Back pain: Causes, Treatment & Risks

It may also radiate from other areas like mid or upper back, a hernia in the groin, or a problem in the testicles or ovaries.
It is described as:

• Acute if it lasts less than 6 weeks
• Sub-acute if it lasts 6-12 weeks
• Chronic if it lasts more than 12 weeks

Incidence 

Nearly everyone has experienced back pain which interfered with work, routine daily activities, or recreation at some point in their life. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Several studies have shown that back pain is the second most common neurological ailment in the United States. It can sometimes lead to more serious conditions but most back pain does not signify any serious underlying problem, and will sort its self out within a few days or weeks.

Anatomy of the back

Human back is a very complex structure made of bones, muscles, and other tissues that form the posterior part of the body’s trunk, from the neck to the pelvis. The centerpiece in the spinal column is the spinal cord - the delicate nervous system structure which carries signals that control the body’s movements and convey its sensations.

Vertebras
The spine is made of 30 little bones called the vertebrae. Each of these bones contains a round hole creating a channel that surrounds the spinal cord.
 
Cauda equina
The nerve roots to the lower back and legs extend many inches down the spinal column before exiting. This large bundle of nerve roots was called the cauda equina, or horse’s tail by early anatomists. Bands of tissue known as ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column.
 
Starting at the top, the spine has four regions:

• the seven cervical or neck vertebrae (labeled C1–C7),
• the 12 thoracic or upper back vertebrae (labeled T1–T12),
• the five lumbar vertebrae (labeled L1–L5), which we know as the lower back, and
• the sacrum and coccyx, a group of bones fused together at the base of the spine

Possible causes of back pain

The lower back bears most of the weight and stress of your body. Back pain most often occurs from strained back muscles and ligaments mostly caused by the improper or heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm can cause back pain. Often, there's an accumulation of stress with one particular event unleashing the pain. In many cases, there may not be an obvious cause.
 
The following specific conditions can also cause back pain.

Herniated disk
This is a specific condition which occurs when disk material presses on a nerve. It is one of the most common causes of back pain.

Sciatica
Sciatica often occurs when a herniated disk impinges on the sciatic nerve causing sharp, shooting pain through the buttocks and the back of the leg.

Spinal stenosis
This condition is rare and it occurs when the space around the spinal cord and nerve roots narrows due to arthritis and bone overgrowth. This can cause a nerve to get pinched or pressed.

Spondylosis
Spondylosis is a type of arthritis affecting the spine. It is caused by several degenerative changes in the spine that often come with aging.

Spondylolisthesis

This condition occurs when one vertebra in the spinal column slips forward over another.

Other conditions:

• Cauda equina syndrome.
• Cancer of the spine. 
• Infection of the spine.
• Injury to the bones, ligaments, or muscles of the back
• Spine curvatures which may be inherited and seen in children or teens
• Other medical conditions like fibromyalgia

Symptoms of low back problems

Low back pain means that the pain is located somewhere between the bottom of the ribs, at the back, and the top of the legs. The pain often begins suddenly and it may travel to or be felt elsewhere. Studies have shown that it often goes into the buttocks, but may go further down the leg and even into the foot. This condition is also known as sciatica, because the main nerve to the leg is called the sciatic nerve.

The pain may be worse on bending and is often worse while sitting, especially in an easy chair. Sometimes turning over in bed and sitting up could be extremely painful. Coughing or sneezing can also make the pain much worse.

When is the medical attention needed?

Most back pain gradually improves with home treatment and self-care.  If not, it is recommended to see a doctor.  You should visit the doctor immediately if the pain is:

• Constant or intense, especially when lying down or at night
• Spreads down one or both legs
• Causes weakness, numbness or tingling in one or both legs
• Causes new bowel or bladder problems
• Is associated with abdominal pain or pulsation, or fever
• Follows a fall, blow to your back or other injury
• Is accompanied by unexplained weight loss

Diagnosis of back pain

None of these diagnostic tools is generally necessary because simple physical examination should be sufficient to make a diagnosis. If there is reason to suspect that patient has a tumor, fracture, infection or other condition that may be causing back pain, the doctor should order one or more tests:

X-ray
This is very good diagnostic tool because these X-ray images show the alignment of bones and whether a patient has degenerative joint disease or broken bones. 

Magnetic resonance imaging (MRI) or computerized tomography (CT) scans
These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.

Bone scan
In rare cases, the doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis.
 
Nerve studies (electromyography, or EMG)
This test measures the electrical impulses produced by the nerves and the responses of muscles.

Risk factors for developing back pain

Certain groups of people have higher risk of developing back pain. They include people who

• Have a job which requires heavy lifting, lots of bending and twisting, or whole body vibration
• Have bad posture
• Are pregnant
• Are over age 30
• Smoke, don't exercise, or are overweight
• Have arthritis or osteoporosis
• Have a low pain threshold
• Feel stressed or depressed

Treatment of back pain

Back pain usually improves on its own, or with home treatment, within a few weeks, unless there's a serious medical condition causing it.

Moving a lot
It is proven that prolonged bed rest isn't a good idea for back pain. Light activity speeds up healing and recovery.

Apply cold, then heat
Sources of heat and cold can soothe sore and inflamed muscles and this kind of treatment is widely used. Patient should use cold treatment first with bags of ice. After spasms and acute pain subside, patient can apply heat from a heating pad to help loosen tight muscles.

Use pain relievers
Several studies have came to the conclusion that some nonsteroidal anti-inflammatory drugs such as ibuprofen (advil, Motrin, Aspirin, others) and other medications such as acetaminophen (tylenol, others) may help control pain, swelling, and stiffness. 

Support brace or corset
Braces, corsets or back belts are available over the counter at pharmacies and medical supply stores. They really can provide warmth, comfort and a degree of support to your back.
 
Acupuncture
Some people with low pack pain report that acupuncture helps relieve their symptoms but this has yet to be proven. During this procedure the practitioner inserts steel needles into the skin at specific points on the body which should stimulate central nervous system to release the body's natural pain-relieving endorphins.

Prevention of low back pain

Exercises
Exercises are important for preventing future back pain. Through exercise patient can:

• Improve his posture
• Strengthen his back and improve flexibility
• Lose weight

To avoid the back pain you should also try to:

• Avoid falls
• Avoid standing for long periods of time.

Quit smoking

Smokers have diminished oxygen levels in their spinal tissues, which can hinder the healing process.

Maintain a healthy weight

Being overweight puts strain on patient’s back muscles. If someone is overweight, trimming down can prevent back pain.
 
When you have to lift some heavy object, try using the following tips to avoid the back pain::

• If an object is too heavy or awkward, get help.
• Spread your feet apart to give a wide base of support.
• Stand as close to the object you are lifting as possible.
• Bend at your knees, not at your waist.
• Tighten your stomach muscles as you lift the object up or lower it down.
• Hold the object as close to your body as you can.
• Lift using your leg muscles.