About

Back pain is ranked second to headaches as the most frequent location of

pain. Four out of five adults will experience at least one bout of back
pain at some time in their lives. It is almost next to common colds in the
list of common diseases.
The most common site for pain is the lower back because it bears the brunt of
our weight and hence is more prone to get affected.

Structurally backache is a condition that usually is caused when one or more

structures of the back gets affected and these includes muscles, cartilage,
bones or spinal cord.
Anatomy of our Back - The back region of our body is made
of interconnecting structures like bones, joints, muscles, ligaments
and tendons. The spine of the back itself is made up of 24 small bones
(seven cervical, twelve thoracic and five lumbar) and is the major support
structure of back. These small bones are called vertebrae and they are further
attached to sacrum and coccyx as we go from top to down. The sacrum
attaches itself in front to the bones of the pelvis.

Our Erect Posture and flexibility of our body-The erect human posture
has made our back adapt to withstand the forces of gravity over our lifetime. It
also has made this region more easily vulnerable to wear and tear,
strains and fractures. To keep us mobile, the flexibility of our back is
important. This is determined by various factors such as joint structure,
muscle elasticity and connective tissue fiber material made up of collagen,
elastin and titin. Disc that are interposed between the vertebra, acts as a
shock absorber and gives joints their strength, stability and flexibility but
limits movement. Vertebrae and discs provide a protective tunnel that allows
the spinal cord and its spinal nerves to pass through. These nerves running
down the center of the vertebrae, branch off to various parts of the body. The
collagen fibers help the disc withstand the tension of the erect posture and our
weight. Disc protects the spine and keeps it stable during strenuous activities
that puts strong force on the spine, such as jumping, running, and lifting.
Back ache is more prevalent between the age of 35 and 55. The most
frequently cause of our back pain are:
Heavy physical work
Frequent bending, twisting, lifting
pulling and pushing
Repetitive work

Static postures
Vibrations
Psychosocial risk factors for backache includes stress, distress, anxiety,
depression, cognitive dysfunction, pain threshold, job dissatisfaction, and
mental stress at work.
Back pain may be sudden and sharp or it may be dull and if
persistent for more than a week it might result in tension, soreness
or stiffness of back muscles. Pain may aggravate with slightest of
movement or even with coughing and sneezing. It may also be
accompanied with numbness and tingling in the arms or legs.
The pain if limited to the back can be treated by simple remedies at home but
if radiating to the lower abdomen, groin, leg or foot, needs medical attention.
Back pain is a common reason for seeking disability benefit from
governments and insurance companies. However as pain is
subjective and difficult to quantify, the process for such claims is
tedious and not everyone who makes a claim gets the necessary
benefit.

Causes of Back Pain

What is the reason for Back Pain?
Posture -Back pain most commonly results from poor posture. Sometimes it
is due to poor body mechanics like standing for extended periods of time or
sitting in an incorrect posture. Back injury, heavy physical work, lifting,
bending, twisting, or awkward positions might act a precursor to triggering
back pain.
Injury -A sudden fall, car crash, or sports injury can cause a sprain or strain.
When a back injury occurs, muscles, ligaments, and tendons become overstretched and swollen up, causing pain, tenderness, and stiffness.
The three common causes of back pain include:

Muscle strains: Strained muscles, tendons or ligaments or inflamed joints

may cause pain along your spine.

Osteoarthritis: This degenerative joint condition affects nearly everyone

past the age of 60. Old age and injury can slowly lead to deterioation of the
cartilage. Cartilage is the protective tissue that covers the surface of the joints
of the vertebrae.
Osteoporosis: One in three women who are older than 50 can be affected by
osteoporosis and this can lead to painful vertebral compression fractures.
What are the Triggering factors for Back Pain?
Triggering Factors -The episode of back ache might result either from a
strenuous event or previous history. Even psycho-social risk factors like stress,
distress, anxiety, depression, cognitive functioning, job dissatisfaction and
mental stress can play a role in triggering back ache. There may be some deep
underlying causes of low back pain, few of which include:
Fracture of vertebral bones.
Slipped disc; disc bulges out of vertebral joint and puts pressure on spinal
nerves.
Spinal stenosis; owing to narrowing of spinal space,pressure is induced upon

the spinal nerves.

