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Chronic Back Pain

Chronic Back Pain: What is it

Since man is an upright creature, his low back bears a considerable amount of weight. The low back region, just above the hip level, is extremely prone to strain. As a result, backache affects nearly everyone at some point in their lives. Backache is said to be ‘chronic’ or persistent if it lasts for 12 weeks or more.

Causes of Chronic Back Pain

Our low back or lumbar region, consists of five bony segments called lumbar vertebrae ‘stacked’ end to end, each separated from the next by a gel-like disc which acts as a shock absorber. The segments are movable at their linkage points called facet joints. These vertebrae together form a column and bony canal through which the spinal cord runs. The spinal cord gives off pairs of spinal nerves at each segment near the facet joints.

Pain may arise if:

  • The disc pops out of position and presses on a nerve (prolapsed intervertebral disc or slipped disc). This may happen in sportsmen who exert themselves, or if sudden heavy lifting is done.
  • The facet joints become worn, developing irregular bony edges that press on the nerves (lumbar spondylosis)
  • The spinal canal gets narrowed from old age and compresses the spinal roots within it (spinal stenosis)
  • The verterbral bone gets softened with age (osteoporosis) and flattens (compression fracture)
  • The spinal segments are not in line, either due to slippage forwards (spondylolisthesis) or curvature sideways (scoliosis)

If any of these happens, the back muscles tense up increasing pressure on the nerves and making the pain even worse (muscle spasm).

Prolonged sitting, standing, lifting or poor posture or overuse can cause muscles in the low back to become sore (backstrain) even if none of the above structural events occur.

Symptoms of Chronic Back Pain

Pain can run down the thigh( sciatica) due to pressure on the sciatic nerve which is the nerve supplying the leg. Sometimes numbness or pins and needles (parasthesia) occur. Calf ache relieved by sitting, is due to pressure build up in the spinal canal in cases of spinal stenosis. Surgery is normally not needed for chronic back pain.

Diagnosis of Chronic Back Pain

X-rays can reveal bony structures, while a more detailed scan called MRI (magnetic resonance imaging) will show up nerves, discs and muscles.

Treatment of Chronic Back Pain

In most cases, bed rest which relieves the back of its weight and pain medication is all that is needed.

If a compression fracture is diagnosed, osteoporosis medications must be administered. Physiotherapy can help relieve muscle spasm by manipulation, traction (stretching of the vertebral column by application of weights) exercises and heat treatment. Back care education on how to avoid straining the back further can be taught by the physiotherapist. Weight reduction is also important to reduce the load on the spine.