Movement problems: A movement or mechanical problem is a problem with the way the spine moves or the way an individual feels when they move the spine in certain ways. Perhaps the most common mechanical cause of back pain is intervertebral disc degeneration. In this condition, the discs located between the vertebrae of the spine break down with age. As the vertebrae deteriorate, they lose their cushioning ability. This problem can lead to pain if the back is stressed. Other mechanical causes of back pain include spasms, muscle tension, and ruptured or herniated discs.
Injuries: Spinal injuries, such as sprains and fractures, can cause either acute (short-lived) or chronic (long-term) pain. Sprains or tears in the ligaments that support the spine can occur from twisting or lifting improperly. Fractured vertebrae are often the result of osteoporosis, a condition that causes weak, porous bones. Less commonly, back pain may be caused by more severe injuries that result from accidents and falls.
Whiplash is a non-medical term used to describe neck pain following an injury to the soft tissues of the neck, specifically ligaments, tendons, and muscles. Whiplash is caused by an accidental motion or force applied to the neck that results in movement beyond the neck's normal range of motion. Whiplash occurs in motor vehicle accidents, sporting activities, accidental falls, and assault.
Conditions and diseases: Many diseases can cause or contribute to back pain. These include various forms of arthritis, such as herniated disk (occurs when disk material presses on a nerve), osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, and cancers from elsewhere in the body that may spread to the spine. Scoliosis, which causes curvature of the spine, does not usually cause pain until mid-life. Spinal stenosis, or a narrowing of the spinal column that puts pressure on the spinal cord and nerves, also contributes to back pain. While osteoporosis itself is not painful, it can lead to painful fractures of the vertebrae. Other causes of back pain include pregnancy, kidney stones or infections, endometriosis (the buildup of uterine tissue in places outside the uterus), and fibromyalgia (which causes fatigue and widespread muscle pain).
Infections and tumors: Although they are not common causes of back pain, infections can cause pain when they involve the vertebrae. Osteomyelitis is an infection (typically caused by bacteria) of bone and bone marrow in which the resulting inflammation can lead to a reduction of blood supply to the bone. Discitis is when the infection involves the discs that cushion the vertebrae. Tumors are relatively rare causes of back pain. Occasionally, tumors begin in the back, but more often they appear in the back as a result of cancer that has spread from elsewhere in the body.
Emotional stress: Although the causes of back pain are usually physical, emotional stress may also play an important role in back pain and how severe and long it lasts. For example, stress may cause back muscles to become tense and painful.
Examination: Diagnosing the underlying cause of neck and back pain can be difficult. A medical history that includes age, weight, current and past medical problems, medications, and height is taken. Also, a complete physical examination, which may include a neurological exam, is performed.
X-ray: X-rays show the alignment of the spine and may reveal degenerative joint diseases, fractures, or tumors.
Magnetic resonance imaging: Magnetic resonance imaging (MRI) scans provide clear images of disc deterioration, pathologies of the spinal cord, spinal stenosis, herniated discs, spinal tumors, and abnormalities in nerves and ligaments. MRIs are conducted in a small, confined areas and some individuals may find this uncomfortable. Some individuals may have to be sedated using a mild sedative such as alprazolam (Xanax®) or lorazepam (Ativan®). If the individual is sedated, transportation should be organized with a family member or friend to take and return home the individual, due to drowsiness and decreased coordination.
Computerized tomography: Computerized tomography (CT) scan is an X-ray that uses computer technology and can be enhanced with the injection of a contrast dye. CT scans are used to show abnormalities in bones and soft tissue. CT scans can be used for individuals who are unable to tolerate MRIs.
Myelography: Myelography is used to examine the spinal canal and cord. Contrast dye is injected into the cerebrospinal fluid in the spine. This allows the doctor to outline the spinal cord and nerve roots, and abnormal disc conditions or bone spurs can then be visualized using an X-ray or CT scan.
