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Back Pain
Back pain is one of the most common complaints among Americans. Back pain
can be linked to many of the problems that are plaguing our society, such
as obesity and not getting enough exercise. For others the cause of back
pain may be more complicated and could be linked to a specific injury or
other condition which has affected the muscles, tendons, or other
structures in the back.
The back is made of many different components, each of which can become
injured and create significant pain that may be localized to a specific
portion of the back, or radiate elsewhere in the body. The bones that make
up the spine are called vertebrae. These bones are responsible for
protecting the spinal cord and the nerves that run throughout the body
from the back. These vertebrae are separated by cartilage discs which aid
in the movement of the spine and also act as shock absorbers. The spinal
column is composed of four different sections; the cervical spine (neck),
thoracic spine (directly behind the chest), lumbar spine (lower back), and
the sacral spine (portion of spine that is connected to the pelvis).
Muscles, ligaments, and tendons also connect to these structures and aid
in the movement and support of the back.
There are two main causes of back pain. Neuropathic back pain refers to
the pain that is associated with a damaged nerve. This types of pain
produces great discomfort and can spread to other parts of the body too,
such as when a nerve is pinched from a herniated disc. The other type of
back pain is nociceptive pain which is the result of some other type of
trauma to the back or disease that is not caused by damage to nerve
tissue. A back sprain is one example of this type of pain. It is also
possible to experience both neuropathic and nociceptive back pain.
Back pain itself can be described in different ways which can be helpful
in determining its cause. Chronic pain is a constant or aching pain that
can be localized in the back, but also radiate elsewhere, such as through
the legs. With chronic pain, your daily lifestyle can become affected.
Work, exercise, and even sitting or standing for long periods of time can
become painful and difficult to endure. Chronic back pain can be caused
from a wide array of conditions.
Acute back pain is generally not as serious as chronic pain. The pain is
sharp, but is localized to a specific area such as the right side, lower
back, etc. This type of pain is most commonly attributed to an injury
involving a strained muscle or similar mild trauma to the back. Acute back
pain is not usually constant, but rather intermittent. In many cases the
cause may not be known, but generally conservative, short-term treatment
methods are required to significantly reduce pain, which may take several
weeks. More severe types of acute pain can cause serious pain through the
back as well as through the legs such as with sciatica.
There are many different ways to determine causes of back pain. X-rays are
one way that physicians can take images of the back and make a diagnosis.
CAT scans are essentially similar to X-rays, but are composed in three
dimensions. An MRI is another powerful imaging device and is the best
tool for diagnosing conditions affecting the spine. Sometimes doctors can
check for abnormalities in the spine by conducting a myelogram. In this
procedure dye is injected into the dura, or sacs, that surround the spinal
column so that the nerve roots can appear in an x-ray. Lastly, physicians
may use a bone scan where they can see the concentrations of radiographic
material that has been injected into the body and test for tumors,
fractures, or other abnormities that can contribute to back pain.
Nonspecific back pain is pain that has no specific cause and accounts for
the most cases of back related pain. Back pain does not have to occur from
specific injuries since many other factors can greatly affect the back
such as bad posture, not exercising correctly, being overweight, or
constantly lifting heavy objects. In most cases, nonspecific back pain
occurs in the lower back. It can also be present in other parts of the
back and radiate throughout the legs as well. A physical examination
combined with other tests that examine abnormalities in the spine are used
to locate the specific source of back pain. Generally, nonspecific back
pain turns out to be caused by muscle strain which can be treated by
relatively conservative methods. These methods usually include rest and
refraining from unnecessary lifting or exercises combined with taking
anti-inflammatory medications.
There are many risk factors that may lead to back pain. Occupations or
activities that require constant or repetitive lifting add unnecessary
weight to the muscles and tissue and as a result cause serious wear and
tear on the back. Long periods of sitting and standing can also place
similar stresses on the back which can lead to acute pain. Not getting
enough exercise is also a serious risk factor. Without regular exercise
the muscles and structures of the back become weak which may cause the
back to become fatigued easily. Additionally, poor posture can lead to
significant back pain over time. Without sitting, standing, and lifting
objects properly, the back is at risk of developing strained tissue,
causing serious problems to arise.
