Back Pain - Types, causes, symptoms, diagnosis and treatments


Background


Back pain is very common problem and has affected many of us at some point during our lives lately. It can influence people of any age, for different reasons. People take plethora of precautions to prevent back pain but the back pain issues are never ending.


Moreover back pain is not serious issue as it might just be caused by a simple strain to a muscle or ligament and can be easily handled with few changes in lifestyle, stretching exercises and medications. But people make fuss of such minor issue and end up taking too many medicines unnecessarily. So as far as possible, it’s best to continue with normal everyday activities and to keep moving without focusing on minor back pain issues. Thus, staying active will help you get better.

Introduction


The spine, which is also called the backbone or spinal column is one of the strongest parts of the body and gives us a great deal of flexibility and strength. It’s made up of 24 bones, known as vertebrae, one sitting on top of the other.


These bones have discs in between and lots of strong ligaments and muscles around them for support. There are also the bones in the tailbone at the bottom of the back, which are fused together and have no discs in between. The structures remain strong but it’s usual for your back to get stiffer as you get older.


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Back Pain Facts and Statistics

  • Low back pain is the single leading cause of disability worldwide, according to the Global Burden of Disease 2010.

  • Back pain is one of the most common reasons for missed work.  In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.

  • One-half of all working Americans admit to having back pain symptoms each year.2

  • Experts estimate that as much as 80% of the population will experience a back problem at some time in their lives.

  • Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.

  • Lower back pain costs the US more than $100 billion every year and the back pain facts and statistics show that health care costs due to lower back pain amount to about $50 billion, while lost wages and decreased productivity account for the other half of the sum.

  • Over 50% of people with chronic back pain have sleep problems as chronic pain affects the quality of their sleep.



What Causes Back Pain?


While there are many prospective causes of back pain, many of them actually have no serious underlying causes. In fact, according to Medscape, in over 97% of cases the diagnosis is acute with no specific location. Moreover back is a complicated structure of bones, joints, ligaments and muscles. The sprain in ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain.


Even though there are many different causes of back pain it can often be treated and managed. Lifestyle changes such as learning to lift heavy objects carefully, sleeping in a back-friendly position and maintaining a healthy weight can help relieve back discomfort.



Types of Back Pain



Back pain is usually located in 3 specific areas of your back: neck (cervical region), upper back (thoracic region) and lower back (lumbar region).


The pain located at the top of the back or in the neck bones (cervical spine) is known in medical terms as cervicalgia. If the pain is located in the lower back, around the lumbar vertebrae, it is called lumbar or lower back pain. Finally, if the pain is located in the middle of the back around the thoracic vertebrae, it is referred to as thoracic or middle back pain.


types of back pain








1. Cervicalgia (neck pain)


It is pain felt in the cervical spine that generally occur anywhere in the neck, from the bottom of your head to the top of your shoulders.


Causes

  • A sports injury or motor vehicle accident.

  • Whiplash or neck strain may cause microscopic tears in the neck muscles, resulting in tightness and swelling.

  • Stress can lead to exhausted, overworked muscles and is another common cause of cervicalgia.

  • Neck pain may also be caused by kyphosis, also known as cervical posture syndrome, which often affects cyclists, baseball catchers, and bodybuilders.

  • Bone conditions, such as arthritis or osteoporosis these conditions are more common in older people, age is a risk factor for cervicalgia.

  • Diseases or conditions that affect the spine, such as spinal infections or meningitis.


Symptoms -

  • Stiffness in neck muscle

  • Muscle tightness and spasms

  • Decreased ability to move your head

  • Headache

  • Nausea

  • Burning or aching sensation in the neck and upper back

  • Numbness, tingling, or weakness in the arm


Diagnosis and Treatment


Most neck pain improves gradually with home treatment but if neck pain

  • Is severe

  • Persists for several days without relief

  • Spreads down arms or legs

  • Is accompanied by headache, numbness, weakness or tingling then its mandatory to consult cervical spine specialist to diagnose your neck pain by performing a physical exam and asking questions about symptoms and any injuries, illnesses or activities that might have been cause the pain. And specialist also check for tenderness, numbness and muscle weakness, as well as see how far you can move your head forward, backward and side to side.


