General Back Pain
More than 80 percent of Americans will experience at least one episode of back pain at some time in their lives. The total costs of a back condition are estimated at greater than $100 billion, annually, Two-thirds of that number is due to decreased wages and productivity.
Anatomy of the Back
Spinal anatomy is a remarkably intricate structure of strong bones, flexible ligaments and tendons, extensive muscles, and highly sensitive nerves and nerve roots. We often don’t think about their form and function, though, until they become a source of pain.
The spinal column and back muscles are responsible for a number of functions:
- Protection for the spinal cord and nerve roots enabling the relay of messages to and from the brain and the rest of the body
- Discs provide shock absorption from sudden jolts and stresses of movement and activity
- Flexibility, especially in the lower back, allowing us to bend and twist in a variety of movements
- It provides strength and stability allowing us to stand upright and move about with precision.
- Once back pain starts, however, the many benefits of this intricate structure can quickly deteriorate.
Symptoms Of Back Pain
Whether you are experiencing a dull ache or a shooting pain, back pain is merely a sign that something is going wrong with the mechanics of your spine, nerves or muscles of the back. In many cases, it can be all of the above.
Acute back pain comes on suddenly and usually lasts from a few days to a couple weeks. Chronic back pain is typically described as lasting over three months.
The pain may be constant, intermittent (comes and goes), or it may simply occur with certain positions or actions. Symptoms can present in the following manner:
- Sharp, stabbing pain
- Dull, achy pain in the muscles or joints of the back
- Radiating pain (travels to other areas such as the legs)
- Bowel or bladder incontinence
There are two cases that warrant emergency medical care:
- Bowel dysfunction (incontinence)
- Bladder dysfunction (incontinence)
Fortunately, these conditions are rare, but if they should occur you must proceed immediately to the hospital.
Causes of Back Pain
Back pain comes on suddenly, especially when caused by a fall or heavy lifting, and typically lasts less than six weeks. Here are some common causes of back pain.
- Muscle or ligament strains: repetitive heavy lifting or improper lifting techniques can strain back muscles and spinal ligaments. Falls, and sport injuries.
- Muscle spasms: muscles of the back can experience an involuntary contraction of the muscle. This condition is called a muscle spasm. When joints of the spine become injured or inflamed, the muscles supporting the spine can spasm, resulting in back pain and limitation of motion.
- Bulging or ruptured discs: discs act as shock absorption or cushions between the bones of the spine (vertebra). The outer layer of the disc is made up of tough fibers and the inside is filled with a gelatin-like substance. Over time, a person can develop microtears in the fibers of the disc, causing the jelly-like material to protrude out and place pressure on spinal nerves. In severe cases, they may even place pressure on the spinal cord.
- Skeletal abnormalities: back pain can occur as a result of scoliosis (an abnormal curve in the spine). Back pain can also occur due to improper joint motion (biomechanics) of the spinal bones (vertebra). In many cases, the joints can become locked in an abnormal position leading to pressure on spinal nerves.
- Poor Posture: whether your slouching in a chair at your desk or while standing, over time the stress caused by poor posture can lead to anatomical changes in your spine. You can develop muscle imbalance and weakness, degeneration of the discs of the spine and joints.
- Osteoporosis: as bones become brittle and weak, typically due to a calcium or vitamin D deficiency or due to hormonal changes, such as menopause, the vertebra can develop compression fractures, which can lead to bone pain
- Arthritis: Osteoarthritis can affect any section of the back and can lead to narrowing of the space around the spinal cord and nerve roots. This condition is called spinal stenosis. The result can be pinched nerves. Spinal arthritis will also result in immobility of the spinal joints or abnormal mobility-leading to back pain.
Back Pain Diagnosis
There are a few necessary steps to achieve a correct diagnosis. The first step always begins with the doctor taking a thorough medical history on the patient followed by completing a physical examination. A medical history is an account of all events which lead up to the patient’s complaint. It also includes any past or present medical conditions or treatments.
Diagnostic tests used for back pain conditions may indicate if the back pain is a result of an anatomic cause. The tests also help pinpoint exact locations and structures involved in the back pain. However, because diagnostic evaluations in and of themselves aren’t a diagnosis, arriving at an accurate clinical diagnosis requires a patient’s medical history to be correlated with their symptoms and physical exam findings.
