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For how long should I stay at rest?


The prolonged bed rest was once considered the treatment of choice for back pain.
This approach was based on the consideration that some people enjoy at least a temporary relief position relaxed, but also on the physiological data for the pressure borne by the intervertebral discs is lower when taking the supine position.

Unfortunately today we find many family doctors who advise people with back pain to spend a week of strict bed rest.
The fear that the work could aggravate the situation and delay the recovery is completely unfounded.

fact, some recent studies and systematic reviews published on the National Plan Guidelines confirm that patients with acute back pain who continue as normally as possible to carry out their normal activities recover better those that bed rest is two to four days.
From these studies so that other people who remain active, despite the acute pain after suffering much less from chronic pain (pain that are considered to last for at least three months or more) and use health services much less those patients who were set aside pending the pain had diminished.

However, the fact that bed rest is ineffective does not mean that people can immediately return to the workplace. Some people with physically demanding activities may in fact not be able to resume work so quickly as those who carry out work activities lighter.
But for people with back pain is often useful to return to work at least in reduced form until they experience a full recovery.

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is always useful to do an x-ray?

Since the causes that produce back pain, as we have seen, are numerous, as are many factors that predispose to this disease, we can then be fully in agreement with recent studies which claim that the majority of low back pain does not require tests of any kind (even if there is a root involvement) because of their success does not necessarily follow a different therapeutic strategy.

effects even if the hernia, as we know, can cause back pain, sciatica and functional impotence, degeneration of the disc can also occur without symptoms. Indeed, in several clinical trials
disc herniations are found with high frequency even in asymptomatic people, in other words people who had never had pain or functional impairment.
In the study by Boos (found in Bibliography) 76% of asymptomatic controls was a carrier of a herniated lumbar disc.

Therefore, diagnosis with imaging tests (X-rays, CAT scan or MRI) herniated disc or a disc protrusion or narrowing of the spinal canal final test only one thing: that the patient has a herniated disc or a bulging or canal stenosis, but not necessarily his back pain depends on one of these diseases.

also determined dall'ernia symptoms may resolve spontaneously or with conservative treatment that there is no need to resort to surgery: a number of imaging studies have shown that the herniated lumbar disc in a high proportion of cases , regress completely or largely, after a rehabilitation treatment (osteopathy and / or postural exercises).

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disease or symptom?

Some who suffer trauma (accidental falls, car accidents, whiplash) can refer, in some cases, the vertebral structures to strains and tensions that sometimes occur many years after their consequences marking the body with scars not visible (because internal) with the Over the years affecting the balance of the structures (muscles, ligaments, fascia, discs) in a dynamic manner in order to maintain the standing position.

Other times it is surgery, pregnancy , or minor injury due to sports or exercise at the gym charged incorrectly to produce scars inside our spine.

Finally, we can not forget the emotional stress and many European and Japanese studies have shown a strong correlation between stressful events (which clearly increase the tone and contraction of a part of the spine and the muscles of mastication) and episodes of low-back pain. Some researchers
when stress or a severe illness passes the memory remains that lurks in the muscles and fascia, then just a hint, not necessarily as serious, and the involuntary contraction mind back and with it the pain that we thought finally resolved.

Back pain, according to data provided in 2000 by ' Agency European Agency for Safety and Health at Work , is caused by diseases of the spine only in 20% of cases, as is too often linked to improper habits, bad posture, stress and sedentary lifestyle.

Back pain (low-back pain ) is therefore a symptom, not a disease, and in most cases the problems, though mechanical, is caused by a loss of function of the column spine in its most sensitive component (muscles, ligaments, fascia and disc).

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Low-back pain?

About 15 million Italians suffering from back pain in a more or less serious and, statistically, this is the leading cause of absenteeism from work and the second permanent disability.
According to the World Health Organization, 85% of the population is suffering or has suffered at least once in their lifetime. Who is affected

unfortunately many times faces a diagnostic and therapeutic extremely diverse, in a sort of "ping-pong" ranging from specialized orthopedic doctor or the physiotherapist, and in the most persistent by the neurosurgeon.
This is because this wonderful structure (and complicated) that it is the backs of human beings has not yet adapted the upright position.

