What is Back Pain?

Back pain is a very common complaint and it is believed that about 85 % of general popu-lation will have at least one episode of back pain in their lifespan. Commonly the back pain is noticed in lower back Lumbar spine ,however pain in mid back, upper back and in neck is also as common as low back pain.

The etiology /cause of back pain is multifactorial, there is no evidence to prove /disprove the quantitative effect of one or other. The risk factors for low back pain can be ;- Muscular sprains and strains, strenuous life style , stressful movements: bad posture , lifting some-thing without using proper techniques or a sudden twisting motion are just two examples of how you can hurt your back. Obesity oblivious nutrition and improper ergonomics.

Back pain is also caused by a specific spinal conditions like …………………Depending on the severity of pain and its cause, one may require more involved medical help, such as physical therapy or even surgery.

Our Spine or backbone, also called your vertebral or spinal column, has a unique structure in a way that it not only gives structural support to take bodys weight but also imparts mo-bility to human body and also protects the spinal cord and nerve roots in spinal column .It is made up of 33 vertebrae (bones) kept one over the other separated by shock absorbers , also called disc ,and linked to each other by joints called facet joints. In between they give way to nerve roots and spinal cord travelling from brain to lower limbs. This structure is a continum from neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). To sacrum and the coccyx, which is commonly called your tailbone ,connecting head to pelvis and imparting mobility of different types (rotation , flexion, forward bending , extension , strecthing , side bends etc) in different segments of spine.

Bones or vertebrae in neck are labeled C1 to C7, seven vertebrae in neck region. Also there are 12 vertebrae in the thoracic spine named as T1-T12, connecting shoulders to your wais with five vertebrae in low back L1-L5 lumbar region/ lumbar spine and below liles sacrum made up of five fused vertebrae connecting lumbar spine to hip bones. The coccyx tail of your spine and attached to sacrum (hence the tailbone).

Intervertebral discs act like pads or shock absorbers for spine and is made up of a tire-like outer band called the annulus fibrosus and a gel-like inner substance called the nucleus pulposus. Facet joints are on the posterior side (back) of your vertebrae. These joints (like all joints in your body) help movement and are very important for flexibility.

Together, the vertebrae and the discs provide a protective tunnel (the spinal canal) to house the spinal cord and spinal nerves.

Spine also has muscles, ligaments, tendons, and blood vessels. Muscles are tissues that act as power generators for movement. Ligaments are the strong, flexible bands of fibrous tissue that link the bones together, and tendons connect muscles to bones and discs. These parts all work together to help you move.

Back pain may be a result of injury to any or all of these body parts. Injury to the muscles, ligaments, tendons can result in sprains or strains, which are generally not considered se-rious. However, injury to bones, nerves may be more serious. However the most common cause of back pain is due to wear and tear causing tears or cracks in outer layer of the of intervertebral disc causing low back pain or neck, allowing nucleus pulposus gel to to bulge out. This process of wear and tear related changes in spine is called degenration or spondylosis

Low back pain / neck pain – type character , duration, recovery and natural course depend on what is causing pain and where it is affecting your spine.The common complaints asso-ciated with back pain are , morning stiffness, spasms , pain in flanks , difficluty in sitting , forward bending and pain with prolonged sitting or performing ground level activities . Diffi-culty in walking and lieing down also is a common presentation . Associated symptoms with back pain are leg pain , numbness in legs , weakness in legs , difficulty in passing urine or motion and difficulty in walking. Back pain may be acute or chronic. Acute means sudden onset pain with duration less than four to six weeks, but chronic pain is persistent, long-term pain and chronic pain can have episodes of acute pain. Back pain may be sud-den and sharp—or it may be dull. Pain may occur with movement, and it may even occur with coughing and sneezing.

