Introduction to Back Pain
According to the WHO, 619 million people were affected by lower back pain in 2020, and over 800 million will report lower back pain cases by 2050. The number increases due to ageing and an increase in population.
Back pain is physical discomfort that affects your back from the base of the neck to the top of your back.
Back pain can be caused by chronic diseases that cause chronic discomfort or problems with the structure of your spine that affect your spinal health.
Globally, lower back pain is one of the musculoskeletal conditions that causes disability. Musculoskeletal pain can be hard to manage therefore, you need rehabilitation to cope.
Back pain can affect your physical and emotional functioning at work, leading to low productivity. Chronic pain can also affect your quality of life when you have to rely on treatments and therapy procedures.
Understanding the Anatomy of the Back
Your back muscles are divided into 3 categories:
- Superficial back muscles. Superficial back muscles help in the movement of your upper limbs. Superficial back muscles include: Trapezius, Levator scapulae, Rhomboids, and Latissimus dorsi.
- Intermediate group muscles. They help in the functioning of your respiratory system. They include: Serratus posterior inferior and Serratus posterior superior.
- Deep back muscles. They help in the movement of the axial skeleton.
The vertebral column helps in movement and posture, and supports and protects the spinal cord. The Vertebral Column comprises vertically aligned vertebrae: Cervical lordosis, Thoracic kyphosis, Lumbar lordosis, and Sacral kyphosis.
Below are the functions of your back:
- Protects the spinal cord.
- Hold your body and head upright.
- Adjusts the movements of your upper and lower limbs.
Your spinal cord runs from the medulla oblongata through the vertebral column. At the end of the spinal cord arise the spinal nerves, which have sensory and motor functions. Cerebrospinal fluids protect and supports the spinal cord.
2 arteries supply blood to the spinal cord: the Single Anterior Spinal Artery and two Posterior Spinal Arteries.
Who Gets Back Pain?
Anybody can get back pain, however, some factors may put you at risk of developing back pain. Below are risk factors that may trigger back pain:
Health conditions.
Diseases like arthritis and cancer may trigger back pain.
Psychological problems.
Psychological conditions such as anxiety, stress and depression may cause muscle tension and trigger back pain.
Failure to work out.
Lack of exercise weakens your muscles, and this may result in back pain.
Weight gain.
Excess weight stresses your back muscles and results in back pain.
Age.
If you are 45 years and above, you may experience back pain at some point in your life.
Smoking.
Smoking causes herniated discs due to too much coughing. Smoking reduces the flow of blood to your spine, therefore causing Osteoporosis.
Improper lifting of items.
Lifting items with your back in the wrong way can lead to back pain. For example, weight lifting in the gym.
Types of Back Pain.
Back pain varies in intensity and frequency. Below are some of the types of back pain.
Acute vs. Chronic Pain.
Acute back pain relates to pain that lasts for a few weeks or days. The pain is sudden and temporary; sometimes, it can go away independently. Acute pain can be triggered by an injury or normal body movements. It occurs to warn you to avoid certain behaviours to avoid injury.
Subacute pain is pain that lasts for 4 to 12 weeks. It mostly feels like a sudden pain.
Chronic pain is pain that lasts for more than 3 months. Chronic pain occurs if you have had a long-term broken bone or a pulled muscle. It may also rise due to health conditions such as arthritis.
Mechanical Pain.
Mechanical pain is pain that intensifies with a change in movement. It originates from your spine’s mechanical structure: ligaments, muscles, facet joints and intervertebral discs. Pain may intensify when you indulge in activities such as lifting, bending and sitting for long hours.
Radicular Pain (Sciatica).
Sciatica is a nerve which runs from the buttocks down to each leg. Radicular pain can feel like it’s everywhere, as the nerve passes. It can be felt on the lower back, buttocks, at the back of your thighs or even calf.
Pain accelerates or feels like an electric shock when you cough, sneeze, or sit for long hours. Sometimes, you may feel numbness and tingling in the affected leg.