The problem then is caused by the "standing", the mainspring of human evolution, the ability to stand and walk.

Since, during the evolutionary process, we lost the position on all fours ", the column had to undergo a series of adjustments that had not been initially designed: this has led to a series of structural problems for our backbone (spine), aggravated by heavy manual work (health, construction, agriculture) or the long stay in a sitting position.
In most cases back pain in fact depends on an incorrect use spine protracted. This applies both to those who engaged in walking and lifting weights, but also for those who must spend long hours in a sitting position to carry out their work. (Use of computer, car or Motor Freight).

Back pain, commonly called Anglo-Saxon low-back pain, in terms of suffering and the economic and social costs induced (sick leave, health care, changes , disability) is one of the major health problems in the workplace.

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L 'herniated disc pathophysiology

When we lift a weight from the floor, leaning forward (with a drop of the spine), we make a significant commitment of the posterior spinal muscles that are equal and clearly overcome the resistance represented by the weight of the body bent forward and weight lifted.

It thus produces a very high muscle tension, which in turn becomes a compressive force on the disk-vertebra complex. The structure of the column that has proven to be more sensitive to these compressive forces is the intervertebral disc.

These compressive forces may lead to a healthier disc cracking in the fibers of the fibrous annulus, which migrates into the part of the gelatinous substance that make up the nucleus pulposus. ( Bulgin disc protrusion or disc )

The drawing is clearly seen as the column bends forward to allow the lifting of weight from the floor. (Figure A ).

Figure B is graphically represented the moment of maximum compression on the intervertebral disc that occurs when we are lifting the weight.

C While the figure is clearly seen as the high compression, which occurs when the weight is lifted completely, produce a migration of the nucleus pulposus into the spinal canal, giving rise to ' disc herniation .

The herniated disc can compress the nerve to go out of the bone marrow giving rise to a very specific set of symptoms: the sciatic

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disk

If we remain in long positions which carry a static load (eg standing or sitting) caused, after several hours, a shutdown of parts for distribution in the disc with a consequent suffering, which, if repeated frequently, is the first step to disc degeneration.
So the disc is dehydrated, it loses elasticity, is reduced in thickness, becomes more fragile and tends to support loads with less effectiveness.
subject to periodic mechanical stress such repeated, the disc loses its strength and elasticity and undergoes partial tears in serious accidents.

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The intervertebral disc

The intervertebral disc in direct contact of the vertebral bodies is composed of two distinct parts:

1. A central part of the nucleus pulposus consists of a gelatinous substance established for over 88% water

2. Some outer ring, the ' fibrous ring, characterized by fibro-cartilaginous structures arranged in ten concentric layers around the core. The front directed toward the abdomen is usually thicker and stronger than the corresponding back.

The intervertebral disc is a non-vascularized and its nourishment is the case for metabolic exchanges through a mechanism of osmotic pump from the beds around capillaries. This mechanism is triggered by movements alternating compression and decompression.
addition, the intervertebral disc through its fibrous structure located concentrically to a gelatinous core, is able to withstand considerable workload, deform and recover its height after removal of the mechanical stress.
If, however, because of degenerative disc changes its ability to perform these tasks will have a negative impact the dynamics of the upright with consequent structural damage

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The spine


The colony is a complex structure with spinal support functions, movement and protection of neural structures contained in the spinal canal.

It is characterized by overlap in a series of bony segments (vertebrae), in such a way as to build a sturdy column can withstand loads
The vertebrae are 33, divided into
cervical (seven vertebrae),
dorsal (twelve vertebrae),
lumbar (five vertebrae),
sacral (five vertebrae) and coccygeal (four vertebrae)

The spine, seen in profile, shows a typical bending Double S to allow better and more effective absorption and distribution of loads due to gravity.

More precisely in the structure of the spine can identify functionally

a. an anterior column support, a mainly static function, represented by smooth overlap of the vertebral bodies, intervertebral disc (anulus and nucleus) and LLP (posterior longitudinal ligament) and

b. a posterior column, and joint motion, determined from the arch back from the transverse processes and thorny and the subsequent interconnection of vertebral articular processes, with their capsule-ligament structures (in the drawing is represented in green il legamento anterior longitudinal or ALL).