Back Pain

The Centers for Disease Control estimates that 70-85% of all people will have back pain at some time during their lives. The most common complaint of pain, back pain affects more and more people every year. It is the fifth most common reason for all physician visits. Back pain is most frequently the cause of limited activity in people, particularly those under the age of 45. It is also a significant cause for loss of productivity at work, costing employers more than $62 billion per year, mostly related to reduced performance rather than loss of time.

Back pain may originate from the discs, joints, muscles, bones, nerves, ligaments or other structures in the spine.

The spine is a network of nerves, discs, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine supply the legs and arms and can cause pain to radiate to those extremities.

Anatomy Of The Spine

The back is composed of vertebrae stacked on each other. There are seven cervical (neck) vertebrae, 12 thoracic (mid-back) vertebrae, five lumbar vertebra, the sacrum, and the coccyx. They are stacked in a way to form an S-shaped column and are supported by muscle and ligaments.

The main function of the spine is to support the weight of the body, while maintaining flexibility. Between each vertebra is an intervertebral disc which acts as a shock absorber. The discs and the vertebrae work together in a series of joints that allow the spine to move forward, back, and sideways and also allow for rotation.

The spine also protects the spinal cord. The spinal cord is a tube of nervous tissue that runs from the brain through the spinal column ending up as a series of nerves. These nerves leave the spinal column at different levels to supply the limbs, organs of the body, and sensation to the skin.

The back is designed to support muscles, ligaments and organs. Because of our varied postures (sitting, standing, bending) and activities, the spine is subjected to numerous stresses during the day. It can cope with everyday stresses such as lifting, but when it is subjected to abnormally high stresses, the muscles and ligaments become overstretched and tear. The discs start to deteriorate and the joint spaces start to decrease, causing joint damage that can lead to nerve compression. As we age, the discs in our back start to shrink and lose their elasticity. This progresses to degenerative disc disease.

Who is most affected by back pain?

Back pain is most common in adults, and more prevalent in men than in women. However, with children carrying heavier backpacks for school and being more sedentary in their activities, back pain is becoming more common in young people.

What causes back pain?

Back pain may be the result of an acute onset (sudden) or chronic (long-term) in nature, and can include:

What are the characteristics of back pain?

The nature of the pain can be:

How is back pain diagnosed?

In diagnosing the cause of back pain, it is important to review the history of the symptoms and injury. Your evaluation will also include an assessment of:

Further testing of undiagnosed back pain can include:

How is back pain treated?

Most back pain will usually improve within a few weeks without medical intervention. Pain relievers, moist heat and/or ice may be all that you need to reduce or eliminate your pain. Bed rest typically does more harm than good. Excessive use of pain relievers may also not be in your best interest as inflammation is part of the healing process.

If home treatments are not working for you, your doctor may suggest stronger medications or other therapy. It should be noted that the focus of treatment at APM is on restoring function and management without reliance on medications. Your treatment for back pain will be determined based on your symptoms and treatment history and may include any of the following:

How can I prevent back pain?

Back pain can be prevented by the following:

Back pain in children can be reduced by:

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