The human back is an incredible piece of architecture designed to support our bodies, protect the spinal cord, and allow distribution of neurons to and from organs, muscles, and bones. All the while it must do this while being squashed, bounced, stretched, twisted, and flexed sometimes in multiple directions. It accomplishes this by using stacked vertebrae that make a tunnel for the spinal cord to be safe in. There are 7 cervical (neck) vertebrae, 12 thoracic vertebrae, 5 lumbar(lower back) vertebrae and fused vertebrae in the sacrum and coccyx. Between each pair of vertebrae is a disc which acts as a shock absorber and the assembly is held together by ligaments and tendons which in turn are attachments for muscles. Nerves that communicate from and to the spinal cord pass through all these structures. So, there are lots of places that something could go wrong. Of course, the back must also provide flawless service from birth until we are deceased. In most cases it does just that when it is well cared for but when not, it is a common reason for seeking medical care.
Lower back pain is pretty common and about 80% of people will have at least one episode in their life. What makes people at risk for lower back issues? Smoking, sedentary work and lifestyle, obesity, age, being female, work that is more strenuous than one’s level of fitness, a stressful emotionally “toxic” work and home environment, depression, and anxiety. Common work related contributions to back problems are sitting and standing for long periods of time with poor posture, long distance driving, poor lifting techniques, and a stressful environment.
Pain is almost always the first indicator of back problems. More than 85% of cases of back pain are “nonspecific” meaning that there simply is no clear cause for the pain that can be identified using the tools that are available to doctors. These tools consist of physical examination, and imaging studies such as X-ray, CT, and MRI to have an inside look. Some other causes for back pain are the wear and tear in degenerative disc disease, arthritis between the facet joints on the vertebrae (facet joint arthropathy), misalignment of the vertebrae in relationship to its adjacent vertebrae (spondylolisthesis), wear in the tough covering of the disc allowing its pulp to bulge through and push on nerve roots (herniated disc), and narrowing of the spinal canal due to inflammation and abnormal bone growth (spinal stenosis). Rare causes of back pain can be infection, tumor, cauda equine syndrome, fracture of bone or other traumatic damage to other structures within the back.
When should you seek medical help for a back problem? Since most folks have had some experience with minor back problems that improved, it is a good idea to consider a medical evaluation if those symptoms continue more than four weeks or worsen without any new injury, if the pain doesn’t go away when you lay down at night, if the pain starts after a serious injury like a motor vehicle accident or fall, if the pain spreads further through your body such as from the lower back into legs, if there is muscular weakness in your legs, abnormal bowel, bladder, or sexual function, if you are over 70 years of age and have sudden back problems/pain, if you have back problems/pain with fever and weight loss, and if you have a history of cancer of any type, immunosuppression, osteoporosis, or prolonged corticosteroid use.
There are a number of possible treatments for back problems depending on the cause. These vary from physical therapy to a number of different surgeries. Perhaps most important is prevention, however hard it is for all of us, but a combination of strength training, flexibility, and cardio training will be valuable in avoiding injury and coping with the discomfort of minor injuries. They are also very helpful with chronic pain from back injuries.
Further information on specific types of back problems can be found at the following links. Please do not mistake information from this blog or the following links for medical recommendation or advice about treating joint disorders, that always needs a health care professional’s examination and recommendations.