------------------------------------------------------------ THE CAUSES OF BACK PAIN ------------------------------------------------------------ In the previous anatomy lesson we described structure. In this section we take that knowledge and focus on CAUSE. With a structure as complex as the spine and its supporting muscles, tendons and nerves you might suspect that there could be hundreds of causes of backache and back pain. Amazingly, the list is small and concise. But consider that for each cause listed below there may be a different therapy to alleviate each specific back pain. Backache and back pains can arise from the following sources: Chronic or Severe Trauma such as prolonged sitting, twisting, strain or sudden mechanical injuries. Poor posture or curvature of the spine. Stress or Fatigue. A "slipped" or ruptured disc. Pregnancy. Birth or congenital defects. Arthritis. Systemic diseases. Hormonal imbalance and aging. Tumors or infections of the back or spine. Lets back up a bit. A list this short suggests that a backache is probably due to a single isolated problem. In reality back pain may derive from multiple causes. One cause can frequently lead to several others if treatment or correction is not taken. For example poor posture and muscle fatigue from sitting at a computer terminal for extended periods of time may give way to muscle fatigue which, over several years, may lead to muscle weakness and loss of tone. A sudden twist or impact might then rupture an intervertebral disc which would not have otherwise suffered damage if muscle tone were healthy. Another example. Stress and fatigue at work may set the stage for chronically tense back and abdominal muscles. Pain begins due to muscle fatigue or spasm. Poor posture develops to attempt to compensate for the pain. Over years, the poor posture can place extreme pressure on the intervertebral discs, causing them to gradually collapse in size. Lets examine each specific back pain cause... Posture and spinal curvature. Perhaps the most common cause of back pain is poor posture which causes incorrect spinal curvature when standing, sitting or moving about. You will recall in our previous anatomy lesson that the spine has four curves. Two primary curves which arch to the rear and are common to all four legged animals. The two forward bending curves are unique to man and are found at the level of the neck, the cervical curve, and the level of the lower lumbar vertebrae, the critical lumbar curve. Since the primary curves are a result of bony vertebral shape, they are relatively stable and rarely cause problems. The secondary curves are due to the positions and shapes of the flexible and more delicate intervertebral discs and thus can change with time, injury or disease. Poor posture can dramatically increase or decrease pressures on the discs. If poor posture is continued over many years, unusual stresses are placed on the supporting muscles, tendons and ligaments. Chronic or severe Trauma. Sudden trauma causes a lot of lost time on the job. Any sudden injury such as a fall, sudden twist, or blow to the back falls into this category. Chronic trauma is more subtle. One example could be years of poor posture at a desk or job site. Poor sleeping posture or an old mattress could would be another example. Driving a car and maintaining poor posture also produces chronic trauma. At a certain point in time the supporting structure of your back cannot stand the continued strain and pain occurs. In chronic trauma, the more severe the pain, the more severe the probable underlying injury. Arthritis. Arthritis in the classic sense simply means an inflammation of a joint. Three types of arthritis can attack the bones and joints of the back. 1) Rheumatoid arthritis involves the delicate lining or synovium of a joint which begins to grow and destroy the flexible cartilage. In its most severe form, rheumatoid arthritis leads to the destruction of the joint cartilage and the gradual fusing of the vertebrae together. 2) Osteoarthritis is by far the most common arthritic disease. Simplifying the process a bit, this form of arthritis is simply the wear and tear process of old age. The delicate surfaces and tissue of the intervertebral joint slowly wear down and become stiff. 