Lower back pain may be linked to 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.
Pain in the upper back may be due to disorders of the aorta, tumors in the chest, and spine inflammation. Problems with the spine such as osteoporosis can lead to back pain. The human back is composed of a complex structure of muscles, ligaments, tendons, disks, and bones, which work together to support the body and enable us to move around.
Problems with any of these components can lead to back pain. In some cases of back pain, its cause remains unclear. Back pain commonly stems from strain, tension, or injury. Frequent causes of back pain are:. Adopting a very hunched sitting position when using computers can result in increased back and shoulder problems over time.
The following factors are linked to a higher risk of developing low back pain:. Lower back pain also tends to be more common in women than in men, possibly due to hormonal factors.
Stress , anxiety , and mood disorders have also been linked to back pain. The main symptom of back pain is an ache or pain anywhere in the back, and sometimes all the way down to the buttocks and legs. The pain often goes away without treatment, but if it occurs with any of the following people should see their doctor:.
You should seek medical help if you experience any numbness or tingling, or if you have back pain:. A doctor will usually be able to diagnose back pain after asking about symptoms and carrying out a physical examination. Back pain is categorized into two types :. If a person has both occasional bouts of more intense pain and fairly continuous mild back pain, it can be hard for a doctor to determine whether they have acute or chronic back pain. Back pain usually resolves with rest and home remedies, but sometimes medical treatment is necessary.
Applying a hot compress or an ice pack to the painful area may also reduce pain. Resting from strenuous activity can help, but moving around will ease stiffness, reduce pain, and prevent muscles from weakening. If home treatments do not relieve back pain, a doctor may recommend the following medication, physical therapy , or both.
Codeine or hydrocodone, which are narcotics, may be prescribed for short periods. These require close monitoring by the doctor. In some cases, muscle relaxants may be used. Antidepressants , such as amitriptyline , may be prescribed, but research is ongoing at to their effectiveness, and the evidence is conflicting. Physical therapy: Applying heat, ice, ultrasound , and electrical stimulation — as well as some muscle-release techniques to the back muscles and soft tissues — may help alleviate pain.
As the pain improves, the physical therapist may introduce some flexibility and strength exercises for the back and abdominal muscles. Techniques for improving posture may also help. The patient will be encouraged to practice the techniques regularly, even after the pain has gone, to prevent back pain recurrence. Cortisone injections: If other options are not effective, these may be injected into the epidural space, around the spinal cord. Cortisone is an anti-inflammatory drug.
It helps reduce inflammation around the nerve roots. Injections may also be used to numb areas thought to be causing the pain. Botox : Botox botulism toxin , according to some early studies, are thought to reduce pain by paralyzing sprained muscles in spasm. These injections are effective for about 3 to 4 months. Traction : Pulleys and weights are used to stretch the back.
This may result in a herniated disk moving back into position. It can also relieve pain, but only while traction is applied. Along with leg pain, the patient may experience low back pain. Cervical spine neck — Symptoms may include dull or sharp pain in the neck or between the shoulder blades that radiates down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm. The pain may increase with certain positions or movements of the neck. Thoracic spine — Symptoms of a thoracic disc herniation can be comprised of posterior chest pain radiating around one or both sides of the rib cage.
Such pain is usually triggered by physical exertion and can even be caused by taking a deep breath. Bands of numbness around the chest wall can also be present. Herniated discs of the thoracic spine are relative rare compared to cervical and lumbar disc herniations.
Surgical replacement of a diseased or herniated cervical or lumbar disc with an artificial disc designed to maintain spinal mobility. These usually consist of a plastic core between two metallic usually titanium plates that lock into the spine see Figures 1, 2 and 3. Figure 2: Left side — C disc bulges most severe at transverse line C level ; Right side — arrow marks narrowing of the right nerve canal causing right arm pain due to C6 nerve root compression.
Figure 3: Post operative cervical disc replacement surgery showing motion preservation in neutral left , flexion middle and extension right views on plain X-ray. Patients with cervical disc herniation as shown in Figure 2 above that require surgery most often undergo anterior cervical discectomy with fusion ACDF.
