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1992-12-04
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THE CAUSES OF BACK PAIN
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In the previous anatomy lesson we described structure. In this
section we take that knowledge and focus on CAUSE.
With a structure as complex as the spine and its supporting
muscles, tendons and nerves you might suspect that there could
be hundreds of causes of backache and back pain. Amazingly, the
list is small and concise. But consider that for each cause
listed below there may be a different therapy to alleviate each
specific back pain.
Backache and back pains can arise from the following sources:
Chronic or Severe Trauma such as prolonged sitting, twisting,
strain or sudden mechanical injuries. Poor posture or curvature
of the spine. Stress or Fatigue. A "slipped" or ruptured disc.
Pregnancy. Birth or congenital defects. Arthritis. Systemic
diseases. Hormonal imbalance and aging. Tumors or infections of
the back or spine.
Lets back up a bit.
A list this short suggests that a backache is probably due to a
single isolated problem. In reality back pain may derive from
multiple causes. One cause can frequently lead to several others
if treatment or correction is not taken.
For example poor posture and muscle fatigue from sitting at a
computer terminal for extended periods of time may give way to
muscle fatigue which, over several years, may lead to muscle
weakness and loss of tone. A sudden twist or impact might then
rupture an intervertebral disc which would not have otherwise
suffered damage if muscle tone were healthy.
Another example.
Stress and fatigue at work may set the stage for chronically
tense back and abdominal muscles. Pain begins due to muscle
fatigue or spasm. Poor posture develops to attempt to compensate
for the pain. Over years, the poor posture can place extreme
pressure on the intervertebral discs, causing them to gradually
collapse in size. Lets examine each specific back pain cause...
Posture and spinal curvature.
Perhaps the most common cause of back pain is poor posture which
causes incorrect spinal curvature when standing, sitting or
moving about. You will recall in our previous anatomy lesson
that the spine has four curves. Two primary curves which arch to
the rear and are common to all four legged animals. The two
forward bending curves are unique to man and are found at the
level of the neck, the cervical curve, and the level of the
lower lumbar vertebrae, the critical lumbar curve.
Since the primary curves are a result of bony vertebral shape,
they are relatively stable and rarely cause problems. The
secondary curves are due to the positions and shapes of the
flexible and more delicate intervertebral discs and thus can
change with time, injury or disease. Poor posture can
dramatically increase or decrease pressures on the discs. If
poor posture is continued over many years, unusual stresses are
placed on the supporting muscles, tendons and ligaments.
Chronic or severe Trauma.
Sudden trauma causes a lot of lost time on the job. Any sudden
injury such as a fall, sudden twist, or blow to the back falls
into this category. Chronic trauma is more subtle. One example
could be years of poor posture at a desk or job site. Poor
sleeping posture or an old mattress could would be another
example. Driving a car and maintaining poor posture also
produces chronic trauma. At a certain point in time the
supporting structure of your back cannot stand the continued
strain and pain occurs. In chronic trauma, the more severe the
pain, the more severe the probable underlying injury.
Arthritis.
Arthritis in the classic sense simply means an inflammation of a
joint. Three types of arthritis can attack the bones and joints
of the back. 1) Rheumatoid arthritis involves the delicate
lining or synovium of a joint which begins to grow and destroy
the flexible cartilage. In its most severe form, rheumatoid
arthritis leads to the destruction of the joint cartilage and
the gradual fusing of the vertebrae together. 2) Osteoarthritis
is by far the most common arthritic disease. Simplifying the
process a bit, this form of arthritis is simply the wear and
tear process of old age. The delicate surfaces and tissue of the
intervertebral joint slowly wear down and become stiff. 3) Gouty
arthritis can be traced to a chemical metabolism problem which
allows excessive uric acid to circulate in the blood stream.
Crystals of uric acid then collect in specific joints such as
the back or the classic "gouty big toe" and extreme pain occurs.
Gouty arthritis is rare but has been reported in medical
literature.
Ruptured or "slipped" disc.
