What Is Back Pain Common causes of Back Pain

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					Health Tip of the Month                  March 2005         Protect Your Back

What Is Back Pain?

Back pain is one of the most common physical complaints among
adults - and a chief cause of misery for many. At some point in their
lives, most people will experience some sort of back discomfort.

Back pain describes pain or discomfort felt in the upper, middle, or
lower back. The pain may extend to the hips and legs as well. The
back consists of a complex arrangement of bone, ligaments, joints,
muscles, and nerves, and pain can result from a problem with any of
these components.

The most common type of back pain is low back pain. That's because
the lower portion of the back is under the most pressure when a
person is sitting or lifting, and it can be easily damaged.

Common causes of Back Pain

The most common causes of lower back pain are sprains and strains.

    1. Strains

Despite their size and strength, muscles of the lumbar spine can rip or
tear. This is called a muscle "strain."

A strain is the result of a heavy load or sudden force applied to the
muscles before they are ready for activity. The muscle essentially rips,
along with the blood vessels within the muscle tissue.

This tear in the muscle tissue is followed by symptoms such as:

    •   Pain
    •   Swelling
    •   Muscle spasms

    2. Sprains

Sprains refer to an overstretching of one or more of the ligaments of
the back. The ligaments can be stretched beyond their natural
integrity and in some cases can completely tear.

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Health Tip of the Month                  March 2005           Protect Your Back

It is common to have both ligament sprains and muscle strains
occurring together. This is especially the case in severe falls and motor
vehicle accidents.

Nice to Know:

Acute and intense low back pain often results from unspecific sprains
and strains. Acute low back pain from lumbar strains and sprains can
be accompanied by sciatica, a term used to describe pain extending
down into the buttock and leg from the irritation of a larger nerve
exiting the lumbar spine called the sciatic nerve.

Other Conditions Causing Back Pain

    3. Disc Injury

A herniated disc, also called a "slipped disc," is a disc that bulges out
from its position between two vertebrae. A herniated disc has the
potential to cause compression against a nerve, producing what is
called radicular pain. (also called Sciatica). This pain is caused by
compression of the nerves as they exit the spinal column. The pain
may be felt radiating into the buttock or down the leg, and may be
accompanied by a sensation of numbness or tingling in the leg.

    4. Spinal Stenosis

Stenosis means a constriction or narrowing. Spinal stenosis refers to
narrowing of the spinal canal, a condition usually affecting people over
age 50.

It results mostly from degenerative changes, or osteoarthritis, in the
spine, particularly from bony formations called osteophytes, which
form around the joints of the spine. When symptoms are severe and
persistent, and do not respond to conservative therapy, surgical
treatment may be necessary.

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Health Tip of the Month                  March 2005          Protect Your Back

    5. Osteoarthritis of the Spine

Osteoarthritis refers to joint damage that results from "wear and tear."
The cartilage (the tissue that lines the joints) between the vertebrae
may become increasingly damaged. This may affect a single joint or
any number of the joints of the spine. These changes to the joints are
also known as degenerative changes.

    6. Spondylolisthesis

Spondylolisthesis is a condition in which one vertebra slips forward on
the one beneath it. It may result from a number of causes, including
trauma to the spine or osteoarthritis (wear and tear) of the spine, or it
may have been acquired from birth.

Treatment depends on the severity of the condition and the
symptoms. This may range from simple exercises and physical therapy
to spinal fusion to stabilize the spine.

    7. Ankylosing Spondylitis

Ankylosing spondylitis is a type of arthritis that primarily affects the
spine. "Ankylosing," in Greek, means, "causing stiffness and
immobility of a joint," and "spondylitis" means inflammation of one or
more vertebrae.

Ankylosing spondylitis causes inflammation of the ligaments and
tendons that connect the vertebrae and ultimately results in fusion of
the spine. This can result in stiffness and pain. In some cases, as the
fusion progresses, the spine curves forward, causing a person to

    8. Osteoporosis and Fractures of the Lumbar Spine

Osteoporosis is a condition in which bone density and bone strength
decreases, making a person more susceptible to fractures. It is a
major cause of bone fractures in postmenopausal women and older
persons in general.

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Health Tip of the Month                  March 2005          Protect Your Back

Because the signs of osteoporosis are subtle and can be easily missed,
many people do not know they have osteoporosis until a bone actually
breaks. In many cases it is the vertebrae that fracture, causing back
pain or deformity. The hip and wrist are also common sites of fractures
resulting from osteoporosis.

  9. Pregnancy

During pregnancy:

    •   The abdomen protrudes.
    •   Both gravity and hormonal changes continue to relax the
        muscles of the low back and abdomen.
    •   The increased lumbar curve places stress on the lower back
        muscles and lumbar spine.
    •   The chance of back pain rises significantly with activity.
    •   Without treatment, the frequency of muscle spasms and pain
        may increase.

Back pain during pregnancy can usually be managed with:

    •   Using better posture
    •   Learning about body mechanics (proper sitting, bending, lifting,
    •   Using an external brace or support
    •   Following a proper exercise plan

Sciatica during pregnancy can also develop from the increased size of
the baby itself. The growing foetus can place pressure directly on the
nerves of the lumbar area, causing direct pressure and pain. Sciatica
almost always goes away after delivery.

    10. Fibromyalgia

Fibromyalgia may cause chronic back pain and is believed to be a
result of inflammation of the body's connective tissue. The condition is
characterized by widespread muscle pain, fatigue, and multiple tender
points on the body.

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Health Tip of the Month                  March 2005          Protect Your Back

How Serious Is Back Pain?

The seriousness of back pain depends on the cause. Tumor, infection,
and fractures are serious problems but are rare. In general, when first
seeing a patient with back pain, physicians consider that the cause of
the pain may be serious if:

    •   It wakes a person from sleep.
    •   It occurs in children (although many cases of back pain in
        children prove not to be serious).
    •   It occurs along with an inability to control urine or stools.
    •   It is accompanied by unexplained fever or weight loss
    •   It occurs in someone with a history of cancer

But back pain may have long-term, adverse effects on the quality of
one's life. While most causes of back pain are certainly not life
threatening, chronic back pain can be life-altering. For many
individuals who suffer from chronic back pain, the condition can
certainly affect their lifestyle.

Frequently Asked Questions

Here are some frequently asked questions related to back pain.

Q: What is a slipped disc?

A: This is actually a mislabeling that refers to a herniated disc. In a
herniated disc, the nucleus pulposus perforates the annulus fibrosis -
but the entire disc does not "slip" out of place.

Q: Back pain wakes me up at night. Are there any correct
positions to sleep at night that will benefit my back?

A: Try to avoid sleeping on your stomach. However, if you find
yourself in this position often, try placing a pillow under your stomach
to maintain support of the lumbar spine. A pillow between the legs can
be a good support when lying on your side. A pillow under the knees is
often helpful when lying on your back.

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Health Tip of the Month                  March 2005            Protect Your Back

Q: Do elastic back supports help prevent back pain?

A: There is probably as much controversy about back supports as
there are back supports. Thin neoprene supports may help abdominal
muscles support the lumbar spine. If you feel as if it helps you be
more conscientious about proper lifting mechanics, then the support
may be worthwhile. More rigid braces are helpful when there is a need
to restrict lumbar motion, as may be the case in compression fractures
and significant strains or sprains. Keep in mind, however, that no back
support is intended to replace a good back-strengthening

Current Treatments for Back Pain

Nearly nine out of ten people with back pain will recover
without treatment within the first month.

