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Definition

Your back is an intricate structure, giving you the power to stand, walk, run, sit and lift. The ligaments of the lower back connect the vertebral bones, support and stabilize this area. An unconditioned back is prone to strain when muscles and ligaments are overworked. Back muscle strain occurs when a sudden, forceful movement injures a ligament, which has become stiff or weak from poor conditioning or overuse.

Acute lower back pain is a common medical problem afflicting two-thirds of Americans during some part of their lives. Each year nearly 6 million Americans suffer from back or spinal problems, making back pain the most commonly reported health condition in the United States.

Lower back pain can be anything from a lumbar sprain to an actual rupture of a disc. However, most cases of lower back pain come from muscle or ligament strain as a result of lifting, bending or overstretching.

Prognosis

In more than 95 percent of cases, the underlying cause is not serious. Over-the-counter pain relievers such as ibuprofen and aspirin for a few days usually help you feel better. You can learn how to keep your back healthy and strong and even avoid pain in the future.

Know Your Aching Back

Almost every American has experienced a bout of back pain at one time or another. Back pain is the second most common diagnosis in the outpatient setting, after headaches. Whether the cause is degenerative or traumatic, back pain leads to missed days of work and temporary disability in 3 to 4 percent of the American population each year.

The Spine through the Ages

Our backs weren't designed for the modern sedentary lifestyle. Anthropologists believe that early humans were bipeds (walked upright), but also spent time on all four limbs. After examining the skeletons of prehistoric species, they think the spinal structure changed as human beings stood for longer periods of time. The lower spine curved more and more over the eons. That curve, the lordosis, supports upper body weight better than the straight spine of much earlier primates that walked on all fours.

Does a more curved lower spine help us deal better with life as an upright but often seated creature? In fact, just the opposite is the case. While increased curvature of upper or lower spine does handle the weight of the upper body on the pelvis, the benefits of a slightly curved spine end at a certain point. Complications of poor posture and obesity tend to offset the stabilizing design. Perhaps further modifications over eons will help us to live life seated. No one is sure. Nonetheless, maintenance of the natural S curve is essential to good back health.

S.O.S: Save our "S"

The spine is naturally configured in an "S" curve. A slight concave curve of the cervical spine (neck) gently changes to the longer convex thoracic (chest) area ending in a concave curve of the lumbar region. The neutral "S" curving cervical, thoracic and lumbar spine is also the most stress free state.

Yet, due to everyday demands, not even from lifting heavy objects, but just by driving, standing, or sitting at a desk for hours at a time, our spine strays from the comforting "S." The neck and mid-back suffer as we slouch forward, or bend the wrong way repeatedly. One day our back is abused just once too often. Picking up a crumpled piece of paper that didn't make it into the trash brings on a sudden twinge of pain. Our back reminds us that it is there and demands our attention.

The Back is the Spinal Vault

Like the brain protected by the skull (a fusion of several bones), bones called vertebrae surround the spine. The highway from brain to limbs, the spinal cord carries information about our world and our intentions-both voluntary and automatic. The index finger tip touches the stove, senses "Far too hot!" and generates a signal that travels up the radial nerve to brachial plexus (grouping of nerves near the axilla or armpit) to the cervical spine and then to the brain. Our sense of touch is processed and the brain generates an impulse that travels down the spine from nerve-to-nerve, and in a lightning flash, we withdraw the finger.

A Vulnerable Vault

The back does a fine job of protecting the delicate spinal cord. Why is it prone to injury? Unlike the skull, the back must maintain flexibility while providing bony protection for the spinal cord. Bending and twisting of bone over bone is only possible with specialized structures called vertebrae and their supporting muscles and ligaments. These components work together, but each is subject to its own share of problems.

Muscles and Ligaments

Back muscles are the most frequently injured structures because they are already working very hard to maintain the "S" curve. Bending too far, or the tendency to overextend with a poor posture, puts more strain on back muscles. Eventually, whole regions of back muscles tighten. Continued demand on tight, tired muscles leads to the injury and pain of a muscle strain, or even a torn ligament when the attachment of muscle to bone gives way.

Vertebrae

Each vertebra is made up of a body and arch. The vertebral body houses a spongy central disc that allows for movement of the vertebra above and below. Behind each vertebral body, the spinous process contains a portion of the spinal cord, which runs continuously above, and below, opening up into nerve roots that converge again to form major peripheral nerves.

In spite of their complex design, the vertebrae cannot handle life's forces without the help of the back muscles and ligaments. When an area of muscle weakens, the stress is transferred to the closest vertebrae at the ligament which surrounds the disc. Eventually, the ligament gives way and the disc slips forward onto the spine or nerve roots.

