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50 Things You Can Do Today to Manage Back Pain
By Keith Souter
Summersdale Publishers LtdCopyright © 2011 Keith Souter
All rights reserved.
About Back Pain
1. Don't panic
If you do experience an episode of back pain, there is no need to panic. Although it can be painful and may restrict your mobility it is highly likely that it will get better of its own accord in a relatively short time.
While it is natural to worry in case the pain is due to some serious injury or to some underlying condition, in fact most back pain is not serious at all. The vast majority of back pain will improve within two days to two weeks. Most simple back strains do not cause any lasting damage.
It is worth knowing that about half of all the people who experience such an episode of back pain will have another one within two years. The thing is that it can be avoided if you take the correct actions and respect your back.
And helping you to do that is just what this book is about.
2. Learn how the back works
All mammals have the same basic bone structure. Most mammals walk on four legs, but human beings evolved into erect creatures. This was an extremely beneficial adaptation in terms of survival of the species. Speed, balance, manoeuvrability and freeing up of the upper limbs were the result, all useful for a hunter-gatherer creature with the potential to make tools.
The spinal column
The human spinal column seems designed for suppleness and mobility. It is not, however, ideally suited to our sedentary modern lifestyles where we sit in cars or at desks peering at computer screens and so on. We will return to this point later on in the book.
The main functions of the spinal column are weight-bearing and protection of the spinal cord.
The spinal column is made up of 33 small bones called vertebrae. Five of these are fused to form the sacrum, a triangular structure that forms the back of the pelvis, and four are fused to form the coccyx which continues down from the sacrum as the internal tailbone. Stacked on top of the sacrum are 24 specialised vertebrae, separated from one another by 23 cartilaginous discs. There are seven cervical or neck vertebrae, twelve thoracic or chest vertebrae and five lumbar or lower back vertebrae.
Each vertebra consists of the following parts: a cylindrical body, like a cotton reel or a marshmallow, and an arch that is attached to the body to produce a ring-like structure which encloses the spinal canal.
Each vertebral 'body' provides a strong surface and it is through these and the buffering discs in between that the weight of the body is supported. When you run a finger down someone's spine you will feel the knobbles of their spinous processes.
The different types of vertebrae all have different shapes because they have different roles to play in the spinal column. The lumbar vertebrae are bigger and stronger than the cervical or neck vertebrae, because they have more weight-bearing to do, but they are less mobile.
These are rather like car tyres. They consist of an outer fibrous ring called the annulus fibrosus, which contains a jelly-like pulp called the nucleus pulposus. They are essentially the spinal column's shock absorbers.
The vertebrae are held together by several small fibrous cords called ligaments (from the Latin ligare, meaning 'to tie'). In addition, there are two long, very strong ligaments that run the length of the spine, which link the vertebrae and help to hold them in position as a column.
* The muscles of the back are arranged in three layers:
* The superficial or outermost layer consists of trapezius, latissimus dorsi, levator scapulae and the rhomboids. Their purpose is mainly to move the muscles of the upper limbs.
* The intermediate layer consists of serratus posterior, which has an inferior and a superior part. Their function is mainly to move the ribs to help breathing.
* The deep layer includes splenius, erector spinae and transversospinales. Their purpose is to move the back.
A healthy back has three natural curves: a slight forward curve in the neck (cervical curve), a slight backward curve in the upper back (thoracic curve), and a slight forward curve in the low back (lumbar curve). Good posture actually means keeping these three curves in their natural state of balanced alignment.
Spinal cord and spinal nerves
The spinal cord and the brain make up the central nervous system. The spinal cord extends down through the spinal canal formed by the vertebrae for a distance of about eighteen inches. It then extends downwards as the cauda equina, so called because it resembles a horse's tail.
Spinal nerves emerge from the cord through special canals to supply the various parts of the body. Thus:
* Cervical nerves supply the head and neck.
* A mix of cervical and thoracic nerves supply the upper limbs.
* Thoracic nerves supply the chest and abdomen.
* Lumbar nerves supply the trunk and the legs.
* Sacral and coccygeal nerves supply the pelvic area.
When any of these nerves are affected they can produce back pain in the area of the back that they supply. Thus pressure on cervical nerve roots will cause neck pain, pressure on lumbar nerve roots will give low back pain, and sacral nerve root pressure can give pain in the buttocks.
3. Assess the type of back pain that you have
It is important, initially, to differentiate acute from chronic pain. Many people mistakenly think that 'acute' and 'chronic' are two poles of a spectrum of experience. This is not the case. They are two entirely different types of pain.
This is the expected physiological response to a stimulation which the body perceives to be unpleasant. The simplest example is the immediate reflex withdrawal of your hand when you burn your fingers. If the burn is mild, the pain will go on for a relatively short period of time. This type of pain is seen to have a useful purpose, in that it alerts the body to a problem that it can readily relieve. It causes the individual to take action to avoid further injury or damage.
'Recurrent pain' describes repeated episodes of pain. This is the type that you get with repeated attacks of back pain.
This is the continual experience of an unpleasant sensation which is unlikely to disappear of its own accord. This is the typical background pain of, say, arthritis. Unlike acute pain, this type of pain has no useful biological function. It just grinds away at you and can, if you allow it, seriously impair your quality of life.
If back pain lasts for more than 12 weeks it is considered to be chronic back pain.
The point is that these two types of pain (acute and chronic) may actually have different mechanisms and different pathways to the brain, where they are perceived as 'pain.' Acute pain is going to get better in time, albeit that it may come again as a recurrent pain. Chronic pain, on the other hand, is by definition on-going, and the individual is going to need to develop strategies to cope with it. This may include medication, but it is unlikely that this will be the whole answer.
It is a somewhat arbitrary differentiation, but back pain is sometimes categorised according to the duration of the pain.
Acute back pain – less than 6 weeks Sub-acute back pain – 6 to 12 weeks Chronic back pain – 12 weeks or more
4. Understand the causes of back pain
Most back pains are experienced in the low back or lumbar area. This is because it is the power base of the back, which is heavily muscled and through which weight-bearing occurs for walking, standing, bending and lifting. The neck is the next most common part of the spine to be affected by pain. The thoracic spine is not an area that is often strained, although it can be subject to problems as a result of degenerative changes caused by osteoarthritis.
Some common causes of back pain
Sprains and strains
These are the most common causes of low back pain. One can usually pinpoint the cause as the result of a lifting injury a problem during bending, a sneeze or cough that provoked a sudden episode of pain, or some other kind of sudden physical exertion.
The old name lumbago' is still used for low back pain that does not radiate beyond the low back. It is a non-specific diagnosis. The problem comes from strain on muscles or ligaments in the back, although it is almost impossible to differentiate the two on clinica examination. It may produce severe pain, but the severity of pain does not in itself mean that it is serious. It usually ends within a period ranging from two days to six weeks.
This is pain occurring in the muscles, arising from 'trigger points' within particular muscles. These are small hyper-sensitive areas within the muscles, which often coincide with the development of little nodules. Myofascial pain is often characterised by pain radiating from the trigger point. It can mimic other conditions and is a common cause of pseudo-sciatica; that is, it produces back pain and radiation of pain down the leg, but without any alteration in reflexes.
It is a common cause of chronic back pain and is usually amenable to massage, physiotherapy and acupuncture.
This is a complex condition where the individual can experience muscular pain anywhere in the body, including the back. The muscles may be quite tender and movement may be limited. It usually builds up and worsens over a few weeks. Most medical investigations will prove negative, but it is important to establish the diagnosis, for it can be the underlying cause of a chronic back problem.
Although people often fear that they may have 'slipped a disc', in actual fact discs do not slip. What can happen is that a disc can bulge, rather in the same way that a car tyre can bulge if there is a weakness in the wall. In this case there may be some irritation on surrounding tissues or nerve roots.
Sometimes a disc can 'prolapse', meaning that the annulus fibrosus, the fibrous ring that resembles the car tyre, partially ruptures to allow some of the inner jelly-like nucleus pulposus to seep out. If this happens near a nerve it will irritate it and pain will be felt down the course of the nerve.
Both of these cases can cause sciatica, by irritating the sciatic nerve, which is the main nerve supplying the leg. Sciatica is the name for a condition in which the sciatic nerve is compressed or irritated by inflammation, the result being pain travelling down the leg. It is a complex nerve formed from several lumbar and sacral nerve roots. The actual distribution of the pins and needles sensation or pain that is felt can guide a doctor to diagnose which disc is pressing on which nerve root or roots.
Arthritis in the spinal column can result in bony outgrowths forming on vertebrae, erosion of cartilage and drying and shrinking of discs. In addition, the small facet joints which allow the vertebrae to glide and move may be affected. This is usually a result of osteoarthritis, which is generally considered to be a type of wear-and-tear problem of all joints.