3) Gouty arthritis can be traced to a chemical metabolism problem which allows excessive uric acid to circulate in the blood stream. Crystals of uric acid then collect in specific joints such as the back or the classic "gouty big toe" and extreme pain occurs. Gouty arthritis is rare but has been reported in medical literature. Ruptured or "slipped" disc. The first question most folks consider when severe pain visits is "do I have a slipped disc?" In fact this condition is uncommon as a source of back pain. In addition this condition is neither "a slipping" of a disc, nor is the structure even a disc at all. In reality it is a joint (not a disc) which has ruptured to some degree. As we saw in our previous anatomy lesson the "disc" is composed of a complex layer of tissues and is not at all shaped like a cylinder or disc. Intervertebral disc joint problems can visit anyone of any age, but are certainly not the most common cause of back problems. However, disc injuries are certainly the source of severe pain unlike that caused by bad posture or muscle stress. Don't jump to the conclusion that you have a slipped disc at the first sign of pain. Chances are that it is probably not the most immediate cause. However it is important to understand that chronic trauma, fatigue and poor posture can eventually lead to an intervertebral disc rupture in time. Congenital defect. During pregnancy and gestation a fetus develops all anatomical structures it will need during life. Defects of the spine can and do occur. Additional intervertebral discs can be formed. Some discs may form and then fuse together. The spinal cord can develop outside the spinal column. Intervertebral discs may develop in incorrect positions or at unusual angles. In some cases these defects can be very slight and cause pain after years of adulthood. Many of these "birth defects" are treatable a rare few are not. Tumors and infections of the back and spine. Most of these conditions are rare. The back obviously contains many sites where certain classic infections can take hold. 1) Meningitis is an infection of the spinal cord within the spinal canal. 2) Osteomyelitis refers to an infection of the bone. 3) Spondylitis involves an infection of the spine. 4) Tuberculosis of the spine. Rare today but quite common and still seen in medical case studies. 5) Cancer and tumors. Statistically the spine and its related bony structures are relatively low incidence sites for tumor growth and cancer. Tumors or growths can appear on the spinal cord itself which cause intense pain. Sometimes tumors developing in other areas of the body can cause "referred pain" into the area of the back and spine. Systemic diseases. Systemic means "system-wide." A systemic disease is not localized in one part of the body. A strong cold or infection with the flu virus is an example. Diseases such as hyperthyroidism (thyroid gland), hyperparathyroidism (parathyroid gland) and Cushing's disease (adrenal gland) are systemic metabolic diseases which can cause back pain. Curiously, certain vitamin deficiency diseases can produce back pain such as lack of vitamins A or C which causes the disease scurvy and lack of vitamin D which produces rickets. Aging and related hormonal imbalance. We all get older. The structures of the back react to this process in unique ways. The intervertebral discs loose flexibility, dry out and gradually become compressed and narrower. Treatment, exercise and understanding of proper therapy can slow down this process. In women, menopause and its consequential hormonal changes can cause osteoporosis or loss of bone mass. Also as one ages, senile osteoporosis begins which is a natural decay of bone structure and mass, regardless of sex. Referred Pain. Pains in the back can be caused by disease, infection or strain in another part of the body. Examples here are certain kidney diseases (because of their close proximity to the back,) pneumonia and, in women, a "tipped" uterus or womb. The reason why the pain from these conditions is felt in the region of the back is the close proximity of the nerve paths serving these organs or regions to the same nerves as those which serve the back. The brain mistakenly "translates" the pain as arising in the back because of the proximity of mixed nerves in the same region. Fatigue and Stress. This is the backache caused by stress or emotion. It can be completely psychological with no direct organic cause. Fear, mental stress from losing a job or spouse, or even having to pay the bills can cause this type of back pain. Simple fatigue, anxiety and overwork can also cause back pain when muscles serving the back become fatigued or occasionally lock in painful spasm when you are tired and or become anxious. This is the backache literally caused by the brain itself. This tutorial is merely a starting point! For further information on back care and back pain, be sure to register this software ($25.00) which brings by prompt postal delivery a printed, illustrated guide to back pain written by a physician plus two software disks. From the main menu select "Print Registration Form." Or from the DOS prompt type the command ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO Box 1506, Mercer Island, WA 98040. If you cannot print the order form, send $25.00 to the above address and a short letter requesting these materials. End of chapter.