Why do I have back pain?

The back is a complicated structure that serves many important functions: it provides support to other areas of the body, and allows movement of the legs, head and arms. The back is composed of many types of tissues including bones, muscles, tendons, ligaments, nerves and blood vessels. Back pain may be associated with damage, injury or inflammation to any of these components.

Back pain is common, and there are many different causes and types of back pain. Back pain is not a medical diagnosis, but a symptom of an underlying condition.
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The back is comprised of muscles and the spine (backbone): a structure made up of bones, called vertebrae, which are held together by ligaments. The vertebrae are separated by intervertebral discs that act as rubbery cushions between the vertebrae and prevent the vertebrae from rubbing against each other.The spinal cord is a bundle of nervous tissue that runs inside the length of the spine (much like electrical wiring inside a cable). The spinal cord connects the brain to the rest of the body: nerves branch off the spinal cord at regular intervals, transmitting signals from the brain to to all parts of the body, and communicating sensations from the body to the brain.
This complicated arrangement of bone, muscle, nerves and connective tissue is particularly prone to experiencing problems, and many (though not all) cases of back pain have something to do with the spine.​

SIGNS & SYMPTOMS

The intensity, location and duration of symptoms associated with back pain may vary, but may include

• Localised ache
• Shooting or stabbing pain
• Limited flexibility
• Limited range of motion
• Inability to stand straight
• Stiffness
• Pain, numbness or tingling that radiates down one or both legs​​
  

Causes of Back Pain

Non-Specific Back Pain
Most causes of back pain have no clear cause. Fortunately, with appropriate treatment, these cases of back pain tend to improve over time.

Back Strains And Sprains
Acute back pain is most often caused by strains and sprains of the back muscles. It generally occurs in the lower back (lumbar muscles).
Back strain occurs when the muscles or tendons within the spine are stretched, torn or otherwise injured. When this occurs, there is an initial period of sudden, intense pain in the back, followed by muscular spasms for 1-2 days. The back is usually sore to touch. Resting helps ease the pain.

Disc Prolapse
A disc prolapse (also known as a slipped disc, herniated disc, or ruptured disc) is a common cause of back pain. It happens when one of the discs between two vertebrae tears, and the jelly-like substance inside it leaks out. The tearing causes irritation and sometimes an increase in the pressure to the surrounding nerves. This can lead to pain and numbness or weakness in the neck, arm or shoulder, buttocks, legs or feet.

Any disc can potentially rupture, but the ones in the lower back are most at risk. The pain is typically felt only on one side or in one leg and is usually worse after long periods of standing or sitting.
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Degenerative Disc Disease
The discs of the spine often wear down as we age. In some people, these changes can cause back pain. This is more commonly felt in the lower back, because the lower parts of the spine support the majority of the body's weight.
​Pain caused by degenerative disc disease is often constant, and mild to moderate. Generally it causes recurrent episodes of back pain that last from a few days to a few months. The pain is made worse by actions that increase pressure on the back such as sitting, coughing, sneezing and flexing.

​Types of Treatment

Chiropractic Care
There are numerous chiropractic care treatment options that can help relieve your back pain. Chiropractic care can help address back pain caused by numerous conditions, including the following

• back sprain injuries
• facet joint sprain
• lumbar intervertebral disc injuries that don't require surgery
• sacroiliac sprain
• spinal stenosis

Chiropractors treat the "whole person"—not just your back pain—so that you'll be able to gradually increase your daily activities. Your chiropractor will also emphasize the importance of back pain prevention. With chiropractic care, you'll learn how to prevent your back pain from getting worse as well as how to prevent future back pain.

Massage or yoga
Either of these treatments can provide some relief in chronic back pain; however, they are best combined with other treatments, particularly physical therapy.

Physical therapy
There is benefit in physical training programs that stretch the back, strengthen core muscles and improve spine flexibility. Exercise can also help with the maintenance of a healthy body weight, which may reduce the risk of further episodes of back pain.

Behavioural therapy
Behavioural therapy teaches techniques to help relax muscle tension, deal with thoughts or feelings that may trigger pain, and/or change behaviours that may increase pain. It is found to help in short-term treatment of chronic back pain.

Back supports
Wearing a posture brace or support may help address poor posture that may be contributing to recurrent back pain. However, it should not be a long-term solution. It is important to strengthen the back with physical therapy. As your posture improves with posture exercises, will gradually use the brace or support less and less, until you no longer need it.

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Prevention

Some cases of back pain are the result of underlying medical conditions. In those cases, back pain cannot be prevented. However, most cases of back pain can be avoided, or the severity of symptoms reduced, by making some lifestyle changes such as:

• Maintaining good posture;
• Lifting objects safely;
• Exercising regularly to improve posture and increase muscle support for the spine;
• Eating a healthy diet that helps to achieve and maintain a healthy body weight to ease the strain on the back;
  
• Taking regular breaks while standing, sitting or driving for long periods, and;
  
• Adopting effective stress management approaches.

References

• Henschke, N. et al (2010) Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. Accessed on 5 February 2016 from link here
  
• Rubinstein, SM. et al (2011) Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2011