• Shruti GOCHHWAL

Back Pain

Back pain is a common yet complex condition. An estimated 540 million people are suffering from Back Pain Worldwide.

The causes of Back Pain vary in different people which results in making the treatment challenging. However, Back Pain is treatable and there are various forms of treatment available.

To understand the causes of Back Pain we first need to understand its structure.

Anatomy of the Back

The Back consists of the Human Spine which is also called the Backbone. It is made up of 24 bones called vertebrae which are sitting on top of each other.

The vertebrae have discs between them and are surrounded by a network of ligaments and muscles for support. The spine has a network of joints on either side called facet joints.

Additionally, the lower part of the back has bones that fuse together to form the tail bone. This complex network can be affected by various phenomena that result in Back Pain.

Types of Back Pain:

  1. Acute Back Pain: The duration of this pain lasts a few days to a few weeks. It usually does not require treatment and resolves on its own. In most cases, there is no loss of function and day to day activities can be done with mild discomfort.

  2. Chronic Back Pain: If pain in the back continues for more than 12 weeks it is called Chronic Back Pain. 20% cases of acute back Pain are converted to Chronic even after the initial treatment.

  3. Back pain is also classified based on the point where the pain is felt. It is classified into Lower Back Pain and Upper Back Pain.

Causes of Back Pain

Most cases of Back pain are due to mechanical factors. However, various non-mechanical factors can also cause Back Pain.

1) Injuries

Injuries include the following:

  1. Sprain: Tearing of ligament(s) is called a sprain.

  2. Strains: Tears in Tendons or muscles.

  3. Muscle Spasms: Sudden Contraction of a muscle or a muscle group is defined as a muscle spasm.

  4. Posture: Use of incorrect posture can cause damage resulting in Back Pain

  5. External Trauma: This refers to extreme conditions that can physically hurt the back. Car accidents and Sporting injuries come under this category.

2) Degenerative Conditions:

Degenerative Problems are mostly observed in people who are involved in Physical Labour. Lifting heavy things constantly over a long period of time can result in Degenerative Conditions. Construction Workers are the most common victims of back pain caused by degenerative conditions. Some degenerative conditions are:

  1. Arthritis: It is the inflammation of one or more joints causing stiffness and pain. Two types of Arthritis are known to cause back pain, Osteoarthritis and Rheumatoid Arthritis.

  2. Spondylosis: Degeneration in the spinal cord which occurs due to the everyday functioning of the body. It is essentially mechanical wear and tears.

3) Back Pain During Early Pregnancy

Back Pain during early Pregnancy is common and felt by most pregnant women. There are two causes for this:

  1. Mechanical Stress: When the Foetus is inside the abdomen, the normal lumbar curvature of the back changes. This results in additional mechanical stress which causes discomfort and Back Pain.

  2. Hormonal Changes: During pregnancy, the levels of hormones increase in the female body. Two of these hormones Oestrogen and Relaxin can cause Back Pain during early Pregnancy.

4) Spinal Cord and Nerve Problems

  1. Herniated or Ruptured Discs: This condition refers to the state when a soft centre of a spinal disc pushes through a crack in the tougher outer casing. All Ruptured discs do not require treatment.

  2. Radiculopathy: Radiculopathy is also called Sciatica. It is a radiating pain that originates along the sciatic nerve. It moves through the buttocks and goes down either one or both legs.

  3. Spinal Stenosis: In certain cases, the Spinal Cord narrows which increases pressure on the spinal cord and nerves.

  4. Cauda Equina Syndrome: This is an extension of a ruptured disc. If a ruptured disc pushes into the spinal canal, it reaches the nerve roots and presses on them. This is a very serious condition and can result in neurological damage if left untreated.

  5. Osteoporosis: It is a condition in which the bones in the body become week and brittle often resulting in repetitive fractures.

5) Back Pain due to Gas

Gas is a very common condition which results in the sufferer feeling bloated. In some cases, bloating is also accompanied by pain which can radiate to the back. Back Pain due to gas is a common condition and, in most cases, it is accompanied by bloating.

It is caused due to GI disturbances. However, reoccurring Back Pain due to Gas can be a sign of a stomach virus.

6) Other Causes:

  1. Tumours: In certain cases, tumours grow on parts of the spine. These tumours can cause severe back pain.

  2. Fibromyalgia: It is a disease in which the patient suffers from widespread musculoskeletal pain along with fatigue.

  3. Kidney Stones: Kidney Stones are known to cause sharp pain in the back on the side on which they are present.

In these cases, the treatment of the underlying conditions is done, and it results in relief from back pain.

Factors which Contribute to the development of Back Pain

  1. Age: People above the age of 30 are more prone to back pain. As age increases, the wear and tear to the back also increase which results in increased levels of Back Pain.

  2. Weight problems: Being Overweight puts you at a much higher risk of developing back pain. Higher weight puts more mechanical strain on parts of the back which increases the chances of developing Back Pain.

  3. Genetic Factors: Certain genetic factors such as the presence of Genetic diseases increase the likelihood of Back Pain.

  4. Job Profile: There are some job profiles that require physical labour. These include construction work, Truck Driving and even jobs that require long consecutive periods of sitting at the same place. People with these job profiles are at a higher likelihood of developing back pain.

  5. Mental Health: Mental health disorders can result in increased or decreased tolerance for pain. This affects the will to seek treatment as well as determining the severity of treatment.