Referred Pain.
Referred pain is pain that originates from a certain part of your body but is felt in another part of your body due to a nerve connection. Your brain can send pain signals to another part of your body.
Localised vs. Diffuse Pain.
Localised pain is pain that you can identify in a specific area of your body. An example is back pain. Localised pain feels like muscle spasms, constant or sharp pain, and sudden pain. Local pain may be worsened or relieved by a change in position.
Diffuse pain is widely spread on your back. Widespread pain may affect your entire back and may be caused by muscle strains, arthritis or disc problems.
Causes of Back Pain.
There are many reasons why your back hurts or you experience constant back pain. Below are back aches:
Muscle or Ligament Strain
If you do weight lifting and play sports that require sudden movements, you are likely to get muscle strain. Repeated heavy lifting and sudden movements strain your back and pressure your spinal ligaments. If you have a poor physical condition, too, you may get muscle strains.
Herniated/Bulging Disk.
Disks are located between your bones, they help you bend and move easily. With time disk may become less effective due to natural wear and tear or an injury occurrence. This presses your nerves and spinal cord, causing pain in your lower back.
Herniated disk feels like sharp pain that shoots down on one side of your butt. Other symptoms of a bulging disk include numbness, weak muscles and lower back pain.
Arthritis/Osteoarthritis.
Osteoarthritis occurs when the cartilage that lines your joint wears away, causing your bones to rub against each other when you use the joint. Osteoarthritis can also be referred to as a degenerative joint disease.
Arthritis feels like pain and stiffness in your lower back. Car accidents, falls, and sports injuries are some of the risk factors for arthritis.
Spinal Stenosis.
The spinal cord and the nerves run through the spinal canal from the base of the brain to the centre of the spine. The spinal canal is the hollow space between the vertebrae. Spinal stenosis happens when the spinal canal narrows and puts pressure on the spinal cord and nerves.
Spinal stenosis causes pain in the lower back, numbness, a burning sensation, and weak legs and feet.
Osteoporosis.
Post menopausal women and older men mostly suffer from osteoporosis. Osteoporosis is a silent disease that you notice when you break a bone. Osteoporosis is a disease that occurs when your bones decrease in mass, change structure, or decrease in bone mineral density. This weakens your bones, increasing the risk of fractures or broken bones.
Poor Posture/Sedentary Lifestyle.
According to a research study, poor posture can accelerate mechanical stress, resulting in back pain. Examples of bad posture that cause back pain include: round back, sway back, lumbar or scoliosis, flat back and lordosis. Poor posture can also lead to lumbar discomfort.
Diagnosis of Back Pain.
Diagnosis helps your healthcare provider understand the root cause of your back pain and provide the right treatment plan. Below are some of the diagnostic tests:
Physical examination.
A physical examination helps your healthcare professional understand the origin and intensity of your back pain. A physical exam also helps identify serious causes of back pain that may require serious attention.
During physical examination, your doctor may ask you to walk, stand. Sit or lift your legs to assess your mobility. Your spine and posture may also be examined to understand changes in your bony structure.
Patient History.
You may also rate the intensity of pain on a scale of 1 to 10 and its effect on your daily activities. Your doctor can ask you about your family and medical history to provide the right treatment plan.
Imaging Tests.
X-ray images show arthritis and bones. Your doctor can see broken bones, changes in bone structure due to ageing and changes in spine alignment. X-rays cannot identify conditions affecting your muscles, nerves, tendons, disks and spinal cord.
MRI or CT scans have powerful magnets that show cross-sectional images. MRI can diagnose diseases affecting soft tissues like discs, ligaments, nerves and the spine.
Blood tests can also be used to determine infections and diseases causing back pain.
Treatment Options for Back Pain.
Home remedies, medications, physical therapy and surgical options can help relieve back pain. Below are some of the recommended treatment plans:
Home Remedies.
Limit activities that accelerate back pain, and gradually increase the activities as your body adjusts. Avoid bed rest to keep your muscles active.
