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| Back pain What is back pain? Everyone's back pain is different. For some people, back pain involves mild pain (nuisance pain, aching, soreness). For other people, back pain involves severe pain (pain that hurts all the time, even when resting). Most doctors refer to back pain as acute (generally severe, but short-lived), sub acute or chronic (long- lasting or occurring often). Acute back pain usually lasts from one to seven days. Pain may be mild or severe and occasionally may be caused by an accident or injury. About 80 percent of all back pain is acute. Sub acute back pain usually lasts from seven days to seven weeks and usually is mild; occasionally it's severe. This pain generally is unrelated to other illnesses you may have. About 10 to 20 percent of all back pain is sub acute. Chronic back pain usually lasts more than three months and maybe mild or severe. It may be related to other illnesses you may have or may have no identifiable cause. About five to 10 percent of all back pain is chronic. What is the structure of the back? The back is held upright by muscles attached to the backbone. Doctors often refer to the backbone as the spine, spinal column, or vertebral column. The backbone isn't one long bone, but actually 24 separate bones called vertebrae. These 24 vertebrae are stacked one on top of another to form the backbone. The points where two vertebrae or bones fit together are called joints. They make it possible for the spine to move and turn in many different directions. Discs located between each vertebra, and these discs are made of cartilage which is a soft, elastic material. Discs act as cushions or shock absorbers - much like the shock absorbers in a car. Their main job is to protect the joints from wearing out. Joints contain a slippery substance called synovial fluid that keeps them moving smoothly. The spinal cord is very important because it transmits electrical signals between the brain and the nerves in your legs, arms, back, and other parts of your body. The spinal cord runs through a hole in each vertebra of the upper and middle parts of your backbone, much like a piece of string through a beaded necklace. The space it runs through is called the spinal canal. At times, a message might signal pain or discomfort. The pain signal is an important one, because pain tells you that some part of your body needs attention. A serious injury to the neck or upper back runs the risk of damaging the spinal cord, causing paralysis of the parts of the body below the injury. It should be noted that the spinal cord is not present in the lower part of your backbone. Here the spinal canal contains a sack of nerves called the cauda equina. Your backbone, with all its parts, cannot hold itself upright. It needs strong muscles, tendons, and ligaments for support. Muscles help you move or hold your position. Tendons fasten muscles to bones. And ligaments stretch from one bone to another to hold bones together. What Causes Back Pain? Anything that puts pressure on your back muscles or nerves can cause pain. Any illness or damage to your spine also can cause pain. The cause of most acute back pain is unknown, but is probably due to minor strains, sprains and overuse. Emotional stress may add to the pain, especially since it slows the rate of recovery. Other possible causes of back pain are included in the following sections: Ruptured Intervertebral Disc This may be the most painful, yet easiest condition to identify. A ruptured or herniated disc is one that bulges into the spinal canal, pressing on the nerve roots. This causes the nerve roots to become irritated. A disc can rupture after bending over and lifting, or it may occur for no apparent reason. A ruptured disc may cause back pain and muscle spasms, but a more common symptom is sciatic pain. This is severe pain spreading down one leg and often into the foot. Sometimes it is the only symptom of a ruptured disc. A ruptured disc usually can be detected by a physical examination alone. Sometimes a procedure such as a myelogram, Computerised Axial Tomography (CAT) scan, or Magnetic Resonance Imaging (MRI) is needed to confirm the diagnosis and determine if surgery is necessary. Spinal Stenosis In spinal stenosis, the spinal canal becomes narrowed. This squeezes the back nerves and puts pressure on them. It is this pressure that causes the back pain. Numbness, pain and weakness in the legs can also occur. The most common symptom of spinal stenosis is pain that worsens when walking and subsides when sitting down. Osteoarthritis Osteoarthritis is just one form of arthritis that can cause back pain. It breaks down the cartilage (soft, elastic material) that cushions the spinal joints and other joints in the body. Lower back pain can become more intense when osteoarthritis affects the hips or the knees. Osteoarthritis can also directly affect the spine, causing muscles, tendons, or ligaments to become strained, which can lead to back and/or neck pain. Ankylosing Spondylitis This form of arthritis causes the joints in the spine to become stiff and swollen. In time, stiff joints can fuse together. The most common symptoms are pain and stiffness in the buttocks and lower back (particularly in the morning) that continue for more than three months. Back to top Injury or Accident Many back injuries are caused by an unexpected twist or sudden motion - often while moving heavy furniture or other such manual action. This often results in muscle strain. With either an injury or accident, severe muscle spasms usually last 48 to 72 hours. They generally are followed by days or weeks of less severe pain. It usually takes two to four weeks to heal completely from a mild back injury. It could take from 6 to12 weeks if there are strained ligaments or if the strain is more severe. Severe back injury from a fall or accident may require hospitalisation and a longer recovery period. Osteoporosis This is a type of bone disorder that causes bones to become thin and weak due to calcium loss. Fragile bones; especially the bones in the spinal column, can break more easily, and there is an increased tendency for this to happen in older women. Osteoporosis also contributes to compression fractures, or spinal fractures in which the vertebrae become flattened. Falls, lifting heavy objects or moving the wrong way can result in a compression fracture. Rheumatoid Arthritis This form of arthritis causes any joint to become stiff, painful and swollen. It can affect the neck but almost never the joints in the lower back. Polymyalgia Rheumatica (PMR) This rheumatic disorder causes muscle pain, aching and stiffness in the neck and shoulders, lower back, thighs and hips. It can last a few months or many years. Most people experience severe stiffness in the morning. Fibromyalgia People with fibromyalgia feel pain and stiffness in muscles and tendons, especially in the neck and upper back. The pain can last for weeks, months or years. The symptoms may disappear by themselves. This condition often is related to sleep problems, poor conditioning or an old injury. Paget's Disease This is a type of disorder in which the calcium in the bone spreads unevenly. The bones most commonly affected are in the lower back, pelvis, tailbone, skull and the long bones of the legs. Back pain may be a symptom, but most often there are no obvious symptoms. Paget's disease usually is discovered on an X-ray or bone scan done for reasons other than pain. Other Conditions Sometimes pain felt in the back actually originates elsewhere in the body. Such problems may include:
Factors That Can Make Back Pain Worse Stress, poor posture, lack of exercise and being overweight can all contribute to the problem. In terms of stress, people react to it in different ways. Some may feel tired, sleep poorly, overeat or feel irritable. Some clench their jaw. Others tighten their neck and shoulders. Others may get a headache or an upset stomach when they are tense. Many people tighten their back muscles when they are worried or tense. This can make existing back problems worse. Being overweight can put added pressure and strain on the back and stomach muscles, causing those muscles to stretch and weaken. Weak back and stomach muscles cannot support the back properly. Poor posture can shift your body out of balance. This forces only a few muscles and joints to do all the work. Without proper exercise, muscles become weak and tire easily. Exercise is necessary to keep the back strong and limber. A good conditioning (aerobic) exercise program led by a trained instructor can be particularly helpful. An effective program includes a warm-up period; about 30 minutes of aerobic activity (exercise that results in a sustained heart rate of l00 or more beats per minute); isolated muscle group work (including abdominal muscle toning); and a cool-down period. Over a period of time, the rewards of regular aerobic workouts can include a slimmer waistline and healthier back. How Is a Diagnosis Made? It often is difficult for doctors to find the exact cause of back pain, especially since there are so many possible causes. If the cause is unclear, your family doctor may suggest that you see an orthopaedist, rheumatologist, neurosurgeon, neurologist, physiatrist or other medical specialist for diagnosis. If your back pain is accompanied by any of the following, it would be preferable to see a doctor without delay:
Regardless of what type of doctor you see, there are some things you can expect your doctor to do during your visit. Medical History Your doctor will most likely ask you a number of questions - the most common of which are listed as follows:
Physical Exam Next, your doctor will give you a physical exam. During the exam, the doctor may perform any of the following:
Special Tests If the doctor needs more specific information, he or she may ask you to undergo one or more of the following tests: X-ray Studies show that in many cases of routine back pain, X-rays may not initially be necessary. However, the signs and symptoms will determine what type of study should be done. In certain cases, X-rays might indicate that pain is due to:
CT Scan Only a few people with lower back pain need a CT (Computerised Axial Tomography) scan. If your doctor advises one, a special machine takes an X-ray scan of the area. A computer turns this scan into a three- dimensional view of the back. This helps the doctor see if there is a ruptured disc that can't be seen on regular X-rays. Other conditions that a CT scan can help to detect are spinal stenosis, tumors and infections of the spinal cord. MRI MRI (Magnetic Resonance Imaging) is another way to make very clear pictures of parts of the spine. The MRI does not use X-rays or radioactive dyes. It can provide clearer pictures of soft tissues such as muscles, cartilage, ligaments, tendons and blood vessels, in addition to bone structure. Myleogram During a myelogram, a special liquid dye called a Contrast Medium is injected into the spinal canal. X- rays are then taken of the area. The Contrast Medium can make problem areas show up more clearly on the X-ray. A doctor may order a myelogram to detect problems such as spinal stenosis or spinal cord tumors. If surgery is being considered, particularly for a person who has had a serious back injury, many neurosurgeons will require a myelogram beforehand. Bone Scan During a bone scan, a very small amount of radioactive liquid is injected into a vein and this concentrates in the bones for a short time. A special radioactive detecting machine then will scan the area of concern to produce a picture. Occasionally bone scans are done to look for damage or tumors in the bones themselves. However, back pain is rarely due to diseases of the bones. Electrodiagnostic studies Electrodiagnostic studies are used to help confirm the presence of nerve compression in the spine. An electrodiagnostic study consists of two tests. One is an electrical test which is designed to study nerve conduction. In this test the nerve is given an electrical stimulation, and the speed of the impulse is measured. The second test is a needle test called an electromyogram, or EMG. The purpose of this test is to study the muscles for primary disease or for the effect of nerve compression on the muscle. The compression is especially seen in herniated discs or spinal stenosis. Blood tests If your doctor orders blood tests for you, a laboratory technician will carefully draw a small amount of blood from a vein in your arm, which then will be tested in the laboratory. Ask for an explanation of the tests which can greatly vary. Back to top Treatment for Back Pain More than 85 percent of people with lower back pain improve with minimal treatment in a matter of days. However, if back problems persist, doctors generally prescribe one or more of the following treatments:
For some back conditions, the doctor may refer you to another specialist such as an orthopedist, rheumatologist, physiatrist, physical or occupational therapist, psychologist, psychiatrist or surgeon. Proper exercise For many people, the key to a healthy back is proper exercise. Some exercises are designed to strengthen your back and stomach muscles, while other exercises are designed to improve your posture. A 30 minute aerobic conditioning program three times a week is ideal for overall fitness. Walking and/or swimming are highly recommended for most people with back problems. The right kind of exercise program may help to keep your back problem under control. It can make it easier for you to continue doing your daily activities. You may need to take a break from vigorous exercise if it makes your back pain worse. Ask your doctor and physical therapist which exercises you can do to relieve back pain, stay fit, and prevent injuring yourself again. If you have any leg pain or other evidence of nerve injury, consult you physician before beginning exercises. DO NOT carry out any exercise that makes your back pain worse! Rest The most common treatment doctors recommend for severe back pain is bed rest - especially in the most acute phase. However, it is best to start moving around as soon as possible. Different people require different amounts of rest. Usually, two to three days of staying in bed, except to go to the bathroom, will be enough to ease your back pain. You may want to ask the doctor if special pillows or devices are necessary to support to your neck, back or feet while you are recovering. Heat and Cold Many people have found that hot and cold treatments help relieve back pain. You might try both to find out which works better for you. Heat relaxes muscles and soothes painful areas. There are many ways to apply heat. Some people like hot showers or baths, while others prefer using heat lamps, heating pads or warm compresses. If you have arthritis, heating your muscles first might make it easier for you to do back exercises. Cold has a numbing effect. This often helps relieve pain. You might try one of these methods for applying cold:
Be sure not to leave ice on after the skin becomes numb. This could lead to localised frostbite. Do not use cold if you are especially sensitive to it or have decreased circulation or sensation. Back to top Posture Training If poor posture is a factor, then posture training may help relieve your back pain. During posture training, an occupational or physical therapist will teach you healthier ways to sit, stand, sleep and lift objects. Techniques for Good Posture when sitting
Techniques for Good Posture when standing
Techniques for Good Posture when sleeping
Body Mechanics To keep good posture while in motion is to use good body mechanics. In lifting, this means that the object lifted is held close to the body and that lifting is done with your legs. The normal back curves are maintained and the legs lift the load. Avoidance of twisting, particularly when carrying a load, is also important for good body mechanics. Move your feet, do not twist as you lift.