In reviewing the medical history, the doctor will note the location, intensity, duration, and radiation of the pain. And check if the pain worsened or improved with turning or repositioning of the head? Any past injury to the neck and past treatments are noted. Aggravating and/or relieving positions or motions are also recorded. The neck is examined at rest and in motion.


Finally after examination the doctor will recommend strong painkiller medicines with muscle relaxants and tricyclic antidepressants for pain relief for few weeks and if the condition is not improved then doctor will recommend -

  • X-ray

  • MRI

  • CT

  • EMG ( electromyography )

  • NGV ( Nerve conduction velocity test )

  • Blood tests


After diagnosing the main issue concerned with neck pain the doctor will recommend few pain relief techniques for relaxing nerve muscle. They are as follows -


Physical therapy - A physical therapist can teach you correct posture, alignment and neck-strengthening exercises to ease pain.


Transcutaneous electrical nerve stimulation (TENS) - It is a electrodes placed on your skin near the painful areas deliver tiny electrical impulses that may relieve pain.


Traction - Traction uses weights, pulleys or an air bladder to gently stretch your neck provides relief of some neck pain, especially pain related to nerve root irritation.


Short-term immobilization - It is a soft collar that supports your neck may help relieve pain by taking pressure off the structures in your neck. But not recommended to use for more than three hours at a time or for more than one to two weeks to avoid further complications.


Yoga poses for neck




















2. . Thoracic or middle back pain


middle back pain

Middle back pain (also known as thoracic back pain) is when the pain is above the bottom of your ribs (about where your waist sits) between your shoulder blades and below your neck.


This pain may be a dull, constant ache or a sudden, sharp pain that makes it difficult to move around. It is a pain felt in the middle of the back up to the base of the neck, around the thoracic vertebrae.



The thoracic spine, which acts as a support structure for the rib cage, is made up of vertebrae that are less mobile than the others, and any problem in this area can cause pain and/or feelings of stiffness or restricted movement.



Symptoms


  • Minor injury or even just heavy lifting in people with 'thinning' of the bones (osteoporosis).

  • Age under 20 or over 50 years when the pain first starts.

  • A history of cancer, drug misuse, HIV infection, a condition that suppresses your immune system (immunosuppression) and use of steroids for a long time (about six months or more).

  • Unexplained weight loss.

  • A recent infection by a germ (bacterial infection).

  • Pain that is accompanied by severe stiffness in the morning.

  • Changes to the shape of the spine, including the appearance of lumps or bumps.

  • Pins and needles, numbness or weakness of the legs that is severe or gets worse over time.

  • Repeating a movement persistently that involves the thoracic part of the spine (as in sport or work): also called overuse injury.

  • Sitting or standing in a slouched position over time.

  • Redness, warmth or swelling of the back


Causes


Injury is one of the most common causes of middle back pain. Injuries can include herniated discs, sprains, or more serious fractures. And if you are experiencing middle back pain, it is very likely the result of some physical or external trauma to this part of your back.


Middle back pain can also be caused by

  • A wide variety of conditions like poor posture i.e. sleeping in compromised positions or slumped back while working on computer can give you middle back pain that can be tough to beat without changing your habits and environments in some way.


  • Due to diseases like Osteoarthritis and Degenerative Disc diseases. These diseases are known to contribute discomfort in middle region. Additionally, middle back pain can be a symptom of gallbladder disease and even have chances of heart attack (this heart attack symptom is experienced more often by women).


Diagnosis and Treatment


1. Address the Pain

If you are experiencing middle back pain that is not very severe or constant, you can try applying heat or cold. Heating pads will help soothe stiffness and soreness, while ice can help reduce swelling.


If home remedies does not work well then a doctor can help you identify what specifically is causing pain in your middle back or refer to specialist who can diagnose or at least eliminate common causes of middle back pain.


2. Physical Therapy

A physical therapist can help guide you through exercises that will help strengthen weakened back muscles to stop future injuries or stress from overuse.


3. Remove Obstacles to Good Posture

The furniture in which you spend the most time should be as ergonomically supportive as possible to maintain good posture. So invest in a good office chair at work and play with the configuration of your desk and computer.


If these above noninvasive treatments don’t help your middle back pain, your doctor may recommend surgery. And recovery from surgery can take several months.

