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Back Pain

Back Pain

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Almost half of all people living in the industrialized world experience some form of chronic or recurring back pain. Around 80 percent of all people report having suffered from back pain at some time during the past two years. After cardiovascular disease, chronic back pain is the most common reason for worker disability and early retirement.

Why is back pain so common?

With very few exceptions, back pain is always related to the spine. The spine was originally conceived by nature for movement on all fours. The weight of the haunches, in particular, is carried in nearly all mammals by a pair of rear legs. When our prehistoric ancestors began to walk upright, this weight had to be redistributed.

The spine was required to adapt to a load-bearing situation for which it was not originally designed. All of the participating muscles, ligaments, discs, spinal joints and nerve structures were subjected to this change. In the process of adapting to the new circumstances, the spine took on a remarkable capacity to heal itself. Indeed, nearly all of us have had the experience of suffering from back pain and then recovering. It is often the case, however, that spinal misalignment, uneven loading, repetitive motions and age-related wear lead to chronic pain and the need for treatment.

Where exactly does it hurt?
The spine is divided into three major sections: the cervical spine, the thoracic spine and the lumbar spine. Each section is associated with distinct problems and kinds of pain.

Cervical Spine
Although the cervical spine carries the least amount of weight, it can be susceptible to injury because it has the greatest range of motion. Blockades in the joints of the cervical spine represent the most common problem.

Thoracic Spine
While the thoracic spine's range of motion is very limited by the ribs, it is also receives vital support from the ribs. This is why the thoracic spine is far less often a source of pain. However, the costovertebral articulations - the points of attachment between the ribs and the thoracic vertebrae - represent a weak spot in the thoracic spine. These joints are subject to continuous motion on account of respiration. That is why the pain originating in this area of the spine tends to radiate into the thoracic cavity. The intensity of this pain sometimes leads people to believe they are experiencing the onset of a heart attack.


Lumbar Spine
Most cases of back pain originate in the lowest section of the spine, known as the lumbar spine. Although the lumbar spine carries the entire weight of the rump, the vertebral bodies that are expected to carry this weight are smaller than the vertebral bodies in the other sections of the spine. The vertebrae in our lumbar spine are exposed to tremendous stress when we are in an upright position. The intervertebral discs that act as a buffer and spring lose a portion of their fluid every day and shrink, or flatten out, as a result. While the fluid in the discs is replenished at night while we sleep in a horizontal position, the degree to which the discs are replenished diminishes as we grow older and the shrinkage becomes a permanent condition.
This condition leads to a decrease in muscle tension. In response, the lumbar spine arches forward (i.e. the hollow of our backs becomes more pronounced), effectively creating additional loading for itself. This can cause a core pain that radiates outward in the shape of a belt.

The lumbar spine also defines an area in which movement extends from the rump into the legs. The muscles involved here include the iliopsoas and the adductors. This is why it is necessary to consider the hips and the legs when arriving at a diagnosis.

With time, continual stress and strain can lead to serious disc injuries. The lumbar spine is the most common site of disc herniation. When a disc herniates or ruptures, a part of it presses out against one of the large nerves in the spine, causing intense pain that often radiates down into the legs.

One type of back pain that was only recently detected is referred to as discogenic pain. This type of pain is thought to arise when the lumbar intervertebral discs begin to deteriorate and when blood vessels and nerves grow into the disc tissue, resulting in an increase in the internal pressure.
Summary: while the causes of back pain are as various as they are complex, they are usually related to degenerative processes that occur in connection with wear and tear.

The Most Common Spinal Diseases

Each of these various conditions may cause back pain, and may occur in combination with others. Some of the conditions can trigger very complex pain responses, with pain occurring simultaneously in the back, legs, buttocks and chest.

Risk Factors
The chances that an individual will one day suffer from serious back pain are influenced by several factors. Genetic disposition, inappropriate posture, repetitive motion and obesity can play a role. A lack of physical activities is almost always involved because the spine is supported by the muscles in the back and stomach. If these groups of muscles are too weak, then back pain will be virtually unavoidable.


Diagnosis and Treatment
The first thing to do is arrive at a diagnosis by investigating the possible causes. This begins with a comprehensive orthopaedic examination. X-rays, computed tomography (CT scans), and magnetic resonance imaging (MRI) may be deployed to confirm or rule out any findings. Neurological examinations may be necessary in individual cases. Other accompanying factors such as rheumatic conditions or other diseases will also have to be taken into consideration.

In close consultation, you and your doctor will then select a form of treatment that best accounts for your specific needs. Conservative treatment, including pain therapy, physiotherapy, acupuncture or the provision of orthopaedic aids is appropriate in most cases. However, if conservative treatment proves ineffective, then proven invasive or surgical procedures are available: