overload.

ANATOMY OF THE ILIOPUM MUSCLE

Common iliopsoas muscle (m. iliopsoas) consists of two muscles: a large lumbar muscle (m. psoas major) and iliac muscle (m. iliacus), which, starting in different places (on the lumbar vertebrae and ilium), are combined into a single muscle. The iliopsoas muscle exits (behind the inguinal ligament) through the muscle gap into the thigh region and is attached to the lesser trochanter of the femur. Before attaching to the lesser trochanter, the iliopsoas muscle is located on the anterior surface of the hip joint, covering the anterior edge of the articular cavity and the femoral head, often having a common mucous bag with the joint. Over a long distance, both parts of the muscle take part in the formation of the muscular base of the posterior wall of the abdominal cavity.

Psoas major (m. psoas major) begins with five teeth from the lateral surface of the bodies of the XII thoracic, four upper lumbar vertebrae and the corresponding intervertebral cartilages. Deeper muscle bundles originate from the transverse processes of all lumbar vertebrae. Located in front of the transverse processes, this muscle is tightly adjacent to the vertebral bodies. Somewhat narrowing, the muscle goes down and slightly outward and, connecting with the bundles of the iliac muscle, m. iliacus, forms the common iliopsoas muscle.

Iliac muscle (m. iliacus) massive, flat and fills the entire iliac fossa, fossa iliaca (ilium), adjacent to the lateral side of the psoas major muscle. It starts from the upper two-thirds of the iliac fossa, the inner lip of the iliac crest, the anterior sacroiliac and ilio-lumbar ligaments. The bundles that make up the muscle fan-shaped converge to the linea terminalis and here merge with the bundles m. psoas major, forming m. iliopsoas.

Iliopsoas muscle (m. iliopsoas) flexes the hip at the hip joint, rotating it outward. With a fixed hip, tilts (bends) the torso forward. Innervation: rr. musculares plexus lumbalis (L1-L4). Blood supply: a. iliolumbalis, circumflexa ilium profunda.

CLINICAL PICTURE and DIAGNOSIS

In recognizing the syndrome of the iliopsoas muscle (iliopsoalgia), the characteristic clinical signs of this syndrome help.

Complaints. Patients complain of bursting pains in the lumbar region, which then appear in the groin or in the lower part of the buttocks. The pains are aggravated in the position on the stomach, when walking, hip extension, turning the torso in the "healthy side".

Vertebral, cognitive and locomotor symptoms. The pelvic tilt on the side of the lesion is characteristic, which leads to functional shortening of the lower limb and hyperlordosis of the lumbar spine. When walking or standing, the patient is tilted forward or to the affected side. Leaning back is not possible, but forward is easily possible. Patients prefer to lie on their back or on their side with a bent leg, which is due to ilio-lumbar myopically. This also explains the fixed lumbar deformity, more often by the type of kyphosis. If the tonic activity of the muscle forms hyperlordosis, then the most unfavorable S-shaped curvature of the spine in the sagittal plane occurs. Patients can hardly walk, prefer to sit or lie only on their side. Spontaneous pain in the groin and lower back appears or increases with hip extension (Wassermann's symptom, currently considered as a test for stretching the iliopsoas muscle). Characterized by soreness of the muscle and its tendon immediately below the middle of the pupart (inguinal) ligament or the place of its attachment to the lesser trochanter. This zone of neuromyofibrosis is palpated in the lower outer gluteal quadrant. Sometimes it is possible to palpate the painful muscle through the relaxed abdominal wall (an analogy with the Shkolnikov-Osn symptom). A positive reaction of postisometric relaxation of the lumboiliac muscle is characteristic: an increase in the range of motion in the joint after a long (2-5 minutes) stretching of the lumbar muscle according to S. P. Veselovsky, a positive result after performing a therapeutic and diagnostic blockade of m. iliopsoas.

Complications of the hip joint. The pathology of the iliopsoas muscle leads to a pelvic tilt “to the affected side”, pressure on the hip joint area, causing its secondary inflammation and rotational flexion and adductor contracture (a type of hyperpressive syndrome of the hip joint). This symptom complex is the cause of persistent pain and contractures in at least 30% of patients, simulating and aggravating the course of various diseases and injuries of the hip joint (Ugnivenko V.I.). The diagnosis of psoas-syndrome is largely hampered by the clinical similarity of this syndrome with the clinical manifestations of arthritis of the hip joint: pain in the area of ​​the femoral head with irradiation to knee-joint, the hip is rotated outward, flexed and adducted, active flexion in the hip joint is sharply limited.

Neural symptom complex. The neural symptom complex initially includes pain, and then paresthetic phenomena along the anterior and inner surfaces of the thigh, and sometimes the lower leg. There are complaints of a slight decrease in strength in the leg, more often noted when walking. Hypesthesia or hyperpathy is determined below the pupart ligament in the anterior-medial parts of the thigh and, rarely, the lower leg. Possible hypotension and hypotrophy of the quadriceps muscle, decreased knee jerk.

Flow usually chronically recurrent, progredient-regredient. The exacerbation stage is delayed for more than one month. The regression of the disease is protracted. Remission is incomplete.

On the radiograph of the lumbar region in direct projection, sometimes an increase in the density of the shadow of the psoas major muscle on the diseased side, a curvature of the spine in the frontal plane associated with a skew of the pelvis, and hyperlordosis of the lumbar region are sometimes detected.

