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Back painPain back

Our backs are complex structures which are involved in virtually every move we make, so it's hardly surprising that back pain is so common. In fact, doctors see more patients for back pain than any other ailment

Eight out of ten of us will suffer from pain or aching in the back at some time in our lives. Lower back pain is most frequent between the ages of 35 and 55 and it is responsible for more lost days at work than all the other causes put together.


There are so many different causes of back pain that it's often hard to pinpoint a single factor. In the first place, walking on two legs instead of on all fours, as our ape ancestors did, means that a lot of extra strain is put on the spine.

Other factors are involved too. If your job requires heavy work; being in the same position for long periods of time; lots of bending, twisting and lifting; or repetitive movements or having to stoop, you are likely to experience back pain. Manual workers, office workers, nurses, drivers, mothers of small children and the elderly are all at risk. Even something as simple as poor posture can give you aches.

There are several physical causes of back pain. A nerve trapped between two vertebrae can be very painful, as can arthritis in the spinal joints. Inflamed or strained muscles or tendons, restricted joints and problems with the ligaments can all cause discomfort.

Stress can contribute to back problems and, if your back muscles are tense, you are more likely to injure your back. Illnesses can also be responsible, such as shingles, gynaecological and kidney problems and, very rarely, cancer.

Most causes of back pain are not serious. In fact, in nine out of ten cases, no single cause of the pain can be found, and doctors refer to the pain as 'non-specific'.

Your back is made up of some 50 bones, 100 joints, 1,000 muscles and 1,000,000 nerves. The spine itself is rather like the central pole of a tent, supported by ligaments and muscles which act as guy ropes. If these become tense or distorted, they pull on the 'pole' and make the back ache.

The spine itself consists of 24 small bones, or vertebrae, stacked one on top of the other. Because of the way our bodies are made, the vertebrae in the lumbar, or lower, region take the most strain, which is why low back pain is so common.

The vertebrae are joined in front by an intervertebral disc - a tough fibrous ring containing a jelly-like substance which acts as a shock absorber. Pressures on the disc caused by moving incorrectly are among the biggest causes of back pain. In fact, even simple things like reaching up to a high shelf can place extra pressure on the discs in the lower back and cause pain.

The vertebrae are joined behind by a pair of small joints, called posterior vertebral joints, which help the body in weight-bearing and also help us to move. When we move, the surfaces of these joints are pushed together, pulled apart, angled to each other or slid across each other - all of which can put strains on different parts of the spine. Pain can occur if anything interferes with these joints.

The joints in turn are held together by a network of ligaments -- tough bands of fibre which hold the bones together -- and a series of 'facet' joints. Each joint is surrounded by muscles and tendons -- the 'ropes' which attach the muscles to the bones.

The spinal cord runs through a hole in each of the vertebrae. The body's nerve roots are attached to the cord, which is an extension of the brain. Pressure on the cord, for example from a damaged disc, can cause pins and needles, acute pain, and, in extreme cases, paralysis.


To determine the cause of the pain, the doctor will examine your back thoroughly and will feel down your spine. He may apply firm or gentle pressure to ascertain the source of the pain and any tender areas. He may also recommend that you have an X-ray, which can detect any abnormalities in the vertebrae. However, an X-ray won't show up the muscles or ligaments, which may be the root of the problem.

Back pain is complicated to diagnose because problems in the spine can lead to referred pain -- pain elsewhere in the body. Spinal problems, for example, can produce symptoms such as chest pain, which can be mistaken for other illnesses, such as heart disease. Other symptoms such as dizziness and ringing in the ears can also originate in the spine, particularly after a whiplash injury.

Pain from the neck and upper back may be referred down the arm and shoulder, between the shoulder blades or to the chest, abdomen or lower back.


Pain from the lumbar spine may be referred to the buttocks, coccyx and to either or both legs, causing sciatica -- pain that radiates along the sciatic nerve which runs from the buttock to the ankle.

Back pain can be acute, which means coming on suddenly, or chronic, which means constant or recurring. By and large, acute back pain is linked to injury, such as dislocated disc, torn ligament or pulled muscle. Chronic back pain is often the result of poor posture.

Most cases of back pain resolve themselves with no treatment at all. In cases of acute severe back pain, the doctor may suggest pain-killing drugs plus a short period of bed rest. However, most experts now agree that the sooner you can get moving the better. In severe cases, the doctor may also suggest tranquillizers, anti-inflammatory drugs or strong pain-killing drugs.

In selected cases, physiotherapy can help to relieve back pain. Physiotherapists can give heat and cold treatments and usually offer a range of electrical treatments such as shortwave diathermy, ultrasound and interferential treatment. TENS (Transcutaneous Electronic Nerve Stimulation), which involves applying a mild electrical current to certain points on the back to block pain messages, can be very helpful in some cases.

Physiotherapists may also perform manipulation and massage and suggest exercises to help strengthen your back. Wearing a collar or a corset can give support.

Surgery is much less often recommended nowadays, except in very severe cases, or where there is a specific known cause that can be corrected by surgery. Rhizolysis and rhizotomy, which involve killing some of the nerve endings, help some people.

Another alternative is nerve root surgery, where the nerve supply to a particular area of the back is cut altogether. Surgeons can also remove disc material which may be pressing on nerves and causing pain. However, surgery should only be considered as a last resort, since it can be risky and may worsen the symptoms.

Some of the most successful treatments for back pain are chiropractic and osteopathy. The theory behind both of these therapies is that misalignments of the spine can cause pain and problems elsewhere in the body. A chiropractor specializes in the spine, while an osteopath deals with the whole skeleton.

The therapist diagnoses the source of pain and then twists, presses or pulls to correct the alignment and restore normal function. Soft tissue work - massaging the muscles around the spine - may also be performed.

Acupuncture has been used with notable success. The acupuncturist takes a full history of your symptoms and inserts sterilized needles into points on your body. The aim is to restore physical harmony and so treat the pain.

The Alexander technique is a method of postural realignment. Teachers believe that almost all of us hold ourselves incorrectly. Learning how to move, stand and sit as we go about our daily lives can relieve strain on the back and so relieve pain.


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