Overview
The spine is made up of bone segments called vertebrae. Vertebrae
have two parts - the cylinder-shaped vertebral bodies to the front and the boney
bridges making up the facet joints at the back. Most of the spine is flexible
enough to let people bend, stretch, and lift. Between the bones of the spine
are small discs that are hard on the outside, and soft and jelly-like on the
inside. The spinal bones are connected by the facet joints at the back
and by the discs at the front. The nerves of the spinal cord run through the
spinal canal, which is just behind the vertebral bodies, and separate
into roots along the length of the spinal cord and at the tail end of the spine.
Some of them pass through the pelvis to become the sciatic nerves, which
pass down each leg. Problems with the vertebrae, joints, or discs can all cause
back disorders. Back disorders can cause mild to very severe backache.
Almost 90% of Canadians between the ages of 20 to 65 will develop back pain.
Though it hurts, back pain is rarely caused by a serious disease and usually
disappears in six to eight weeks. It often comes back, however, making it the
second most common reason people see doctors.
Causes
Most cases of back disorders aren't caused by underlying disease. They're
usually caused by aging, wear and tear, and poor posture. Obesity and smoking
are risk factors for back problems. There are a number of back disorders, each
having a different cause.
Muscle spasms in the back can occur when any part of the back is irritated.
Muscle spasms are often an attempt by the body to protect a sore back. Muscle
spasms also occur when the spinal nerves are irritated or damaged. Joint pain
occurs when the joints become worn by activity or by being twisted.
Disc trouble, also called discogenic back pain, can occur in two
ways. The jelly-like material inside the disc either bulges out or bursts
through the hard outer cartilage of the disc. When this material bulges out
and presses on a nerve, it causes pain and is called a herniated or prolapsed
disc. Disc pain usually gets worse over the course of a few days. It usually
goes away after two weeks, but it may continue as a dull, nagging ache. If the
material inside a disc comes out completely, the condition is called a ruptured
disc and is more serious.
Anything that causes pressure on the sciatic nerve root causes sciatica.
The most common cause of sciatica, which is characterized by buttock and leg
pain, is a disc or bone spur pressing on spinal nerve. It usually gets worse
over a period of days, and may last up to several weeks.
Bone spurs, called osteophytes, are new growths of the bones in the
spine. After the age of 60, they may grow together and cause fewer problems.
Spinal stenosis occurs when the canal holding the spinal cord becomes
narrower, due to bone spurs sticking out into the canal.
Symptoms
The pain from a muscle spasm in the back can travel down the buttocks and
leg. Joint pain in the lower back may spread down the backs of the thighs.
It's a stabbing pain at the time of the injury or a few days after. Someone
who has trouble getting out of a car or bed or rolling over often has back joint
pain. The pain lasts 4 to 14 days, and may return a few times a year. It usually
gets worse when the person bends backward. Also, there's usually more pain in
one leg than in the other.
Pain when bending forward is usually, but not always, a sign of a disc trouble,
as are short severe attacks of back pain alternating with longer bouts.
If someone has pain when bending both forward and backward, thinning discs have
probably thrown the back joints out of line, making them easy to strain. Thinning
discs can also make the back less flexible and pinch a nerve, causing sciatic
leg pain, which is pain that travels down the leg and possibly to the feet.
Sciatica gets worse when bending forward. If there's enough pressure on the
nerve, muscles can weaken and bowel and bladder problems may occur.
A herniated disc causes a constant back and leg pain. Intense persistent sciatic
pain going down the leg to the foot is a sure sign of a herniated disc.
Bone spurs jut out into the spinal cord and press on nerves, causing pain.
Spinal stenosis is usually not a major problem. However, if someone feels worsening
numbness or has trouble moving, they may need surgery for spinal stenosis.
Treatment
Anti-inflammatory medications, painkillers, and rest are common treatments
for mild to moderate back pain. Surgery, bed rest, and medications have
been used to treat severe back disorders without much success. Doctors now know
that long periods without exercise can make back disorders worse: it weakens
the muscles, increases the risk of blood clots, and makes it harder to get back
to doing normal activities. As soon as the most severe pain goes away, back
disorders should be treated with daily exercises to improve general fitness,
as well as with exercise routines geared to the specific back problem. Your
doctor or physiotherapist should provide a personalized exercise routine for
back problems. Brisk walking, cycling, and swimming are excellent exercises
for people with bad backs. A health care professional can also provide instruction
about proper lifting techniques to minimize stress on the back.
Your doctor may advise you to lose weight, which may also ease some back problems.
Alternative therapies such as massage and acupuncture may help some people with
back pain.
Other tips:
Your doctor will do one of the following tests for underlying medical problems
only if your back pain does not improve with rest and painkillers:
- a back X-ray
- bone scans
- computed tomography (CT) scan, in which computers combine many pictures
to show a very detailed view of any area of the back
- magnetic resonance imaging (MRI), a type of scan that uses electromagnetic
waves to visualize soft tissue
X-rays can show problems with the vertebrae, but not with the soft tissues
such as discs, ligaments, or muscles. Bone scans can help your doctor screen
for abnormal areas, which are further investigated with other tests.
CT scans can diagnose arthritis and spinal stenosis and other bone changes,
but not always a herniated disc. MRI is the most useful test and can show soft
tissue, including discs, nerves, the spinal cord, and tumours.
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