The Spinal Cord

So why make us carry a "vault" on our back? All the armor of the vertebrae (bones), muscles and ligaments serves to protect the spinal cord, a delicate, whitish gray vertical tube. The spinal cord is composed mainly of myelin, a fatty substance that insulates nerve fibers. Nerve cells and other nutrient-supplying cells gather in clusters to receive and transmit impulses from the brain and out to the rest of the body and back.

Your Back Hurts: 'Why Me?'

Two people may be diagnosed with a herniated disc between the fourth and fifth lumbar vertebrae, one a 24-year-old football player hurt when tackled and the other a 55-year-old librarian who felt terrible sharp pain after bending over to pick up a piece of paper. There are many factors leading to back pain, from lifestyle to hereditary characteristics. Several combinations of factors contribute to varying degrees. There are six main factors underlying back pain:

• Age
• Underlying disease process
• Poor posture
• Excess weight
• Sedentary lifestyle
• Stress

Age

Many older adults suffer from arthritis that involves one or multiple vertebrae (back bones) partially due to disc degeneration. Intervertebral discs provide cushioning and flexibility between vertebrae and lose some of their fluid. However, it's not known why some older people with a lot of back problems are more prone to pain than others.

Posture

The relationship between our backbones and their respective ligaments and tendons determines posture. Good posture is established by conscious effort, habit and heredity. Constant energy exerted by muscles around the spine help to balance the vertebrae against gravity all the time, even when we sleep. Consciousness of how we hold our bodies when walking and sitting significantly helps to minimize strain against gravity and motion. Your mother was right when she said, "Don't slouch!" and "Stand up straight!" Whether due to bad habits or a hereditary condition, when posture is poor, back problems often result.

Underlying Disease

Diseases may affect vertebral bones. Arthritis and cancer (especially when a tumor spreads to the spine) can impinge on the spinal cord and nerve roots, causing pain or other symptoms.

Excess Weight

There is a natural curve of the lower spine or lumbar region (the third curve in the "S"). However, abdominal fat tends to pull the lumbar spine forward and downward resulting in "lordosis." The heavier we get in the mid-section, the greater weight we carry in the already vulnerable lower back. Unlike the thoracic spine, where ribs add protection - like the ribbed ceiling of a Gothic cathedral - the cervical or neck region and lower back are more vulnerable to stress and strain. The cervical spine tends to be injured when we come to a sudden stop, such as acceleration/deceleration injuries (whiplash). The lower back, over time, becomes vulnerable even to the usual, everyday demands of bending and walking.

Sedentary Lifestyle

When out of shape, our muscles, including those that support the spine, atrophy, or weaken from lack of use. Strong abdominal muscles provide additional protection to the lower back.

Stressful Life

There are two types of stress: good stress and bad stress. When the reactions to the demands of every day life are extreme our body reacts by tightening muscles. Our jaw muscles contract, our fists may clench and the back muscles tighten as though gearing up to flee. Unfortunately, all the extra muscle effort leaves less energy for our back to work smoothly doing the delicate balance of protecting the spine while permitting the flexibility and range of motion we tend to take for granted. The back's ready-or-not-stressful state is a set-up for injury, as stiff back muscles cannot work efficiently.

Symptoms and Remedies: Neck and Back Pain

 

What is it?

Most everyone at one time or another develops pain in the neck or in the back. Usually, an activity brings on the pain, and the pain typically improves with rest. There are simple ways to bring relief and a few important signs that indicate when pain is more than a simple strain. Chronic pain usually gets worse despite bed rest, wakes you in the middle of the night, progresses despite medication and interferes with daily activity.

How Bad Is It?

Pain is a very good messenger. It tells us that something is wrong. The more mysterious it is, the more likely it is to be significant, either by itself or as an indicator of some other condition. Back and neck pain come in all degrees; from a brief, mild ache after a day of painting the ceiling to a crippling years-long misery that defies potent pain-relievers, intense physical therapy and even surgery.

What Causes It?

Most back and neck pain is easily recognized as the result of overdoing some activity. It is amazing what the human body can be trained to do, but it is equally amazing how incapable it is of doing something it is not accustomed to. There are two categories of strain that cause nearly identical pain - acute and cumulative. We all know what weekend warriors feel like on Monday morning, whether they just dug up the   garden or began the tennis season. But there is a more insidious type of strain that takes many days or even months to notice. Cumulative stress injuries (CSI) in the workplace are now being recognized as major causes of disability and work loss. The human body is not used to the many activities required of us today. Probably the first CSI to be recognized was the pitcher's elbow in baseball. Little leagues won't let children pitch more than a few innings because of the strain it puts on their arm. Another more common CSI is carpal tunnel syndrome, often the result of hours a day at a keyboard. The back and the neck can suffer similar strains by remaining in certain positions for long periods of time. The whole science of ergonomics has been developed to prevent these repetitive stress injuries by designing furniture and appliances that place body parts in the optimum position for working.