You can use ice packs to reduce back pain and hot packs to increase blood circulation. Proper blood circulation promotes the healing of your muscles.
Physical Therapy.
A physical therapist can help you practise exercises that will improve your flexibility, strengthen your back and muscles. Regular practice helps improve your posture and reduce back pain. Your physical therapist may also recommend the modification of movements to relieve back pain. This helps you stay active and avoid back pain from interrupting your daily activities.
Medical Treatments.
Medical treatments help in reducing pain, swelling and relaxing your muscles.
Over-the-counter treatments such as Ibuprofen and Naproxen can help relieve pain. Ensure you take pain relievers as instructed by the doctor; overdose may result in serious side effects.
If you have chronic back pain, you can use muscle relaxants to relieve muscle tension.
Besides oral anti-inflammatory treatments that relieve pain and inflammation, anti-inflammatory injections treat back pain caused by nerve compression.
Neuromodulatory agents control how your nervous system processes pain. You can use them when you have severe back pain.
Surgical Options.
Disc replacement is a type of surgery that involves replacing a damaged disc with a synthetic one.
Radiofrequency ablation is a surgical option where a needle is passed through your skin close to the area where you are feeling pain. The needle emits radio waves that damage the nearby nerves to interfere with pain signals.
Discectomy and microdiscectomy surgery options help in removing the herniated disc that puts pressure on the nerve root and spinal canal.
Spinal fusion involves joining two or more vertebrae that have moved from their normal position. The doctor removes the discs between the vertebrae and uses metal devices to secure your bones. Spinal fusion surgery is recommended for people with a degenerative disc condition.
Laminectomy is used to treat spinal stenosis. The doctor removes bone spurs and bone walls of the vertebrae to open up the spinal column and remove pressure on the nerves.
Alternative Therapies.
Massage is an alternative therapy if you have overworked muscles and back pain.. You can have a massage twice a month if your work involves high use of muscles.
Yoga includes poses, postures, breathing exercises and relaxation techniques to stretch and strengthen your muscles.
Prevention Strategies.
Regular physical activities keep your back muscles strong. Performing exercises that focus on balance and strengthening prevents you from falling and getting injuries. Weight-bearing exercises and yoga are physical exercises that challenge and improve your balance. Warming up before an exercise or sports activity helps prevent back pain later.
Include foods rich in vitamin D and calcium in your diet to keep your spine strong and healthy.
Manage your weight to avoid unnecessary injury. Excess weight can trigger stress and strain on your back.
Practice good posture while sitting, standing, working or walking. Good posture supports your back and reduces stress on your spine. Workplace ergonomics tips can help prevent back pain and maintain good posture. Below are ergonomic tips that you can use:
- Use an ergonomic chair with a backrest to support the curves of your lower back.
- Use a lumbar support cushion.
- If you have been sitting for long hours, stretch your shoulders and neck to relax your back muscles.
Use your legs and abdominal muscles to lift heavy items. You can also use assistant tools to lift heavy items.
Quit smoking. Smoking prevents the flow of blood to the disc and also reduces the absorption of calcium and the development of new bones. Smokers are also at a high risk of getting bone fractures.
When to See a Doctor.
You should see your doctor if you have had back pain for more than a week, even after home treatment. You can seek medical help if you have:
- Constant lower back pain while lying down.
- Intense back pain that spreads below the knee, either to one leg or both legs.
- Noticed inflammation or a change in skin colour on your back
- Long-term back pain
- Back pain with unintended weight loss
Conclusion.
Back pain is a common health problem.It can be caused by poor posture, health conditions such as arthritis, spinal structural problems and muscle strains. However, there are a variety of treatments to cure back pain. Physical therapy and surgery are chronic back pain treatment options, while common back problems can be treated with over-the-counter medicines and home remedies.
Proactive spinal health activities, such as exercise and proper posture, can keep your spinal cord healthy. Seek professional consultation when you notice back pain that doesn’t disappear after a week.
