| Back & Neck Pain |
| If you are experiencing pain in your neck or back, you are
not alone. Back and neck pain is one of the most prevalent physical problems
facing Americans today. The American Academy of Orthopaedic Surgeons estimates
that 80 percent of the population will suffer some kind of neck and back
pain in their lives. In addition, back pain is one of the largest causes
of lost work days and costs over $80 billion a year in medical, legal and
lost production costs.
Many back problems are minor and will correct themselves. For some people, however, back pain becomes a chronic problem that can devastate their lives by making even simple tasks seem impossible. Learning what causes back pain, how to prevent it, and what the treatment options are can help make your life --and your back -- as pain free as possible. About the SpineThe human spine is a complex structure and vulnerable to injury, misuse and the natural aging process. Part of the reason for this is that the spine must be both mobile (so you can bend and twist) and stable (so you can remain upright all day).Made up of 33 bones called vertebrae, the spine features three natural curves, the cervical (neck) curve, the thoracic (middle back) curve, and the lumbar (lower back) curve. In a normal spine, the cervical and lumbar sections curve forward, while the thoracic section curves backward. The cervical spine is the top seven vertebrae in the neck area. These are smaller bones that allow us to turn our heads freely while the rest of our back remains stationary. The thoracic spine is made up of the 12 vertebrae in the upper back, and each thoracic vertebrae is attached to a rib. The lumbar spine is made up of the next five vertebrae. The lower back usually receives the most stress and strain, so most spine problems occur in the lumbar region. Below the lumbar region are the five fused vertebrae of the sacrum and the four fused vertebrae of the coccyx. Joining each pair of vertebrae is a facet joint. Functioning like hinges, the facet joints guide the movement of the spine, while also stabilizing the vertebral column. Ideally, the joints in the spine are lined up so that the back can twist and bend with little friction between the vertebrae. Between each pair of vertebrae lies a flat, circular intervertebral disc. The outer part of the disc, the annulus, is strong and hard. The inner portion, the nucleus pulposus, is soft and absorbs shocks to the spine during any movements. Two long ligaments run the length of the spine and help hold the vertebrae together along with the smaller ligaments between each vertebra. The extensors and flexors are the two main muscle groups that affect the back. The extensors are small muscles in the back that span two or three vertebrae and allow the body to straighten up and lift objects, while the flexor muscles, which include the abdominal muscles, are in the front and allow us to bend forward as well as provide back support. The vertebrae surround and protect the spinal cord, a column of nerves running from the brain. Peripheral nerves branch off from the spinal cord and, with their roots passing through the vertebrae, extend all over the body. Unfortunately, this means that pain from a back problem can also travel to other parts of the body.
Causes of Back PainIn general, back pain is not the result of a single incident. Rather, your back deteriorates from repeated wear and tear over the years, in turn making you more vulnerable to serious injury and back pain. Often stress on your back comes from too much forward bending or heavy lifting, sitting or standing too much at your job, sports that involve impact or twisting, and poor posture.Some common causes of back pain are: Most back pain stems from either muscle strains or joint and ligament sprains. Strains and sprains can occur when you bend too far or too often, lift a heavy load or twist suddenly. While activities like these can occur everyday, the damage may be mild enough not to cause inflammation, in which case you may not feel any pain. When the damage heals, however, it often creates scar tissue, which is weaker and less flexible than normal muscle and ligament. Over time the back becomes less flexible and strong and more prone to painful damage. This common and painful disorder is also called a ruptured disc or prolapsed disc. It is sometimes erroneously referred to as a slipped disc, although there is no actual slippage. When a tear occurs in the annular portion of the disc, the soft nucleus pulposus can protrude into the spinal canal and compress a nerve root or the spinal cord. The damaged disc can also leak inflammatory fluid which inflames the nerve roots. The tear can be the result of degeneration, wear and tear, or trauma. In addition to causing back pain, a herniated disc can cause pain in other parts of the body if it is compressing a nerve root. The exact area where pain will occur is determined by the particular root that is compressed. For example, if the herniated disc is in the lower back and the sciatic nerve root is compressed, the person may feel the pain and/or numbness known as sciatica running down the back of the leg. If its a cervical disc that’s herniated, neck and arm pain can result. While discs can take much abuse, they cannot repair themselves when torn. Rather, like the muscles and ligaments, they heal by forming scar tissue, which is weaker that normal tissue. Most disc herniations, however, heal without the need for surgery. Some less frequent causes of back injuries include: Severe force--such as a car accident, a fall or a direct blow--can dislocate or fracture the vertebrae and/or rupture the ligaments, causing severe pain and swelling of the area. In the most serious cases, the spinal cord may be damaged, resulting in loss of sensation and possible motor function in areas below the injury. Stress fractures, fractures caused by the repetitive jarring of a bone -- often by overexercising, can also occur in the spine, most often in the lower back. This narrowing of the spinal canal is most commonly caused by degeneration of the spine. Several factors can contribute to this degeneration, including wear and tear of the joints, bulging or herniating discs, arthritis, or the swelling and buckling of the back’s major ligament. Another cause of stenosis is spondylolisthesis (see below). With stenosis, the spinal cord and nerves can become irritated and inflamed because there is less room for them to move. If the stenosis is in the lower back, it can cause pain in both the back and legs, with the pain becoming worse when walking or standing. Spondylolysis and Spondylolisthesis Caused by degeneration, trauma or congenital defects, spondylolysis is a weak arch in a vertebra in the lower region of the back that can cause instability in the vertebrae. When the muscles and ligaments holding the vertebrae in place become overworked, the vertebral body can slide forward--a process called spondylolisthesis. Nerves become pinched and cause pain in the back as well as sciatica. Spondylolistheis can also occur in the cervical spine and may result from a neck injury or rheumatoid arthritis. Cervical spondylolisthesis usually causes neck pain and stiffness. This inflammatory disease affects the joints between the vertebrae of the spines and the joint between the spine and pelvis, causing pain and stiffness, especially in the morning. The joints in the neck and lower back can be affected by osteoarthritis -- a disease in which the cartilage that lines the joints degenerates. This most often affects the spines of elderly people, particularly those who do heavy manual work or whose spines have already sustained injury. Scoliosis, a deformity in which the spine is curved to one side, can also cause back pain. While it usually starts in adolescence, scoliosis can worsen with age. Whether or not treatment is necessary depends on the severity of the curve and whether or not it is causing pain and functional limitation. As with other bone cancers, tumors of the spine have usually spread from elsewhere in the body. Usually malignant, spinal tumors can cause the vertebrae to collapse and damage the spinal cord. Conditions such as an infection in the kidney, tuberculosis, discitis, or influenza or other virus infections, may cause backaches that are sometimes quite severe.
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