Some possible surgeries include: Laminectomy, Laminotomy and Diskectomy


Yoga poses for middle back pain














3. Lower back pain



It is pain felt in the lower part of the back which starts below the ribcage which is called the lumbar region and is mostly caused by sudden or prolonged movements, or by staying in the same position for too long. It is the most common type of back pain.




There are two types of lower back pain. They are -


  • Non-specific low back pain - This is the most common type of back pain and are classed as nonspecific as its not clear what is actually causing the pain and the severity of the pain can vary from mild to severe. This is the type of back pain that most people will have at some point in their lives.


  • Sciatica (nerve) root pain - Nerve root pain means that a nerve coming out from the spinal cord is irritated or pressed on. Pain is felt along the course of the nerve. Therefore, you typically feel pain down a leg, sometimes as far as to the calf or foot. And this pain in the leg or foot is often worse than the pain in the back.

Sometimes the pain in lower back can accompany with inabilities in bowel and bladder function (usually inability to pass urine), numbness in the saddle area (around the back passage (anus)) and weakness in one or both legs which is rare disorder named as Cauda equina syndrome.


Causes

  • Muscle or ligament strain due to heavy lifting or a sudden awkward movement by unknowingly straining back muscles and spinal ligaments.

  • Bulging or ruptured disks due to bulge or rupture and press on a nerve. However, you can have a bulging or ruptured disk without back pain. Disk disease is often found incidentally when you have spine X-rays for some other reason.

  • Arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis. In simple words inflammation of the joints.

  • Fibromyalgia is long-term pain and tenderness in the joints, muscles, and tendons.

  • Spondylitis which is inflammation of the joints between the spinal bones. It is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause of the condition, the location and rate of degeneration is specific to the individual.


Symptoms

  • Stinging, burning pain that moves from the low back to the backs of the thighs, sometimes into the lower legs or feet and can include numbness or tingling (sciatica)

  • Muscle spasms and tightness in the low back, pelvis, and hips

  • Difficulty standing up straight, walking, or going from standing to sitting

  • This can cause an inability to plantar flex the foot. In simple words body is unable to stand on the toes or bring your foot downward.


Diagnosis and Treatment


A doctor will initially use palpation hand technique along the low back to locate any muscle spasms or tightness, areas of tenderness, or joint abnormalities. And usually doctor will be able to diagnose nonspecific low back pain from the description of the pain shared by patient and by examining patient.

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Therefore, in most cases, no tests are needed as some doctors argue that tests can actually do more harm than good when the diagnosis is nonspecific low back pain.


However, on the basis of initial examination doctor likely to include -

  • A motor exam, which involves manual movement of hip, knee and big toe extension and flexion (movement forward and backward) as well as ankle movement.

  • Range of motion test which means bend or twist in certain positions to look for positions that worsen or recreate pain and mainly to check if certain movements are limited by discomfort.

  • Reflex test to evaluate weakened reflexes and decreased muscle strength to check nerve root responds or not.

  • Leg raise test in which patient is asked to lay on the back and raise one leg as high and as straight as possible to recreate low back pain to suspect any herniated disc related issues.


Yoga poses for relaxing lower back pain













Risk factors for developing any type of back pain are -


  • Age - Back pain is more common as you get older, starting around age 30 or 40.

  • Lack of exercise - Weak, unused muscles in your back and abdomen might lead to back pain. So regular exercise for 30-45 minutes is sufficient to prevent sedentary lifestyle.

  • Excess weight - Excess body weight puts extra stress on your back. So reducing weight is best option to prevent back pain.

  • Diseases - Some types of arthritis and cancer can contribute to back pain. If routine has regular exercises and healthy diet then body will be less prone to any type of disease.

  • Improper lifting - Using your back instead of your legs can lead to back pain. If you are new to lift any heavy weights then avoid or learn to lift it.

  • Psychological conditions - People prone to depression, anxiety or any mental disorder appear to have a greater risk of back pain. So practice meditation daily to be mentally strong and stable.

  • Smoking - Smokers have increased rates of back pain. This may occur because smoking prompts more coughing, which can lead to herniated disks. It can also decrease blood flow to the spine and increase the risk of osteoporosis.


