Back pain

From Free net encyclopedia

Back pain (also known as "dorsopathy") is pain felt in the human back that may come from the spine, muscles, nerves, or other structures in the back. It may radiate from the lower, mid or upper back. The pain may be a tingling or burning sensation, a dull aching, or sharp pain. Weakness may also be felt in the legs or feet.

Back pain is one of humanity's most frequent complaints and does not always reflect any underlying condition.

Back pain that does not improve after a few days can sometimes indicate significant and serious conditions which might not otherwise be diagnosed. Back pain is very rarely a sign of a serious medical problem. It is however important that the treatable medical causes are identified early on. Typical warning signs are bowel and/or bladder function disturbance, severe pain spreading along a nerve (e.g., a radiculopathy - pain spreading down the back of the leg to the outside of the foot) or severe pain occurring with other signs of severe illness (e.g., fever, confusion).

1 Underlying causes
2 Management
3 See also
4 References
5 External links

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Underlying causes

Frequently, pain will sometimes be triggered by strenuous lifting that is uncharacteristic - that is, that follows a previous period of inactivity, but inactivity is not usually the precondition for an episode of back pain; the usual precondition is musclebound back muscles, a consequence of prior injury or long-term stress.

Incidence of back pain in Western countries has increased in recent years. Most back pain is not caused by damaged intervertebral discs or any underlying physical damage. It is often thought to be linked to a relatively inactive lifestyle, with people doing less exercise and less physical activity in their work. The current opinion of physicians is that those with back pain should become active as quickly as possible, as the previous prescription, bed rest, has been found to be counterproductive.

Common back problems may be attributed to the evolutionary history of bipedalism, the idea being that humans are not quite adapted to upright movement, and not at all well adapted to modern inactivity that allows muscles to become deconditioned. The amount of time spent in chairs for which human bodies aren't particularly well adapted, can also contribute to back pain. A more complete understanding, however, is that periods of relative immobility combined with heightened stress and high concentration, predispose people to accumulate muscular tension, which leads to muscle fatigue, soreness, and vulnerability to spasm. Thus, it is not the inactivity, per se, but the habituation into a state of heightened tension, that is the precondition for back pain.

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Management

Lower back pain is the single most common chronic pain syndrome seen in pain clinics in the Western world. 90% of patients with acute back pain improve within one month, the 10% who do not improve account for 85% of annual expenditures on back pain.Template:Citation needed

The management goals when dealing with back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore function; to help the patient cope with residual pain; to assess for side effects of therapy; and to facilitate the patient's passage through the legal and socioeconomic impediments to recovery.

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Back manipulation and spinal manipulation

Back manipulation, as performed by osteopaths and chiropractors is thought to be beneficial in some people. Back surgery is only considered to be necessary in very few cases of back pain — around one or two percent.Template:Citation needed

The Medical Journal "Patient Care" August 2005 found that spinal manipulation performed by osteopaths and chiropractors was an effective treatment for lower back pain.Template:Citation needed

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Chiropractic, exercise, and behavior modification

Chiropractic, physiotherapy and exercise are important in reducing back pain. According to the National Center for Complementary and Alternative Medicine, back pain is the most popular condition treated with alternative medicine. Fifty percent of all patients in the United States use alternative medicine to treat back pain.Template:Citation needed

Back pain sufferers are sometimes advised to use an ergonomic chair or to use a standing desk on a regular basis.

In the past, sleeping on a firm mattress has been recommended. A recent study suggested that a medium-firm mattress may give better results than a firm mattresses. (Kovacs et al., 2004)

Postural re-education, such as the Alexander Technique or sessions of somatic education (sensory-motor/movement) training and somatic exercises, such as Hanna somatic education, may also be recommended as a first-step, less invasive approach than surgery.

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Back Pain, Core Stability and Gymballs

Studies have shown that if back pain is present there is inhibition of the nerve impulses that activate the transverse abs, ie when there is back pain this muscle switches off. This inhibition is the natural consequence of the activation of opposing muscles in the back, a brain phenomenon known as "reciprocal inhibition." The studies went on to show that unless this muscle was specifically restrengthened it doesn’t just come back on by itself – specific retraining is required. Further studies that worked on restrengthening the transversus abdominis have shown fantastically positive results in reducing the incidence of reinjury (from 83% to 30%) (Hides, Jull and Richardson, 2001).

The specific retraining required involves freeing the back muscles from their "musclebound" condition, which "turns off" the brain's inhibition of the abdominal muscles, permitting them to resume their normal strength. A more complete understanding of the muscular component of back pain and the brain-muscle connection has begun to explain the phenomenon of chronic back pain; the incompleteness of regimens that address only the abdominal muscles and overlook the brain's involvement in muscular control is believed to be one of the reasons that once someone has injured their back, the chances of reinjury are significantly higher.

So if you have had back pain, or currently suffer any form of back pain, it is highly likely that your transverse abs aren’t working as well as they should and that your back muscles are excessively tight and fatigued (sore). (Hanna, T.L., Ph.D., Somatics -- ReAwakening the Mind's Control of Movement, Flexibility and Health. De Capo Press, 1988)

A recent study showed that working on a gymball showed significantly faster improvements in stability than exercising on the floor (Cosio-Lima et al). Significant improvements have been seen in 6 week gymball training programs (Stanton et al).

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Medical procedures

The pain itself is caused by strong muscle spasms severely tightening back muscles, in what is known as "Landau Reaction", a postural reflex involved in such common activities as sitting erect, standing, walking, and, of course lifting (Hanna, 1988). Landau Reaction is triggered by arousal into heightened vigilance and often becomes habitual muscular tension. Injury and overuse/overconditioning also lead to back spasms. One immediate treatment for such spasms is the application of cold, such as by an icepack or bag of frozen vegetables wrapped in a towel, as opposed to the application of heat. However, a more direct approach to long-term relief is training to free back muscles from their habitually tightened state.

Though pain, and especially chronic pain is multifactorial in cause, local anesthetics or nerve blocks can be used to facilitate physiotherapy and help gain diagnostic information.

Several medical therapies are used, including: