Back Pain Causes :
There
are many causes of back pain. Anything that puts
pressure on the back muscles or nerves can cause
pain. Any illness or damage to the spine also
can cause pain. Back pain in often related to
long-term problems of posture, lifting
techniques and repetitive motions. In fact,
about 85 per cent of back pains are caused by
simple irritation of the back muscles. This
irritation can be caused by irritation of the
nerves controlling the muscles or fatigue or
mechanical displacement or poor biochemical
functioning of the back muscles and ligaments,
resulting in chronic stress and strain. The
discs are unaffected.
When the posture is poor and the back is
unsupported, weight load increases on the spine.
If the person is overweight, excess weight in
addition to poor posture increases the stress
and strain on the spine and makes the back more
vulnerable to injury. The spine cannot maintain
its natural curves when compensating for this
type of posture. The result is increased stress
on the supporting structures leading to chronic
wear and tear of muscles and ligaments. Working
in a stooped position for extended periods of
time (gardening, vacuuming, bed making )
increases the likelihood of sustaining injury.
Stooping causes a significant strain to be
placed on the lumbar spine. Sitting in poor
posture is harder on the back than
standing.
Another common cause is pot belly. A pot –
bellied person has weak abdominal muscles. Weak
abdominal muscles often mean weak back muscles,
too.
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Stress and fatigue can have tremendous impact on the physical performance of the back and posture. Emotional stress can cause back pain or pain in any other part of the body by increasing the tension or spasm muscles, and slowing the rate of recovery. It is common to have backache at the end of the day, especially when one is fatigued. Job satisfaction and psychosocial status are more direct predictors of job-related back injuries than the amount of lifting required in the job!
Injury or accident
It is a common experience to move an object that didn’t seem too heavy, only to feel pain in the back after some time or to stretch for something that was just a little out of the reach and feel a twinge in the back. Many back injuries are caused by such unexpected twist or sudden motion. This usually results in muscle strain or ligament sprain.
Nerve roots exit the spinal canal through small passageways between the vertebrae and discs. Disc herniation occurs when the tyre – like annulus fibrous breaks open or cracks, allowing the gel-like nucleus pulposus to escape. Disc herniation can develop suddenly or gradually over weeks or months.
A herniated disc has the potential to cause compression of the nerves as they exit the spinal column, and produce pain. When it affects the sciatic nerve, it is called sciatica. All herniated discs do not cause symptoms. Many a times, a bulging or herniated disc is detected when a CT scan or MRI is done for an unrelated reason.
The incidence of disc herniation is maximal in the middle age. More than 95 per cent of the disc herniation occurs between the fourth and fifth lumbar vertebra or between the fifth lumbar and the first sacral vertebra. About 75 per cent of the lumbar herniated discs resolve spontaneously within six months.
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Many factors increase the risk of disc herniation :
1. Use of tobacco, lack of regular exercise, and inadequate nutrition substantially contribute to poor disc health.
2. Aging leads to natural biochemical changes which cause the discs to gradually dry out, reducing disc strength and resilience.
3. Poor posture combined with incorrect body mechanics stresses the lumbar spine and affects its ability to carry the bulk of the body’s weight.
Combine these factors with the effects of daily wear and tear, injury, incorrect lifting, or twisting and it is easy to understand why a disc gets damaged and
herniates.
When people grow old, they often show the effects of wear and tear in the spine
(spondylosis) and this wear and tear is often associated with worn-out discs. Worn-out discs are less likely to improve. However, strangely enough, in spite of the worn-out discs, there is less backache in older people.
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Stenosis means a constriction or narrowing. In spinal
stenosis, the spinal canal becomes narrowed. It usually affects people over the age 50 and results mostly from degenerative changes or
osteoarthritis, in the spine, particularly from bony formations called
osteophytes, which form around the joints of the spine. These bony overgrowths, together with the thickening of the ligaments inside the spinal canal, narrow the available space in the spinal canal for the spinal cord and its nerves. This squeezes the nerves and puts pressure on them, which causes the back pain. Numbness, pain and weakness in the legs can also occur. The most common symptom of spinal stenosis is back pain and pain in the thigh or leg, as well as weakness in the legs is made worse with long periods of standing or walking, particularly downhill. The pain subsides with rest.
This is a medical term used to describe the presence of a ‘defect’ or stress fracture in the posterior part of a vertebra. It commonly occurs at the
lumbo-sacral junction. It is more common among sports persons such as gymnasts, fast bowlers in cricket, and weightlifters.
Only 10-15 per cent of individuals with spondylolysis develop symptoms of lower back pain that can be attributed to this condition. It is not a serious problem as majority of people who have spondylolysis experience no more back pain than people who do not have this condition.
Treatment is avoidance of activities that aggravate the condition and cause discomfort. In some cases a brace is used to reduce movement at the level of the spondylolysis if the defect is thought to be of recent onset. This is done to allow the defect or stress fracture to heal. Healing is, however, not always achieved, but symptoms usually settle within six to twelve weeks. The best treatment is to develop a programme of muscle toning exercises to improve the muscular support of the area and decrease the risk of further symptoms.
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Spondylolisthesis
Spondylolisthesis is a condition in which one vertebra slips forward on the one beneath it. The amount of vertebra slips may be minimal or significant.
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Genetic : An individual may be born with thin vertebral bone and, therefore, be vulnerable to this condition. Significant periods of rapid growth may encourage slippage.
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Overuse : Some sports, such as gymnastics, weightlifting and football, put a great deal of stress on the bones in the lower back. They also require that the athlete constantly overstretch the spine. This can lead to stress fracture of the vertebra and vertebral slippage.
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Degeneration : Degenerative changes in the vertebral joints can also lead to
spondylolisthesis.
In
many people, spondylolysis and spondylolisthesis
are present, but without any obvious symptoms.
Spondylolisthesis can cause spasms that stiffen
the back and tighten the muscles of the thigh
(hamstring muscles), leading to changes in
posture and gait. If the slippage is
significant, it can compress the nerves and
narrow the spinal canal. Pain usually spreads
across the lower back, and may feel like a
muscle strain. With a major slip and increase in
the bend of the lower back becomes
noticeable.
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Ankylosing spondylitis
‘Ankylosing,’ in Greek, means, ‘causing
stiffness and immobility,’ and ‘spondylitis’
means inflammation of one or more vertebrae.
Anklosing spondylitis initially causes
inflammation of the ligaments and tendons that
connect the vertebrae. Inflammation causes
damage to the bone also. The body heals this
damage by growing a new bone, which replaces the
elastic soft tissue at the back of the spine.
This leads to a fusion of the spine. As a result
the back becomes stiff and painful. In some
cases, the spine curves forward, causing the
person to stoop. Stiffness and pain usually
begin in the pelvis and at the base of the
spine, and progress upward through the back to
the neck. The stiffness is more in the morning
and improves during the day.
Osteoporosis is a condition in which bone density and bone strength decrease, making a person more susceptible to fractures. It is a major cause of bone fractures in postmenopausal women and older persons. After menopause, osteoporosis is much more common in women. As the signs of osteoporosis are subtle and can be easily missed, many people do not know they have osteoporosis until a bone breaks. When the vertebrae get fractured, it causes back pain or deformity. In India it is a common cause of back pain even in menstruating women.
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Fibromyalgia can also cause chronic back pain.
This common condition is characterized by
widespread muscle pain, fatigue, and multiple
tender points on the body. The pain is constant
and may last for years. The severity of the pain
varies from time to time. Location of the back
pain can also vary. Emotional stress makes the
pain worse. Chronic pain, along with anxiety
about the problem and how to get well, can be
fatiguing by themselves and increase the
pain.
Back Pain and Obesity.
Spine is designed to carry the body’s weight and distribute the loads encountered during rest and activity. When a person is overweight his spine is forced to bear the burden. This may lead to structural compromise and damage the spine and surrounding structures and contribute to the development of osteoporosis, Osteoarthritis (OA) Degenerative Disc Dissease
(DDD), Spinal Stenosis, and Sponydylolisthesis.
Lower back pain : Lower back is most vulnerable to the effects of obesity. Obesity coupled with lack of exercise leads to poor flexibility and weak muscles in the back, pelvis, and thighs. This can increase the curve of the lower back, causing the pelvis to tilt too far forward. Poor posture contributes to back pain. Obesity may aggravate an existing lower back problem and contributes to recurrence of the condition. Therefore, if you are overweight or obese, chances are you have, or will have, back pain.
Osteoporosis : A sedentary lifestyle coupled with an unbalanced diet can affect the density, or strength of the bones (spinal vertebrae). When the structural architecture of a vertebral body is compromised, it is at risk for fracture. Vertebral fractures can be painful and disabling.
Osteoarthritis (OA) and Rheumatoid Arthitis (RA) : The joint in the spine are called facet joints. Excessive body weight place unnatural pressure and stress on the joints during movement and at rest.
Other condition
Sometimes pain felt in the back actually originates elsewhere in the body.
Such problems may include :
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