Treatment depends on the condition that is causing the pain. Some of
the conventional treatments that have long been used to treat back
pain - including traction, corsets, and electrical stimulation - are now
accepted to be generally unhelpful for many sufferers, though some do
obtain benefit. Non-surgical treatments for back pain include:

    1. Heat and Cold

When a back injury occurs, the use of heat or cold applied to the back
may be helpful.

    •   Use cold within the first 48 hours after the back symptoms start.
        Apply a cold pack (or a bag of ice) to the painful area for five to
        ten minutes at a time. This can control excessive inflammation
        and provide pain relief.
    •   Use heat if symptoms last longer than 48 hours. A heating pad
        or hot shower or bath can helps relieve muscle tension and pain.
        Be careful to avoid burns with a heating pad; don't use it while

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Health Tip of the Month                  March 2005           Protect Your Back

    2. Exercise

Exercise is the most important component for the treatment of
chronic low back pain. Experts suggest resting the back in the very
early stages, but usually not for more than two days, and then
beginning an exercise plan as soon as the pain permits, once the worst
is over.

What About Bed Rest?

Spending more than a day or two in bed is not recommended. Too
much bed rest cause the bones to lose calcium, weakens muscles, and
is likely to make your back problem worse.

To strengthen your back after injury - and to help prevent future
backaches - try aerobic exercise. Research has shown that low-
stress aerobic exercise is an effective form of treatment for back pain.

    •   Aerobic exercise releases the body's own natural painkillers,
        called endorphins.
    •   Exercise speeds up back rehabilitation and has been shown to
        help reduce the risk of future back injuries.
    •   In addition, the more fit a person is, the more discomfort he or
        she can tolerate.

It is important to start any exercise program slowly and to gradually
build up the speed and length of time of the exercise. At first,
symptoms may worsen as one increases activity. Usually this is
nothing to worry about, but if pain becomes severe, contact your

Activities that can be performed without putting much stress on the
lower back include:

    •   Walking short distances
    •   Using a stationary bicycle
    •   Water aerobics or swimming

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Health Tip of the Month                  March 2005                 Protect Your Back

    3. Physical Therapy

Physical therapy offers a wide range of treatments for back problems.
Physical therapy treatments have four main goals:

                           •   Relieve pain
                           •   Accelerate natural healing processes
                           •   Increase strength and flexibility of back muscles
                               and ligaments
                           •   Help prevent future episodes of back pain

Types of treatment used by the physical therapist will depend on the
nature of the condition being treated. Some treatments have not been
proven scientifically but can still be helpful in certain individuals. These
treatments include:

    •   Flexibility and strengthening exercise programs. These
        types of programs are important to keep the low back muscles
        flexible and strong. They are among the main safeguards to
        prevent future back injuries. It is important to begin slowly and
        progress as tolerated, using pain as your guide. The old adage
        "no pain, no gain" is not the rule of thumb for the recovery of
        back pain.
    •   Heat. Heat usually is applied when there is a small area of tissue
        damage and inflammation. Electrical currents can be used to
        relieve pain and also to stimulate circulation in the deeper
    •   Hydrotherapy. Hydrotherapy involves the use of water to treat
        physical disorders and may include baths, spas, pools, or shower
    •   Electrical nerve stimulation. This includes transcutaneous
        electrical nerve stimulation (TENS), in which electrodes are
        placed on the back to gently stimulate nerves and help alleviate
        pain. TENS appears to be helpful for some people with spinal
        stenosis, but has not otherwise been found to be generally
        helpful. An alternative version delivers the electrical stimulation
        through acupuncture needles. Treatment generally consists of

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Health Tip of the Month                  March 2005            Protect Your Back

        45-minute treatment periods three times a day. Most people
        hardly feel the electrical sensation.
    •   Tissue mobilization and massage techniques. Massage and
        a variety of soft tissue mobilization techniques are being used
        more often by therapists who specialize in manual therapy.
        These techniques may be helpful to increase circulation to the
        area, release muscle spasms, and stretch back tissues.
    •   Traction. Traction or spinal stretching equipment has been used
        to help decrease pressure on the nerve roots and provide a
        stretch to tight muscles of the back. While once used commonly,
        traction has now generally fallen out of favour.
    •   Back education. This involves teaching proper posture and
        lifting techniques as part of a total back care program. This
        information helps people to adapt and adopt the right attitudes
        toward the body and its functional use.
    •   Spinal Manipulation. This involves manual treatment to apply
        force to the back to adjust the spine. The aim is to "manipulate"
        the back, or "realign the spine" in order to restore the range of
        motion of the back.

        Spinal manipulation can be helpful for some people in the first
        month of low back symptoms. It is unlikely to help those with a
        disc prolapse and may be unsafe for people who have had:

             •   Previous back surgery
             •   Back injury from disease affecting the back
             •   Malformation of the back

        Only a professional with experience in manipulation should do
        this. This includes chiropractors, osteopaths, and therapists.

        With the patient lying on his or her side, the practitioner places
        one hand on the shoulder and the other on the hip, and applies
        pressure in opposite directions, thus twisting or rotating the
        spine. A cracking sound is often heard.

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Health Tip of the Month                  March 2005            Protect Your Back

        Before having a spinal manipulation, it is important to have a
        proper medical assessment to be sure there is no serious
        condition that may be causing the back pain. Manipulations are
        not generally dangerous, but in people with osteoarthritis, the
        bony spurs may rarely cause serious complications if the twisting
        maneuver brings the spurs into contact with and damages the
        spinal cord or nerves.

    4. Epidural Steroid Injections

Epidural steroid injections involve injecting medication directly into the
spine, as a way to reduce swelling and relieve pain. These injections
do not work well for everyone with back pain, but they can be helpful
for some people in whom other therapies have not been effective but
who wish to avoid surgery.

    5. Medication

Medicines for back pain can be purchased over-the-counter (OTC) or
are prescribed by a physician. Their purpose is to relieve pain and
reduce inflammation.

OTC pain relievers include paracetamol (Panadol) and aspirin.

    •   Acetaminophen generally is considered safe, although it may
        pose risks to the kidneys or to the liver in some individuals with
        liver disease.
    •   Aspirin is a popular medicine because of its ability to relieve pain
        as well as inflammation (swelling, redness). However, aspirin is
        not suitable for people who have had a stomach ulcer or aspirin
        allergy. Children should never take aspirin because of the risk for
        a rare but serious condition called Reye's syndrome.

OTC nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain
as well as inflammation. There are a wide variety of NSAIDs to choose
from, including:

    •   Diclofenac (Cataflam, Voltaren)

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Health Tip of the Month                  March 2005         Protect Your Back

    •   Diflunisal (Dolobid)
    •   Flurbiprofen (Ansaid)
    •   Ibuprofen (Brufen, Motrin)
    •   Indomethacin (Indocid)
    •   Ketoprofen (Oruvail)
    •   Naproxen (Naprosyn)
    •   Piroxicam (Feldene)
    •   Salsalate (Disalcid)
    •   Sulindac (Clinoril)

Unfortunately, NSAIDs have been characterized as having a "double-
edged sword," since gastrointestinal (GI) complaints - which range
from stomach upset to ulceration and bleeding - are common side
effects of these medicines.

    •   Such complaints sometimes can be controlled by taking the
        NSAID with food or by using antacids between meals.
    •   However, if GI problems are more than mild or are long-lasting,
        the physician may prescribe an NSAID that causes fewer GI side
        effects (for example, salsalate).
    •   NSAIDs also can cause kidney damage, worsen blood pressure
        (with salt and fluid retention), and contribute to bleeding by
        affecting the platelets (clotting elements in the blood).

 Muscle relaxants sometimes are prescribed for back pain if muscle
spasms contribute to a person's discomfort. These include:

    •   Distalgesic
    •   Zafor
    •   Proxyvon

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