This procedure requires the surgeon to operate through the front of the neck and can be performed using many types of implants including anterior titanium metallic plates and screws or intra-discal implants not requiring anterior plating low or no profile implants. These implants are made of titanium, plastic or a combination See Figure 4 on the left, of a case using a long anterior cervical titanium plate C in his first operation followed years later by a no profile implant at C Other less commonly used procedures include anterior and posterior microdiscectomy usually without fusion.
Some cases of extensive cervical stenosis require decompressive posterior laminectomy or laminoplasty augmented often by instrumented posterior cervical fusions titanium rods, screws, plates. Alternatively, even these types of cases can be performed from the front of the neck and the surgery is called a corpectomy, with instrumented or metallic cage fusion.
Figure 5: Left side Pre-op lumbar disc herniation; Right side Post-op lumbar microdiscectomy. Patients with lumbar disc herniation as shown in Figure 1 that require surgery are most commonly treated with micro-discectomy or other minimally invasive techniques to simply remove the herniated disc without destabilizing the spine.
The indications to perform this procedure or others can be confusing and requires clear communication between patient and surgeon.
Second opinions can be helpful but can also add to the confusion if first and second opinions conflict with each other. Figure 5 on the left shows axial views of before left side and after microdiscectomy right side.
Another surgeon might have performed a total disc replacement which could have been as equally appropriate and effective. Surgical removal of most of the bony arch, or lamina of a vertebra for general decompression of neural elements with or without discectomy.
An opening made in a lamina, to allow surgical access to relieve pressure on the neural elements such as nerve roots by removal of bone spurs and disc herniations as in Figure 5 above.
Often after decompression of the neural elements the spinal stability needs to be improved. This is particularly so in certain spinal diseases that imply spinal instability even before surgical treatment is provided; i. Stabilizing surgical procedures are commonly referred to as spinal fusion and can be performed in many ways. Generally, bone is grafted onto or into the spine, creating a solid union between two or more vertebrae; and in which metallic usually titanium instrumentation such as plates, screws and rods may be used to provide additional spinal support.
Such internal support can be thought of as an internal brace to support the spine while the natural fusion takes place and matures.
In order to improve the probability of successful fusion, the surgeon might use bone harvested from the patient, allograft processed cadaveric bone made safe for surgical use and biochemical fusion enhancing substances for example: demineralized bone matrix and human bone morphogenic protein or BMP. A successful fusion usually takes a minimum of three months and can take as long as a year or more to mature.
Figure 7: Showing lateral left side and anterior-posterior views right side of lumbar 5 compression fracture due to osteoporosis. Patients with decreased calcium content can sustain vertebral body collapse with normal activities of daily living see Figure 4. This usually causes the acute onset of moderate to severe spinal pain and can be treated with a back brace and pain medication, injection of the collapsed vertebrae with plastic vertebroplasty and kyphoplasty or open surgery, in selective cases see Figure 7 on the left.
The surgeon will give the patient specific instructions following surgery and usually will prescribe pain medication. Sometimes a spinal brace will be applied for weeks to months depending on the specific postsurgical needs. The surgeon will help determine when normal activities such as returning to work, driving and exercising may resume. You can cut that pressure in half by placing a pillow under your knees.
The numerous health benefits of exercise are well-known. A regular strength-training routine that focuses on your core muscles can help reduce your risk of back-related injuries, such as strains and muscle spasms.
Try incorporating back and abdominal strengthening exercises into your workout at least two times per week to develop a stronger, more flexible back. Strong bones can help prevent osteoporosis. Keep the bones in your spine strong by consuming plenty of calcium and vitamin D. Calcium is in:. Wear comfortable, low-heeled shoes to prevent back pain. They reduce the strain on your back while standing. Shoes with less than a 1-inch heel are the best bet for your back.
It protects the intricate pieces of your spine to keep them healthy and functioning properly. Bad posture puts strain and stress on your back and can change the architecture of your spine. Avoid rounding your shoulders, slouching, or bending sideways when standing. When sitting in an office chair, use the same good posture techniques you use when standing.
Choose a quality chair that provides firm support for your lower back, and make sure your knees are a little higher than your hips when you sit. Move around the room to avoid putting pressure on your spine, which can happen if you stand in one place for too long. We all know smoking is a serious health risk, and smokers are also more likely to experience back pain than nonsmokers.
One reason for this is that nicotine restricts blood flow to the disks in the spine. This can cause them to dry out, crack, or rupture.
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