With magnetic resonance imaging (MRI) an increase in the contour of the lumbar muscle at the level of L2-L4 is determined, probably due to its hypertonicity.

With needle EMG in the zone of muscle exit from under the pupart ligament, there is an increase in spontaneous activity during hyperextension in the hip joint and a decrease in amplitude with maximum effort on the affected thoron.

A method for diagnosing unilateral or bilateral pelvic pain caused by the syndrome of the iliopsoas muscle published by Ulyatovskaya LN; Silver L.A.; Zaporozhtsev D.A. February 10, 2003 (Base of patents of the Russian Federation). The essence of this method is as follows. Post-isometric relaxation is carried out by bending one leg at the knee in the supine position, then the patient rests on the knee with the palms of both hands and alternately strains and relaxes the leg for 10 seconds for 2-3 minutes. Similar actions are carried out with the other leg. If post-isometric relaxation leads to a noticeable decrease in the level of pelvic pain on one or both sides, then unilateral or bilateral pelvic pain is diagnosed due to the iliopsoas muscle syndrome.

TREATMENT

Methods for eliminating the syndrome of the lumboiliac muscle

In the early stages of the syndrome of the lumboiliac muscle (with the exception of cases of the occurrence of this syndrome in the pathology of the abdominal cavity and pelvic organs), it is performed by the method of post-isometric relaxation, in case of ineffectiveness, drug blockade of the muscle is performed. Comprehensive treatment includes methods for stabilizing the lumbar spine (unloading mode, bandage, therapeutic exercises to strengthen the muscles of the body), general strengthening, anti-inflammatory drug therapy, hydrokinesitherapy, muscle relaxants.

Postisometric relaxation of the iliopsoas muscle

First option. Initial position the patient - lying on his back, the leg hangs freely from the couch. The starting position of the doctor - standing facing the head end, fixes the upper third of the lower leg with the same hand. On inspiration, the patient raises the straight leg, overcoming the resistance of the doctor. The position is fixed for 9-12 seconds. On the exhale - the leg freely falls down. Reception is repeated 3-4 times.

Second option. The initial position of the patient is lying on his stomach. The starting position of the doctor is standing facing the head end. The doctor's opposite hand and thigh fix the lower third of the patient's thigh, the other hand fixes the lumbar spine. On inspiration, the patient seeks to press his leg to the couch, and the doctor resists. The position is fixed for 9-12 seconds. On exhalation, the doctor passively stretches the muscle, lifting the patient's leg up and fixing the lower back. Reception is repeated 3-4 times.

Third option. The initial position of the patient is lying on his back, at the end of the couch, the pelvis at the edge of the couch. The leg, on the side of the relaxed muscle, hangs freely, the other leg is bent at the knee and hip joints. The starting position of the doctor is standing at the foot end of the couch, facing the patient. One hand of the doctor fixes the lower third of the thigh, the other - the upper third of the lower leg of the bent healthy leg. On inspiration, the patient seeks to raise the lowered leg, overcoming the resistance of the doctor. The position is fixed for 9-12 seconds. On exhalation - the doctor passively stretches the muscle with moderate pressure on the thigh of the lowering leg. Reception is repeated 3-4 times.

Medicinal blockades of m.iliopsoas according to the methods developed in CITO

First option. The drug mixture in a volume of 50-100 ml (0.5% novocaine solution, 25-50 mg hydrocortisone, 400 mg cyanocobalamid) after appropriate anesthesia through a 15-20 cm long needle is injected into the abdomen of the iliopsoas located in the pelvic area. Direction of the needle: entry point - 6 cm below the inguinal fold at the level of its middle and outer third, the direction of the needle at an angle of 30 degrees to the surface of the thigh in the direction of the posterior superior iliac spine, through the lacuna musculorum into the cavity of the small pelvis until resistance of the muscular fascia appears . The correctness of the introduction is determined as paresthesia appears in the projection of innervation femoral nerve and elimination of the muscular component of flexion contracture in the hip joint.

Second option. Blockade of the lumbar muscle by paravertebral access. Paravertebral (departing from the spinous process by 5-6 cm) at the level of L1-L2, a puncture needle 15-20 cm long is inserted until it stops into the transverse process of the vertebra and, bending around it along the upper edge, until a “dip” is felt to a depth of 5 cm. in the forward direction. With the technically correct implementation of the blockade at the time of injection, there is a feeling of warmth in the limbs, paresthesia, elimination of pain in the hip joint.

Third option. In the absence of skills or tools necessary for a full puncture, the drug mixture is injected into the area of ​​the "Skarpovsky triangle" outward from the vascular bundle.

In the lumbar region, there are the following weaknesses:

• Petit triangle It is formed in the place where the edges of the external oblique muscle of the abdomen and the latissimus dorsi muscle diverge. The base of this triangle is the ilium. In turn, the bottom of the triangle is formed by the internal oblique muscle of the abdomen. Petit's triangle is a weak point in the lumbar region, since here the muscle layer is relatively unexpressed.
• Lesgaft-Grunfeld rhombus formed by the edges of the internal oblique muscle of the abdomen and the lower posterior dentate muscle of the abdomen. The upper border of the rhombus is the lower edge of the lower posterior serratus abdominis muscle, and from below and outside the rhombus is bounded by the posterior edge of the internal oblique muscle of the abdomen. The inner border of this formation is the edge of the muscle that straightens the spine. The bottom of the rhombus is represented by an aponeurosis ( broad tendon plate) transverse muscle belly.

The muscle layer is followed by the transverse fascia, which, in fact, is part of the general fascia of the abdomen. A little deeper is the retroperitoneal tissue, and behind it is the retroperitoneal fascia, which contains the kidney, adrenal gland, along with the ureter.

The arteries that are located in the lumbar region are branches of the abdominal aorta, as well as the median sacral artery. At the top of the artery of the lumbar region are communicated ( anastomose) with branches of the intercostal arteries, and below - with branches of the iliac arteries. The outflow of venous blood is carried out by veins that belong to the system of the inferior, as well as the superior vena cava. The nerves in the lumbar region are branches of the lumbosacral plexus.

What structures can become inflamed in the lower back?

Lumbalgia ( pain in the lumbar region) can occur against the background of inflammation of any tissue or organ that is located in the retroperitoneal space. Pain in this area can be acute or chronic.

In the lumbar region, the following tissues and organs can become inflamed:

• Leather lumbar region can be affected by pyogenic microbes ( staphylococci and streptococci). These pathogens can infect the hair, sweat and sebaceous glands. With a boil in the pathological process ( purulent-necrotic inflammation) the hair shaft is involved, as well as the tissues surrounding it. With this pathology, the most pronounced pain is observed on the third or fourth day, when the boil core undergoes purulent fusion ( nerve endings are also damaged.). With furunculosis ( ) a high temperature occurs ( up to 39 - 40ºС), chills, severe headaches. Another pathology that can affect the skin of the lower back is carbuncle. Carbuncle is characterized by damage to several hair follicles at once ( hair shaft) that are close to each other. As a result, a general infiltrate is formed ( accumulation of lymph, blood and some cells), which can reach a diameter of up to 6 - 10 centimeters. Unlike a boil, a carbuncle is a more painful formation and proceeds with severe symptoms of general intoxication of the body ( weakness, decreased performance, decreased appetite, headache, dizziness, etc.). Also, the skin of the lumbar region can be affected in ecthyma ( penetration into the skin of streptococci). During this pyoderma ( bacterial infection of the skin) a small vesicle with pus is formed on the skin, which later transforms into an ulcer. It is this sore that is a rather painful formation.
• Adipose tissue may be involved in the inflammatory process in pancreatic necrosis ( death of pancreatic tissue) or with purulent damage to the kidneys, adrenal glands or other structures located in the retroperitoneal space. Retroperitoneal phlegmon ( purulent fusion of fiber) proceeds unspecifically. At the initial stage, body temperature rises to 37 - 38ºС, chills and malaise may occur. Later in the lumbar region there is pain of a pulling or pulsating nature, which gradually becomes diffuse ( pain may radiate to the buttock or abdomen). It is worth noting that pain sensations intensify during movement and force a person to take a forced lying position.
• Vertebral column. Non-infectious inflammation of the spine with lesions of the lumbar and sacral department, as well as paravertebral tissues ( ankylosing spondylitis) also leads to pain. The pain is localized not only along the spinal column, but also in the muscles. In addition to pain in the spine, there is a feeling of stiffness that occurs at rest and gradually decreases during movement. As Bechterew's disease progresses, pain and stiffness appear in the hip joints, and all active movements in the spine are practically blocked due to the fusion of the articular surfaces of the vertebrae. Also, the spine can be affected by tuberculosis, brucellosis ( infection transmitted from sick animals to humans, which affects various internal organs ) or osteomyelitis ( purulent inflammation of the bone tissue).
• Muscles and ligaments lumbar region can also be involved in the inflammatory process. Most often, these tissues become inflamed against the background of traumatic injuries, hypothermia, or during prolonged stay in a forced position.
• Kidneys. Inflammation of the renal pelvis ( ) and intercellular substance of the kidney ( glomerulonephritis) is also characterized by the occurrence of pain in the lumbar region. Pathological changes most affect the renal tubules, through which blood is filtered.
• appendix ( appendix). If the appendix is ​​in an unusual position ( behind the caecum), then when it is inflamed ( appendicitis) there is severe pain in the lumbar region. It should be noted that acute appendicitis is an indication for emergency hospitalization and surgical operation.

Causes of back pain

There is quite a large number of causes that can cause pain in the lumbar region. Athletes are most often diagnosed with sprained muscles and ligaments, while older people are diagnosed with lumbar osteochondrosis, which leads to the appearance of intervertebral hernia, which can compress the spinal roots of the spinal cord.