Not knowing immediately what brought on your current discomfort is the first warning sign to take a pain seriously. Some pains that seem to be coming from the spine are actually referred there from elsewhere inside the body. For instance, a sick gall bladder can masquerade as a strain of the mid-back and usually hurts just beneath the right shoulder blade. Heart attacks can mimic neck pains that pinch nerves going into the left arm.

Additional symptoms that accompany the pain are further clues. Some of the most important are related to all the nerves that pass through your spine on their way between the brain and the rest of your body. These nerves send feelings in one direction and movement commands in the other. If either of these functions - feeling or movement - is disturbed, something serious is happening. Numbness is the most common failure of feeling; weakness is the most common disturbance of movement. Certain changes in feeling such as tingling, burning or extreme sensitivity are also signs of nerve problems. Paralysis is the extreme form of weakness. The urinary bladder can also be affected by nerve damage related to back pain. So if your back pain comes with inability to control urinating, there is likely to be a significant relationship between the two.

How Do I Know I Have It?

If pain isn't present, it doesn't exist. The important question is: How do you know what is causing it? If your pain is clearly related to what you are doing and has no peculiarities like numbness or weakness associated with it, chances are their just mechanical strains. But you should see a doctor for any pain that lasts more than a few days without improving, that has no obvious cause, that gets worse without provocation or that has associated symptoms.

What Can I Do About It?

If you decide to seek professional care for unusual spinal pain, first get a competent diagnosis from a medical doctor. This may require X-rays or special scans (CT or MRI) to identify unusual and serious causes such as tumors or bone and joint disease. When nothing beyond mechanical strain can be found, the first and foremost intervention is a good posture and exercise program. Secondly, for the more serious mechanical spinal pains, such as whiplash neck injuries and crippling, chronic low back pain, a variety of helpful and sometimes controversial treatments are available. Osteopathic/chiropractic manipulations and acupuncture have helped some patients but have also failed in others. The foundation for treatment remains an accurate diagnosis.

Starting New Activities

Your body is able to do extraordinary things but not all at once. Remember two things about any physical activity:

·         If you are in generally good shape, new activities will be better tolerated.

·         Begin any new activity gradually

The first point doesn't require more than common sense - 15 to 30 minutes a day of anything that tires you out is good. The more you get tired, the better. Swimming is close to ideal because you use everything at once, without being able to overuse or abuse anything. Water provides resistance without being as hard on the joints like pavement.

When starting new activities, you should start slowly and briefly. But each beginning should be preceded with a warm-up. Jog in place. Stretch the muscles you will be using. Plan your time.

Points to Remember

·         Nearly all back and neck pains are because of unwise over activity.

·         If you pay attention, your pain will tell you how serious it is.

·         Seek medical advice if there is anything unusual about your pain.

·         Stay in good shape and use common sense when beginning new activities.

What Is Chronic Pain?

Pain is an unpleasant sensory and emotional experience that starts with an injury or illness. The incoming pain signals trigger specialized nerve cells in your brain to tell your muscles how to respond. (Drop that steaming mug of coffee now!) This response is only one part of a complex warning system where one alarm sets off another, and the control center works hard to figure out what the emergency is all about.

What you feel has both physical and emotional components. If the pain is severe, your pulse may race, your blood pressure may rise, you may start to sweat and the pupils of your eyes may dilate. Meanwhile, your body pumps out chemicals, among them adrenaline to supply extra energy, and endorphins, your body's natural painkillers. You might become frightened, anxious or annoyed.

Your response is as individual as you are. Pain, even when resulting from the same pain signal, differs in each person. You may even react differently at different times. This uniqueness of pain adds to the difficulty in measuring and treating it. There are two basic types of pain, acute and chronic.

Acute Pain

You stub your toe, you yelp in pain. You touch a hot iron; you feel a searing burn. You have your gallbladder removed; you're laid up for days. Whether the pain is mild or severe lasts minutes or days, in each case, the cause of the pain is known, and as you heal, the pain goes away. This is acute pain. Most of the time you can take a pill and acute pain is relieved.

Chronic Pain

In chronic pain, the pain signals keep firing up the nervous system for months, even years, either continually or as flare-ups. In many cases, the response is needless since the initial injury or illness is over. Or the cause may be an ongoing condition like arthritis, an illness like cancer or unknown. Whatever the cause, chronic pain often is intractable. The cause of the pain cannot be removed or treated, and the pain itself cannot be relieved. Unrelieved pain creates a vicious cycle. It can make people unable to work, concentrate, socialize, eat properly, sleep and have sex. That in turn may lead to depression, anxiety and frustration, which accentuates the pain and leaves the patient even less able to cope with the normal activities of life.

For More Information: Please ask your attending physician on your next visit.