Back Pain: Causes and Treatment

  INTRODUCTION

Many of us at some point in our lives have that 'crunch moment' when we lift the shopping the wrong way or twist at the wrong angle. Seconds later we have that sickening pain in the back that shoots through our lower back and sometimes down our leg. We know that we have done it again, and back pain is on its way!

This article is a no nonsense guide to back pain and its treatment. It tells you about the common causes of back pain and what the treatment options are.

At any one time approximately 5% of the population are suffering from back pain, and it is seen as a major socio-economic problem in the world today.

So what are the causes of back pain? The main causes and their treatment are listed below, starting with the most common one.

Figure-1 The Spinal column

Details of the human spinal column
Details of the human spinal column

MECHANICAL STRAIN

  • Back Injury/Muscular And postural Back Pain: The majority of back pain falls into this category. Back injury as a result of an accident is one of the most common causes of pain and usually is caused by lifting heavy objects using a poor posture. Many accidents happen at work, playing sports, carrying a child, heavy shopping or being pregnant (sway back). The pain usually starts suddenly and is often helped by rest. The lower back is particularly vulnerable to mechanical stress in the lower lumber vertabrae (see Figure-1). It can be overloaded suddenly or subject to stress over a longer period of time leading to general muscular or postural pain. Most tissues of the back appear to be able to cause pain, whether it is the muscles, ligaments or intervertebral discs. One particular type of muscular pain can arise from nodules in the muscles (fibrositic nodules) that result from constant local stress and trauma. Treatment: This type of back pain responds well to acupuncture, physical manipulation (osteopathy; physiotherapy) or exercise routines (physiotherapy). Stay as active as you can within pain limits. If you have fibrositic nodules (lumpy regions in the back muscles) then acupuncture is the therapy of choice.

Figure 2. Section of vertebral column

Vertebrae in blue, intervertebral disks in yellow, spinal chord in red.
Vertebrae in blue, intervertebral disks in yellow, spinal chord in red.

 

  • Prolapsed Disc: Between each spinal vertebra lies an intervertebral disc (see Figure-2). In a young person each disc consists of a ball of jelly surrounded by a tough casing composed of a ring of fibres. It is possible for this disc to rupture as a result of lifting, twisting or bending and the jelly-like contents to leak out. If this puts pressure on ligaments or nerves it can give rise to pain, and the person is said to have a prolapsed disc. Symptoms include low back pain, muscle spasms, shooting pains down the legs and into the buttocks and possibly numbness. The symptoms tend to be one sided. As we age the internal jelly hardens and the thick casing becomes stronger so that a prolapse is less likely to occur. Treatment: Acupuncture or electroacupuncture is a safe and effective intervention for this type of back pain, otherwise it is bed rest and pain killers. Do not alow any physical manipulation as this may cause more damage. Your doctor may recommend physiotherapy. If the pain remains severe after 6 weeks then further investigations and surgical intervention may be necessary in the form of a 'discectomy'. 

INFLAMMATORY CONDITIONS

  • Ankylosing Spondylitis: Is a form of chronic inflammatory arthritis which affects joints in the spine resulting in the gradual fusion of spinal segments. The spine gradually becomes more rigid over time. Spondyltis tends to run in families and usually becomes evident in young adults (between the ages of 17 and 35). Symptoms include chronic back pain and stiffness, which is worse for rest and improves with activity. Treatment: This condition can be very effectively managed, particularly if caught early. Regular morning exercises to keep the spine supple and a pain killing regime (non steroidal anti-inflammatories) can be very effective. Acupuncture can be very useful to help reduce pain and keep back muscles supple.
  • Sacroiliitis: This is a painful condition that arises as a result of inflammation of the sacroliliac joint at the base of the spine. Inflammation can arise as a result of arthritis, pregnancy, trauma or other infectious processes. Treatment: Acupuncture, exercise and  non steroidal anti-inflammatories are important approaches.

OTHER CAUSES

  • Spinal Canal Stenosis: Occurs when the central spinal canal through which the spinal chord travels begins to narrow. This can be caused by compression of the intervertebral discs or osteoarthritis. The symptoms include pain radiating down both legs and into both buttocks and numbness when walking. Rest and bending forwards often helps. Treatment: Pain can be treated by acupuncture or drugs (see your doctor). Surgical intervention may be necessary to widen the canal in the case of unremitting pain.
  • Osteoporosis: Results from a loss of bone density or mass, causing bone fragility. Loss of bone density occurs as men and women age. Those in their seventies and eighties are at risk and some women show an accelerated bone density loss in the ten years after the menopause. It is very easy to fracture/break bones in the spine if osteoporosis is severe. Treatment: Pain can be treated by acupuncture safely or with pain killers if preferred. Calcium & Vitamin D supplements are important as well as maintaining an adequate body weight (see your doctor). Regular exercise encourages bone growth. Your doctor may recommend other interventions such as hormone therapy.

IN CONCLUSION

  • I hope this brief guide to back pain has been useful. If you would like to know more about acupuncture to treat back pain or siatica then check out the links below.

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