If you have any form of back pain you are certainly not alone. Most people at some time in their life will experience some sort of low back pain. This back pain often gets in the way of work activities, activities of daily living and elective activities. The most recent estimate on the cost of low back pain in the United States was $90 billion dollars per year, with $20 billion going towards medication costs. Lower back pain is the number one reason for disability related to the workplace and a common reason for absenteeism on the job. It is also the 2nd most common neurological problem suffered by Americans. The 1st being headaches. The general consensus is that back pain will go away by itself, even though this is a common belief by many health care professionals, the fact is back pain often comes back.
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Short Lasting Back Pain
Short lasting back pain often called acute low back pain can last anywhere from a few days to a few weeks. The most common reason for an episode like this is some sort of trauma or injury as well as an inflammatory condition like arthritis or a degenerative or damaged disc. These episodes can be caused by a sports injury an auto accident, bending over excessively as well as any sudden bending or twisting. A person experiencing this type of pain can experience a muscle ache, a sharp pain, even a burning sensation. Movements may be limited and very painful. In addition a person may have a difficult time standing up straight. It is not uncommon for an acute episode of lower back pain to also include a bout of sciatica or pain in the leg. This is often a consequence of the inflammation that accompanies these types of injuries. Acute low back pain can become quite serious if it isn’t treated appropriately.
Chronic Back Pain
If you are suffering from what is termed “chronic back pain” it means that you have had symptoms for longer than 3 months. This type of back pain often worsens over time and is sometimes difficult to pinpoint, because the longer the problem goes on the more common it is for other structures to become involved.
Now let’s look at the structures of the back
Back Pain Structures
The back is a very complex structure devised of bones, muscles, ligaments, tendons and nerves. These structures combine to make up the posterior region of the body from the neck all the way to the pelvic bones. The spinal column makes up the central portion of back and supports the weight of all these additional structure and has the job of protecting the spinal cord. The spinal cord is the delicate and fragile structure that carries all of the nerve impulses from the brain to the body. This structure controls all the movements and relays all the sensations that we experience from the body.
The spine consists of more than 30 bones including the vertebrae that make up the cervical, thoracic and lumbar spinal column. In the center of each of these vertebrae is the canal that the spinal cord travels through. The spinal cord starts at the base of the brain and travels to about the level of the 2nd lumbar vertebrae in an adult which is slightly below the rib cage.
As the nerves descend from the base of the brain they form small roots that exit from the spinal cord out the lateral portion of each vertebra through small holes called foramen. Because the spinal cord ends effectively at the L2 level the nerves continue downwards in a mass of nerves called the cauda equina or horses tail because it resembles a horses tail. Between each vertebrae is a soft gelatinous structure called the intervertebral disc.
The discs are a combination of a connective tissue type material and a softer inner core. They allow flexibility and shock absorption to the spine to allow the twisting bending and movements that we are used to. The ligaments and tendons surrounding the spine keep the spine tethered and connected as this movement occurs.
The spine is comprised of 4 distinct areas, starting at the top of the spine they are as follows:
- The Cervical Spine in the neck consisting of 7 vertebrae labeled C1-C7
- The Thoracic Spine in the mid-back consisting of 12 vertebrae labeled T1-T12
- The Lumbar Spine in the lower back consisting of 5 vertebrae labeled L1-L5
- The sacral and coccyx region in the tailbone area consisting of a fused section of bone
The most common area of dysfunction is the lower back because of the load of the upper body and trunk that burdens the lumbar spine.
What are the causes of low back pain?
As we age the discs begin to lose their rudimentary blood supply and the adult disc lacks a blood supply for the most part altogether. Combine that with the changes in elasticity of the ligaments and tendons as well as changes in muscle flexibility and strength. As the disc loses its blood supply it relies on movement and activity to push fluid in and out of the disc, a process called imbibition. This process keeps the disc healthy and hydrated and nutrients flowing in and out.