Electromyogram: Electromyogram, or
EMG, is the use of tiny electrodes inserted into muscle tissue to test for abnormal electrical signals. Abnormal electrical signals may indicate that a nerve root is pinched or irritated at the spine. An anesthetic, such as lidocaine or Xylocaine®, is used to reduce the pain of electrode insertion into the skin.
Spinal tap: Spinal tap involves drawing a sample of cerebrospinal fluid and analyzing it for elevated pressure, infection, bleeding, or tumor. Spinal tap may be painful and may require sedation.
Radioactive bone scan: Radioactive bone scans locate problems (such as a fracture or osteoporosis) in the vertebrae. A chemical called a radioactive tracer is injected into the patient and after several hours, a gamma camera picture will reveal bone undergoing rapid changes where large amounts of tracer accumulate.
signs and symptoms
Pain: Pain can be constant or intermittent (off and on). Intensity can vary from a dull ache to searing agony. The onset may be sudden or acute (short-term), with or without apparent reason, or gradual and chronic (long-term).
Most back pain resolves in a few days or weeks with or without treatment. However, some individuals have chronic pain that lasts months or years.
Severe pain lasting more than a few days without improvement may require medical attention. Individuals having difficulty passing urine; numbness in the back or genital area; numbness, pins and needles, or weakness in the legs; shooting pain down the leg; or unsteadiness when standing should see a doctor immediately.
Pain is often described as aching, tight, stiff, sore, burning, throbbing, or pulling. The pain may worsen while bending, sitting, walking, or standing too long in one position. It may also be more prevalent at different times of the day, such as when a person wakes up in the morning.
Pinched nerves produce numbness or tingling, warm or cold sensations, and burning or stabbing pain that begin in the back and radiate down the leg or the arm. Activities such as coughing, sneezing, or walking may increase pressure on the pinched nerve and aggravate the pain.
Compressed nerves may cause numbness and weakness in the muscle associated with the nerve. The muscle may atrophy (waste away) if the compression is not relieved.
Complications of back pain include: limited mobility, such as trouble walking up stairs, standing, or sitting; pain; lost work time; surgery; and disability.
Age:The first attack of low back pain typically occurs between the ages of 30-40. Back pain becomes more common with age.
Aging produces wear and tear on the spine that may result in conditions (such as disc degeneration or spinal stenosis) that produce neck and back pain. Having a previous back injury puts the individual at risk for another injury and increased pain.
Diet:A diet high in calories and fat, especially trans-fats found in fried foods, combined with an inactive lifestyle, can lead to obesity. Obesity has been found to be a major risk factor in the development of back pain due to increased stress on the back.
Heredity: Some causes of back pain, including disc disease, may be genetic or passed from one generation to the next through genes. More research is being performed in the area of back pain and heredity.
Race: Race can be a factor in back problems. African American women, for example, are two to three times more likely than white women to develop spondylolisthesis, a condition in which a vertebra of the lower spine (lumbar spine) slips out of place.
Occupation: Physically demanding occupations, such as construction work and healthcare, which require repetitive bending and lifting, have a high incidence of back injury. Jobs that require long hours of standing without a break (such as hairdressing and fast food service) or sitting in a chair that does not support the back well (computer keyboard operation or writering) also put a person at risk for neck and lower back injury.
Lifestyle: Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. Clinical studies report that low-impact aerobic exercise is good for the discs that cushion the vertebrae.
Although smoking tobacco may not directly cause back pain, it increases the risk of developing low back pain and low back pain with sciatica. Sciatica is back pain that radiates to the hip and/or leg due to pressure on a nerve. Smoking has been reported to negatively affect bone mineral density, lumbar disk disease, the rate of hip fractures, and the rate and extent of bone and wound healing.
Poor posture, such as slouching in a chair, driving hunched over, standing incorrectly, and using poor body mechanics when lifting and carrying heavy loads, are risk factors. Sleeping on a soft or sagging mattress also can lead to back pain.
Sports that involve twisting the back, such as golf and basketball, can result in back injury and they also worsen existing lower back pain.