As mentioned above, many cases of back pain may begin treatment through
the use of simple methods such as rest and anti-inflammatory medications.
Additionally, regular exercise and maintaining good posture are effective
ways to reduce tension and strain on the back. Other ways of treating back
pain may include osteopathic or chiropractic manipulation which can help
at the early onset of pain. Acupuncture may also be an option, however its
effectives is still controversial. Transcutaneous electric nerve
stimulation (TENS) is a less common method of treatment and involves
pulses of electricity sent through the back via electrodes placed on the
back. In addition, there are also many forms of back braces and supports
available that can add support and ease strain on the back.
Back pain is very common and there are many conditions that can contribute
to discomfort. It’s important to understand the structures and
complexities of the back in order to help prevent discomfort and injury as
well as to better understand symptoms as they arise. Luckily, for most
cases of back pain there are various treatment options available to ease
discomfort. There are also many prevention techniques that can be employed
to limit pain and keep it from reoccurring in the future.
Questions & Answers:
QUESTION: Hi, I have a question about my back pain. When I reach over my shoulder and try to massage my back it hurts and I also get some pain coming down into upper arm. I've taken Aleve but it hasn't helped much. What can I use to relieve the pain?
ANSWER: Sometimes pulling or tearing a muscle in your shoulder blade or upper back can cause this pain. If you are not stretching the muscles and then trying to resume the same range of motion that you had before the muscle tear, this could be why the pain feels like it is not going away. Aleve will only work on dull and aching pain, pain from pushing the muscle beyond its limits and putting pressure on the tear will cause acute pain and Aleve will not help.
If Aleve has not helped your pain and you feel that you have not hurt one of your muscles, you might have something called referred pain. Referred back pain is caused by another symptom and is felt in the back, shoulder blades or upper arms. Pain in the shoulder blades can be caused by many referred pain such as disorders of the stomach, esophagus, and pancreas. Shoulder and back pain can be caused by an aortic dissection, which is a tear in the wall of the aorta. This tear causes blood to seep into the walls of the aorta and puts pressure on these walls, forcing them apart. If you feel like you do have back pain due to a referred pain, see a doctor and have them check your cardiovascular system and gastrointestinal system.
QUESTION: I am a welder by trade and due to the body positioning required to weld in the awkward angles I do, I often experiance middle back pain and tenseness, especially near the spine. I also have to maintain strict form in position where I can stand or sit with correct posture less often than I would like. Hunching, twisting, and bending all have to be done in order for me reach the areas I need to weld. Despite this positioning, are there any stretches or exercises that would aleviate the persistance of this aching? Some things to note: when my wife massages my back, just to the right of my spine I feel her press on a sensitive nerve that I don't feel eslewhere. I also experiances a compression fracture in this area a year ago possibly aggravated by the heavy weight of the insulated bib overalls I wore, which in turn caused me to involinarily hunch until I forced myself to walk and stand upright. It is not chronic but inhibitory.
ANSWER: After contorting your spine, it is important to do a stretch to counter the position you were just in. If you are hunched over, for example, putting your hands on your lower back and doing a small back bend will alleviate the muscles and give them some relief. The most important thing you can do to relieve this back pain is stretch. Different stretches can be helpful to get rid of your back pain, as long as you do them gently and slowly. Small back bends after hunching, sitting on the floor with one leg infront of you with the other crossed and twisting your spine opposite the leg crossed will allow the muscles on the sides to feel relief are two good stretches. Do them slowly and hold for about 30 seconds each. Doing these before you go to work and after will give you more relief of your back pain.
QUESTION: Could pain in the upper left of your back be caused by internal problems or any serious medical problems?
ANSWER: Usually the pain in the upper back is not caused by any serious internal problems. If you are experiencing pain else where, such as your stomach or lungs, back pain can be a symptom of these disorders and should be checked by a doctor. If the pain is a dull ache, it is most likely that you simply have put strain on a muscle and stretching it will increase the range of motion and eventually allow it to heal and the back pain should dissipate.
