backache

the back

origin of pain

causes of backache

diagnosis

treatment of backache

Back pain afflicts four out of five persons at one or another time of their lives. It is second only to headache as a common disorder characterized by pain. Our backs were actually designed for us to walk on all fours. With evolution, man adopted the upright posture. This has led to increased strain on the vertebral column, causing backache. The incidence of backache is on the rise due to a sedentary life style, obesity, longevity of life, and necessity to travel by automobiles and other jerky modes of transport.

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The back

Human beings belong to a class of animals, the vertebrates, because of the presence of a bony column, the vertebral column, or the spine. The human spine is made up of 33 bones called vertebrae. The spine is not absolutely straight, but rather has three normal curvatures namely, cervical, thoracic and lumbar. The cervical curve consists of 7 cervical vertebrae in the neck area, which allow us to move our head. The thoracic curve has 12 thoracic vertebrae in the midback, which are attached to ribs providing stability to the rib cage. The lumbar curve has 5 lumbar vertebrae in the lower back. The sacrum consists of 5 fused sacral vertebrae, which are present below the lumbar region. 4 fused vertebrae called the coccyx follow this.

The bones are designed in a manner that a channel is created within them. This channel runs from the skull upto the sacrum, and is called the spinal canal. The delicate spinal cord lies within this canal. The spinal cord contains nerve tissue and is a continuation of the brain. There are regular holes in the spinal canal that allow the exit of the spinal nerves from their roots in the spinal cord to the organs. The nerves exit in pairs, one to the left and the other to the right. There are 8 pairs of nerves in the neck, twelve in the thoracic or chest region, 5 in the lumbar, 5 in the sacral region and one pair of coccygeal nerves, making 31 pairs of spinal nerves in all. The regions of the spinal cord are named according to the position they occupy in the spinal column. Thus the C2 nerve root takes origin in the spinal cord near the second cervical vertebra. A nerve may contain fibers from more than one nerve root.

The cervical and lumbar spines are the most mobile segments of the vertebral column and hence are exposed to maximal stresses during movement. They are therefore the commonest sites of mechanical pain.

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Where does the pain originate in low backache?

Stress and strain or inflammation of the myofascial structures of the spine may cause backache. The capsule and ligaments of various vertebral joints, bony surfaces, annulus fibroses, dura and neural elements may also cause pain

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What are the causes of low back ache?

The common conditions are briefly tabulated below:

  • herniated disc, spondylolisthesis, spinal stenosis

  • spinal tumors: benign, malignant (including metastatic)

  • infections of the spine: tuberculosis, pyogenic

  • rheumatologic conditions affecting the spine: rheumatoid arthritis, Reiters syndrome, psoriatic arthritis, ankylosing spondylitis

  • metabolic diseases involving the spine: osteoporosis, osteomalacia, Paget’s disease, steroid induced

  • spinal trauma: Fracture

  • Other diseases that may be associated with backache include renal disease eg stones, femal genital diseases such as ovarian cysts and tumors, vascular diseases such as aortic aneurysm, gastrointestinal disease such as peptic ulcer and pancreatic disease

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Diagnosis

A careful clinical examination, laboratory investigations, and newer imaging modalities (x-ray, CT Scan, MRI, Isotope bone scan) often help to arrive at a diagnosis. If needed tissue obtained by needle or open biopsy also confirms the diagnosis.

Recent studies indicate that fewer than 15% of cases of back pain are attributable to structural defects such as ruptured discs, tumors, infections etc. In most cases the back pain arises due to improper posture, abnormal positions, and weakness of musculature surrounding the spine.

Many patients suffering from back pain are unable to receive adequate medical help due to a variety of reasons. These include a lack of understanding of their symptomatology, chronicity of the problem and inability of the patient to reach a qualified specialist in this field.

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Treatment

The treatment of acute backache is essentially by rest, medication and physical therapy. Once the acute pain subsides spinal exercises are gradually instituted and ambulation is permitted, initially with a corset. If the pain does not subside within 4-6 weeks, or there is a recurrence, sophisticated investigations are warranted to know the exact pathology and its location. A few patients will need an operation, which will depend upon the nature of disease that is causing the backache. With modern techniques, surgery can be performed with very small incisions, so that the discomfort to the patient is reduced.

A correct posture is the key to a healthy spine

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Author

Dr Anil K Sethi, MBBS (MAMC), MS (PGI, Chandigarh), is a practicing orthopedic surgeon. After working at Delhi's prestigious University College of Medical Sciences and Guru Teg Bahadur Hospital, he spent a year training in the United States of America before returning to join VIMHANS, Delhi and Kailash Hospital, NOIDA.
Contact 91-4512074, drsethi@hotmail.com


Editorial board:

Dr Suneet Sood,MS, MAMS, Editor in chief
Dr Anurag Krishna, MS, MCh, MAMS


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Last revised: May 20, 2000