Every second person has a curved spine: experts at PNIPU explain the reasons behind back pain.

“Among the primary causes of back pain are degenerative spine diseases: osteochondrosis, spondyloarthrosis, spondylosis, and intervertebral disc hernias. Muscle spasms in the back can occur due to a sedentary lifestyle, injuries, inflammation from hypothermia, or infections,” explains Vladislav Nikitin, PhD in physics and mathematics, associate professor at the Department of Computational Mathematics, Mechanics, and Biomechanics at PNIPU.

Spinal curvature (scoliosis, kyphosis) leads to impaired blood supply, muscle strain, and the friction of vertebrae due to their incorrect positioning can cause acute pain syndrome. Endocrine diseases, such as osteoporosis, disrupt metabolism, resulting in reduced bone density. Respiratory organ diseases like pleuritis can cause sharp pain that radiates to the back when coughing.

Kidney diseases such as glomerulonephritis, pyelonephritis, and urolithiasis can also lead to back pain. For instance, if a stone completely blocks the ureter's lumen, urine begins to accumulate in the kidney, causing renal colic. This condition is characterized by sharp, spasmodic pain in the lower back.

Spinal curvature affects every second person

Usually, these are minor manifestations of scoliosis that do not interfere with daily life or sports activities. Spinal curvature often occurs during the rapid growth phases of a child (i.e., in elementary and middle school), when muscle tissue cannot keep up with the growth of the skeleton. It begins to compress the spine like a spring, causing it to shift position. The pathology is associated with an imbalance in muscle strength on the left and right sides, as well as body asymmetry.

“It is crucial not to overlook the signs of scoliosis, which is why monitoring the shape of the spine and the tone of the back muscles by visiting an orthopedic doctor is necessary. It should be noted that one visit per year during these periods may not be sufficient. It is better to see a doctor 2-3 times a year when you notice that your child is growing rapidly,” advises Vladislav Nikitin.

If scoliosis is left untreated, it can escalate into a serious issue that manifests not only as an aesthetic reduction in height but also leads to improper gait, compression of internal organs, decreased thoracic volume, the emergence of hernias, and pain in the spine and back muscles, as well as changes in the shape of the vertebrae.

“As scoliosis progresses, the methods of treatment become more complex. At the first signs, therapeutic physical culture—a set of exercises—can help, but in advanced stages, when there are visible signs of spinal curvature, surgical intervention is often unavoidable,” adds Vladislav Nikitin.

How to diagnose scoliosis?

The standard method for diagnosing spinal curvature is X-ray examination. Specifically, the doctor will identify deviations from the X-ray image, where hard tissues, especially bones, are well-visualized. A modern, harmless method is computer optical tomography, which analyzes the three-dimensional surface of the back.

“We have developed the ScolView application based on artificial intelligence. You just need to take a photo of the back and upload it to the website for processing. Our program allows for the identification of changes in the shape of the spine, similar to computer optical tomography, but based on indirect signs, and it is quite accurate. However, the most reliable method, trusted by all doctors, is still X-ray, which allows for the visualization of the positions of the vertebrae,” explains Vladislav Nikitin.

How does a subluxation differ from scoliosis?

According to the biomechanist from PNIPU, the spine is not a solid rod, and the shifting of its vertebrae allows for various movements. Accordingly, under normal conditions, the vertebrae shift relative to each other. Problems arise when the disc between these vertebrae changes its position relative to them. Due to incorrect positioning, a subluxation can develop, which may turn into an intervertebral disc hernia. Other possible consequences include microtraumas to ligaments, their stretching, and compression of the spinal cord. Scoliosis, on the other hand, refers to the shape of the entire spine, which is determined by the relative positions of the vertebrae.

What happens when we crack our back?

“Cracking of the vertebrae is generally associated with the release of gases from the joint fluid or changes in pressure within the joints. Self-induced ‘cracking’ can provide temporary relief, but its safety depends on the method and situation. Although there are no strict medical recommendations for self-cracking, most doctors advise against it,” explains Andrey Dolgikh, director of the Center for Youth Initiatives at PNIPU, and a member of the Council of Young Scientists and Specialists under the Ministry of Education and Science of the Perm Territory.

