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Causes of Back Pain
The causes of back pain are broadly divided into mechanical and chemical. Mechanical back pain is the leading cause of spinal problems. Current research indicates that 97–98% of back pain is due to mechanical factors.
A significant proportion of back pain cases—up to 90%—are associated with damage to the intervertebral disc. This pain may result from sudden movements or lifting heavy objects. Patients may experience pain in the spine with possible radiation to the limbs. Another common scenario involves overloading, which leads to a loss of flexibility and mobility in paraspinal tissues. Causes may include previous trauma, surgical procedures, past episodes of disc injury, sedentary lifestyles, or prolonged static positions during the day.
The last category of spinal pain is postural syndrome, primarily affecting young individuals and caused by incorrect posture habits.
Chemical Causes of Back Pain
Pain stemming from chemical causes is characterized by persistent symptoms. Patients find it challenging to assume a position that alleviates their discomfort, and any movement exacerbates the pain. Additional symptoms may include swelling, redness, and elevated temperature in the affected spinal area.
Classification of Back Pain Syndromes
- Acute Back Pain
If back pain arises suddenly or develops rapidly over a short period, it is classified as acute.
- Chronic Back Pain
When symptoms develop gradually, initially appearing intermittently but progressively intensifying to occur daily, the pain is deemed chronic.
Lumbar Spine Pain – Lumbar-Sacral Region
Lumbar spine pain is typically caused by mechanical factors. These include static overloads from poor posture at work or sudden dynamic overloads. Pain in the lumbar region is a physiological response to exceeding the allowable range of motion or performing tasks with excessive load, acting as a protective mechanism against injury.
Lumbar Disc Disease
Between 60–80% of lumbar spine pain cases are related to disc disease, commonly occurring in individuals aged 30–50. This condition involves herniation of the intervertebral disc, where the outer disc layer tears, causing the disc to protrude and compress nerves, muscles, or blood vessels.
The immediate cause of disc disease can be a sudden flexion movement or flexion combined with rotation, displacing the nucleus pulposus and causing disc rupture.
Disc disease often has a prolonged course with periods of exacerbation, complicating treatment. Nerve root compression can cause sciatica, an intense, sharp pain radiating down the leg. Patients may also experience difficulty standing upright and leg numbness.
Degenerative Changes and Lumbar Spine Pain
Degenerative changes typically occur with age, peaking between the ages of 50–60. Contributing factors include reduced physical activity and weakened muscles that stabilize the spine. This leads to overloading of spinal structures, which are unaccustomed to prolonged strain, especially in sedentary lifestyles.
Mild degenerative changes can be treated conservatively, focusing on physical therapy and education on lifestyle modifications. Therapeutic injections may support rehabilitation efforts.
Overload-Related Spine Pain
Chronic overload of muscles, ligaments, and intervertebral discs, often resulting from strenuous physical labor, sports activities, or poor posture, is a frequent cause of chronic back pain. Symptoms may sometimes manifest in distant parts of the body rather than the spine itself, varying widely depending on the contributing factors. Treatment requires consultation with a specialist.
Spondylolysis and Spondylolisthesis
Spondylolysis refers to a fracture or defect in the vertebral arch, often occurring in young, physically active individuals. Pain is usually localized and more intense on one side.
When one vertebra shifts forward relative to the vertebra below it, spondylolisthesis occurs. This condition may arise from untreated spondylolysis or significant instability due to degenerative changes. Typical symptoms include lumbar spine pain, often described as low back pain.
Both conditions may be treated conservatively with rehabilitation. Early diagnosis is crucial for spontaneous healing of bone defects in spondylolysis. When conservative treatment fails, surgical options, such as vertebral stabilization or isthmus repair, may be necessary.
Cervical Spine Pain
Cervical spine pain is the second most common type of spinal pain. It increasingly affects individuals with sedentary jobs, particularly those working in static positions, such as seamstresses, laboratory technicians, and office workers. Prolonged poor posture during daily tasks is a significant factor.