Here are common diagnostic tests used in evaluating back pain:
- X-ray: This test offers information about the bones in the spine. An x-ray is frequently used to assess for spinal instability (such as spondylolisthesis), bone & joint misalignments, tumors and fractures.
- CT scan: A CT scan, also known as a computed tomography scan, allows doctors to see inside your body with a great degree of detail. It uses a combination of x-rays and computer techniques to create pictures of your organs, bones and other tissues. It shows far greater detail than a regular X-ray. For spinal disorders, CT scans tend to be less accurate than MRI scans.
- MRI: A magnetic resonance imaging (MRI) scan is a common procedure used by hospitals and diagnostic facilities around the world. It uses strong magnetic fields and radio waves to create detailed images of the organs and tissues within the body. An MRI is particularly useful to evaluate abnormalities of the spinal cord, spinal column, intervertebral discs and nerve roots. These scans can also be used to rule out spinal infections or tumors.
Risk Factors in Developing Back Pain
Anyone can develop back pain, even children and teens. In fact, back pain in children and adolescents has become a common occurrence due to the rising incidence of overweight and obese children. Even children and adolescents who may not have an issue with their weight are experiencing back pain as a result of sedentary lifestyles. Here is a list of common factors that may increase your risk of developing back pain:
- Age: Back pain incidence increases with age
- Lack of exercise: A Sedentary lifestyle leads to weak muscles with increased instability.
- Lack of flexibility: Tight and stiff muscles in the back often lead to back pain and even injury.
- Excess weight: Carrying excess weight, even as little as an extra 15 pounds, puts extra stress on your back
- Pregnancy: Sudden weight gain places abnormal stress on the back muscles and joints. In addition, hormonal changes cause the ligaments in the pelvic area to relax and the joints to become looser in preparation for the birth process.
- Diseases: Certain types of arthritis, like osteoarthritis, kidney stones, and cancer can contribute to back pain
- Improper Lifting: Using your back to lift, instead of your legs can lead to back pain and injury.
- Poor unloading techniques: Equally important to how you lift an object is how you set the object down. Most people will hold an object far out from your body while setting it down increases your risk of back injury.
- Poor Posture: Whether sitting at a desk or standing, chronic poor posture will lead to muscle weakness, ligamentous instability, and decreased circulation.
- Smoking: Smoking decreases oxygenation to all cells and tissues in the body and can also lead to premature disc dessication (drying out) or degeneration (breaking down).
- Contact Sports: Injuries from contact sports can commonly cause back problems
- Wearing High Heels: Regular use of high heeled shoes of 3 inches or higher increase your risk of back pain. Chronic use of high heeled shoes causes shortening and tightening of calf muscles and hip flexors. This will lead to postural abnormalities, such as an increased arch in the low back. This puts abnormal stress on the discs.
- Sleep Habits: Lack of sleep (regular), sleeping on a mattress with little to no support and sleeping positions all increase your risk of back pain. Sleeping on your stomach is one of the worst positions for your back.
What To Do For Back Pain
It’s important to know the underlying cause for the back pain, as remedies will often differ depending upon the origin of the back pain. However, here are some standard rules of thumb.
If this is your first incidence of back pain and it is a mild case, you may be able to easily clear up the symptoms with some simple home remedies. These may include:
- Ice: Use ice if back pain is due to an injury or has suddenly occurred. If you don’t have an ice pack at home, a bag of frozen vegetables works great (especially peas). Never apply an ice pack directly to your skin (even if using a bag of frozen veggies). Always wrap it with a layer of paper towels. Do not leave ice on longer than 20 min. Wait 1 hour, then you may re-apply.
- Heat: Use heat if the back pain is still present after 1 week. Never use heat on a new injury (within the first 7-10 days). Moist heat is better than a dry heating pad. Apply heat for 15-20 minutes at a time. If you are using an electric heating pad, avoid falling asleep while the pad is on, or set a timer.
- Stretching exercises: Specific gentle stretching exercises can be used to alleviate back pain and lesson muscle spasm.
- Essential Oils: Peppermint and wintergreen essential oils are effective analgesics (pain relievers) that cool inflamed joints and reduce back pain. Always mix essential oils with a carrier oil like coconut oil, almond oil or jojoba oil, before applying to your skin.