The cracking in a joint (including the spine) is safe only when its frequency does not increase, as noted by Vladislav Nikitin. Uncontrolled and frequent (reckless) cracking of the vertebrae, accompanied by sharp movements, can lead to the displacement of discs between the vertebrae and result in spinal cord compression, causing pain and muscle spasms in the back.

“There is a risk of becoming disabled after such ‘cracking,’ but it should be accompanied by serious injuries. Moreover, ‘cracking’ can damage ligaments and nerve structures, exacerbate existing spinal conditions, accelerate joint wear, and contribute to the development of osteoarthritis,” adds Andrey Dolgikh.

According to PNIPU scientists, since cracking is particularly dangerous due to the sharp displacement of vertebrae, it is better for it to occur under the supervision of a doctor, who will choose the necessary exercises and assess the physical readiness to perform them. Therapeutic physical culture can help reduce the frequency of cracking, increase joint mobility, and tone the muscles to keep the spine in the correct shape.

Why does modern medicine not recognize chiropractic?

There are several reasons for this. Firstly, there is a lack of scientific basis. Medical professionals believe that chiropractic is a cult, practiced by individuals who lack the necessary training and experience to diagnose and treat human diseases. Secondly, there is an absence of evidence-based support. Research has not confirmed any theories regarding the influence of subluxation on the development of other health issues. Thirdly, there is a high risk of harm, as experts from Perm Polytechnic believe.

“Manipulations on the spine can cause serious complications. They should only be performed by highly qualified medical professionals, utilizing X-rays or computed tomography to assess the positions of the vertebrae and spinal cord. There are situations where chiropractic is practiced by individuals who do not even have a medical education or have only completed courses for massage therapists,” notes Vladislav Nikitin.

It is important to understand that the spine is the foundation for the entire musculoskeletal system, and manipulations within it should be conducted under the supervision of an orthopedist and neurologist. They will prescribe the correct treatment, which may involve controlled (necessary) displacement of the vertebrae under medical supervision.

Interestingly, chiropractic in the USA, Canada, and some European countries is not considered unproven, as a medical education is required to practice it there. However, even there, manual therapy can be deemed unproven and unscientific if the doctor conducts treatment without an objective assessment of changes in parameters, such as the degree of vertebral displacement, the shape of the spine, and various other analyses.

What to do if a chiropractor has displaced your vertebra?

“First and foremost, you should see a doctor (therapist, orthopedist, neurologist, or surgeon) if you can do so independently. If there is a significant displacement of the vertebrae that has resulted in severe, unrelenting pain, you should not move on your own, as this could cause further harm. In such cases, it is better to call emergency services,” advises Vladislav Nikitin.

Depending on the severity of the displacement and the patient's symptoms, treatment may include the following approaches. To reduce pain and inflammation, analgesics and anti-inflammatory medications, as well as muscle relaxants, may be prescribed. In physiotherapy, the therapist will suggest a series of exercises to strengthen the back muscles and correct the spine, as well as stretches to improve mobility and reduce muscle tension. Orthopedic devices—such as braces or posture correctors—may be needed to help maintain the spine in the correct position and alleviate the load on the displaced vertebrae. If these methods do not yield the expected results and the patient's condition continues to deteriorate, the doctor will consider surgical intervention.

When is massage necessary?

Back massage may be recommended for muscle spasms and tension, to alleviate pain and relax the muscles. In cases of osteochondrosis, regular sessions help improve circulation and relieve discomfort, enhance flexibility, and reduce inflammation—particularly in sciatica (sciatic nerve neuralgia) and radiculitis. Patients with scoliosis and other spinal deformities require comprehensive therapy, and massage will help maintain muscle tone and posture. Another reason to prescribe back massage is rehabilitation after an injury.

“Massage