The type of shoes you wear can also affect your posture. For women, high heels may put more stress on your lower back by changing your posture. You might find it more comfortable to wear low or flat heels. Cushioned-soled shoes also provide "shock absorbency" for your spine. Weight Loss If applicable, your doctor may recommend weight loss as one way to reduce your back pain and improve your general health. The best way to lose weight is with a balanced diet along with regular exercise. Back to top Stress Management and Relaxation Exercises Every day of our lives is filled with some kind of stress. In fact, any situation can cause stress such as work, personal relationships, raising children, paying bills, the death of a loved one or a new experience. Even very happy occasions such as a family wedding, birth of a new baby or family vacation can be stressful. For many people with back pain, the greatest stress comes from unwanted changes in their lives caused by the pain itself. If your pain is acute, you may be able to reduce your stress by reminding yourself that you just need to wait until the pain disappears. However, if your pain has become chronic, you may need to take a good look at what you want to do, what you need to do and what you actually can do within your limitations. Since we cannot remove everyday events from our lives, the key to controlling stress is changing how we react to daily living. Think about how you react to everyday events. What methods do you have for relaxing and releasing tension from daily stress? Tips for Managing Stress
Medication If your back pain is not relieved using other forms of treatment, your doctor may prescribe medication. The medication chosen depends on the back pain. For example, medications called analgesics can help relieve pain. Other medications called muscle relaxants can help relax tight muscles. If your back pain is caused by arthritis, your doctor can give you medication that will reduce inflammation as well as relieve your back pain. The most common medications prescribed are called nonsteroidal anti-inflammatory drugs (NSAIDs). These medications can reduce inflammation without working like cortisone, the body's anti- inflammation steroid hormone. Aspirin and Ibuprofen are NSAIDs. Other NSAID medications are prescribed when needed. Learn all you can about your medications by asking your doctor or pharmacist questions such as the following:
Let your doctor know if you are taking other medications. Sometimes certain medications cannot be taken together. Back to top Surgery People with sciatica or spinal stenosis often benefit from surgery. A few people with tumors within the spinal canal require it. Other than that, few people with back pain need surgery. Most people can be treated successfully with rest, exercise and medication. Surgery does not always work for many common kinds of back pain, and it is difficult to know who will be helped and who will not An orthopedist can help you decide if a back operation is necessary. It is recommended that you also seek a second opinion. Unproven Remedies It often is difficult to be patient when you are suffering from chronic back pain. You might be tempted to try unproven treatments. A treatment that promises "a quick cure" or "miraculous relief" can sound wonderful. But remember, these unproven treatments usually are expensive and may do nothing for you. The sensational successes you hear about usually are illusions. They even may be harmful and often keep you from getting the medical care you really need. If you hear about a new treatment, discuss it with your doctor and get his or her advice. Coping with Chronic Back Pain Many relieve their back pain by doing special breathing or muscle relaxation exercises. If you have chronic back pain, check with your doctor to see if relaxation training can help. 80% of back pain resolves on its own with or without medical intervention. Back pain and Chinese medicine Qi stagnation Qi is the energy or "life-force" that circulates throughout your body. This Qi flows through a network of channels and meridians. Left untreated, the Qi stagnation can lead to blood stagnation, and what was a dull ache can become a very sharp fixed pain. Qi stagnation of the lower back pain is sometimes found in women who have painful periods. In this case, acupuncture may be the treatment of choice. Another cause of Qi stagnation is the invasion of cold or dampness into the acupuncture channels that go up and down the spine. In Western culture this is generally what is known as "catching a cold", and in Chinese medicine we can catch a damp too. This damp and cold can end up in the meridians and slow the flow of Qi and cause pain. For instance, if cold or damp weather aggravates the condition, then it is likely that you've got some cold or dampness stuck in the channels of the back impeding the flow of Qi. Blood Stagnation Any specific trauma to the back can give rise to what we call blood stagnation.The treatment principle is the same as with Qi stagnation: the blood system needs to get moving again, and the pain should lessen or go away. Herbs can often dispel the blood stasis. Blood stasis is the local inflammation and bruising that is found at the site of a trauma. Yun Nan Bai Yao is a commonly used herbal formula that is used to heal bruising. It is sold in capsule form and also in powdered form. The capsule form is most commonly taken if the skin isn't broken, and the powdered form sprinkled right on to the wound if there is bleeding present. Damp Heat In the context of back pain, this pathology can cause radiating pain that actually circles the lower back and down into the groin area, and is often associated with an infection in the urinary tract or other area in the lower abdomen. This might be kidney stones or possibly a bladder infection. Herbal medicine is often used to dry the damp and clear the heat. Kidney Pathology Like damp heat above, this is not a nerve impingement syndrome but an issue that deals with the organs found beneath the skin in the lower back - the kidneys. Kidney pathologies range from kidney-stones to a deficiency of Yin or Yang in the body. Yin deficiency tends to include lower back ache that is a long term problem - six months minimum with no history of trauma. Acupuncture treatments can assist in stimulating kidney functions and herbal medicines such as Liu Wei Di Huang Wan could be employed to treat the root cause of the pain. A deficiency of Kidney Yang could also give rise to lower back pain. Herbal medicines to treat this condition might include: Jin Gui Shen, Qi Wan or certain other formulas designed specifically for lower back ache due to a deficiency of Kidney Yang. East and West integration and back-care Backaches are all too common pathology among people everywhere. With the integration of East and West with regard to Oriental therapies, many people are beginning to appreciate the age old medical wisdom of the Orient - especially with regard to back pain. Back to top |
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