Causes of back pain

Name of the disease	Mechanism of back pain	Other symptoms of the disease
Furuncle (purulent-necrotic inflammation of the hair shaft)	Pain occurs due to irritation or destruction of pain receptors located around the hair shaft ( follicle). The most intense pain occurs on the third or fourth day, when purulent fusion of the central part of the boil occurs ( furuncle rod).	As a rule, body temperature rises to 37.5 - 38ºС. After the purulent-necrotic mass has undergone rejection or removal, the pain subsides. The skin at the site of the boil is scarred for several days.
Furunculosis (the appearance of boils on the skin at various stages of development)	The same as with a furuncle.	At the site of the appearance of boils, the skin can hurt, itch and tingle. With furunculosis, there is a general malaise of the body with symptoms of intoxication ( headache, dizziness, weakness, loss of appetite, nausea, vomiting). Body temperature can rise up to 39 - 40ºС. Sometimes there may be loss of consciousness.
Carbuncle (inflammation of several hair shafts located nearby)	The same as with a boil.	When several affected hair follicles merge, a rather large infiltrate is formed ( up to 8 - 10 cm). This infiltrate is extremely painful and tense. This disease causes fever up to 40ºС), chills, nausea and/or vomiting, headache.
Ectima (Streptococcus skin infection)	Pain occurs due to a deep and painful ulcer that appears at the site of a small superficial abscess ( conflict). Within a few days, the ulcer scars, and the pain gradually decreases.	In the first days after the onset of the disease, a small bubble forms on the skin, which contains pus or purulent-hemorrhagic contents ( pus with blood). After a couple of weeks, the conflict dries up, after which a crust forms on top of it. After the crust is torn off, an extremely painful ulcer is visible on the surface of the skin.
Bechterew's disease (ankylosing spondylitis)	Pain occurs due to inflammation in the intervertebral joints. The fact is that during inflammation a large amount of biologically active substances is released ( bradykinin), which cause and exacerbate pain. It is worth noting that the pain, as a rule, worries at night or in the morning. In addition, the load on the muscles of the spine gradually increases. As a result, pathological tension and pain arise in them.	As the pathology progresses, pain and stiffness, which are localized in the lower back and sacrum, can spread to the entire spinal column, as well as to the hip joints. Sometimes the pathological process may involve the knee, ankle and elbow joints (peripheral form of the disease). Ankylosing spondylitis also has extra-articular manifestations. These include pathologies such as iridocyclitis ( inflammation of the iris of the eye), aortitis ( inflammation of the aortic wall), heart valve insufficiency ( most often aortic valve), pericarditis ( inflammation of the outer connective tissue of the heart).
Retroperitoneal phlegmon (diffuse suppurative process, localized in the retroperitoneal tissue)	The accumulation of pus in the retroperitoneal space compresses the blood vessels and nerve tissues, which causes a feeling of pain of varying intensity. Also, in this pathological condition, there is a release of biologically active substances that increase pain ( bradykinin). The pain is usually throbbing and pulling.	At the initial stage, general malaise, fever ( 37 - 38ºС) and chills. In the future, the pain intensifies, especially while walking. It should be noted that the pain can spread to the sacral or gluteal region, as well as to the abdomen.
Myositis (muscle tissue inflammation)	The inflamed muscles of the lower back can significantly compress the blood vessels in which the nerve receptors are located, as well as the nerves located in the superficial and deep layers. Compression of the nerve tissue and leads to pain.	Myalgia, or muscle pain, is somewhat aggravated by pressure on the inflamed muscle, during movement, at rest, or when the weather changes. In some cases, over the area of ​​\u200b\u200bdamage to the muscles of the lower back, tissue thickening is determined, as well as redness of the skin. Chronic myositis leads to loss of muscle functionality ( atrophy). Sometimes new muscles can be involved in the inflammatory process.
Osteochondrosis of the lumbar ()	The decrease in the elasticity of the cartilaginous tissue of the intervertebral discs gradually leads to a decrease in the space between adjacent vertebrae. In the future, a hernia is formed, which, moving, can compress the nerve roots and ganglia ( collection of nerve cells) of the spinal cord. Pain may be constant or may come and go. Pain can be localized not only in the lumbar region, but also in the buttock or leg ( with compression of the sciatic nerve).	The pain intensifies against the background of physical activity or psycho-emotional overstrain. In some cases, there may be increased sweating ( hyperhidrosis). Muscles that are innervated by the affected nerve lose their functionality, become weak and lethargic, which ultimately leads to their atrophy. In the buttocks and lower extremities may occur discomfort (tingling, numbness, burning).
Scoliosis of the lumbar (rachiocampsis)	Scoliotic curvature of the lumbar vertebrae can lead to pinching of the spinal roots, which causes pain of varying intensity. It is also worth noting that scoliosis leads to the early development of osteochondrosis.	In addition to a violation of posture, the normal position of the pelvic bones, as well as the organs of the small pelvis, may be disturbed ( bladder, uterus with appendages, rectum).
Scheuermann-Mau disease (kyphosis adolescents)	Due to the fact that some vertebrae undergo deformation, and intervertebral discs - pathological restructuring of the type of fibrosis ( cartilage is replaced by connective tissue), there is a curvature of the spinal column in the upper back ( thoracic kyphosis). The muscles of the lower back are not able to cope with a constant load, which leads to their pathological tension and pain.	Increased fatigue, as well as the occurrence of pain in the lower back during moderate physical activity or prolonged sitting. Severe pain indicates the involvement of the lumbar vertebrae in the pathological process.
Brucellosis of the spine (damage to the spinal column by the causative agent of brucellosis)	Damage to one or more vertebrae leads to sclerotic changes and the formation of lateral osteophytes ( pathological growths that form from the body of the spine), which can compress nerve tissue.	Fever comes on 37 - 38ºС), chills, general malaise, excessive sweating, pain in the joints of the lower extremities. Often brucellosis of the spine leads to osteomyelitis ( suppurative lesions of the vertebrae).
Tuberculosis of the spine	The destruction of the vertebral bodies leads to compression of the nerve roots ( radiculopathy). In addition, nerve structures can be compressed by a local accumulation of pus ( abscess).	Body temperature can rise to 37 - 38ºС. There is a general weakness, pain in the muscles of the back, which are pulling and aching in nature. As the disease progresses, the pain syndrome increases. In some cases, the pain becomes unbearable. Stiffness appears in the spine, posture is disturbed, as well as gait. Due to the constant pathological tension of the back muscles, their partial, and later complete atrophy occurs ( loss of functionality).
Spinal osteomyelitis (purulent lesions of the vertebrae and surrounding tissues)	The accumulation of pus can compress the nerve tissue of the spinal cord, spinal roots, muscle tissue, blood vessels. The pain is constant and quite severe. In some cases, fistulas are formed ( pathological channels), through which pus can penetrate into more superficial tissues and compress the nerve receptors located in the muscles, subcutaneous fat or skin.	The temperature can rise to 39 - 40ºС. Detect an increase in the number of heartbeats ( tachycardia), as well as a decrease in blood pressure ( hypotension). Often there is a violation of consciousness and convulsions. Pain increases somewhat at night.
Acute appendicitis (inflammation of the appendix)	Lower back pain with appendicitis can occur when the appendix ( appendix) is located behind the caecum ( retrocaecal) both intraperitoneally and retroperitoneally. Pain occurs due to numbness ( necrosis) appendix tissues, as well as due to squeezing of the blood vessels in which the pain endings are located.	Body temperature rises to 37 - 38.5ºС. There is nausea and 1 - 2 multiple vomiting. Appetite is completely absent. In some cases, diarrhea may occur, an increase in heart rate. The pain can spread to the spine, to the right hypochondrium or to the iliac region.
Intestinal obstruction	Pain occurs when the intestines squeeze the mesentery, in which the nerve trunks are located, as well as blood vessels. Depending on the type of intestinal obstruction ( dynamic, mechanical or mixed) pain can be constant and bursting or cramping and severe.	The main symptom is abdominal pain, which may radiate to the lumbar region. With the progression of the disease, the pain subsides due to complete intestinal atony and inhibition of peristalsis and motility. There is also nausea and repeated and indomitable vomiting. The abdomen becomes swollen, its asymmetry is revealed. In addition, there is a delay in stool and gases.
Renal colic	Pain occurs due to a violation of the renal blood supply, which occurs due to increased pressure in the pelvis ( funnel-shaped cavity that connects the kidney and ureter). In turn, the pressure in the pelvis increases due to their overflow with urine. The pain comes on suddenly and is paroxysmal. It should be noted that an attack of pain can last from a few seconds or minutes to several tens of hours.	Pain can spread irradiate) in the lumbar inguinal or suprapubic region, in the lower limbs. The attack of pain leads to an increase in the frequency of urination. After the cessation of the attack of pain in the lumbar region, dull and aching pain persists. Nausea and vomiting often occur. The amount of urine excreted completely or almost completely stops ( anuria, oliguria) with occlusion of the ureter by a stone.
Pyelonephritis (nonspecific inflammation of the pelvis and renal tissue)	Inflammation of the connective tissue of the kidney and glomerular apparatus ( morphofunctional unit of the kidney) leads to stagnation of urine and overstretching of the pelvis, which causes pain. If pyelonephritis has arisen due to blockage of the ureter or pelvis with a stone, then severe and paroxysmal pain occurs. In the case of non-obstructive pyelonephritis ( occurs against the background of a descending or ascending infection), then the pain is dull and aching.	Body temperature can rise to 38 - 40ºС. Chills, general malaise, nausea and / or vomiting occur. There is also a decrease in appetite. If pyelonephritis develops against the background of inflammation of the bladder ( cystitis) or urethra ( urethritis), then urination disorders are possible ( dysuric phenomena).

