Back Pain

Low back pain can often be attributed to complex origins and symptoms, and it does not discriminate. It can originate from identified muscle trauma, or an unknown non-traumatic event. Low back pain can also begin in other regions of the body and eventually attack the muscles or other structures in the lower back. Sometimes low back pain can even begin in the nerves or nervous system. Other origins for low back pain are postneural difficulties, congenital disorders, trauma, infections, degenerative disorders, inflammatory diseases, circulatory disorders or any of other 30 additional causes.

It is often difficult for physicians to pinpoint the exact cause of a patient's low back pain, because of the complex composition of the human spine. Bone, discs, muscles, ligaments, tendons and various other tissues are arranged like a three-dimensional puzzle to make up the spine. The complex make up can easily mask the exact cause of low back pain.

Where Back Pain Starts

In addition, depression, anxiety, frustration, reinforcement, stress, anger, fear and many other psychological states can help to cause the onset of back pain, can be a reaction to prolonged pain, or exist concurrently with pain.

The emotional component can complicate the back pain diagnosis, sometimes resulting in needless surgery and disability and can sometimes mask the underlying physical causes of pain.

As a result of the natural wear and tear that occurs with aging, certain parts of the spine start to degenerate and wear out, as we grow older. This process makes some of the anatomic structures of the spine, the bones, intervertebral discs, ligaments, and muscles less flexible and less resistant to injury.

Spondylolysis

Spondylolysis is a defect in the lamina of the vertebrae in the pars interarticularis, usually the fourth or the fifth lumbar vertebrae in the lower (lumbar) spine. Spondylolysis may occur as a congenital defect or be the result of repetitive trauma. Some physicians believe spondylolysis may be caused by genetics, and that someone could be born with thin vertebral bones causing them to be vulnerable to the condition. Spondylolysis is common in teenage gymnasts and football players, and presents with lower back pain that is worse with strenuous exercise or activity. Radiographic findings are subtle, but bone scans or CT scans will usually detect the lesion. Activity modification, bracing, or surgical treatment may be indicated for persistent symptoms.

Spondylolisthesis

Spondylolysis is a prerequisite for spondylolisthesis. Spondylolisthesis occurs when spondylolysis weakens one of the vertebrae so much that the bone slips out of place. The condition can also be caused by degenerative disc disease. If the vertebrae slip too much and begin to press on nerves, surgery may become necessary. Spondylolisthesis may also be caused by degenerative conditions that affect the vertebral joints, such as cerebral palsy.

Early treatment usually involves rest and medication. Progressive spondylolisthesis usually requires surgical treatment.

Sprains and Strains

Most acute pain in the back results from sustaining a mild strain in the back or back musculature. Sprains and strains in your lower back usually happen during a sudden and stressful injury, causing stretching or tearing of the muscles, tendons, or ligaments in your lower back. When you strain or sprain your lower back it causes a lot of stress on your spine, irritating it. If you have this condition you may also suffer from painful muscle spasms which can occur during your daily activities or at night while you're sleeping. The pain is usually limited to five or ten days.

Sciatica

Sciatica is the descriptive term for when pain runs from your back or buttocks down your leg and into your foot It is a condition caused by either compression or trauma of the sciatic nerve. Sciatica is made worse when you cough or if someone lifts your leg up while you are laying down. Symptoms may begin abruptly or gradually, are usually irritated by movement, and often grow worse at night. Sciatica implies that there is an irritation of your nerve root in the lower part of your spine. In some instances, this could be due to a ruptured or herniated disc in your lower back.

Herniated / Ruptured Discs

A herniated ("slipped") or ruptured disc in your back can cause each of these pain patterns. The ways in which a slipped disc causes different pain patterns and problems with your back is related to the location of the slipped disc along your spine, and also to the anatomy of your spinal column. The spinal column, or backbone, consists of 33 bones (vertebrae) and can be divided into five segments, called the cervical, thoracic, lumbar, sacral, and coccygeal sections of the spine. Each of these sections corresponds to a particular part of your body. The cervical spine is that part of the spine in your neck, the thoracic spine supports your trunk, the lumbar spine supports your lower back and abdomen, the sacrum supports your pelvis, and the coccyx is your tailbone.

Stenosis

Stenosis produces a dull, aching pain in the lower back when standing or walking. The pain usually radiates down into the buttocks and thighs, and can be relieved by stopping to rest, or by using a walker or a shopping cart in the grocery store. These symptoms usually slowly get worse over time, and people who suffer from spinal stenosis will notice a slow decrease in their ability to walk shorter and shorter distances. Lumbar stenosis is a natural product of aging, and the wear and tear on the spine throughout our lives. As our bodies grow older, the ligaments and bones that make up the spine grow thicker and become stiffer. The spinal canal gradually narrows, and the spinal cord is slowly compressed. The lack of space interferes with the normal function of the spinal cord and the body becomes less able to function normally.

Spinal Infection

Though infections and inflammation of the spine are rare, if they are neglected for a period of time, or if there is a delay in diagnosis, they can become a significant source of pain and disability. Bone and joint infections anywhere in the body can be crippling and life threatening.