  6. Wrong Technique: The use of wrong techniques in Sport as well as fitness activities can cause severe injuries. Cases of serious injuries in unsupervised fitness activities are increasing.

Diagnosis of Back Pain

The diagnosis is usually done taking the complete history of the patient into account while doing a physical examination. The following tests are available for confirming specific causes of Back Pain:

  1. Bone Scans: Detect bone disorders and fractures.

  2. Electromyography: Assess muscle strength by assessing its electrical activity.

  3. MRI and CT Scan: Used to detect problems in ligaments, tendons and bones.

  4. Discography: It is a confirmatory test used to confirm which disc in the spine is the cause of the pain.

  5. Blood Tests: These are not used often but can be used to check signs of inflammation and cancer.

  6. Nerve Conduction Studies: Used to detect nerve damage.

  7. X-ray Imaging: Xray imaging can show misaligned vertebrae and broken bones.

Credits: Pexels Caption: X-ray equipment being used in diagnosis:

Treatment of Back Pain

Pharmacological Treatment:

These consist of medication prescribed by the doctor. There are different types of medication that a doctor can prescribe for back pain. Some of them are:

  1. Treating the underlying condition: The target is to treat the cause. It is used in back pain where the pain is a result of medical conditions other than mechanical stress.

  2. Analgesics: Analgesics are painkiller drugs. Mostly, non-steroidal anti-inflammatory drugs (NSAIDs) are used.

  3. Opioids: Only used in severe cases under the supervision of Physician.

  4. Other Drugs: Other drugs such as anti-convulsant and anti-depressant have shown effective results in specific conditions. These are only to be used if prescribed by the doctor.

Alternative Treatment

This refers to various techniques and forms of treatment which have shown results in treating back pain.

  1. Acupuncture: It is a traditional Chinese system of medicine. In acupuncture, thin needles are inserted into specific points of the body to treat diseases. It has been moderately effective in Back Pain.

Credits: Pixabay Caption: This is an illustration of the Chinese system of medicine called acupuncture. The needles are stuck into particular spots to treat different conditions. Alt Text: An illustration of an individual being treated on a table.

  1. Chiropractic Treatment: Chiropractic is a pseudoscientific complementary. It is classified as an alternative system of medication that deals with musculoskeletal pain by correcting the alignment of body parts. It is effective in diagnosing the cause of Back Pain as well as in treating it.

  2. Nerve Stimulation: Transcutaneous nerve stimulation is a technique that uses small electric currents to stimulate nerves.

Exercises for Back Pain

Exercise can help treat back pain. The important part while deciding your exercise regimen is to know which exercises to do and which to avoid.

Exercises for Lower Back Pain

The following exercises should be done to relieve back pain

  1. Partial Crunches: Do not attempt full crunches. Partial Crunches will strengthen your core without causing you much discomfort. Perform small, repetitive sets.

  2. Hamstring Stretches: Hamstring stretches are helpful as they strengthen the muscles on the back of the leg. These muscles then help in relieving the pressure of the back.

  3. Wall sits: A wall sit is an exercise in which you lean into the wall until your spine is straight. Follow this by sliding down and bending your knees. Hold this for a few seconds.

  4. Knee to Chest: Knee to Chest helps in treating lower Back Pain as it strengthens the back muscles.

This exercise for lower Back pain is very simple. It involves lying down on the floor of your back. Pull one knee towards your chest while holding the other leg straight and alternate.

  1. Aerobic Exercises: Aerobic Exercises are very helpful for lower back pain.

Credits: Pexels Caption: Aerobic exercises such as this one are helpful in treating lower back pain.

Exercises for Upper Back Pain

The following exercises can help in relieving upper back pain

  1. Opposite Arm Leg Raises: In this exercise, get down on your arms and knees. Stretch your left arm forward and at the same time stretch your right leg back. Alternate arm and leg must be stretched simultaneously. Repeat this with both arms and legs. This is also called bird dog and it strengthens abdominal and back muscles.

  2. Press Up Exercise: A relatively simple yet very effective exercise for upper back pain relief. Lie face down and put your hands under your shoulders. Lift your upper body while keeping both your hips and arms on the ground.

  Credits: Pixabay Caption:  This is the correct method to do a press up exercise. The stretching of the back muscles provides relief from back pain.

  1. Corner Stretch: In this exercise, face the corner of a room. Keep your feet together. Place your forearms on each wall so that they are just above your shoulder. Lean forward and stretch your back. This pose should be held for a few seconds.

There are some exercises which can do more damage to your back. The following exercises should be avoided when suffering from back pain:

  1. Leg Lifts

  2. Sit-Ups

  3. Toe touches

  4. Heavy Weight Training

Belts for Back Pain

There are various kinds of back pain belts available in the market. Some of them are suggested by doctors while others are advertised widely on television. The purpose of Back Pain belts is to hold the stomach in which increases the intra-abdominal pressure.

It was theorized that this would decrease the strain on the spine and prevent as well as treat back injuries. However, this theory is widely disputed and there has not been enough evidence to prove or disprove it.

Another theory says that wearing belts weakens the muscles whose job is to normally support the spine. This becomes a long-term problem. Belts for Back Pain should only be used after consulting a doctor and for short periods.

There are various forms of treatments available for Back Pain and some cases can be treated with self-care methods.

However, if you are suffering from persistent and severe back pain then you should see a doctor who will be able to help you. The most effective treatment for Back Pain is a combination of Pharmacological therapy, exercise and lifestyle changes.

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