Also, lower back pain can occur for the following reasons:

• Stretching of the muscles and ligaments of the lumbar most often occurs in athletes with excessive physical activity or by using the wrong technique. In addition to pain, which is the result of a strong spasm of muscle tissue, there is a feeling of stiffness in the spine and tissue swelling. Soft tissue injury may result in hematoma local accumulation of blood), which can increase pain due to compression of the surrounding tissues in which the nerve receptors are located.
• Fractures of the spine in the lumbar region. Most often, we are talking about a compression fracture of the spine, which occurs when the spine is excessively flexed or fractures of the transverse and spinous processes. A compression fracture is indicated by constant pain in a standing or sitting position, which almost completely disappears if a person lies down. In addition to pain, there may be loss of sensation and weakness in the perineum and lower extremities.
• Tumors of the spine as benign ( osteoblastoma, osteoid osteoma, hemangioma, etc.), and malignant ( myeloma, osteosarcoma, penetration of metastases into the spine) lead to pain, which can have different intensity. Pain quite often radiates to the lower extremities, and sometimes to the upper ones. A characteristic feature of such pain is the lack of a therapeutic effect from the use of painkillers. There is also weakness and numbness in the lower extremities ( in some cases - paralysis), violation of the act of urination and defecation, violation of posture.

Diagnosing the causes of back pain

Depending on the cause of back pain, you may need to consult doctors such as a general practitioner, nephrologist, surgeon, dermatologist, orthopedist, traumatologist, neurologist or infectious disease specialist.

