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Back Pain Causes

Back pain is an extremely common condition, with around eighty percent of adults experiencing a back pain episode at some time in their lives. It varies from a mildly irritating restriction of one's daily activities to a severe and chronically disabling condition in some people.

Lower back pain causes are thought to be many but it is not clear what causes many of the back pain episodes with people suffer from. Back pain causes which have been put forward include sprains, strains and other injuries to the discs, bones, ligaments, joints, muscles and nerves of the spine and local areas.

Back pain can occur in several regions of the spine and spinal pain is divided into neck pain, upper back pain, middle back pain and lower back pain, with coccyx pain or coccydynia occurring in rare cases.

Back or spinal pain can refer pain to various areas and internal organs may refer pain which can be interpreted as back pain so it is useful to carefully assess patients with shoulder pain for neck or upper back pain causes and lower back pain can be kidney pain.

Good resources about low back pain causes can be found at NHS Choices and PatientUK.

Non-specific Low Back Pain

This is the name given to the commonest type of lower back pain and around 80% of all episodes are diagnosed as “non-specific” which means that no structure can be identified as the cause with any certainty. This type of back pain can be mild or extremely severe and troublesome but is not serious from a medical point of view, i.e. there is no serious condition underlying it.


Low Back Pain Causes

Most low back pain is classified by doctors and physiotherapists as being non-specific lower back pain. This is really a non-diagnosis or diagnosis of exclusion, which means that all medically serious diagnoses have been ruled out, and back pain causes due to a strain or sprain of one of the tissues in the back is the most likely reason.

The lower back pain causes of a strain or sprain of a muscle or a ligament are the most likely, along with damage to the capsule (fibrous bag) surrounding one of the small facet joints or damage to the back wall of the disc. In almost all of these cases it is not possible to determine which structure is responsible for the back pain.

However, a physio will know that lower left back pain causes are going to be substantially the same as lower right back pain causes and will home in on the relevant examination findings such as a disc related syndrome.

Upper back pain causes and middle back pain causes are rather different from low back pain causes although similar to each other, with disc problems being vanishingly rare and joint problems from the facets and rib joints much more common.

While it can be frustrating not to have a specific diagnosis for back pain, this at least means that the pain is not serious from a medical point of view as there is no underlying condition responsible for it.

Back pain treatment covers a large variety of techniques and health professions such as physiotherapy, osteopathy and chiropractic.



Specific Back Pain Problems


Slipped Disc or Prolapsed Disc

Disc problems are common and may vary from a tear in the outer covering due to a twist and lift through to a split in the outer disc wall where the gel inside the disc bulges out. The outer disc walls are sensitive to pain from injury and overstress.

Nerve Root Pain – Sciatica

Much less common than back pain, sciatica occurs in around five percent of cases and is distinguished from back pain by being very severe, surging pain down the leg, often worse in the foot than further up. The pain is usually in a typical pattern related to which nerve is involved. In some cases there may be no back pain at all.

Sciatica is mostly caused by nerve compression and irritation from by a disc prolapse, as the gel nucleus of the disc protrudes through the outer wall and hits what is called the nerve root, the part of the nerve which has just come off the spinal cord and is on its way down to the leg. This is often referred to as a trapped nerve.

Irritation and compression of the nerve root gives the severe pain in the leg and also can give loss of reflexes on testing, loss of muscle power in the muscles it supplies, pins and needles and numbness.

Most leg pain is not sciatica but referred pain from the structures in the spine, where the brain interprets the messages coming in from the spine as being in the buttock, hips or legs. This kind of pain rarely goes below the knee and is more achey and hard to pin down, rather than the sharp, very unpleasant and clearly defined pain of sciatica.

Cauda Equina Syndrome CES – A Rare but Serious Condition

Cauda equina syndrome a very serious type of nerve compression where the nerve in the lowest part of the spinal canal are compressed severely, either by a huge disc prolapse, trauma such as a fracture, or a tumour.

Symptoms of CES include severe and disabling back pain, variable leg weakness or pain, interference in bladder or bowel function and loss of feeling between the legs around the genitals and anus. This is an extremely serious condition if it occurs and you should consult a doctor at once if you have this combination of symptoms, or you may risk long term problems.


Other Back Pain Causes

Osteoarthritis, the commonest degenerative joint condition in the world, can affect the posterior spinal joints and become painful. This is more common in older people.

Ankylosing spondylitis is an arthritic disease most commonly presenting in young men, where the inflammation and pain leads to increasing joint stiffness over time. AS needs management by a rheumatologist.

Rheumatoid arthritis, another arthritic disease, can have serious spinal effects along with the more obvious effects on the limb joints. Rheumatological management is important here too.

Tumours, infections, trauma, osteoporosis and other conditions may also cause low back pain and are referred to as non-mechanical low back pain. These problems all need specialist assessment and treatment. These occur in less than 1% of cases of low back pain and are more common again in older people.


Back Pain Treatment

Physiotherapists assess patients with back pain, noting the back pain symptoms and fitting their back pain treatment to the symptoms and the examination findings. For instance on thinking about right side back pain causes the physio will consider the hip joint, the sacroiliac joints, the facet joints and ligaments and the intervertebral discs.

Back pain relief can can be provided by core stability work, back exercises, joint mobilisations, joint manipulation, advice and general fitness work. Pain relief for back pain can be a sensible strategy if the pain is interfering with normal function and may speed up the return to normal activity.



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