Causes of Back Pain and Anatomy

Introductory post

Basic Anatomy

There are many types of back pain and the lower back is the most common site of back pain. It is made up of a large number of strong muscles and also the bones that make up the spine, which are called vertebrae. The vertebrae are made up of a vertebral body, vertebral arches, and the vertebral discs. There are also key ligaments and of course the spinal cord and nerves. The vertebral discs are made of a strong gel like material and act as shock absorbers. The spine is adapted for movement and weight bearing. The spinal cord is protected by the spine.

What are the different types of lower back pain?

General Non-Specific Pain: This is the most common type of back pain and most people will be affected by this type of back pain at some point in their life. Continue reading

Whiplash Injury and Claims

Whiplash is the term given to a broad range of symptoms caused by an injury to the neck. It is commonly associated with forced movements to the neck and is caused, for example, by motor vehicle accidents. It is very common and insurance companies generally pay out a fixed amount of money for claims of whiplash from an injured individual.

The most common symptom of whiplash is back pain which may be lower back pain or, most commonly, pain in the neck or shoulders.

Whiplash, indirectly, affects almost all of us through motor insurance premiums. The increased frequency of whiplash claims has led to spiralling costs for insurers and this is being passed on in the form of ever higher quotes and premiums.

The UK government has started to take notice of this and is now pushing for changes to insurance practice to reduce the number and ease of claims for whiplash. Although injury lawyer will argue this is a bad thing, how justified are the claims for compensation?

Whiplash is essentially a self limiting condition from which almost all sufferers will recover with minimal treatment. Evidence has shown that the best treatment is often no treatment. For example, wearing a soft collar may be useful in the first few days and reduce neck pain but it may actually prolong symptoms by taking work away from the muscles that need to heal back to normal function. Sufferers who have gone on to have back surgery will have either had underlying damage to the back before their injury, or sustained a more serious injury such a spine fracture that should arguably be classed separately to ‘whiplash’ and are exceptionally rare.

To give you an idea of the spectrum of symptoms, whiplash severity ranges from a feeling of pain or stiffness in the neck and shoulder, to decreased movements in the neck, to weakness of arms or legs, and may even include injuries to the spinal cord or fractures to the bones of the spine. The more severe the symptoms the longer the duration of the symptoms will be. Claims for compensation for injuries to the spinal cord or fractures are likely to make separate to a simple ‘whiplash’ diagnosis and should therefore, probably, be considered under a different banner and the ‘self-limiting’ argument does not stand as strongly for this group although the prognosis for most remains good.

People will disagree on whether a painful condition which often affects lifestyle but is rarely permanent is worthy of financial compensation. Should there be a minimum duration for the symptoms before a claim is approved? Should a specialist doctor make the review and diagnosis? Currently any doctor can diagnose whiplash and there is little in the way of criteria for diagnosis. As the diagnosis is often based on ‘symptoms’ it could be considered to be subjective – it cannot be proven on an x-ray or blood test, for example. For the same reason it can be difficult to defend a claim for compensation for the injury as it can equally not be ‘disproven’. This has led to a fixed payout culture with few legal challenges.

The UK government report comes from the House of Commons Transport Committee which is recommending a higher threshold for claims and discourages the practice of many insurers in seeking whiplash payments from rivals in the case of a claim. There have been allegations of insurance companies passing the details of an accident and individual involved to injury lawyers to encourange a claim and also that the insurer may in turn benefit financially.

The government is applying pressure on insurers now and has threatened legislation if changes to current practice do not occur. Is this a good thing? That is open to debate with powerful parties on both sides of the argument ready to set their case which may ultimately be settled in the courts and parliament.

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Back Pain in Pregnancy

Back pain and particularly lower back pain is extremely common in pregnancy with up to three out of every four pregnant women being affected at some point. It occurs more commonly as the pregnancy develops and can take many different forms – from simple back ache to severe back pain and sciatica.

It is important to see a doctor about the back pain as soon as you can to ensure you get early treatment but it is rare for the back pain to affect the pregnancy or your labour directly.

Causes of back pain in pregnancy

There are many factors that can lead to back pain developing when you are pregnant and they include direct physical factors and even hormonal changes. Continue reading

Spinal Stenosis

Spinal stenosis is the term given to a narrowing of the spinal canal – the space in the back in which the spinal cord runs. This occurs to some extent in most people as part of the aging process and is a common cause of back pain. Spinal stenosis can also cause numbness of areas of skin – especially of the legs. It can also cause weakness of the legs or other muscles. Spinal stenosis most commonly affects the lower, lumbar spine and often causes lower back pain for this reason.

The condition occurs in both men and women although women require treatment more often then men. It develops progessively with age but generally presents over the age of 50-60 years.

Causes of spinal stenosis

Spinal stenosis occurs to some extent in everyone during aging. A narrowing in the spinal canal may develop due to overgrowth of the soft tissues or bone in the spine, or due to some protrusion from the vertebral discs. Most commonly it is a combination of factors that leads to the narrowing causing symptoms. Continue reading

Tailbone Pain (coccydynia)

Coccydynia is the term given to tailbone pain. The tailbone (coccyx) is a set of bones at the very base of the spine. Because of the position of the tailbone, the pain may be worse when sitting down.