Spondylolithesis; when one of the back bones slips forward and out of
position.
Degenerative disc disease; when the discs in spinal cord gradually gets worn
out.
Osteoarthritis; a wear-and-tear disease of bones.
Rheumatoid arthritis; an inflammatory condition of joints.
Carcinoma or benign tumors.
Kidney stones.
Endometriosis.
Pelvic inflammatory disease in females.
Sometimes a routine activities such as gardening, picking up a child, reaching
for an object or even coughing, can trigger back ache.

Symptoms of Back Pain

Pain that interferes with sleep, weakness or numbness in one or
both legs or groin area can mean nerve compression and requires
thorough evaluation.
Problems with bladder or bowel control can also occur due to
compression. Typically there is a continuous ache in the back that is not
relieved by change of posture and is worse in the morning. Generally the
person affected is unable to perform normal daily chores or housework.
Bending to pick up something from the floor can be a painful task.
Back pain arises in many forms, it may be sudden and sharp or it may be dull
and if persistent for more than a week, it might result in tension, soreness
or stiffness of back muscles. Pain may aggravate with slightest of
movement or even with coughing and sneezing. It may also be accompanied
with numbness and tingling in the arms or legs. The pain distribution and
pattern indicates its severity. The pain if limited to the back can be
treated by simple remedies at home but if radiating to the lower
abdomen, groin, leg or foot, needs medical attention.
Symptoms such as pins and needles sensation, numbness or a
burning sensation across the leg or foot region are an indication of
severity of pain and should not be left untreated. These symptoms
might indicate damage to the root of the sciatic nerve, the nerve travels from

the lower back down towards the back of the leg to the foot and enervates the
long muscles of the leg and is responsible for the sensation of the leg and foot.
Category of Pain:
Acute - if lasting up to six weeks
Sub-acute - If lasting up to three months
Chronic - If longer than three months
Warning Signs when medical help is required:
Pain getting significantly worse
Pain affecting every day activities
Groin weakness or numbness
Weakness or numbness in one or both the legs
Arm or hand weakness
Tingling, or numbness in arms radiating to fingers
Loss of bowel or bladder control
A fever (high temperature) accompanied with redness or swelling on back
Constant pain, even at night
Factors that increase the risk of developing back pain include:
Smoking
Obesity
Older age
Being a female
Physically strenuous work
Sedentary work
Physically or mentally stressful job
Anxiety
Depression
Although the back pain often gets triggered suddenly but the causes may have
been piling up for quiete some time owing to:
Maintaining slouched posture in chairs
Driving in a hunched position
Standing in an arched manner
Lifting without bending knees
Sleeping on sagging mattress
Being unfit

Sleeping prone
Getting out of the bed straight from supine lying position
Chronic back pain and Disability Back pain is a common reason for
seeking disability benefit from governments and insurance companies.
However as pain is subjective and difficult to quantify, the process for such
claims is tedious and not everyone who makes a claim gets the necessary
benefit. Even the most genuine of cases are liable for rejection, The fear
accompanying back pain can sometimes leads to prolonged inactivity and can
make the backache worse and make it a chronic condition. This can lead to
work-loss and may push a person to seek disability allowance.
The physiotherapist should ensure that the fear factor of back pain
should not let a person from stop performing their daily chores. The
general advise therefore is that people suffering from low back ache
should NOT avoid their daily activities or exercises and should keep
performing these with some necessary precautions.