- Fish Oil: Take 2000 mg daily of Omega 3 fatty acids to reduce inflammation present with back pain.
- Turmeric: Take 1000 mg daily. Turmeric contains curcumin, which is an active ingredient that has powerful anti-inflammatory abilities and reduces pain.
- Proteolytic Enzymes: Take 500 mg three times a day on an empty stomach. Protease, bromelain and papain normally used for digestion are, also, natural anti-inflammatories when taken on an empty stomach. They also help reduce swelling and speed up healing time.
- MSM: Take 2000-8000 mg daily. MSM is an anti-inflammatory supplement that’s high in sulfur to help rebuild cartilage. It can help alleviate muscle spasms, too.
- Magnesium: Take 400-500 mg daily. Spread the dosage out throughout the day to avoid loose or watery stools. This mineral is often called the ‘relaxation mineral’ because it helps relax muscles and reduce stress. If you experience loose or watery stools -not to worry – simply reduce the dosage.
Chronic Back Pain Treatment Options:
If your back pain is moderate to severe or has been present for 2 weeks or longer, it is time to have it checked out. Prior to starting any type of treatment, it is always advisable to first see an appropriately trained spine specialist to develop a treatment program for your specific condition and medical history. Typically, this may be a chiropractic doctor.
Chiropractors specialize in musculoskeletal (muscles, bones, and joints) conditions and are considered one of the experts on back pain. Some osteopathic physicians may also specialize in musculoskeletal conditions, but unlike chiropractic doctors, not all do. An orthopedic surgeon is typically your last stop. Most back cases are not surgical cases. For this reason, we will concentrate on non-surgical treatment options.
- Chiropractic manipulations: Chiropractic manipulations, also referred to as adjustments, relieve low back pain by reducing pressure on nerves and spinal discs, increase flexibility, restore normal joint alignment and movement, improve blood flow and reduces muscle tension. Adjustments can only be performed by a chiropractic doctor or an osteopathic physician.
- Spinal Decompression Therapy: This is a non-surgical, painless technique utilizing a specific form of motorized medical table. It creates a negative intradiscal pressure to promote retraction or repositioning of the herniated or bulging disc material. It also promotes an influx of nutrients into the disc to promote healing. This method is not to be confused with surgical decompression, such as a laminectomy or microdiscectomy.
- Therapeutic massage: Therapeutic massage, unlike a Swedish massage, is a deep tissue massage. It improves blood flow, reduces muscle spasm and stiffness. However, if your back pain is caused by a herniated (slipped disc) or abnormal joint biomechanics, massage by itself will not be able to correct the dysfunction.
- Physical Therapy: Physical therapy aims to ease pain by improving muscle strength, flexibility and balance while decreasing inflammation. A physical therapist will devise programs and protocols for specific exercises to aid in your recovery from your back pain. If there are abnormal joint biomechanics or a herniated disc, physical therapy alone will not reverse these conditions. Physical therapy may be performed by a physical therapist, a chiropractic doctor or an osteopathic physician.
When To Contact A Back Pain Doctor
Don’t know when you should seek medical attention for your back pain? It is always a good idea to visit a doctor for an evaluation when your back pain has any of the following attributes or causes:
- Back pain that follows an accident, such as a car accident or an injury like falling from a ladder
- Back pain from a sport injury
- Sudden upper back pain, especially if you are at risk for osteoporosis
- Ongoing back pain that is becoming worse
- The back pain continues for more than two weeks
- The back pain becomes severe or persistent
- Back pain interferes with your ability to perform normal daily tasks
- The back pain interferes with your ability to sleep
- Back pain with coughing or sneezing
- The pain is severe and does not improve after a few days of typical remedies, such as rest, ice and pain relievers
- Severe pain during the night that wakes you up, even from a deep sleep
- Back pain accompanied by abdominal pain
- Numbness or altered feelings in the upper inner thighs, buttocks or groin area
- Neurological symptoms, like weakness, numbness or tingling in the extremities — the leg, foot, arm or hand
- Back pain which leads to incontinence
- Unexplained fever with increasing back pain
The bottom line that everyone should remember is…when in doubt, consult a physician.