back pain

"80% of the population will suffer from low back pain at some time in their life".

Back and neck pains can be caused suddenly by a specific injury such as lifting a load awkwardly or it may come on gradually. This is normally due to an accumulation of several minor factors. This could include poor sitting posture at a computer or driving, poor physical fitness and having weak muscles that support the spine. If you leave your problem untreated these muscles will become even weaker and the spine becomes more stiff and painful. The problem then will become chronic and recurrent. Therefore it is important to get your spine checked over as soon as possible, even if you have a minor twinge, if you want to prevent long-term problems. A lot of people avoid early treatment as their problems are intermittent but research shows that early intervention is the most successful way to resolve back and neck pains.

Back anatomy

The back is made up of 24 building blocks called vertebrae which support the body. There are seven cervical vertebrae, twelve thoracic vertebrae, and five lumber vertebrae. The majority of the problems stem from the lower lumber vertebrae. The vertebrae sit on top of each other separated by the spinal disc. On the back of each vertebrae there are two joints on each side called facet joints. Half the weight of the body goes through the body of the vertebrae and the disc while the other half of the bodies weight goes through the two facet joints.

The spine has three healthy natural curves. This allows the spine to act as a shock absorber. As a load is placed upon the spine the curves bend to dissipate the force. If for any reason these curves are lost then there is a dramatic increase of force through the individual vertebrae and disc.

The facet joints are true joints they allow the back to bend forward and backward as well as rotate from side to side. They are placed under the most stress when the back is bent backward especially with some rotation. Like any joint it is easily sprained and because there is so much stress through these small joints they are more prone to degenerate. view video about facet joint

The most talked about structure in the back is the spinal discs. These shock absorbing discs sit between each vertebrae. They are made up of a softer centre and a realatively hard outer shell. They also provide a lot of stability to the lumber spine. Problems usually start when the outer annulus breaks down from injury and aging.

The muscles and ligaments around the spine are crucially important. There is a long ligament that runs down both the front and back of the spine. They stabilize the spine and like any ligament around any joint in the body they can be sprained and cause problems short and long term. The back muscles are important to support the spine and the abdominal muscles are also connected to the lumbar back tissue and have a very important role in the health of your back. It is these muscles and ligaments which we can have the most effect on to ensure a healthy back.

The messages from the brain to the body are carried in the spinal cord. The spinal cord runs down through and is protected by the vertebrae. At each vertebrae there exits a spinal nerve. Often the spinal nerve is injured or irritated as it leaves the vertebrae. The spine is a very complex structure which can easily have problems. Now we know the anatomy we will discuss what can go wrong.

The back is a very complex structure, many structures within the back can be causing pain. While we can often be very specific about what exactly is causing your back discomfort, more often than not we can not. After taking a careful history of your problem and a thorough examination we usually have a good idea about your back problem but NOT a definitive diagnosis

Back pain can be causing symptoms locally in the back and buttock region or it can cause referred symptoms into the leg and as far as the foot. It can be a dull vague feeling or a very direct shooting pain down the leg. Other complaints include pins and needles, numbness, muscle weakness and general stiffness. Abnormalities of joints, muscles and neural structures may contribute significantly to back pain.

Recent onset of back pain is usually from the joints. In long standing cases of low back pain there maybe associated muscle and neural involvement. Chronic low back pain is caused by instability in which there is disc degeneration. This can cause inflammation of the joints. An imbalance of muscles is also usually present showing weakness of the main stabilisers transverse abdominus and multifidius. Poor posture/postural control can result in this muscle imbalance. Muscle strains are rare in the back unless taking part in extreme torsional sports like javelin or bowling in cricket where stress is placed on the quadratus lumborum.

MECHANICAL BACK PAIN Most back pain falls into this category. The pain is vague and not specific to any structure. It is usually do to a dysfunction of the supporting ligaments and muscles. The stress to the back structures causes the pain. The predisposing factors for this pain vary with age. As adolescents grow the bones grow faster than the muscles and ligaments. This leads to tightness and weakness of the structures supporting the back. With increased activity such as athletic participation there is increased stress on the back structures and pain ensues. As we get older a different process takes over. The back naturally starts to degenerate after about age 20. If we do not keep the back in shape the muscles get tight and put stress on the back structures. Combine this with the weakness of the muscles supporting the spine and we have a situation where there is either an increase in abnormal movement between the vertebrae or a decrease in the normal functional movement between the vertebrae. Often these two occur at the same time in different parts of the spine.

Techniques have demonstrated that damage to the facet joints and intervertabral disks are the most common causes of pain in the back.

This spasm of adjacent muscles is the bodies way of protecting the area and tries to prevent you from moving and incurring more damage. Symptoms can vary greatly and be confused with disc related disorders as its possible for patients to report referred pain into the lower extremities. The traditional facet locking syndrome may lead to such an acute attack but can be resolved successfully by freeing the offending joint and restoring normal function. This should only be attempted by suitably qualified practitioners following the correct diagnosis.

Looking at someone's spinal curves can say a lot to why someone is suffering from back pain. The main one I see is lordosis followed by flat back. It is also important to look out for scoliosis especially with children. Postural problems are caused by instability, weakness and muscle spasm. Other causes include deformities whilst growing or it can be hereditary.

To recover from back pain and prevent re-occurrence the basics of the exercises come from pilates. Pilates has been in use for decades with ballet and dance and has now become beneficial in all sports. With athletes you can progress from floor based exercises to more sport related activities. Many back pain sufferers who learn these exercises learn to control there symptoms and have little re-occurrence through keeping the exercises going. It has been found that back pain sufferers have lost the control of their pelvis and activation of the deep abdominals which are vital in back stability.

Exercise equipment can be adjusted to simulate the sporting environment and a graded programme can be introduced to return the athlete to his or her chosen sport as soon as the back is capable of performing the rigorous demand of their sport.

Re-education of the pelvic tilt and activating the lower abdominals is most important and must be achieved before advancing to sport specific exercises.

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