------------------------------------------------------------ ARTHRITIS ------------------------------------------------------------ Arthritis would probably be placed third on any list of backache causes. Chronic back strain and disc disorders would earn first and second place respectively, but arthritis affects some people and for a variety of reasons, both mechanical and metabolic. Osteoarthritis is the most common of the three arthritic afflictions of the back. It is a reflection of the gradual wearing out of the spinal column. Over time the joints of the back wear. The process can be accelerated by faulty posture or chronic strain, but the end result is the same. In one scenario leading to osteoarthritis a disc can begin to bulge outwards due to pressure or chronic strain. Eventually one of the connective ligaments may be lifted free from the surface of two adjoining the vertebral bodies. As time passes, this injured site fills with "bone spur" growths which eventually join to fuse the two vertebrae together. Once natural fusion takes place, the discomfort is somewhat lessened, but while the damaged space is filling with the new bone spurs, grinding and pain is felt. Other types of osteoarthritic growth can occur and this is only one example. Since the lower lumbar region and upper cervical region of the back have the greatest range of motion naturally, it is these regions that frequently show the first signs of osteoarthritis. Treatment may consist of one or a combination of the following: bed rest, exercise therapies, pain killers and surgical spinal fusion. Rheumatoid arthritis is the second type of arthritis which can afflict the back. It is not a mechanical problem like osteoarthritis but a true disease and is much more serious. It is not necessarily limited to the old, but can be found in all age groups. Frequently it begins in the large joints of the body and may spread to other joints. The spine may be affected in later stages. The pain and inflammation of the joints may also involve a gradual loss of bone mass, termed osteoporosis. Ankylosing spondylitis or Marie-Strumpel disease is quite rare. It has characteristics of some arthritic conditions. Gradually the intervertebral joints of the spine are replaced by bone. Eventually the entire spine may become rigid. The primary dorsal curve of the back can become acute as leaving the victim with a severely bent back. Surgery is the primary method of treatment and can affect only modest restoration of function. Gouty arthritis is the third arthritic condition which can affect the back. It is seen infrequently in medical literature today. It is a true metabolic disease involving uric acid crystal buildup within the joints. The first joints to feel pain are usually those of the foot and toes, although the spine can also be affected. A blood test, X rays and appropriate medications can usually identify and manage this type of arthritic condition. It is most frequently seen in males. ------------------------------------------------------------ SYSTEMIC DISEASES ------------------------------------------------------------ Systemic diseases, in simplest terms refer to diseases or infections which are "system wide" or throughout your body. Unlike localized back ailments such as chronic strain or a slipped disc, these diseases can produce backaches and pains from the perspective of their overall impact on the body. Specific metabolic diseases, those that affect your metabolism or endocrine balance, can cause back pain. The endocrine system secretes hormones directly into the bloodstream. The pituitary gland at the base of the brain, for example, secretes growth hormone. Too much of this growth hormone and you end up becoming either a giant or a dwarf. Three systemic endocrine imbalances can affect the spine and bones of the back... Hyperthyroidism is a disease of the thyroid gland located in the neck. It controls the rate of bodily metabolic functions. Hyperthyroidism refers to the "hyperactive" state of this gland when it secretes too much hormone. When the rate of metabolism is speeded excessively, calcium can be gradually removed from the bones, frequently those of the spine. The individual vertebrae begin to lose bone mass and density and can become collapsed or misshapen. This obviously leads to back pain. Hyperparathroidism refers to the small parathyroid glands which are located in pairs on either side of the thyroid gland. When these four glands become hyperactive a similar calcium depletion can take place in the bones of the vertebrae, but in a non- uniform, irregular manner. Gradually gaps are created in the vertebrae and other bones. A fibrous tissue fills in the gaps. The bone becomes irregular and weakened. Surgery may be required reduce back pain in severe cases. The third primary metabolic disease which can affect the spine is hyperadrenalism or Cushings Disease. In this instance excessive cortisone is present in the bloodstream caused by hyperactivity of the adrenal glands located near the kidneys. Gradually osteoporosis or loss of bone mass begins. Frequently in the bones of the spine. Metabolic diseases can also affect the spine other than endocrinological imbalances. Paget's disease is also known as osteitis deformans. In this situation the bone mass of the vertebral bodies begins to rapidly grow and thicken. Usually this involves the bones of the lower spine. The tiny holes through which nerve roots emerge, the foramina, begin to narrow. Pressure is placed on spinal nerves which become irritated by the compression. The disease is confirmed by a blood test for enzyme alkaline phosphatase. The cause of the disease is not fully understood. Surgery is frequently the only remedy. Diseases of the circulatory system can also affect back pain. If a blood clot forms which partially blocks oxygen and nutrients to muscles of the legs or buttocks severe pain can result which mimics back pain. The pain is referred to the area of the back and spine, but nonetheless originates from blockage of blood to muscle groups in the leg. Thrombophlebitis, an inflammation of the veins, can also cause backaches which can be referred to the back and spinal region. Likewise arterial obstructions and classic varicose veins can cause pain which is referred to the back region. On a mundane level, infections such as a common cold can also cause backaches. A system wide viral infection lowers your threshold of pain and tends to produce fatigue in joints and muscles. Mild muscle spasm can result and as a consequence backaches are not uncommon when you have a cold. A practical solution is to encourage bed rest and keep those knees bent which reduces strain in the lower lumbar region of the back. 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.