Causes
of back pain
Most
references to back pain focus on lower back pain in the lumbar
spinal region. However, back pain causes in no particular
order are:
A.
Accidents or injuries leaving muscle pain
B. Osteoarthritis with deteriorating cartilage
C. Osteoporosis with bone loss / fracture
D. Fibromyalgia
E. Major conditions like cancer
Muscle,
ligament and tendon problems are generally at the root of
the pain problems along with some weakness in the lower back.
Other body parts in the region can also be associated like
bones
and small joints.
When
no specific cause is apparent, the term NSLBP (nonspecific
low back pain) is used. Any number of reasons for this pain
can
include degenerative disk disease, psychological issues,
systemic
disease, facet syndrome (similar to pinched nerves symptoms),
herniated disk, spondylolisthesis or the forward displacement
of
one of the lower lumbar vertebrae over the vertebra below
it or
on the sacrum. Other factors could be spinal stenosis or
constriction or spondyloarthropathy (disease affecting
spinal
joints).
Let’s
take a look at each of these and what pain relief solutions
are available.
DEGENERATIVE
DISK DISEASE
The
degeneration of vertebral disks is a natural part of the aging
process. What often happens though, is that when the narrowing
of the disk space combines with the nociceptors, sensory receptors
that respond to pain, in the outer annulus (in the disk space
outside the nucleus) or dorsal root ganglion (spinal nerves)
that become heightened, the result can be pain, although not
always. Sometimes pain can be felt by some people, and other
times not. For example a minor accident like missing a step and
landing a little harder than
usual on your feet might cause back pain. And certain
activities
can aggravate degenerative disks, like yard work
or house cleaning movements. But overall, pain associated
with degenerative disk disease generally heals within
a few days at most.
Preventative
measures like strengthening muscle groups to lessen future traumas
are usually recommended along with an analgesic or medication
that helps relieve pain. Only in some cases are epidurals or
injections, blocks or surgery needed.
PSYCHOLOGICAL
ISSUES
If
acute back pain turns into chronic stages, factors of depression,
fear and anxiety could increase discomfort and pain. And the
longer the chronic pain persists, the more these factors tend
to play a role,
an increased role over time. So treatment strategies
may need to include learning coping skills and alternative lifestyle
enhancements to deal with the psychological factors present.
SYSTEMIC
DISEASE
This
disease is the cause for up to 10% of back pain and largely among
the elderly. Causes could be cancer-related or related to reduced
bone mass or simply the aging process. Increasing or decreasing
activities as well as switching positions
all may have no affect on pain relief. Alternative therapies may
be in need.
FACET
SYNDROME
Similar
to pinched nerves symptoms, this is believed to be associated
with pain in the back’s side
joints and the main cause of up to
20 percent of back pain cases, with buttocks and upper leg pain
increasing
with long-term standing, and when switching
sitting / standing / lying positions. An injection of local anesthetic
into the facet joint helps determine the diagnosis. However,
since the anesthetic relieves the pain at the same time and is
used
as a short-term solution, an x-ray
doesn’t
help with imaging the pain results.
Recommended treatment includes rigorous
lumbar activities and body mechanics exercises to learn proper
or more beneficial posture and movement techniques.
HERNIATED
DISK
Also
known as a ruptured or protruding disk, a herniated disk extends
beyond its own area into a surrounding region. Compression of
the nerve root can cause pain. And pressure on the fibers in surrounding
ligaments can cause pain.
Although an accident involving
lifting could be the cause of a
herniated disk, it’s not
necessarily so. For many, the
cause is
unknown; pain can occur suddenly
or gradually over time. Relief
for the pain can come from walking
instead of sitting or standing,
and surgery is rarely required right away, if at all
in the event relief from pain
happens within a limited amount of time.
During
this time (up to several weeks) any of the following might be
effective to
use, depending upon your healthcare provider: medication, physical
therapy or non-frequently,
steroid spinal injections.
SPONDYLOLISTHESIS
or the forward displacement or slippage
of one of the lower lumbar
vertebrae (generally
the
fourth or
fifth) over the vertebra
below it or on the sacrum. This state
of health
is diagnosed
by x-ray.
Pain is
believed to
occur where
the displacement is, at or
below the displacement, or from
spinal stenosis,
discussed
next.
Depending
upon the
patient, strengthening
exercises or a back support
may be all that’s required.
In others, surgery may
be an option.
SPINAL STENOSIS
This
is the constriction or narrowing of the vertebral canal. Mainly
due to aging, as the
gradual lessening
of disk space and changes
in ligaments advance
upon the
nerve roots below the
lumbar vertebra or L2, pain can result.
It’s
often accompanied by
numbness in the legs
and is not
aided
any by walking. Different
vertebra and varied physical
activities
can affect the pain’s
location, intensity,
recurring and duration.
To
help diagnose this condition, healthcare
providers
can use myelography,
or an x-ray of the
spinal cord after
injection of air or
a radiopaque substance
into the subarachnoid
space, with a post-CAT
scan. And depending upon the
patient, treatments
can vary and be minor
with medication if the pain
gradually disappears,
to epidural corticosteroid injections
in the epidural, to
blocks or surgery.
SPONDYLOARTHROPATHY
This
term refers to a variety
of diseases affecting
spinal joints; arthritis
variations-
psoriatic arthritis
and ankylosing spondylitis, the
more common of
the two and in males more
often than women;
and sacroiliitis,
accompanies inflammatory
bowels. Diagnosis consists
of a physical
exam, history and
testing including x-rays,
CAT or MRI, as
the disease progresses
slowly long-term fusing
sacroiliac joints
together and joints
between vertebrae together. To relieve
pain, there is
treatment with exercises and physical therapy
to promote better
enhanced posture and mobility and
some arthritic
medications.
Written by Shelley
Hitz, Licensed
Physical Therapist
and Certified
NASM Personal Trainer. Sign up for her
free Exercise
Advice journal
at http://www.abs-exercise-advice.com/journal.html or read
more
of her articles
at http://www.abs-exercise-advice.com.
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