What Are Some Causes Of Back Pain?

Ask The Doctor > Back Pain > What Are Some Causes Of Back Pain?

Back pain is one of the most frequently encountered complaints in people of working age. Back pain often indicates a pathological processes occurring in our body. Successful treatment of back pain begins with a correct diagnosis and identifying the underlying cause of the disease. Therefore, treatment should be directed towards eliminating the root cause.

Causes of Back Pain
According to the statistics of patients complaining of back pain, these are the major reasons causing backaches:

  1. Herniated disc
  2. Rupture of the fibrous ring
  3. Spinal stenosis
  4. Myogenic pain (pain originating from muscles)
  5. Facet arthropathy

Herniated disc
Disc herniation is characterized by the following:

  • History of injury or a history of frequent Microfracture (sports, running, jumping etc)
  • Pain may be aggravated by sitting, coughing, sneezing, bending forward and straightening the legs.
  • Possible sensory disturbances in the form of numbness or paresthesia (abnormal sensations)
  • Reduced muscle strength and atrophy (in a later stage)
  • Positive Lasegue Test/Straight Leg Raising Test (SLR)
  • MRI or CT scan may reveal violations in the intervertebral disc in the form of disc herniation and nerve root involvement.

Clinical manifestations of disc herniation depend on its degree – protrusion or prolapsed and orientation (isolated medial and posterolateral, and foraminal or extraforaminal).

Rupture of the fibrous ring
Rupture of the fibrous ring is characterized by the following features:

  • History of injury
  • Back pain is usually more pronounced than pain in the leg.
  • Leg pain can be both bilateral and unilateral.
  • Positive Lasegue Test/Straight Leg Raising Test (SLR) (but MRI or CT data do not provide radiological confirmation of root compression as in disc herniation)
  • Pain is also enhanced when sitting, bending forward, coughing and sneezing, and/or straightening the legs.

Myogenic pain (Pain originating from Muscles)
It is characterized by the following features:

  • History of single or repeated muscle strains.
  • Recurrence of pain associated with increase in muscle tension.
  • Back pain occurs on electrical stimulation of paravertebral lumbar muscles.
  • Electrical stimulation of the gluteus maximus causes pain in the buttocks and thighs
  • Pain in the lower back
  • Pain is worse in the morning and after a rest, as well as when cold
  • Pain increases on prolonged muscular work and the most intense pain is just after the cessation of muscular load.
  • Pain on palpation of the involved muscles.
  • Pain may be exacerbated by the active and passive muscle contraction.
  • MRI and CT did not reveal any pathological changes.

Lumbar stenosis
Lumbar stenosis is often a consequence of age-related changes in the spine. It is characterized by the following:

  • Pain in the back and/or in leg appears after walking a certain distance.
  • Symptoms gradually increase when you continue to walk.
  • Weakness and numbness in the legs.
  • Flexion relieves symptoms
  • MRI and CT scans reveal a decrease in disc height, hypertrophy of the facet joints, degenerative spondylolisthesis.

Facet arthropathy
For facet arthropathy, it is characterized by the following features:

  • History of injury
  • Pain appears immediately on extension of the spine.
  • Back pain increases with flexion on the affected side.
  • Pain stops after administration of corticosteroids and/or anesthetic into the joint (this is also the treatment of back pain with facet arthropathies).

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Diagnosis of back pain
Diagnosis begins with a careful history. Doctors asks the patient about the complaints, the course of the disease, its forms and features, and evaluates the neurological symptoms like whether there is a decrease of tendon reflexes, to determine where the reduced sensitivity of the skin.

The most accurate method of diagnosis of diseases of the spine is magnetic resonance imaging (MRI) and computed tomography (CT scan) of a spine. These are important to study the structure of the spine, to diagnose the presence or absence of herniation of intervertebral disks and to know the general condition of the vertebrae of the spinal cord.

In modern neuroradiology, MTP diagnosis is considered the most sensitive and accurate method of examination.

Treatment of Backache
It is clear that the treatment of back pain begins with detection and accurate diagnosis of the underlying cause. The diagnosis can be established on the basis of clinical examination and if necessary updated with modern diagnostic methods. The most informative method today is magnetic resonance imaging, or MRI.

Correct diagnosis and identifying the causes of pain predetermine treatment programs that include one or more treatment options that have synergistic and complementary action. Medical treatment, surgery, physiotherapy and many other treatment options are available and can be used if advised by a doctor and acceptable to the patient.

We can also use one or more of the following techniques:

  • acupuncture
  • vacuum therapy
  • sparing manual therapies (postisometric relaxation)
  • laser therapy
  • pharmacopuncture
  • dry traction
  • magnitopunktura
  • electrical and other treatments

Prevention of back pain
There are some basic rules that help maintain a healthy spine and prevent back pain. These are “avoid bending your back during walk or stand, sit properly, don’t lift or carry weight in bending position, sleep properly and perform moderate exercise”.

To avoid pain in the back, in the first place, it is necessary to remember the correct posture. Position of muscles during walking, standing, sitting or lying have an important role. One should not to slouch. Keep your back straight and do not crane your neck forward. Being in a sitting position, you need to pay attention to the fact that the back should be against the backrest of the chair or, to avoid furniture which does not have the back and legs should be touching the floor.

Lifting heavy objects while bending forward is strictly forbidden.

Also important in the prevention of back pain is your position while in bed, where a person spends a considerable amount of time in their everyday life. Hard beds are often recommend which may not always be right. This type of bed is intended generally for people who present with severe chronic back pain. For the rest of us, semi-rigid beds can be more useful and convenient.

The most important factor in the prevention of back pain and many other diseases is a healthy lifestyle that includes regular balanced diet, exercise, avoiding bad habits and controlling your emotions, as you can read more about in our other Daily Dose articles.

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Dr. Jimmy Obaji M.D.

Dr. Jimmy Obaji completed his residency in Family Medicine at the University of Manitoba. He currently operates a walk-in-clinic in downtown Toronto.

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