For the diagnosis of these types of pyoderma ( skin lesions caused by the penetration of pyogenic bacteria) as a furuncle, carbuncle or ecthyma, a consultation with a surgeon or dermatologist is necessary. An accurate diagnosis is made based on the clinical picture of the pathology, as well as on the basis of a visual examination of the affected area of ​​the skin. To determine the type of pathogen ( staphylococcus and/or streptococcus) resort to bacterial culture, and also do an antibiogram ( determine the sensitivity of the pathogen to various antibiotics).

Myositis is diagnosed by a neurologist. Characteristic complaints, the clinical picture of the disease, as well as electromyography data are taken into account ( method of recording electrical potentials emanating from muscles). Sometimes ultrasonography is used ultrasound) to study muscle tissue to assess their structure and degree of damage. In a general blood test, an increase in erythrocyte sedimentation rate, an increase in the number of white blood cells, an increase in C-reactive protein ( one of the proteins of the acute phase of inflammation).

ankylosing spondylitis ( ankylosing spondylitis) is diagnosed by a rheumatologist. In order to confirm the diagnosis, specific symptoms are taken into account, such as pain and stiffness in the spine, which are worse at rest, as well as pain in the chest. It is also necessary to conduct magnetic resonance imaging of the spine or x-rays. It should be noted that magnetic resonance imaging is a more sensitive method and can detect pathological changes at the very beginning of the disease. In addition, a general blood test is mandatory, in which an increase in ESR is most often found ( erythrocyte sedimentation rate).

Diagnosis of retroperitoneal phlegmon should be carried out by a therapist or surgeon. Sluggish phlegmon is extremely difficult to diagnose, since the symptoms are extremely inexpressive ( especially when already prescribed treatment for another disease). Acute phlegmons are diagnosed by palpation of a painful volumetric formation ( infiltrate). In the general blood test, an increase in the number of white blood cells characteristic of the inflammatory process is noted ( leukocytes), shift of the leukocyte formula to the left ( increase in the number of young forms of neutrophils) and increased erythrocyte sedimentation rate.

Scheuermann-Mau disease should be diagnosed in adolescence by an orthopedic doctor. One of the leading clinical manifestations of the disease is an increase in the severity of thoracic kyphosis ( physiological curvature thoracic spine), which is not eliminated even with maximum extension of the spine. With the progression of the disease, a wedge-shaped deformity of the bodies of the spine of the thoracic and lumbar spine is revealed on x-rays. With magnetic resonance imaging and indirectly on x-rays, dystrophic changes in the intervertebral discs can be detected. It should be noted that at the initial stages of this disease, the clinical picture is extremely non-specific and diagnosing Scheuermann-Mau disease is very problematic.

The diagnosis of brucellosis of the spine should be made by an infectious disease specialist. Important data for confirming such a diagnosis is the confirmation of the presence of contact with animals ( cattle, small cattle or pigs) or eating undercooked animal products. The clinical picture of the disease is also taken into account. Confirmation of the diagnosis is carried out by setting specific laboratory tests that detect the pathogen in the blood ( polymerase chain reaction, blood culture, Wright test).

In order to detect tuberculous lesions of the spine, an x-ray or computed tomography is performed ( the picture is taken in two projections). The images show foci of vertebral destruction, sequesters ( areas of completely destroyed bone tissue), and also, in some cases, shadows that speak of local accumulations of pus. In order to confirm the diagnosis, it is necessary to do a bacterial culture of the affected bone tissue or the contents of the abscess. In the blood test, signs of an inflammatory process are found - an increase in the erythrocyte sedimentation rate, an increased concentration of C-reactive protein, an increase in the number of white blood cells. They also put a tuberculin test, which in most cases will be positive. The diagnosis is confirmed by an orthopedist.

A neurologist can confirm the diagnosis of osteochondrosis of the lumbar. The diagnosis is made on the basis of typical clinical signs of the disease ( pain along the affected nerve, unilateral muscle atrophy, as well as a violation of the sensitivity of the compressed nerve). Confirmation of the diagnosis is carried out using radiography or magnetic resonance imaging ( "gold standard of diagnostics") of the lumbar region. On the pictures you can see dystrophic changes in the intervertebral discs, as well as the place and degree of compression of the spinal root.

Scoliosis should be diagnosed by an orthopedist. Most often, this pathology is detected in childhood. To determine the degree or severity of scoliosis curvature, a scoliometer is used or the angles of curvature are detected on an x-ray of the spine. It is the X-ray method that makes it possible to detect scoliosis at the earliest stages of the disease.

Diagnosis of osteomyelitis of the spine is carried out by an orthopedist, therapist or surgeon. The diagnosis takes into account the clinical picture of the disease, as well as radiography or tomography. It should be noted that the "gold standard" is tomography ( computer or magnetic resonance), which allows you to identify the volume and degree of damage to the bone tissue of the spine. In the presence of fistulas, fistulography is performed ( filling the fistula channel with a contrast agent followed by radiography).

Acute appendicitis is diagnosed by a surgeon, internist or emergency physician. With an atypical position of the appendix ( if it is located behind the caecum, and not below it) the clinical picture is somewhat different from the classical one. To confirm retrocecal appendicitis, a finger is pressed on the right Petit triangle, and then it is sharply removed, as a result of which the pain increases sharply ( Gabai's symptom). Pain is also characteristic when pressing with a finger on the right Petit triangle ( Yaure-Rozanov symptom).

Diagnosis of intestinal obstruction is carried out by a surgeon. The diagnosis is confirmed by identifying various characteristic symptoms of intestinal obstruction ( listening to the "splash noise" over the intestinal loops, etc.). X-rays reveal horizontal liquid levels, and gas bubbles above them ( Kloiber's symptom) and transverse striation of the intestine ( symptom of kerkring's folds). Ultrasound examination reveals an enlarged area of ​​the intestine, thickening of the intestinal wall with mechanical intestinal obstruction ( intestinal blockage at any level) or excessive accumulation of gases and fluids - with dynamic intestinal obstruction ( intestinal motility disorder).

In women, back pain can occur in the following situations:

• Adnexitis ( salpingoophoritis) is a pathology in which inflammation of the uterine appendages occurs ( ovaries and fallopian tubes). In acute adnexitis, there is severe pain in the lower back and lower abdomen. In addition, body temperature rises 38 - 38.5ºС), chills appear, sweating increases. Quite often there are muscle pains, as well as headaches. The chronic course of adnexitis is manifested by dull and nocturnal pain in the lower abdomen, in the groin, and sometimes in the vagina. The pain also radiates distributed by) in the lower back and pelvis.
• Pregnancy. During pregnancy, the load on the spine is redistributed. As a result, the load on the lumbar spine and the musculoskeletal apparatus increases several times, which leads to pain of varying intensity. It is necessary to mention the fact that most often back pain during pregnancy occurs in pregnant women with weak muscles back and abs, as well as those women who have excess weight or is obese.
• Premenstrual syndrome in quite rare cases, it causes pain in the lumbar region. Some scientists explain this phenomenon by the fact that when the hormonal background changes, there is an increase muscle tone, leading to overstrain of the muscles of the back and in particular the muscles of the lower back.

What are the causes of pulling back pain?

Drawing pains in the lower back most often indicate muscle spasm. Persistent muscle tension spasm) can occur due to severe physical overstrain, with prolonged stay in an uncomfortable position, or with certain diseases.

There are the following causes of pulling pain in the lower back:

• Stretching of ligaments and muscles is one of the most common causes of pulling pain in the lower back, especially among athletes and people leading an active lifestyle. Depending on the degree of damage, the pain can be both acute and pulling. There is also swelling of the tissues and stiffness of movements. In some cases, muscle injury may result in hematoma ( local accumulation of blood), which can compress surrounding tissues and increase pain.
• Prolonged stay in an uncomfortable position quite often leads to back pain. Most often, pain occurs due to long sitting position, since it is in the sitting position that the spinal column and muscles experience the maximum load. Sometimes the pain occurs in the morning after waking up. This suggests that the person slept in an uncomfortable bed and/or in an uncomfortable position, which led to a spasm of the muscles of the lower back.
• Inflammation of the back muscles occurs when tense muscles are bruised or when they are hypothermic. The pain is usually aching, pulling and aggravated by movement. If time does not treat myositis ( muscle inflammation), then there is a partial or complete loss of functionality of muscle tissue.

Why does the lower back hurt during pregnancy?

During pregnancy, the center of gravity of the body shifts somewhat, which leads to an increase in the load on the spinal column. Lumbar at the same time, it bends, and the muscles and ligaments of the lower back are in constant tension. Gradually, this tension leads to pain. Lower back pain may appear on different terms pregnancy. Most often, pain occurs in the fifth month of pregnancy, and the most intense pain occurs at the end of pregnancy ( 8 – 9 month). The fact is that it is at the end of pregnancy that the child begins to put pressure on the lower back, thereby increasing the pain.

Pain may also radiate to the buttock, thigh, lower leg, and foot ( seen with compression of the sciatic nerve). The nature of the pain can be different, but most often they are described as shooting, burning or stabbing. Often there is a burning sensation and tingling in the leg.

It should be noted that most often back pain occurs in pregnant women with overweight or obesity, as well as those women who have poorly developed back muscles and abs. Also at risk are women who were diagnosed with osteochondrosis of the spine before pregnancy ( dystrophic changes in the intervertebral discs) or scoliosis ( rachiocampsis). In this case, back pain may continue to bother after childbirth.

Why does the lower back hurt on the left?

Lower back pain on the left can occur against the background of various pathologies of the spine, with damage to the musculoskeletal apparatus, as well as with certain diseases of the abdominal cavity and retroperitoneal space.

Below are the most common causes of left-sided low back pain:

• Ulcer of the stomach and duodenum usually manifested by pain in the upper abdomen, which can radiate to the thoracic and lumbar segment of the spine, as well as in left side loins. Characterized by the appearance of "hungry" pain ( docked after meals) and night pains. Also, with peptic ulcer, heartburn, nausea, and sometimes vomiting occur.
• Left side renal colic most often occurs due to occlusion ( blockage) ureter stone. In this case, there is a sharp and severe pain that radiates to the groin, to the left side, and sometimes to the thigh. After an attack, the pain subsides somewhat and becomes pulling.
• Osteochondrosis is a pathology in which the cartilaginous tissue of the intervertebral discs is affected. As a result, the peripheral part of the intervertebral disc is destroyed, and the central part, protruding, compresses the nerve roots of the spinal cord. If there is a pinching of the left spinal root, then this leads to weakness of the muscles located to the left of the spinal column. Also, pain can be reflected in the buttock and lower limb (sciatica).
• Stretching the muscles and ligaments of the lower back on the left quite often occurs when performing heavy physical work combined with the tilt of the body. This type of damage often occurs in untrained people or in athletes with excessive exercise. When the musculoskeletal apparatus is stretched, pain of varying intensity occurs. It is also characterized by the appearance of tissue edema and restriction of movement in the spine.