Discitis

Discitis is a low-grade infection that affects the disc space between two vertebrae. Although discitis is uncommon, children under ten are usually the ones affected by this condition which is the result of an inflammation caused by staphylococcus, viruses, or other inflammatory processes. Discitis is characterized by the slow onset of severe back pain and may or may not be associated with fever, chills, sweats, feeling tired, loss of appetite or other symptoms. The diagnosis is usually made by seeing narrowing of the disc space between two vertebrae and a bone scan that shows that the disc and adjacent vertebrae are "hot" on the scan. This condition can be very painful and is often aggravated by any movement of the spine. The pain often travels to other parts of the body including the abdomen, hip, leg, or groin. It usually occurs in the lower (lumbar) back and upper (thoracic) back. Though

Young children with this condition are usually irritable and uncomfortable and refuse to sit up, stand or walk. The treatment of discitis generally involves antibiotics, rest, and a brace. Surgery is rarely needed.

Ankylosing Spondylitis

Ankylosing spondylitis is a rare condition that can cause back and neck pain. It is a rheumatic inflammatory disease that affects the spine and sacroiliac joints. Although it primarily attacks the spine (usually the low back first), this chronic and painful disease can also attack other joints, tendons and ligaments, and the chest wall.

Over time, this disease can cause the vertebral bodies in the spine to fuse together. When this happens, patients with ankylosing spondylitis can have difficulty moving freely. Common symptoms for ankylosing spondylitis are gradually occurring back pain and stiffness (usually over a period of weeks or months). Early morning stiffness is often helped with a warm shower or light exercise. Symptoms last longer than three months.

In particularly severe cases, patients may be unable to look above the level of the horizon, or they may develop a significant amount of pain from having a hunched over posture. Ankylosing spondylitis is usually diagnosed using x-rays of the sacroiliac joints, looking for changes in the tissues caused by inflammation. However, tissue changes are not always visible.

ain that is worse with strenuous exercise or activity. Radiographic findings are subtle, but bone scans or CT scans will usually detect the lesion. Activity modification, bracing, or surgical treatment may be indicated for persistent symptoms.

Metastatic Cancer

Tumours of the spine and spinal cord are relatively uncommon. The most common initial symptom that patients with a spinal tumour have is pain. Because back pain is very common, it is also not a specific symptom of any one disease or medical condition. Spinal cord tumours can be either primary (originating in the spinal cord) or secondary (metastases of cancer that originated elsewhere in the body). Therefore, the challenge is to determine how to evaluate back pain with the goal of specifically excluding a tumour as the cause of the pain. Luckily, most back pain is not due to a tumour. However, if a cancer were discovered after a long period of "conservative" management of back pain, most patients would feel that their problem should have been investigated more thoroughly in the beginning.

Benign Tumours

Doctors use the term "benign" to indicate that a particular tumour is unlikely to spread to other parts of the body. Benign tumours can still be a significant problem however, depending upon their location, size, adjacent structures, blood supply, and other factors. Fortunately, most benign tumours can be treated successfully.

Malignant Lesions

Doctors use the term "malignant" to indicate that a particular tumour or a cancer often spreads to other parts of the body, and can be difficult to cure or treat. This is very different from "benign" cancers, which are much less likely to spread, are easier to treat and control.

It is impossible to predict how badly someone's spine has been injured before a doctor has evaluated them. Therefore, everyone who is involved in an accident that could have damaged their back is treated as if they do have an injury to their spine. Most people are familiar with the "backboards" that paramedics use to transport accident victims, but they are unaware of how important these devices are in keeping the spine stable while they are taken to the hospital.

Paramedics and emergency response teams treat accident victims according to strict protocols that have been developed in order to save lives. These protocols are designed to minimise the possibility that someone with a spine injury could be injured while moving him or her from the accident scene or while taking them to a hospital. With these protocols, cervical collars are placed on all accident victims, they are secured on a back-board, and then taken to a hospital for further evaluation.

Spinal Cord Injuries

Each year in the United Sates, there will be approximately 50,000 new spinal cord injuries caused by accidents. A spinal cord injury occurs when the cord itself is crushed, stretched, or torn by the accident.

Unfortunately, this is still an injury that can not be reversed or cured by modern medicine. More than half of these injuries involves the cervical spine, and most of them happen to young men. These injuries are incredibly devastating to the patient, their families, and also to their communities. There is currently a lot of research being done on ways to minimise spine injuries by designing cars for better safety, improving protective gear like football helmets, and educating people about the dangers of certain activities.

There is also a lot of research being done on how to care for someone immediately after they have had a spinal cord injury, and also what kind of rehabilitation is best for them.

Osteoporosis is a disorder caused by a decrease in the amount of calcium in your bones, which can cause the bones in your spine to break because they are too weak to support the weight of the body. When this happens, people usually suffer from sharp back pain, and they often become shorter or have a "hunched over" posture. If you have these symptoms you could be suffering from osteoporosis.

Osteoporosis is a disease that affects more than eight million women and two million men in the USA. It¹s characterized by low bone mass and deterioration of bone tissue which can lead to fragile bones and increased risk in fractures of the spine, hip and wrist. In the USA, more than 700,000 vertebral fractures every year are caused by osteoporosis.

Osteoporosis is some times called the "silent disease" because bone loss has no symptoms, and the disease usually remains painless until a bone breaks. Although the disease can affect any bone, spinal or vertebral compression fractures can have serious consequences including loss of height, severe back pain, and deformity, a curving of the shoulders and back, and a thickening waistline. Women in particular reach their maximum bone mass at about the age of 20. After that, they will gradually lose bone mass. In the 5-7 years immediately following menopause, women will lose up to 20% of their bone mass. When osteoporosis affects the spine, there is a gradual collapse of the vertebrae producing back pain, loss of overall height, and a stooped posture. The back pain at vertebral collapse may be severe at times.