Low Back Pain Introduction What Are the Parts of the Spine? How Does Your Spine Change With Age?

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1 Low Back Pain Introduction Back problems are common, affecting about 80 percent of adults at some time in their lives. Back problems may begin for many reasons including minor strains, sprains or injuries. The normal aging of the spine can also contribute to back pain. This resource discusses diagnosis and treatment of low back pain and ways to help maintain a healthy back. If you have questions after reading this information, please talk with your healthcare provider. What Are the Parts of the Spine? To understand how your spine (backbone) changes with age, it is helpful to understand the parts and function of the spine. Your spine is made up of many separate bones (vertebrae), rubbery shock absorbers (discs) and small joints on the back of the vertebrae (facet joints) (see figure 1). The vertebrae are stacked on top of each other from your tailbone to the base of your skull. The vertebrae form a column that surrounds and protects your spinal cord. The spinal cord is the main pathway of your nervous system. Spinal nerves branch out from the spinal cord between each vertebra to serve the muscles and tissues throughout your body. The spinal discs maintain the spaces between the vertebrae. Discs are made of a rubbery outer layer and a soft, jelly-like center that helps them to act as shock absorbers. The facet joints, together with bands of fibrous tissue called ligaments, hold the vertebrae and discs together, but are flexible enough to allow the spine to bend and twist. Tendons fasten your back muscles to your spine. Your back muscles support your spine, which helps you stand upright and move. They also help support the weight of your body and the loads you carry. How Does Your Spine Change With Age? It is normal for your spine to change as you age. Your back absorbs a great deal of force each day as you stand, sit, move and lift. Over time, the stresses and strains of daily living can start a process in which your spine and surrounding structures begin to wear down. This process is

2 sometimes called spinal degeneration (see figure 2). As you age, spinal changes may progress (see figure 3). Common degenerative changes may include the following: The spinal discs shrink and wear down. This decreases the spaces between the vertebrae, which can cause you to lose height as you age. The discs lose the ability to retain their usual amount of fluid. This makes them more rigid and less able to cushion the forces placed on the spine by normal activities such as sitting, walking, running and jumping. The facet joints begin to wear down and become less stable. Degeneration of other parts of the spine can force the facet joints to bear more weight than usual and make them less able to support the vertebrae. The ligaments in your back become thicker and less flexible. As you age, your muscles, tendons and ligaments thicken and become less flexible. This is a normal process that may be associated with back problems. Who Is Affected by Low Back Pain? Low back pain is so common that many people experience it at some time in their lives. Certain factors may be associated with an increased risk of low back pain. These factors include: An inactive lifestyle Placing unusual amounts of stress on your back (for example, doing heavy construction work) Poor posture Being overweight Repetitive or improper lifting Smoking Family history of back problems

3 Does Low Back Pain Mean Your Spine Is Damaged? Low back pain or other symptoms do not usually result from any permanent injury or damage to the spine. The solid bones and powerful muscles of the back make it one of the strongest parts of the body. The spine can usually tolerate a great deal of stress without injury. How Is Low Back Pain Diagnosed? Your evaluation for low back pain will include a complete medical history. physical examination and possibly other diagnostic tests (such as X-rays or other imaging scans of your spine). How Is Back Pain Treated? Treating back pain depends on the cause and the severity of symptoms. You will need to take an active role in any plan for the treatment of your back. Your health-care provider may first recommend a combination of the following non-surgical treatments: Rest, accompanied by activity change You may be advised to rest your back for a few days after the start of pain. This will usually not involve complete bed rest. Remaining active can help the healing process. Exercise One of the most important steps to help heal and protect your back is regular exercise. An individually tailored exercise program can help: Relieve pain. Increase your overall fitness. Shed excess weight that stresses your back. Stretch, tone and strengthen the muscles that support your back. Reduce your risk of falls and other injuries. Increase your flexibility. Aerobic exercises may also be included to help relieve pain and improve your overall fitness. Appropriate forms of aerobic exercise for people with back pain may include walking, stationary cycling and swimming. Physical therapy Physical therapy techniques can help relieve pain. Traction may be used to relax muscles of the spine that have gone into spasm (muscle tightening that you cannot control) and relieve nerve root tension. Ultrasound uses deep heat to relax painful muscles. Transcutaneous electrical nerve stimulation (TENS) applies mild electrical currents to your skin to help control pain. Heat or cold therapy applies heating pads or ice packs to relieve acute pain and reduce inflammation. Back supports (for example, a brace or corset) may help support your spine and maintain a healthy posture. Generally, back supports are most effective when used for short periods of one to two hours at a time or during demanding physical activities. The long-term goal is to strengthen your back so support is no longer needed.