Facet syndrome is a situation where one or more of the facet joints become inflamed, causing the back to lock up. It can occur very suddenly when bending, almost as if one has been kicked in the small of the back by some unseen individual.
In older people, the condition 'osteoporosis' or 'thinning of the bones' can produce pain in the thoracic spine, effectively the upper back. Everyone tends to lose calcium from their bones as they get older, but in some people this loss is excessive. Women after the menopause are especially prone to this, so it is a good idea to have this checked by your doctor if you think you are at risk.
The loss of bone mass can predispose people to fractures of the wrist, hips and thoracic vertebrae. The thoracic vertebrae can become distorted or compressed at one edge, rather like a marshmallow, and effectively collapse. This happens in 'crush fractures' of the thoracic spine and results in very sudden, severe pain. As a result of the worsening osteoporosis there may be a tendency for the sufferer to stoop forward, eventually producing the so-called 'dowager's hump' of old age.
Risk factors for osteoporosis
* Family history – if one of your parents had a hip fracture you may be at risk.
* Age – bone loss increases with age. Over the age of 75 years, 50 per cent of the population have osteoporosis.
* Sex – females are more prone to develop osteoporosis.
* Smoking – this is one of the greatest risk factors.
* Low body weight – a low BMI of 19 or less is a significant risk for osteoporosis.
* Past history of fractures – if you have easily broken bones in the past then you may be at risk.
* Hormone problems – the female hormone oestrogen protects bones, but when the level drops at the menopause the protection goes. Early menopause is therefore a risk, as is a history of hysterectomy where the ovaries have been removed. So too is a history of overactive thyroid and parathyroid glands.
* Malabsorption conditions – these are conditions that may be associated with diminished absorption of calcium from the food. For example, coeliac disease or Crohn's disease.
* Other conditions – rheumatoid arthritis, diabetes, HIV, chronic respiratory disease or a history of organ transplantation.
* Drugs – some prescribed medication can predispose towards osteoporosis, including: long term steroids by mouth (longer than three months), anti-epileptic drugs, breast cancer drugs, prostate cancer drugs.
As mentioned above, osteoarthritis is the most common type of arthritis and is considered to be a wear and tear problem. There are other types of arthritis, such as rheumatoid arthritis, where the problem is inflammation. This is characterised by early morning stiffness, which improves slightly as one gets moving. Back pain is not usually the earliest symptom, but it may need to be excluded, as should other related conditions.
Polymyalgia rheumatica is an inflammatory condition of the muscles, mainly affecting the shoulder and pelvic girdles. It classically presents itself in middle age, literally overnight, so that the individual cannot get up in the morning or cannot raise their arms to do their hair. With such a dramatic onset, an early medical opinion is advised.
Not all back pain arises from the spine or from the causes mentioned above. Kidney infections, bowel disorders and even malignant conditions of organs such as the thyroid, kidney, breast, prostate and ovary can all spread to bone. While these account for only a small percentage of back pains, they do need to be diagnosed early, so one should take note of 'red light' warning symptoms, which we shall look at shortly (See item 6. Visit your GP)
5. Determine to reduce your risk of back trouble
The following factors increase the risk of back pain:
* Smoking – this is the greatest risk to health in general. Smoking reduces the body's ability to repair itself; it actually promotes inflammation and it interferes with the absorption of calcium.
* Obesity – this is predominantly a mechanical problem in that being overweight puts a continual strain on the spine which has to support the extra weight. In addition, abdominal or belly fat will tend to pull the body forward, thereby throwing extra strain on the spine.
* Congenital structural problems – some people are born with defects in the structure of the individual vertebrae, the pelvis or the limbs. Anything which causes the body to adopt a posture that is not symmetrical will predispose to back pain.
* Scoliosis – this is a sidewards bend in the back. It will inevitably cause the body to bear weight in an uneven manner.
* Older age – there is increased bone loss with age, effectively thinning the bones.
* Being female – the bones in females are generally smaller and thinner.
* Strenuous work – this is liable to cause wear and tear on the skeleton.
* Being sedentary – this causes weakness of the supporting muscles.
* Stressful occupation – with increased stress the body is less able to repair itself and inflammatory processes are more likely.
* Anxiety – it is well recognised by GPs that anxious people are more likely to experience painful conditions.
* Depression – similar to anxiety, depression seems to lower the threshold for pain, so that painful conditions including back pain are more common.
Excerpted from 50 Things You Can Do Today to Manage Back Pain by Keith Souter. Copyright © 2011 Keith Souter. Excerpted by permission of Summersdale Publishers Ltd.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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