Back pain, more commonly known as back ache, is discomfort felt at the back area. The back consists of five main regions: upper back, lower back, ribs, hip and buttocks. The back region is further divided into upper neck pain (facing ahead), middle back pain, lower back pain, buttocks or coccyx pain depending on the section affected. Pain in the lower back may be a result of a strained muscle, back spasm or disc herniation. On the other hand, pain in the buttocks or hips may indicate sciatica, muscle fatigue or weakness.
Back pain is often difficult to diagnose due to its nonspecific character. Doctors typically rely on complex tests such as computerized tomography (CT) scan, magnetic resonance imaging (MRI) and x-ray machines. Specific structural abnormalities, joint fluid leak or a herniated disc are rarely found to be the causes of back pain.
Physical therapy is usually suggested to treat back pain. Often, physical therapy is recommended for a patient following an acute injury or chronic overuse. Physical therapy aims at correcting the mechanical problem underlying the cause of back pain by improving the patients’ range of movement, endurance and flexibility.
There are four primary structures of the spine that contribute to back pain: cervical spine, thoracic spine, lumbar spine and sacral spine. The discs of the lumbar and cervical spine are composed of two to nine bones, while the sacral spine and thoracic spine have between twelve and twenty bones. Spinal dysfunctions usually result in back pain. This is due to the failure of the spinal cord to provide the necessary strength to stabilize the body’s weight.
Some common dysfunctions of the spinal cord are dysplasia, subluxation and herniated intervertebral disc. Each of these conditions are chronic and progressive, and the resulting dysfunction leads to increasing impingement of the spinal cord, increased muscular tension and decreased flexibility. When left untreated, the consequences of subluxation and herniated intervertebral discs can cause debilitating back pain. Chronic overuse injuries are typically the outcome of a traumatic event that involves an increase in repeated stress on muscles or ligaments.
X-ray and magnetic resonance imaging are typically used to diagnose the exact cause of back pain. These imaging techniques are not sensitive enough to determine if the lesion is muscular or soft. This is why patients with suspected muscular abnormalities are advised to undergo MRI and X-ray scans. MRI scans identify and map abnormal bone structures in the spine which can be weak spots and areas of tenderness.
In the case of suspected neurological abnormalities, neurological tests such as MRI and X-ray scans are performed. If these tests reveal evidence of neurological dysfunctions, the appropriate treatment is then recommended. However, in the vast majority of back pain cases, a conservative treatment is typically indicated. Back pain usually affects people who have a limited amount of strength, poor posture and/or weakness in their upper extremities. Therefore, back pain include issues which affect the muscles, ligaments, tendons, muscles and tissues which are located around the spine and surrounding regions.
Other common causes of back pain include infection and inflammation. An infection can occur when trauma or a blockage is placed on an infected area. Spine inflammation is caused by trauma, inflammation of the surrounding tissues or bone which results in swelling. Imaging tests such as magnetic resonance imaging and x-ray therapy are typically used to confirm the diagnosis of an infection. Once the source of an infection is determined, treatment is typically directed towards reducing the pain and controlling the inflammation.
Another one of the most common causes of back pain is compression of the buttocks. Compression usually occurs while performing squatting and is considered a common cause. Although there are many potential causes of back pain in the buttocks, one of the most common causes is wearing tight fitting apparel. Tight clothing that utilize fabrics such as lycra and spandex often restrict the movement of the muscles and tissues which in turn cause back pain. Additionally, certain activities, such as sports, may also be quite uncomfortable, stressful and awkward. As a result, back pain in the buttock is typically caused by wearing too-small sports gear, excessive physical activity, sitting for extended periods of time and/or excessive lifting.
Several other causes of back pain include autoimmune diseases, such as fibromyalgia and polymyalgia rheumatica. Chronic pain can also be caused by several illnesses, including leukemia and lymphoma, HIV/AIDS and hepatitis. Moreover, nerve disorders such as stenosis, cerebro vascular ischemia, multiple sclerosis and Parkinson’s disease are frequently listed as causes of chronic pain in the back. In addition, several types of cancer, such as cervical, ovarian and melanoma are also known to sometimes cause chronic back pain.
Finally, another very common type of back pain is due to nerve root pain. Nerve root pain relief involves using topical anesthetics to temporarily block pain receptors in the body. An anesthetic such as Toradol is often used for nerve root pain relief. A less popular option is the use of epidural steroid injection, which involves injecting steroidal or suction-free medication into the spine at the site of pain. Epidural steroid injection has shown promising results in several patients, however this type of treatment can lead to unpleasant side effects and should only be considered as a last resort when everything else has been tried.