4 Pain medication Your healthcare provider may recommend over-the-counter and / or prescription medication to help relieve pain and inflammation. Spinal manipulation Some people find spinal manipulation helpful. A healthcare provider who is trained in the use of manual manipulation can provide this type of treatment. Injections Steroid injections to the affected area of the spine may help reduce pain and other symptoms. Although the effects may not be long-lasting, they may help promote better long-term results if the pain relief allows you to participate more actively in physical therapy, exercise and other parts of your treatment program. You may have some discomfort when you first begin to exercise or participate in physical therapy. This is usually temporary and should lessen as your muscles get stronger. Surgery Surgery is rarely needed for back pain. However, if non-surgical treatments are unsuccessful, your health-care provider may advise you to consider surgery. Surgery is generally recommended for severe and persistent pain that continues to get worse and significantly affects your ability to function. Surgery may also be recommended if you experience weakness in your legs or have trouble controlling your bladder or bowels. Ask your surgeon about the procedures, benefits and risks of surgery. Maintaining a Healthy Back The following suggestions may help you manage back pain and other symptoms: Start and continue an exercise program. Exercises that strengthen and increase the flexibility of your back and stomach muscles can also help you avoid injury to your spine. Participate in an aerobic exercise activity at least three to five times a week. Maintain a healthy posture. Poor posture can lead to weak and tight muscles, place additional stress on your spine and cause more frequent episodes of pain. Maintain a healthy diet and weight. Carrying extra pounds places unnecessary stress on your back. Learn proper lifting techniques. Bend at the knees and hips and keep your back straight when lifting objects. Carry objects close to your body. Be aware of how you sit, stand and lie down. When sitting, put your feet on a stool or other object that raises your knees above the level of your hips. When standing for a long time, alternately put your feet on a low stool or other raised object. Avoid wearing highheeled shoes. Do not lie on your abdomen for long periods. Do not smoke. Smoking interferes with the healing process and damages your overall health. When Should I Call My HealthCare Provider? If you notice a significant change in your symptoms that lasts more than one week, contact your health-care provider. Seek immediate medical treatment if you have either of the following symptoms:

5 Significant numbness, tingling or weakness in your leg(s) Changes in ability to control your bladder or bowels Conclusion Low back pain is increasingly more common as you age. You can take steps to reduce your risk of developing back problems and help control any symptoms you may experience. Maintaining proper body position and exercising regularly may help prevent and reduce the effects of spinal degeneration. If other treatment is needed, a non-surgical approach is often successful. Researchers continue to explore new ways to prevent and treat low back pain. Word List Aerobic exercise To repeatedly contract large muscle groups, such as your legs and arms, to increase your breathing and heart rate. Degeneration Wearing down of a structure. Discs Rubbery cushions of cartilage that act as shock absorbers between each vertebra. Facet joints Small joints on the back of the vertebrae. Ligaments Strong, fibrous connective tissue resembling a band or sheet that connects a bone to another bone. Spinal cord Lengthy, cord-like bundle of nerves that connects the brain with the nerves of the trunk and extremities. Spinal nerves Nerves that run from the spinal cord between each vertebra to serve different muscles and tissues throughout the body. Spine The backbone. Vertebrae One of the bony sections that make up the spine.

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