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Back Pain Education

At some point, practically everyone experiences back pain that interferes with their work, routine daily activities, or recreation.  Back pain is the second most common neurological ailment in the United States — only headaches are more common – and the most common cause of job-related disability and a leading contributor to missed work.  At least $50 billion is spent each year in the U.S. alone on lower back pain.  Men and women are equally affected.  It occurs in part due to the aging process, as incidence of disc disease or spinal degeneration increases with age, bone strength and muscle elasticity and tone tend to decrease.  The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae.  Lower back pain also can occur as a result of a sedentary lifestyle, when, for example, someone unconditioned for strenuous activity lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back.

Fortunately, most occurrences of lower back pain go away within a few days.  Others take much longer to go away, or, occasionally, they may indicate a more serious medical problem.  For example, pain accompanied by fever or loss of bowel or bladder control, pain when coughing, and progressive weakness in the legs may indicate a pinched nerve or other serious condition. People with diabetes may have severe back pain or pain radiating down the leg related to neuropathy.  People with these symptoms should make an appointment with a doctor as soon as possible to help prevent permanent damage.

The anatomy of back pain:

Starting at the base of the skull and moving downward, the spine’s vertebrae are grouped into four regions:

  1. 7 cervical or neck vertebrae (labeled C1–C7)
  2. 12 thoracic or upper back vertebrae (labeled T1–T12)
  3. 5 lumbar vertebrae (labeled L1–L5), i.e., the “lower back”
  4. the sacrum and coccyx, a group of bones fused together at the base of the spine.

The lumbar region of the back supports the weight of the upper body and is where most back pain is felt.  Recurring back pain resulting from improper body mechanics or other non-traumatic causes is often preventable.  A combination of exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries.

There are two distinct levels of severity of joint / back pain:

Acute or “short-term” lower back pain generally lasts from a few days to a few weeks and is most often mechanical in nature.  Some acute pain syndromes can become more serious if left untreated.  Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and/or range of motion, or an inability to stand straight.  Acute pain in the lower area of the back originates either from some trauma to the lower back (such as that caused by a sports injury, or a sudden jolt as in a car accident, or other stress on spinal bones and tissues), or from a disorder such as arthritis.  Occasionally, pain felt in one part of the body may “radiate” from a disorder or injury elsewhere in the body.

Chronic back pain is measured by duration — pain that persists for more than 3 months is considered chronic.  It is often progressive and the cause can be difficult to determine

Diagnoses that may indicate lower back pain requiring treatment:

Bulging disc (also called protruding, herniated, or ruptured disc).  As intervertebral discs degenerate and weaken, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain.  Studies have shown that most herniated discs occur in the lower, lumbar portion of the spinal column.

A much more serious complication of a ruptured disc is cauda equina syndrome, which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.

Sciatica is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve that extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg.  This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling.  The condition may also be caused by a tumor, cyst, metastatic disease, or degeneration of the sciatic nerve root.

Spinal degeneration from disc wear and tear can lead to a narrowing of the spinal canal.  A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time.

Spinal stenosis related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease.

Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength.  Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone and/or absorbs too much existing bone.  Women are four times more likely than men to develop osteoporosis.

Skeletal irregularities produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column.  These irregularities include scoliosis, a curving of the spine to the side; kyphosis, in which the normal curve of the upper back is severely rounded; lordosis, an abnormally accentuated arch in the lower back; back extension, a bending backward of the spine; and back flexion, in which the spine bends forward.

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple “tender points,” particularly in the neck, spine, shoulders, and hips.  Additional symptoms may include sleep disturbances, morning stiffness, and anxiety.

Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints.  Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints).

Tips to a better back:

  • Always stretch before exercise or other strenuous physical activity.
  • Don’t slouch when standing or sitting.  When standing, keep your weight  balanced on your feet.  Your back supports weight most easily when curvature is reduced.
  • At home or work, make sure your work surface is at a comfortable height for you.
  • Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back.  Switch sitting positions often, and periodically walk around the office or gently stretch muscles to relieve tension.  A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support.  If you must sit for a long period of time, rest your feet on a low stool or a stack of books.
  • Wear comfortable low-heeled shoes.
  • Sleep on your side to reduce any curve in your spine.  Always sleep on a firm surface.
  • Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed.
  • Don’t try to lift objects too heavy for you.  Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back.  Keep the object close to your body.  Do not twist when lifting.
  • Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles.  A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.
  • If you smoke, quit.  Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.

The use of wide elastic belts that can be tightened to “pull in” lumbar and abdominal muscles to prevent low back pain remains a focus of study.  Medicare covers a range of back support braces, both with and without rigid removable panels for added support directly where and when it’s prescribed.  CarePoint Medical carries the most advanced, effective and user-friendly support and bracing products available on the market.· We are leading national provider of the insurance-covered products most prescribed by physicians for chronic lower back pain.· We make it easy for our patients to receive the back braces, knee braces, and/or foot-ankle orthotics that are the solutions their doctors prefer for joint and back pain.

 

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