Prevention


You might avoid back pain or prevent its recurrence by improving your physical condition and learning and practicing proper body mechanism by following below tips -


1. Exercise regularly with low-impact aerobic activities and all those activities that don't strain or jolt your back which increases strength and endurance in your back and allow your muscles to function better.


2. Build muscle strength and flexibility by medium intensity workout like lifting weights. working with resistance bands, climbing stairs, hill walking, cycling, dance, push ups, sit ups and squats.


3. Maintain a healthy weight as being overweight strains back muscles.


4. Quit smoking as smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. It also increases the risk of osteoporosis and impedes healing & increases risk of low back pain.


5. Use your body properly like

  • Stand smart as good posture can reduce the stress on back muscles. Don't slouch. maintain a neutral pelvic position. If you must stand for long periods, place one foot on a low footstool to take some of the load off your lower back.

  • Sit smart by choosing a seat with good lower back support, armrests and a swivel base. Placing a pillow or rolled towel in the small of your back can maintain its normal curve. Change your position frequently, at least every half-hour.

  • Lift smart or avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight with no twist and bend only at the knees. Hold the load close to your body. and then lift any heavy equipment.



Myths about back pain



1. Always Sit Up Straight

We know slouching in chairs is bad for your back. However, sitting up too straight and still can also irritate your back. For relief of back pain from prolonged sitting, intermittently try leaning back in your chair with your feet on the floor with a slight curve in the low back or walk around for few minutes.


2. Don't lift heavy objects

It is ok to lift heavy objects but when lifting, it's the way you lift is most important, not just the weight you are lifting. When lifting, try to be as close to the object as possible and be in squat position to lift i.e. in simple words use your legs to lift and dont torque your body or bend during the lift.


3. Bed rest Is always best

Bed rest can help an acute back strain or injury. But it is not true that you should stay in bed to relax back as sometimes remaining immobile in bed can actually make back pain worse. Doctors today are more likely to recommend moderate body stretches, simple activities with less exertion as you heal from back pain.


4. Pain Is caused by Injury

Yes its true, if you lift heavy objects at work routinely, you are more likely to have back pain. Posture and the weight of the things you carry certainly can cause or exacerbate your pain. But workers with sedentary jobs are actually more prone to disk injury than those who are moderately active at work.


According to many different studies related back pain it was found that 85% of people who have back pain can't recall a specific moment when it occurred which suggests many other things are more likely to cause back pain than injury, such as disk degeneration, infections, and conditions that are inherited, such as ankylosing spondylitis.


5. Exercise Is bad for Back Pain

Regular exercise is very good for preventing back pain. Actually, for those with an acute back injury, sometimes a guided, mild exercise program is recommended. This often begins with gentle exercises that gradually increase in intensity.


6. X-Ray, MRI can always find the cause

Machines that can look deep inside your body X-ray, MRI, CT scans don't always work well for back pain. Where your muscles spasm or if your ligaments are strained, it won't show up on one of these imaging tests. That's why a thorough physical examination is often more useful.


7. Applying heat will help a sore back

Applying heat can sometimes worsen inflammation in the joint and surrounding muscles and ligaments. As a rule of thumb, use ice on back injury for the first 48-72 hours, then you should alternate between ice and heat, 20 minutes on 20 minutes off. When in doubt about ice and heat, it is always best to take the advice of your physician.



Conclusion


The prevention tips discussed can prevent back pain for sure. But in some situations back pain might be due to age factor or factors connected to prevailing health conditions of individual. So its necessary to consult physiotherapist for preventing further complications.


Within each type of back pain there is no ‘one size fits all’ treatment approach.

Even after establishing the correct diagnosis, a skilled physiotherapist will work with the patient on a treatment plan focusing on factors driving the specific issue and assisting the patient to cure back pain to some extent.


Indeed! the growing technologies has proved that back pain is curable provided we adhere to all the instructions recommended by doctor to prevent back pain and by opting healthy lifestyle.



Sources


https://patient.info/


https://cornerstonephysio.com/


https://www.spine-health.com/


https://www.mayoclinic.org/


https://www.onhealth.com/


https://www.medicinenet.com/


https://www.omron-healthcare.com/


https://www.acatoday.org/


https://www.versusarthritis.org/