Symptoms

The primary symptom is tailbone pain – that is pain at the base of the spine. The pain is very variable between people suffering from the condition but is often made worse by sitting, lifting objects and standing up. There are many other symptoms that you may have which occur with variable frequency.

  • Tailbone pain
  • Back pain
  • Pain on passing stools
  • Pain during sex
  • Pain during periods
  • Pain in buttocks/hips

Causes

Coccydynia is a fairly rare cause of back pain and can be provoked by a variety of factors including: Continue reading

Yoga for Back Pain

Yoga for back pain is becoming more and more popular and with good reason. It combines three key aspects of the treatment of back pain: back stretches, back exercise and good posture. All three of these are targeted by yoga and although classes that specialize on the treatment of back pain are quite uncommon, most basic yoga classes are useful.

There is evidence that yoga for back pain is more effective than the standard treatments often suggested for the early management of back pain, including simple painkillers, exercise classes, manipulation of the spine and also alternative treatments such as acupuncture. Continue reading

Sciatica Pain

Sciatica is the name given to a range of symptoms that is caused by compression or irritation of the sciatic nerve. As a term, it is often used to describe any leg pains thought to originate from the back. Sciatica is commonly associated with back pain and is a condition that is not uncommonly treated by back surgery although many other treatment options exist.

Sciatica symptoms can be quite variable and often vary significantly by the time of day or the day of the week. They range from mild be extremely severe and can be made worse or improved by certain movements and positions.

Sciatica Symptoms:

  • Burning or Tingling pain in the leg – often in a specific, consistent area
  • Sharp shooting pain down the leg
  • Pain worse on sitting or bending down (especially when for long periods of time)
  • Weakness of leg, foot or toe muscles
  • Numbness of skin of legs
  • Pain particularly on one side of the lower back or one leg

Is it permanent? What is the risk of sciatic nerve damage?

Although the symptoms of sciatica originate from irritation of the sciatic nerve, it is uncommon for any permanent damage to the nerve to occur – in other word, a delayed diagnosis or delay to treatment is unlikely to affect final outcome. Nevertheless, it makes sense to start treatment early and it is certainly important to seek a review by a qualified back doctor at the first possible opportunity.
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Back fusion of vertebrae for back pain

Back fusion (vertebrae fusion, spinal fusion) is generally performed to relieve back pain caused by damaged joints or discs in the back. The purpose of back fusion surgery is to stop movement at a degenerated and painful part of the spine. Most commonly this is the lumbar spine and procedures include anterior lumbar interbody fusion (ALIF) and posterior lumbar interbody fusion (PLIF). These procedures involve the insertion of screws and rods between the affected levels of the spine and generally additional bone is added as a graft  to help the fusion – bone is taken from either from the hip or the spine itself. Note that in addition to the common problems of degenerative facet joints or vertebrae, back fusion may also be a type of back surgery used in the treatment of back tumours, back deformity (such as scoliosis), back infections or breaks (fractures).

Before back fusion is considered, the back pain must be typical of pain from the joints or vertebral discs of the back and a qualified specialist should review this. The same specialist should perform an examination and determine the site of the worst pain and symptoms. Finally, a scan and x-rays of the back is generally performed and the findings on this should match those from the examination.

Even if all three of the above points apply, back fusion is only a last resort. In the first instance, sufferers should try exercises, stretches, physiotherapy and perhaps a review by a chiropractic.

After the above measures have been tried unsuccessfully, it is often worth trying a good quality back brace which tries to simulate the effect of a back fusion.
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Back Pain and Cancer – Red Flags

Back pain is very rarely caused by cancer or tumours but the possibility of this is an understandable concern for many people. The worrying signs of back pain are listed below and are described as ‘red flags’ by the medical profession. If you have back pain and any of the following describes you or your symptoms then it is important to see your doctor as soon as you can. However, try not to worry as even if you feel your back pain has red flag features, the possibility of cancer remains unlikely and another cause such as muscular pain remains most probable.

Features suggestive of cancer - the ‘Red Flags’:

  • First back pain at under age 20 or over age 55
  • Worsening or persistent pain
  • Pain in upper or middle of back
  • History of high impact injury / trauma
  • Using steroid medications
  • History of cancer currently or in past – see below
  • General feeling of being unwell
  • Unexplained loss of weight
  • Persistent difficulty bending forwards
  • Weakness or abdnormal feelings in arms or legs
  • Problems passing urine or opening bowels (or loss of sensation when doing the same)
  • Deformity of spine
  • History of drug abuse or HIV infection

What types of cancer affect the spine:

Cancer of the spine can either originate in the bones of the back itself or can be present due to spread of tumour from a cancer elsewhere (metastasis).

Cancers that can spread to the bones of the spine:

  • Breast cancer
  • Prostate cancer
  • Kidney (renal) cancer
  • Lung cancer
  • Ovarian cancer
  • Bowel cancer
  • Pancreatic cancer
  • Multiple myeloma
  • Thyroid cancer

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