Diagnosis of Back Pain

Physical examination: Your doctor examines your back to find out where
the pain is and what degree of movements are possible without inflicting pain.
He will find out if the back pain is as a result of muscle spasms.
If necessary the doctor would also checks the muscle power in your limbs and
if the sensation is normal. If there is weakness the nerve reflexes will need to
be checked too.
X-ray: These images show the alignment of your bones and suggest if there
are degenerative changes in the vertebral bones and if the joints show any
wear and tear. They also show the disc spaces. In a slipped disc the space is
diminished between the two vertebral bodies. Two views are necessary one
from the front and the other is taken from the side. The x-rays are a good
starting point and provides the doctor with all the basic information.

MRI or Magnetic Resonance Imaging

If there is any nerve problem suspected an MRI will be ordered. This is more
expensive and takes longer to perform. MRI gives a complete picture of the
spinal cord and the its emerging nerves
The patient is requested to lie still on a sliding table. Care is taken to ensure
that the patient is comfortable in the position. Following positioning, the table
slides into a cylinder like structure, housing a large magnet. With the patient
inside the MRI unit, a two dimensional image of the spine is created. The
patient can communicate with the radiologist or the technician in case of any
difficulty or trouble.
While inside the MRI unit, a loud thumping noise is usually heard. However
mufflers are provided to the patient to protect the ears form the noise.
Earplugs are also provided to a relative or friend who accompany the patient
in the room.
Some degree of movement is allowed in between the imaging sequences.
Computed Tomography (CT) Scan: These scans like MRI can generate
images that may reveal herniated discs of the spine or problems with bones,
muscles, cartilage, ligaments, tendons or blood vessels.

Bone scan: You'll receive an injection of a radioactive substance called as

tracer into a vein. Using a special camera, your doctor may be able to detect
bone tumors or compression fractures caused by osteoporosis.

reatment and Exercises of Back Pain

Most cases of back pain can be managed with exercises that help to strengthen
the muscles of the back. Very few cases will require operative treatment like
surgery for slipped disc to release an entrapped nerve.
Treatment Methods Non-operative for Back Pain
If the back pain is localized to an area, one needs to follow a rigid exercise
regimen and with some precautions. But if the pain is radiating there is a need
to visit a physical therapist. If, pain still doesnt subside down, there might be
some specific underlying cause which requires immediate medical attention.
Self-help
Stay active and perform all the daily activities normally
Avoid bed rest for extended periods as it might make low back pain worse

Apply hot pack to the affected area if pain is chronic or cold packs if pain is
acute. Traction for Back Pain This has been the mainstay of
treatment for back pain in the past. However the current thoughts
have been this treatment method outdated. Its principle is that it
traction stretches tight spinal muscles that are in spasm and it widens the
inter-vertebral foramen to relieve nerve root compression.
Traction is generally applied to the cervical (neck) region or to the lumbar
region. Sometimes a mechanical weight is used that hangs by the pulley which
is attached by ropes to a harness, with the patient being confined to the bed.
Traction has been condemned by many therapist who believe it causes more
harm then good.
In a review of 25 randomized clinical trial (2206 patients; 1045 receiving
traction) on this subject the Cochrane review concludes that for patients who
had mixed symptom patterns i.e. acute, sub-acute and chronic low back pain
with and without sciatica the results was as follows:
Strong evidence of no statistically significant difference in
outcomes between traction as a single treatment and placebo,
sham or no treatment;
Moderate evidence that traction as a single treatment is no more
effective than other treatments;
Limited evidence of no significant difference in outcomes
between a standard physical therapy program with or without
continuous traction.
Electrical Stimulation:
Transcutaneous electrical nerve stimulation (TENS) may help stop
pain by blocking nerve signals from reaching your brain. A physical therapist
places electrodes on your skin near the area of your pain. TENS may relieve
pain in your leg due to inflammation or compression of nerves in your back.
This treatment involves manipulation and massage of your spine and back
muscles to relieve mild-to-moderate pain.
Acupuncture:

An acupuncturist inserts hair-thin needles under your skin. The needles

usually stay in for 15 to 30 minutes. The insertion causes little or no pain.
Expect to have several sessions. Research suggests pain relief may come from
the release of endorphins, your body's natural painkillers.