Cervical Disc Disease accounts for nearly half of cervical spine pain cases. Symptoms include tenderness, muscle tension, stiffness, or even immobility. Pain may radiate to the back, shoulders, or jaw and can be accompanied by migraines, jaw pain, or visual disturbances.
Cervical spine degeneration, stress, and emotional distress can exacerbate these symptoms, highlighting the importance of ergonomic adjustments and physical activity.
Cervical Spondylosis
Cervical spondylosis is a degenerative process involving the vertebrae, intervertebral discs, and joints, typically due to aging and accumulated injuries.
Cervical Radiculopathy
Cervical radiculopathy occurs due to nerve root compression, causing numbness, weakness, and pain radiating to the arm. The condition may be triggered by degenerative changes, repetitive tasks, or microtraumas.
Whiplash Injuries
Cervical whiplash injuries often result from rear-end vehicle collisions. Symptoms include persistent neck pain, headaches, and dizziness. Proper diagnosis and immobilization are crucial for recovery.
Spine Injuries and Overload
Acute Trauma: Damage to the intervertebral disc due to sudden force.
Chronic Overloads: Long-term wear and tear leading to spinal degeneration.
Treatment for all these conditions requires early diagnosis and specialist intervention for optimal outcomes.
Treatment of Back Pain
The treatment of back pain primarily focuses on addressing the underlying causes of back pain rather than just alleviating the symptoms. For patients experiencing discomfort, therapeutic movement is applied, tailored to the results of a functional spinal examination. Statistics indicate that nine out of ten patients who have experienced low back pain will encounter a recurrence within the next year, with one-third of them experiencing more severe symptoms. Given these concerning statistics, prevention of recurrence is the cornerstone of treatment.
The primary tool in treatment is patient education, ensuring the individual learns to perform daily activities differently than before. Actions such as sitting, putting on shoes, getting out of bed, or lifting objects from the floor can trigger back pain. Educating patients makes them independent in their treatment process, equipping them with both emergency and preventive measures to avoid recurrence.
Rehabilitation as the Primary Treatment
In most cases, spine treatment involves rehabilitation. Each patient is prescribed an individualized rehabilitation protocol aimed at quickly reducing pain to enable daily activities. In the subsequent phase, the focus shifts to consolidating the achieved results and preventing relapses.
In special cases where rehabilitation progress is deemed unsatisfactory by physicians, therapeutic injections may be performed. Following the procedure, patients are advised to return to rehabilitation.
Surgical Interventions
In cases of significant neurological symptoms (e.g., severe limb pain, sensory disturbances, or muscle weakness in the limb) that persist or worsen, urgent decompression of neural structures may be recommended. This is typically achieved via a discectomy procedure. After surgery, rehabilitation is essential to prevent similar incidents in the future.
In rare instances, particularly in older individuals, minor injuries or sudden overloads can lead to compression fractures in the vertebrae. Patients report severe spinal pain, exacerbated by movement or positional changes. These fractures resemble the crushing of a box. Imaging tests are crucial to determine the fractured vertebra and the extent of the deformation. Vertebroplasty, a specialized procedure, is employed to treat such fractures.
For advanced cases involving significant spinal degeneration or severe neurological symptoms, surgery may be necessary. The scope and technique of the procedure are tailored to each patient. All surgical interventions aim to stabilize the spine while decompressing neural structures to varying extents. Post-operative rehabilitation is crucial for resuming normal function and adopting appropriate behaviors.
Prevention of Back Pain
Developing the habit of protecting your spine is essential to ensure that daily activities, often performed automatically and incorrectly, do not result in cumulative microtrauma or overload on the spine.
Related Topics
Explore other potential causes of back pain.
Bibliography:
- Spine-health - Lower Back Pain Symptoms, Diagnosis, and Treatment - John Peloza, MD - 2017
- Healthline - Everything You Want to Know About Lower Back Pain - Medically reviewed by Angela M. Bell, MD, FACP — By Janelle Martel and Angela Myers — Updated on October 30, 2022
- Medical News Today - What is causing this pain in my back? - Medically reviewed by Peggy Pletcher, M.S., R.D., L.D., CDE — By James McIntosh on February 23, 2017