QUESTION: I have been having pain in my lower left back. It seems to flair up when I am running or sometimes I just move the wrong way. Doesn't happen everytime I run, usually if I run after doing a spinning class. It goes away after awhile. Not sure what is the problem.
ANSWER: Running is a very hard activity on your spine. It is high impact and can put lots of pressure on your spine. If you have any type of cartilage wear or back problems it can increase the likely hood of them worsening overtime. If the back pain occurs after you do a spinning class, it could be that you are overworking your muscles, ( i.e. leaning forward at spinning and then putting pressure on them upright while running). Try and space out your workouts, go to spinning in the morning and in the evening try running to give your muscles a rest. If this does not help it is possible that you have pulled a muscle or hurt the fibers. Resting and gentle stretching would be a good course of action.
QUESTION: I am not sure if the pain I have is considered middle back pain but the pain I am having is right at my bra line. I have had this pain for over four years. When it bothers me it is so bad it brings tears to my eyes and I have even been nauseated. The pain is noticeable when I say am standing at the sink cleaning strawberries or peeling potatoes. When I sew or embroidery. I have had it bother when I mow lawn. (I ride a mower for 4 hours) When I try to swing my granddaughter. I have basically been sort of ignored by doctors - if am complaining to a doctor than the pain is more than I can stand. I have had a pain pill prescribed which does help if I rest and lie down at the time. I have noticed that when I am in excruciating pain - if I sit in a recliner and recline with my back some - it feels better. I finally did have an MRI and I do have a herniated disc with compression of a nerve in the lower back. I knew I had something going on there too but I can handle that pain so far but this pain at the bra line really does get too me. The nerosurgeon would have done surgery to repair my disc problem but he said he couldn't help me with the other problem and recommended to see someone in pain management who could give some type of shot to the area that might help. It's like since I won't let him do anything or am not complaining about the herniated disc - he just passed me off and didn't really explain what this other might be. I just want to know what it is and what can be done about it. Could it just be a muscle that would pain me worse some days than others and last for four years. I am to the point that I am thinking I must learn how to manage this pain myself better. I think sometimes when your younger or male the doctors take you more serious. I am not a lazy person!! I must admit this has really got to me lately or I wouldn't have gone to the expense of an MRI. Now as it is -- I don't know anything more than I did before. What help, suggestions or other type of relief do you know of. Thank you.
ANSWER: Since you have a herniated disc and it is putting pressure on a nerve, fixing the herniated disc could solve your upper back problem as well. The entire spinal cord and nerves running along it are connected, the pinched nerve from the herniated disc could be affecting the muscles in your upper back. It is important to do light stretching and gentle exercise to try and keep blood flowing and lubrication to the area that is affected. Your back pain could also be caused by a repetitive motion injury, if you perform the same tasks everyday and hunch, it could just be your muscles fatiguing and that causes the pain. A back brace may help you keep your posture in line and alleviate the stress on the muscles along your bra line. If the pain in your lower back intensifies, please go back to your doctor and weigh the options of herniated disc surgery again. It could help but it can also cause you to have to stop many of your daily activities.
QUESTION: My 82 year old mother is experiencing severe burning pain in her back and sides. She is not know to suffer from Osteoporosis, but could the pain be caused by a hairline fracture? The pain is more severe since gall bladder surgery.
ANSWER: Osteoporosis is common in women over 50 and hairline fractures are common, especially in the lower spine. Your mothers symptoms sound like they are more severe than osteoporosis and due to the fact she is experiencing pain on her sides, it could be caused by kidney infection, kidney stones or a kidney abscess. If the pain on her sides is accompanied by chills, fever, blood in her urine, and frequent or urgent urination, the issue is in her kidneys. If this is the case you should immediately take her to see a doctor and have a urine test done to see if she has a kidney infection. Pain in the lower back and sides can also be caused by spinal arthritis. The fact that it is a burning pain is a symptom of chronic back pain, usually associated with arthritis or the possibility of osteoporosis.
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