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This is one of the most common problems seen in medical practice; low back pain strikes 8 out of 10 adults at some point in their lives. Back pain is the fifth most common reason for visiting a physician.
Before getting into the actual terms with back pains, let us understand in brief about the structure, responsible for its cause most of the times, Spine.
The busy and stressful life you lead will soon come to an end if your spine collapses or lets you down. The spine is literally scaffolding for the human frame, keeping it upright for long hours at a stretch.
The human spine is made up of 33 bones, called vertebrae. The column is grouped into three sections: the cervical vertebrae are the 7 spinal bones that support the neck and allows to turn your head freely; the thoracic vertebrae are the set of 12 spinal bones present in the mid-back, that connect to the rib cage to provide stability to your stanus; and the lumbar vertebrae are the 5 largest bones of the spinal column. Most of the body's weight and stress falls on the lumbar vertebrae. Below the lumbar region are 5 fused vertebrae of the sacrum, a shield-shaped bony structure that connects with the pelvis at the sacroiliac joints. At the end of the sacrum are 4 tiny partially fused vertebrae known as the coccyx or "tail bone".
Joining each pair of vertebrae is a facet joint that function like a hinge. Between each pair of vertebrae lies a flat, circular intervertebral disc. The outer portion of the disc is hard and the center (nucleus pulposus) is soft. This cushions the vertebrae and absorbs shocks to the spine during any movements.
Each vertebra and its processes surround and protect the spinal cord that is the central trunk of nerves that connects the brain with the rest of the body. Each nerve root passes from the spinal column to other parts of the body through small openings bounded on one side by the disc and the other by the facets.
Low Back Pain
Low back pain is usually defined as pain affecting the lower region of spine and back. They are either acute or chronic. Physicians diagnose low back pain as acute if it lasts less than a month and is not caused by serious medical conditions. Most cases clear up in a few days without medical attention, although recurrence after a first attack is common. If the pain persists beyond six months, it is considered chronic low back pain; this constitutes only 1% to 5% of all low back pain cases.
What Causes Low Back Pain
The causes of 85% of back pain are unknown. Most often, pain is not organic, but functional, meaning without involvement of any major structural defects in and/or around the spine. These are called idiopathic or functional back pains. At least eight out of ten cases accounts for such kinds where backache are caused by muscle tension produced by poor posture while seated, incorrect sleeping habits, incorrect standing habits, bad bending and lifting moves and twisting of the spine. Another commonest cause for idiopathic back pain is psychological stress and depression.
Stress can surface anywhere a person has a weak link, whether it be back pain, neck pain, headaches, or whatever, if a person has a propensity for back or neck problems, stress can easily bring them to the surface or exacerbate them.
Dietary insufficiencies of vitamin D and / or calcium most commonly seen with aging though younger ones are no bar, is also a common cause .
The organic/structural Back pain may be triggered by various pathological conditions that occur along the spinal region and /or in the other region of body.
The pain due to problems related to spine could be various: Mechanical cause related to Injuries and small fractures. Muscle spasms can cause pain. Pressure on a weakened disc may cause it to rupture so the nucleus pulposus protrudes out from the spinal column, a condition known as herniated disc. The facets can become misaligned or they can deteriorate. The spinal canal itself can become narrowed, a disorder called spinal stenosis. If any of these conditions occur, the nerve roots passing between the discs and facets may be stretched or pinched, causing pain. This region is also prone to lumbar spondylosis, which occurs as a result of the spine undergoing certain degenerative changes like thinning of the disc, which accounts for the most common cause of chronic low back pains.
Let’s in brief understand about few of the most common conditions accounting for organic /structural back pains-
The nerve most likely to cause trouble is the sciatic nerve; at some time, up to 40% of people experience pain caused by compression of this nerve, which branches from the nerve roots that descend off the spinal cord in the lumbar and sacral areas. Sciatica usually occurs on one side when a sciatic nerve has been stretched or pinched, usually by a herniated disc, although spinal stenosis or other vertebral abnormalities can also cause this pain. The sensation of sciatica can vary widely from a mild tingling to pain severe enough to cause immobility. The pain increases after prolonged standing or sitting and is aggravated by sneezing, coughing, or laughing. If spinal stenosis is causing sciatica, patients may also experience it after bending backwards or walking more than 50 to 100 yards.
A herniated disc, sometimes “but incorrectly” called a slipped disc, is the most common cause of severe back pain. A disc in the lumbar area becomes herniated when it ruptures or when the gelatin within the disc protrudes far enough outward.
Studies are finding, however, that bulging and protruding discs show up on the scans of up to 60% of people who have no back pain at all. Experts now generally believe that discs might even swell in response to stress and then contract again, so, do not necessarily indicate serious back problems.
- Osteoarthritis and Spinal Stenosis
Osteoarthritis occurs in joints where cartilage is damaged and then destroyed; in reaction to this destruction, the bones associated with the joints develop abnormalities. The patient may also experience muscle spasms and diminished mobility.
Spinal stenosis, the narrowing of the spinal canal, is usually caused by bone overgrowth, which occurs mostly in the elderly who have degenerative osteoarthritis, but it can sometimes be caused by infection and birth defects.
Osteoporosis is a disease of old age in which the amount of calcium present in the bones slowly decreases to the point where the bones become fragile and prone to fracture, also resulting into increase in pressure and compression of the vertebrae. If the vertebrae collapse suddenly, pain is often severe. A recent study indicated that very tiny fractures in the vertebrae might be an undetected cause of back pain in many older women.
Ankylosing spondylitis is a chronic inflammation of the spine that may gradually result in a fusion of the spine causing the patient to stoop over. The back is usually stiff in the morning with a slow development of back discomfort, with pain lasting for more than three months; pain improves with exercise. It occurs mostly in young in their mid-twenties.
Spondylolisthesis, another cause of back pain, is a condition in which one vertebra has slipped forward over the other.
Back pain can also be caused by other problems not related to spine, including inflammation, abscesses, blood clots, tumors, certain genetic problems etc...
Chronic uterine or pelvic infections can cause low back pain in women. This condition is called referred back pain.
Atherosclerosis (commonly called hardening of the arteries) may occasionally cause chronic low back pain, because the condition reduces the supply of blood. When it blocks arteries in the legs it may cause pain that resembles sciatica caused by spinal stenosis. Fibromyalgia is also a cause of back pain.
Juvenile chronic arthropathy is an inherited form of arthritis that can cause pain in the sacrum and hip joints of children and young people.
What Are the Risk Factors for Low Back Pain?
We can divide these risk factors into two categories –Irreversible and Reversible.
- Irreversible causes
- Aging (above 40 years of age)
2. Reversible causes
- Lack of adequate exercise
- Weak or easily fatiquable
- Stressful unaccustomed activity
- Habitual sub optimal body mechanics such as
- Heavy occupational demands, including lifting, twisting, sitting, and driving
- Sedentary life style as Sitting puts 11 times more pressure on your lower back than standing, walking, or lying down.
Indications for Seeing a Physician
Certain warning signs should alert a patient to see a physician immediately for low back pain. Symptoms include dull back pain associated with weakness or numbness in buttocks, thigh, legs, or genital area, and / or an inability to control urination or defecation, back pain accompanied by fever, Pain that lasts for more then a month, unexplained fever or weight loss, and a history of cancer.
Other conditions warranting rapid attention are very severe pain * particularly if it awakens the person at night or is increased by lying down * and any neck or back pain in children.