The first question most folks consider when severe pain visits
is "do I have a slipped disc?" In fact this condition is
uncommon as a source of back pain. In addition this condition is
neither "a slipping" of a disc, nor is the structure even a disc
at all. In reality it is a joint (not a disc) which has ruptured
to some degree. As we saw in our previous anatomy lesson the
"disc" is composed of a complex layer of tissues and is not at
all shaped like a cylinder or disc. Intervertebral disc joint
problems can visit anyone of any age, but are certainly not the
most common cause of back problems. However, disc injuries are
certainly the source of severe pain unlike that caused by bad
posture or muscle stress. Don't jump to the conclusion that you
have a slipped disc at the first sign of pain. Chances are that
it is probably not the most immediate cause. However it is
important to understand that chronic trauma, fatigue and poor
posture can eventually lead to an intervertebral disc rupture in
time.
Congenital defect.
During pregnancy and gestation a fetus develops all anatomical
structures it will need during life. Defects of the spine can
and do occur. Additional intervertebral discs can be formed.
Some discs may form and then fuse together. The spinal cord can
develop outside the spinal column. Intervertebral discs may
develop in incorrect positions or at unusual angles. In some
cases these defects can be very slight and cause pain after
years of adulthood. Many of these "birth defects" are treatable
a rare few are not.
Tumors and infections of the back and spine.
Most of these conditions are rare. The back obviously contains
many sites where certain classic infections can take hold. 1)
Meningitis is an infection of the spinal cord within the spinal
canal. 2) Osteomyelitis refers to an infection of the bone. 3)
Spondylitis involves an infection of the spine. 4) Tuberculosis
of the spine. Rare today but quite common and still seen in
medical case studies. 5) Cancer and tumors. Statistically the
spine and its related bony structures are relatively low
incidence sites for tumor growth and cancer. Tumors or growths
can appear on the spinal cord itself which cause intense pain.
Sometimes tumors developing in other areas of the body can cause
"referred pain" into the area of the back and spine.
Systemic diseases.
Systemic means "system-wide." A systemic disease is not
localized in one part of the body. A strong cold or infection
with the flu virus is an example. Diseases such as
hyperthyroidism (thyroid gland), hyperparathyroidism
(parathyroid gland) and Cushing's disease (adrenal gland) are
systemic metabolic diseases which can cause back pain.
Curiously, certain vitamin deficiency diseases can produce back
pain such as lack of vitamins A or C which causes the disease
scurvy and lack of vitamin D which produces rickets.
Aging and related hormonal imbalance.
We all get older. The structures of the back react to this
process in unique ways. The intervertebral discs loose
flexibility, dry out and gradually become compressed and
narrower. Treatment, exercise and understanding of proper
therapy can slow down this process. In women, menopause and its
consequential hormonal changes can cause osteoporosis or loss of
bone mass. Also as one ages, senile osteoporosis begins which is
a natural decay of bone structure and mass, regardless of sex.
Referred Pain.
Pains in the back can be caused by disease, infection or strain
in another part of the body. Examples here are certain kidney
diseases (because of their close proximity to the back,)
pneumonia and, in women, a "tipped" uterus or womb. The reason
why the pain from these conditions is felt in the region of the
back is the close proximity of the nerve paths serving these
organs or regions to the same nerves as those which serve the
back. The brain mistakenly "translates" the pain as arising in
the back because of the proximity of mixed nerves in the same
region.
Fatigue and Stress.
This is the backache caused by stress or emotion. It can be
completely psychological with no direct organic cause. Fear,
mental stress from losing a job or spouse, or even having to pay
the bills can cause this type of back pain. Simple fatigue,
anxiety and overwork can also cause back pain when muscles
serving the back become fatigued or occasionally lock in painful
spasm when you are tired and or become anxious. This is the
backache literally caused by the brain itself.
This tutorial is merely a starting point! For further
information on back care and back pain, be sure to register this
software ($25.00) which brings by prompt postal delivery a
printed, illustrated guide to back pain written by a physician
plus two software disks. From the main menu select "Print
Registration Form." Or from the DOS prompt type the command
ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO
Box 1506, Mercer Island, WA 98040. If you cannot print the order
form, send $25.00 to the above address and a short letter
requesting these materials. End of chapter.