Seek medical attention if your back pain persists—and seek immediate attention if you have back pain with any of the following emergency signs :

• Pain is getting significantly worse
• Pain affects every day activities
• Severe symptoms
• Groin or leg weakness or numbness
• Arm or hand weakness, tingling, or numbness
• Loss of bowel or bladder control

There are a variety of causes of back pain, it's vital to know the exact cause of your pain .Some common causes of back pain include :

• Aging : Ligaments thicken and discs dry out with age, and discs can lose their normal struc-ture and function. These age-related changes in the spine may lead to disorders that create pressure on your spinal nerves with symptoms such as pain, numbness, or weakness. Degenerative disc disease is an example of an age-related spinal disorder.The bulging or herniated disc can push on a nerve, causing pain that travels to another part of your body. For example, a herniated disc could push on a nerve in your low back and send a shooting pain down your leg (also known as sciatica You can experience cervical radiculopathy, which affects your arms mainly, or lumbar radiculopathy, which affects your legs.
• Daily Life : Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Poor posture—standing for long periods of time or sitting in-correctly—can cause back pain , heavy physical work, lifting or forceful movement, bending or twisting, or awkward positions can really hurt your back. Gardening, ten-nis, horseback riding, biking, and even golf can all potentially hurt your back.
• Injuries and Accidents : fracture in spinal bone in a fall or a car accident. If you have osteoporosis, a condi-tion that weakens your bones, you're much more prone to fracturing a bone.
• Obesity : Being overweight puts pressure and stress on the back, especially the low back. Plus, carrying excess weight aggravates other health conditions such as osteoporo-sis (weak bones), osteoarthritis (joint pain), rheumatoid arthritis (an autoimmune disease), degenerative disc disease (described above in the aging section), spinal stenosis, and spondylolisthesis.

Physiotherapy has major role in treatment and recovery of back pain It teaches how to condition your body to prevent further injury and help in recovery of painful episode . There are a variety of physical therapy techniques. Passive and active treatments Passive treat-ments relax your body and include deep tissue massage, hot and cold therapy, electrical stimulation (TENS), and hydrotherapy.

Active treatment involves active stretching and strengthening exercises trunk stability , core strengthening

• Deep Tissue Massage : Deep tissue massage relieves deep muscle tension and spasms, which develop to prevent muscle motion at the affected area.
• Hot and Cold Therapy : Both hot and cold therapies offer their own set of benefits, and your physical therap-ist may alternate between them to get the best results. This reduces inflammation, muscle spasms and pain.
• Hydrotherapy : Gently relieves pain and relaxes muscles.
• TENS (transcutaneous electrical nerve stimulation) : Uses electrical current to stimulate your muscles and reduces muscle spasms and is generally believed to trigger the release of endorphins, which are your body's natural pain killers.
• Traction : Reduce the effects of gravity on the spine. the intent is to reduce the disc herniation and is usually performed in the cervical or lumbar spine.

Active Treatments :Help to reduce recurrent pain but will also benefit your overall health.

Core stability :Many people don't realize how important a strong core is to their spinal health. Your core (abdominal) muscles help your back muscles support your spine. When your core muscles are weak, it puts extra pressure on your back muscles. Your physical therapist may teach you core stabilizing exercises to strengthen your back.

Flexibility : Learning proper stretching and flexibility techniques will prepare you for aerobic and strength exercises. Flexibility helps your body move easier by warding off stiffness.

Muscle strengthening :

Drugs, Medications, and Spinal Injections to Relieve Back Pain : Medication alone is not the ultimate solution to your back pain, however during emergency or during severe pain these medicines may help you curb the suffering.

Acetaminophen : Your doctor may call this an analgesic, but most of us refer to acetaminophen medications as painkillers. They don't help reduce inflammation, though.

NSAIDs (non-steroidal anti-inflammatory drugs) : These will help reduce swelling (or inflammation) while relieving your pain; that's how NSAIDs differ from acetaminophen. If an over-the-counter NSAID is an option for you, you have plenty to choose from. You can use ibuprofen, aspirin; however seek medical advice before you take any medicine.

Muscle Relaxants : If you have chronic back pain caused by muscle spasms, you may need a muscle relaxant, which will help stop the spasms.

Anti-depressants : As surprising as it may seem, anti-depressants can be effective drugs for treating pain be-cause they block pain messages on their way to the brain. They can also help increase your body's production of endorphins, a natural pain killer.

Opioids : In the most extreme cases, and only under careful supervision, you doctor may also pre-scribe an opioid, such as morphine or codeine.

Medication Warning : As with all medications, you must follow your doctor's advice precisely. Never mix over-the-counter and prescribed drugs without consulting your doctor.