Why does it hurt and pull the lower back after a massage?

A slight pain in the muscles may appear after the first massage sessions. This is due to the fact that in untrained people, lactic acid is produced in the muscles during massage. It is lactic acid that causes pain in the muscles. During subsequent sessions, the pain gradually subsides completely. However, in some cases, pain may indicate an incorrect massage technique, massage during an exacerbation of pain associated with a disease of the spinal column, or the presence of contraindications to massage.

If the pain in the lower back persists for three or more days, and if the pain is localized in the spine, then this is a reason to stop the massage, as it can only aggravate the pain. You should also immediately consult a doctor to identify the cause of these pains. It is worth noting that back massage has some contraindications.

Among the contraindications to massage, it is worth noting the following:

• tumors;
• diseases of the hematopoietic system;
• allergic diseases with skin rash;
• high body temperature;
• atherosclerosis of cerebral vessels ( blockage of blood vessels by atherosclerotic plaques);
• hypertensive and hypotensive crises ( marked increase or decrease in blood pressure);
• some mental illnesses;
• purulent-inflammatory diseases;
• myocardial ischemia ( decreased arterial blood flow to the heart muscle).

The iliopsoas muscle belongs to the pelvic muscles. It is attached to the lesser trochanter of the femur. Its purpose is to bend the torso and fasten other thigh muscles in the lumbar region. In a relaxed state, the iliopsoas muscle allows you to pull your knees to your chest. It turns out that she is actively involved in the process of running, walking, as well as in the coordination of the human body.

The syndrome of the iliopsoas muscle is a disease of a muscular-tonic nature. The main reason is an injury to the muscle itself, or to the area of ​​the body where it is located. Most often, and this is about 40% of all diagnoses, this syndrome is observed in people who have certain diseases of the joints.

Other factors of damage include hematomas in the retroperitoneal space. They can occur on their own, for example, with blood diseases, or as a result of trauma to the abdomen. In rare cases, tumors, both initial and those that have appeared from metastases, become the cause.

But the main danger of this disease is that the affected muscle begins to affect the work, which is located in close proximity. This leads to the development of femoral neuralgia syndrome, and if there is a violation of the sensory or motor function of this nerve, there is a high risk that the leg will completely stop bending or unbending.

Clinical picture

The syndrome of the iliopsoas muscle, the symptoms of which are quite pronounced, is based on a spasm, that is, involuntary muscle contraction, accompanied not only by pain, but also by a violation of the work of the muscle itself.

The main symptoms of the disease can be considered weakness of the leg on the affected side of the body during flexion or extension, which is especially pronounced in the hip joint. It becomes very difficult for a person to take a sitting position from a lying position. Sometimes you can't do it on your own.

The knee joint also suffers, so walking, running, active sports sometimes become impossible. For movement, you have to use a wheelchair, crutches, or the help of another person.

In addition to muscle spasm, and this can be called a kind of reaction to pain, damage to the femoral nerve occurs, which is very dangerous if left untreated and if the muscles remain spasmodic for a long time.

Pain can be located in various parts of the body. It can be the lower back, and in the supine position, the pain almost completely disappears. Pain may also be felt in the intestines or along the front of the thigh.

How to get rid of spasm

Spasm can be removed in several ways. For this you can:

1. Take advantage of acupuncture.
2. Make a self-massage of the thigh and lower back.
3. Go to the bath - warm water and warm air help well.
4. Make a compress.
5. Take medications prescribed by your doctor.
6. Use the muscle stretching system.

Lusoiliac muscle syndrome can also be treated with the help of specially designed exercises that can be performed only as prescribed by a doctor.

Stretching exercises not only relieve spasm, but also alleviate general state patient. It also relaxes, restores tone, impaired blood circulation, and has a positive effect on the physical and psychological state of the patient.

Execution rules

Treatment of iliopsoas syndrome with the help of exercises must be performed according to certain rules.

1. Do not apply excessive force when doing exercises.
2. Follow the rules of breathing.
3. Do not overwork, and if pain occurs, stop the exercise.

The first exercise is performed lying on your back. Bend the leg at the hip, take it to the side, hang the lower leg freely down. A healthy limb is also bent in the thigh area. Press your back tightly in bed and fix this position for 20 seconds.

The second exercise is performed in the supine position. Leaning on your hands, you need to bend the torso in the upper part, throwing your head back as much as possible and stretching your neck. Fix the position for 20 - 30 breaths, then slowly lower the head, relax the torso, and lower to the starting position.

The third exercise is also performed on the floor on the back. The back should be pressed firmly to the floor, after which the legs should be slightly raised from the floor, which must first be bent at the knees. Repeat these movements 8-10 times.

Before starting such treatment, it is necessary to consult with a specialist. If the above exercises have not been beneficial, then you can use medication, which should also be prescribed only by a neuropathologist.