Back pain; causes, symptoms, diagnosis and treatment
Back pain is a common reason for people to miss work and seek medical help. It’s inconvenient and debilitating.
It can be caused by an injury, physical activity, or certain medical conditions. Back pain can strike people of all ages for a variety of reasons. Lower back pain is more likely to develop as people age, due to factors such as previous occupation and degenerative disk disease.
The bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdominal and pelvic internal organs, and the skin around the lumbar area are all possible causes of lower back pain.
Aortic disorders, chest tumors, and spine inflammation can all cause pain in the upper back.
Causes
The human back is made up of muscles, ligaments, tendons, disks, and bones, all of which work together to support the body and allow us to move around.
The segments of the spine are cushioned by disks, which are cartilage-like pads.
Back pain can be caused by issues with any of these components. The source of back discomfort in some situations is unknown.
Strain, medical conditions, and poor posture, among other things, can cause damage.
Strain
Back discomfort is frequently caused by strain, tension, or injury. The following are some of the most common causes of back pain:
- muscles or ligaments that have been strained
- a spasm of the muscles
- muscular tenseness
- disks that have been damaged
- falls, fractures, or injuries
Strains or spasms can occur as a result of the following activities:
- incorrectly lifting something
- hefting anything that is excessively hefty
- making an unpleasant and sudden movement
Problems with the structure
Back pain can also be caused by a variety of structural issues.
- Ruptured disks: Disks cushion each vertebra in the spine. When a disk ruptures, it puts more pressure on a nerve, causing back pain.
- Bulging disks: A bulging disk can put greater pressure on a nerve in the same manner as a ruptured disk does.
- A bulging or herniated disk pressing on a nerve causes sciatica, a severe and shooting pain that runs down the buttock and down the back of the leg.
- Osteoarthritis is a type of arthritis that affects the hips, lower back, and other joints. The area around the spinal cord can narrow in some circumstances. Spinal stenosis is the medical term for this condition.
- Back discomfort can come from abnormal curvature of the spine. Scoliosis is a condition in which the spine curves to one side.
- Osteoporosis is a condition in which bones, including the vertebrae of the spine, become brittle and porous, increasing the risk of compression fractures.
- Back discomfort might be caused by kidney stones or a kidney infection.
Posture and movement
When using computers, adopting a slumped seating position might lead to increasing back and shoulder difficulties over time.
Back discomfort can also be caused by certain daily activities or bad posture.
Here are some examples:
- twisting
- sneezing or coughing
- muscular tenseness
- over-stretching
- bending in an awkward manner or for long periods of time
- Something is being pushed, pulled, lifted, or carried.
- Long periods of standing or sitting
- bending the neck forward, as when driving or working on a computer
- lengthy periods of driving without stopping, even while not crouched
- sleeping on a mattress that does not provide adequate body support and does not keep the spine straight
Other reasons
Back pain can be caused by a variety of medical issues.
- Cauda equina syndrome is a grouping of spinal nerve roots that emerge from the lower end of the spinal cord. Numbness in the buttocks, genitalia, and thighs, as well as a dull pain in the lower back and upper buttocks, are some of the symptoms. Bowel and bladder function can be disrupted at times.
- Spinal cancer: A tumor in the spine can press against a nerve, causing back pain.
- Infection of the spine: A fever and a sore, warm spot on the back could indicate a spinal infection.
- other inections: Back pain can also be caused by diseases such as pelvic inflammatory disease, bladder infections, or kidney infections.
- Sleep problems: People with sleep difficulties are more likely than others to suffer from back discomfort.
- Shingles: Shingles is a nerve infection that can cause back pain. Which nerves are affected determines the outcome.
Risk factors
The following factors are associated with an increased chance of experiencing low back pain:
- activities at the workplace
- pregnancy
- a sedentary way of life
- insufficient physical fitness
- advancing years
- Obesity and being overweight
- smoking
- intense physical activity or work, particularly when performed wrongly
- Aspects of genetics
- Arthritis and cancer are two examples of medical diseases.
Lower back discomfort is also more common in women than in males, which could be attributed to hormonal causes. Back discomfort has also been connected to stress, anxiety, and mood disorders.
Symptoms
An aching or soreness anywhere in the back, and occasionally all the way down to the buttocks and legs, is the most common sign of back pain.
Depending on the nerves involved, some back problems can cause pain in other parts of the body.
The discomfort usually goes away without treatment, but if any of the following persons have it, they should consult a doctor:
- Fever
- weight loss
- inflammation or swelling on the back persistent back pain that does not improve with lying down or resting pain down the legs
- soreness that extends to the knees
- a recent back injury, blow, or trauma
- urinary incontinence, or the inability to urinate,
- fecal incontinence, or the inability to control bowel movements
- numbness in the area of the genitals
- numbness in the area of the anus numbness in the area of the buttocks
When should you see a doctor?
You should seek medical assistance.
If you have any numbness or tingling, or if you have back pain,
- after an injury or fall with numbness in the legs,
- weakness,
- fever,
- and unexplained weight loss that does not improve with rest
Diagnosis
After asking about symptoms and performing a physical examination, a doctor can typically diagnose back discomfort.
If you have any of the following symptoms, you may need an imaging scan and other tests:
- Although back pain appears to be the result of an injury,
- there may be an underlying cause that requires treatment
- if the pain lasts for a long time.
The status of the soft tissues in the back can be determined via an X-ray, MRI, or CT scan.
- X-rays can reveal bone alignment and detect arthritis or broken bones, but they may miss injury to the muscles, spinal cord, nerves, or disks.
- Herniated disks, as well as abnormalities with tissue, tendons, nerves, ligaments, blood vessels, muscles, and bones, can be discovered using an MRI or CT scan.
- Bone scans can detect bone cancers or osteoporosis-related compression fractures. A tracer or radioactive material is inserted into a vein. The tracer collects in the bones and, with the help of a special camera, helps the doctor spot bone abnormalities.
- The electrical impulses produced by nerves in reaction to muscles are measured by electromyography, or EMG. A herniated disk or spinal stenosis can cause nerve compression, which can be confirmed with this test.
If an infection is suspected, the doctor may also prescribe a blood test.
Other kinds of diagnosis
- A chiropractor uses touch (palpation) and a visual examination to make a diagnosis. Chiropractic is noted for taking a straightforward approach that focuses on correcting the spinal joints. Imaging scans, as well as any blood and urine tests, may be requested by a chiropractor.
- Palpation and ocular inspection are also used by osteopaths to make diagnosis. Osteopathy entails gentle and rhythmic stretching, often known as mobilization, as well as pressure or indirect treatments and joint and muscle manipulation.
- A physical therapist specializes in identifying and treating problems with the body’s joints and soft tissues.
Chronic or acute pain?
Back pain is divided into two categories.
- Acute pain appears out of nowhere and can linger for up to six weeks.
- Chronic or long-term pain develops over time, lasts longer than three months, and causes issues.
It can be difficult for a doctor to tell whether a patient has acute or chronic back pain if they have both occasional bouts of more intense pain and fairly constant mild back pain.
Treatment
Back pain usually goes away with rest and home remedies, but medical treatment may be required in some cases.
Treatments at home
Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, are commonly used over-the-counter (OTC) pain relievers.
A hot compress or an ice pack applied to the painful area may also help to relieve pain.
Resting from heavy activities can help, but moving about can aid with stiffness, discomfort, and muscle weakness.
Medication.
If home remedies fail to ease back pain, a doctor may prescribe one or both of the following medications or physical therapy.
Back discomfort that does not respond to over-the-counter pain relievers may require a prescription NSAID. Narcotics such as codeine or hydrocodone may be administered for brief periods of time. The doctor must keep a watchful eye on these. Muscle relaxants may be utilized in some instances.
Antidepressants, such as amitriptylineTrusted Source, may be prescribed, although research into their usefulness is still underway, and the data is mixed.
Physical therapy:
Applying heat, ice, ultrasound, and electrical stimulation to the back muscles and soft tissues, as well as some muscle-release techniques, may help relieve pain.
The physical therapist may introduce some back and abdominal flexibility and strength exercises as the pain improves. Posture-improvement techniques may also be beneficial.
To avoid back pain recurrence, the patient will be encouraged to perform the exercises on a regular basis, even after the pain has subsided.
Cortisone injections:
If all other treatments have failed, they might be injected into the epidural area, which surrounds the spinal cord. Cortisone is a corticosteroid that is used to treat inflammation. It aids in the reduction of inflammation surrounding nerve roots. Injections may also be used to numb the areas where the pain is thought to be coming from.
Botox (botulism toxin): Botox (botulism toxin) is supposed to alleviate pain by paralyzing sprained muscles in spasm, according to some early research. These injections last approximately 3 to 4 months.
Back traction is achieved through the use of pulleys and weights. A herniated disk may move back into place as a result of this. It can also help with pain relief, but only when traction is used.
CBT (cognitive behavioral therapy): CBT encourages new ways of thinking, which can help manage chronic back pain. It could include things like relaxation techniques and ways to keep a happy attitude. Patients who receive CBT are more active and exercise, according to studies, and have a lower risk of recurrence of back pain.
Complementary medicine
Complementary therapies can be utilized in conjunction with or instead of traditional treatments.
Chiropractic, osteopathy, shiatsu, and acupuncture may treat back pain while also promoting relaxation in the patient.
- An osteopath is a doctor who focuses on the skeleton and muscles.
- A chiropractor heals disorders with the joints, muscles, and bones. The spine is the main focus.
- Shiatsu, also known as finger pressure therapy, is a style of massage that involves applying pressure along the body’s energy lines. The shiatsu therapist uses his or her fingers, thumbs, and elbows to provide pressure.
- Acupuncture has its origins in China. Fine needles and specific points are inserted into the body. Acupuncture can help the body release endorphins, which are natural analgesics, while also stimulating nerve and muscle tissue.
- Yoga comprises a variety of positions, motions, and breathing techniques. Some may aid in the strengthening of back muscles and the improvement of posture. It’s important to make sure that your exercises don’t aggravate your back discomfort.
Complementary medicines have yielded mixed results in research. Some people have reaped substantial rewards, while others have not. When contemplating alternative therapies, it is critical to work with a skilled and registered therapist.
Transcutaneous electrical nerve stimulation (TENS) For patients with chronic back pain, is a popular treatment option. Through electrodes placed on the skin, the TENS machine sends small electric pulses into the body.
TENS, according to experts, stimulates the production of endorphins in the body and may stop pain signals from reaching the brain. TENS research has yielded mixed results. Some said there were no benefits, while others said it would be beneficial to some people.
A doctor or other health professional should be consulted before using a TENS machine.
It is not to be used by anyone who is:
- is pregnant,
- has epilepsy,
- wears a pacemaker
- has a family history of coronary artery disease
TENS is “safe, noninvasive, affordable, and patient-friendly,” and it appears to relieve pain, but more research is needed to demonstrate its usefulness in increasing activity levelsTrusted Source.
Surgery
Back surgery is extremely uncommon. If a patient has a herniated disk, surgery may be a possibility, particularly if the pain and nerve compression are severe enough to cause muscle weakness.
Surgical procedures include the following:
- A bone graft is put between two vertebrae and they are fused together. Metal plates, screws, or cages are used to splint the vertebrae together. There’s a much higher chance that arthritis will develop in the adjacent vertebrae as a result.
- The cushion between two vertebrae is replaced by an artificial disk, which is inserted.
- Diskectomy: If a portion of a disk is irritating or pressing against a nerve, it may be removed.
- Partially removing a vertebra: If a vertebra is squeezing the spinal cord or nerves, a tiny section of it may be removed.
- Injecting cells into the nucleus pulposus to rebuild spine discs: Duke University scientists created new biomaterials that can administer a boost dose of reparative cells to the nucleus pulposus, thereby removing discomfort caused by degenerative disc disease.
Prevention
Steps to Reducing the Risk
The most effective way to prevent back pain is to address some of the risk factors.
Regular exercise aids in the development of strength and the management of body weight. Low-impact aerobic activities that are guided can help to improve heart health without straining or jerking the back. Consult a health care professional before beginning any exercise program.
People can reduce their risk of back pain by engaging in one of two types of exercise:
- Core-strengthening exercises strengthen the abdominal and back muscles, which help to protect the back.
- Core flexibility, which includes the spine, hips, and upper legs, is improved through flexibility training.
Diet: Make sure you get enough calcium and vitamin D in your diet, as these are essential for bone health. A balanced diet also aids in weight management.
Smoking: When compared to nonsmokers of the same age, height, and weight, smokers have a significantly higher rate of back pain.
Body weight: People’s weight and where it is carried has an impact on their risk of developing back pain. The risk of back pain differs significantly between obese and normal-weight people. People who carry their weight in their abdomen rather than their buttocks and hips are also more vulnerable.
When standing, make sure your pelvis is in a neutral posture. Stand tall with your head forward, back straight, and weight properly distributed on both feet. Maintain a straight line between your legs and your spine with your head.
Sitting posture: A decent working seat should have good back support, armrests, and a swivel base. Keep your knees and hips level while sitting, and your feet flat on the floor or on a footstool. You should be able to sit upright with support in the small of your back in the ideal situation. Make sure your elbows are at perfect angles and your forearms are horizontal if you’re using a keyboard.
Lifting: Rather than using your back to lift things, use your legs instead.
Maintain balance by maintaining your back as straight as possible and keeping your feet apart with one leg slightly front. Bend only at the knees, keep your weight close to your body, and straighten your legs as little as possible while keeping your back in a neutral position.
It’s impossible to avoid bending your back at first, but try not to stoop and keep your stomach muscles tight so that your pelvis is pulled in. Most importantly, do not straighten your legs before lifting; otherwise, you will be doing the majority of the effort with your back.
Lifting and twisting at the same time is dangerous. If something is especially heavy, see if you can lift it with the help of another person. Keep your gaze straight ahead, not up or down, while lifting, so that the back of your neck forms a continuous straight line from your spine.
Moving items: Pushing objects across the floor with your leg strength is healthier for your back than pulling them.
Shoes: Flat shoes are better for your back since they put less strain on it.
When driving, it’s critical to have adequate back support. Make sure the wing mirrors are in the right place so you don’t have to twist. Your feet should be directly in front of the pedals. Take frequent pauses if you’re on a long travel. Get out of the automobile and take a stroll around the area.
Bed: You should sleep on a mattress that supports the weight of your shoulders and buttocks while keeping your spine upright. Use a pillow, but not one that pushes your neck into a hunched position.