What Causes Low Back Pain

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1 What Causes Low Back Pain Your back is a complex structure composed of bones, muscles, ligaments, tendons and discs the cartilage-like pads that act as cushions between the segments of your spine. Back pain can arise from problems with any of these parts. In some people, no specific cause for their back pain can be found. Strains The Spinal Column Back pain most often occurs from strained muscles and ligaments, from improper or heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm can cause back pain. Structural problems In some cases, back pain may be caused by structural problems, such as: 1. Bulging or ruptured disks. Discs act as cushions between the vertebrae in your spine.sometimes, the soft material inside a disk may bulge out of place or rupture and press on a nerve. Many people who have bulging or herniated discs experience no pain from the condition so finding a bulging disc on a scan may not necessarily be the root of your pain. 2. Sciatica. If a bulging or herniated disk presses on the main nerve that travels down your leg, it can cause sciatica sharp, shooting pain through the buttock and back of the leg. 3. Arthritis. The joints most commonly affected by osteoarthritis are the hips, hands, knees and lower back. In some cases arthritis in the spine can cause joint pain at the effected level or can lead to a narrowing of the spaces around the nerves in the back causing leg pain. 4. Skeletal irregularities. Back pain can occur if your spine curves in an abnormal way. If the natural curves in your spine become exaggerated, your upper back may look abnormally rounded or your lower back may arch excessively. Scoliosis, a condition in which your spine curves to the side, also may lead to back pain. There are many other very rare irregularities like this one that could cause pain.

2 Healthy disc Injured disc Factors Can Increase Your Risk of Low Back Pain Research has shown that some factors can increase your risk of developing low back pain. If you pain becomes a longstanding problem then you may have to address these factors Smoking Older age Physically strenuous work Stressful job Depression Obesity Female gender Sedentary work Anxiety When to seek medical advice If you have no recent history of a fall, heavy tackle or other trauma, your injury may be minor and can possibly be managed at home with self care. However even in these cases it is still important to contact you doctor, chartered physiotherapist or other health care professional if you have any of the signs below, or if your pain has not begun to improve within 72hrs of beginning your self care. Discuss your pain with your team physiotherapist or doctor if your pain - Is constant or intense, especially at night or when you lie down - Causes new bowel or bladder problems - Is associated with pain or pulsation (throbbing) in the abdomen, or high temperature - Follows a fall, blow to your back or other injury. - Is accompanied by unexplained weight loss - Spreads down one or both legs, especially if the pain extends below the knee - Causes weakness, numbness or tingling in one or both legs - You should also tell your doctor if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse. Tests and diagnosis Research has shown that diagnostic tests aren't usually necessary to confirm the cause of your back pain. However, if you do see your doctor or chartered physiotherapist for back pain, he or she will examine your back and assess your ability to sit, stand, bend, walk and lift your legs. He or she may also test your reflexes if there are signs that nerves are involved. These assessments help determine where the pain comes from, how much you can move before pain

3 forces you to stop and whether you have muscle spasms. They will also help rule out more serious causes of back pain. If there is reason to suspect that you have a tumor, fracture, infection or other specific condition that may be causing your back pain, your may be sent for further investigations: - X-ray. These images show the alignment of your bones and whether you have arthritis or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, nerves or discs. - Magnetic Resonance Imaging (MRI) or computerized tomography (CT) scans. These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels. - Bone scan. In rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera. - Nerve studies (electromyography, or EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerveconduction pathways can confirm nerve compression caused by herniated discs or narrowing of your spinal canal (spinal stenosis). Treatment Most back pain gets better with a few weeks of home management and careful attention. Painkillers and anti-inflammatory medications may help control the pain.your pharmacist or doctor can advise you on suitable medication. In more serious cases a short period of bed rest is okay, but research has shown that lying down for too long can actually do more harm than good. If home treatments aren't working, your doctor may suggest stronger medications or other therapy. Muscles That Support the Spine

4 Chartered Physiotherapy and Exercise On assessment a chartered physiotherapist will establish the severity of the injury and the most likely cause. The aim of treatment is to relieve pain and restore normal movement and strength, returning you to full training as quickly as the injury will allow. You will be advised on the best home self management strategies which may include exercises, modified training activities, modified work postures etc. Hands-on treatment may involve manual therapy or manipulation, massage or other muscle energy techniques. Physiotherapists may also use other methods of pain relief like heat/ cold treatment, acupuncture or electrotherapy. When the time is right you will begin a low back and abdominal muscle strengthening and flexibility programme which aims to reduce the risk of recurrence in the future. Finally you will be advised on a graded return to your previous level of training and play. Depending on the severity of the injury, in many cases fitness can be maintained by getting advice on modified training programmes while you are recovering. Medications If your pain is persisting, despite home treatment, over the counter medication and physiotherapy, your doctor may prescribe other medication eg muscle relaxants, prescription pain killers or antiinflammatories. For pain that has persisted for a very long time some doctors may prescribe low doses of certain types of antidepressants particularly tricyclic antidepressants, such as amitriptyline which have been shown to relieve chronic back pain, independent of their effect on depression. Injections If other measures don't relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone an anti-inflammatory medication into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts less than six weeks. Other injection therapy might include the use of Botox or analgesics. Surgery Few people ever need surgery for back pain. To date there are no effective surgical techniques for muscle- and soft-tissue-related back pain. Surgery is usually reserved for pain caused by a herniated disc. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery. Some of the types of back surgery that are available are Fusion - This surgery involves joining two vertebrae to eliminate painful movement. A bone graft is inserted between the two vertebrae, which may then be splinted together with metal plates, screws or cages. A drawback to the procedure is that it increases the chances of arthritis developing in adjoining vertebrae Partial removal of disc - If disc material is pressing or squeezing a nerve, a surgeon may be able to remove just the portion of the disk that's causing the problem. Partial removal of a vertebra - If your spine has developed bony growths that are pinching your spinal cord or nerves, surgeons can remove a small section of the offending vertebra, to open up the passage.

5 Prevention You may be able to avoid back pain by improving your fitness, strength and flexibility and learning and practicing proper techniques and postures for work, rest and sport. To keep your back healthy and strong: Exercise. - Regular low-impact aerobic activities those that don't strain or jolt your back can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices. Build muscle strength and flexibility - Abdominal and back muscle exercises (core-strengthening exercises) help condition these muscles so that they work together like a natural corset for your back. It is crucial that you get the right balance between the strength and flexibility of these muscles and your hamstrings, gluteal and quadriceps muscles. A well balanced core stability programme should help prevent recurring back problems during the season. Smokers - have diminished oxygen levels in their spinal tissues, which can hinder the healing process. Maintain a healthy weight. Being overweight puts strain on your back muscles. If you're overweight, trimming down can prevent back pain. Use proper posture, work and training strategies: Stand Well - Maintain a neutral pelvic position. If you must stand for long periods of time, alternate placing your feet on a low footstool to take some of the load off your lower back. Sit Well - Choose a seat with good lower back support, arm rests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level. Train Well - Repeatedly training one muscle group to the detriment of another can lead to imbalances in the function of your back and pelvis and predispose you to injury. Make sure your gym programme is well balanced and targeting your specific needs. Your chartered physiotherapist or team trainer may guide you with this. Repeated twisting and bending in one direction can create imbalances, you should include a variety of skills and techniques in skills sessions. Lift Well - Let your legs do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward. To download the booklet Back Care written by Chartered Physiotherapists: For more information:

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