About
Back Pain
Several Factors
Cause Back Pain:
1. Injury
2. Accident
3. Age
4. Diet
5. Health
6. Stress
7. Spinal Nerve Condition
8. Exertion
9. Strain
10. Arthritis
Back Pain Symptoms:
1. Radiating pain in back and neck
2. Low back pain
3. Lower leg pain
Diagnosing
Back Pain:
1. Physician will write up a complete history on your pain
2. Review family medical history
3. Conduct a comprehensive physical exam
4. Determine the need for X-Rays, MRI, and other lab tests
5. Determine pain frequency and scale
The physician
will also inquire about the following:
Pain
and when it flares up
How long the pain lasts
What you use to help the pain
Any symptoms associated with the pain
When and how does the pain subside if no pain pills are taken?
Medical recommendations from General Practitioner
Previous trauma
Medications
Allergies
Any loss of bladder or bowel control
Stress
Work
Exercise Routine
Anatomy of
the Human Back
The spinal column (or vertebral column) extends from the skull
to the pelvis and is made up of 33 individual bones termed vertebrae.
The vertebrae are stacked on top of each other group into four regions:
- Cervical 7
Neck C1 C7
- Thoracic 12
Chest T1 T12
- Lumbar 5 or
6 Low Back L1 L5
- Sacrum 5 (fused)
Pelvis S1 S5
- Coccyx 3 Tailbone
None
The cervical spine
is further divided into two parts; the upper cervical region (C1 and
C2), and the lower cervical region (C3 through C7). C1 is termed the
Atlas and C2 the Axis. The Occiput (CO), also known as the Occipital
Bone, is a flat bone that forms the back of the head.
Atlas (C1)
The Atlas is the first cervical vertebra and therefore abbreviated
C1. This vertebra supports the skull. Its appearance is different
from the other spinal vertebrae. The atlas is a ring of bone made
up of two lateral masses joined at the front and back by the anterior
arch and the posterior arch.
Axis (C2)
The Axis is the second cervical vertebra or C2. It is a blunt toothlike
process that projects upward. It is also referred to as the dens
(Latin for tooth) or odontoid process. The dens provides
a type of pivot and collar allowing the head and atlas to rotate around
the dens.
Thoracic Vertebrae
(T1 T12)
The thoracic vertebrae increase in size from T1 through T12. They
are characterized by small pedicles, long spinous processes, and relatively
large intervertebral foramen (neural passageways), which result in
less incidence of nerve compression.
The rib cage is
joined to the thoracic vertebrae. At T11 and T12, the ribs do not
attach and are so are called "floating ribs." The thoracic
spine's range of motion is limited due to the many rib/vertebrae connections
and the long spinous processes.
Lumbar Vertebrae
(L1 L5)
The lumbar vertebrae graduate in size from L1 through L5. These vertebrae
bear much of the body's weight and related biomechanical stress. The
pedicles are longer and wider than those in the thoracic spine. The
spinous processes are horizontal and more squared in shape. The intervertebral
foramen (neural passageways) are relatively large but nerve root compression
is more common than in the thoracic spine.
Purpose of
the Vertebrae
Although vertebrae range in size; cervical the smallest, lumbar the
largest, vertebral bodies are the weight bearing structures of the
spinal column. Upper body weight is distributed through the spine
to the sacrum and pelvis. The natural curves in the spine, kyphotic
and lordotic, provide resistance and elasticity in distributing body
weight and axial loads sustained during movement.
The
vertebrae are composed of many elements that are critical to the overall
function of the spine, which include the intervertebral discs and
facet joints.
Functions
of the Vertebral or Spinal Column Include: Protection Spinal Cord
and Nerve Roots and
Many internal organs
Base for Attachment Ligaments
Tendons and Muscles
Structural Support Head, shoulders, chest - Connects upper and lower
body - Balance and weight distribution
Flexibility and Mobility Flexion (forward bending)
Extension (backward bending)
Side bending (left and right)
Rotation (left and right)
Combination of above
Other Bones produce red blood cells - Mineral storage
Back
Pain
The epidemic of back pain is enormous: It's a $44 billion industry,
the leading injury in industrial accidents; the cause of disability
for people under the age of 45; will strike 90% of all American adults;
the second-leading surgical procedure, and it is getting worse!
- Up to 85% of
the US Population will have Back Pain at some time in their life.
- On any given
day 6.5 million people are in bed because of back pain.
- 5.4 million
Americans are disabled annually due to back pain.
- An estimated
93 million workdays are lost each year due to back pain.
- 90% of all
back pain resolves in 6-12 weeks.
- 5-10% of low
back pain becomes chronic.
- Only 20% of
all back surgeries are successful after 2 years.
- The total number
of spine surgeries in the U.S. approaches 500,000 per year.
- An estimated
$45 54 billion is spent on the treatment of low back pain
per year
Herniated
disc
As a disc degenerates, it can herniate back into the spinal canal,
which is known as a disc herniation (or a herniated disc). The weak
spot in a disc is directly under the nerve root, and a herniated disc
in this area puts direct pressure on the nerve, which in turn can
cause pain to radiate all the way down the patient's leg to the foot.
Approximately
90% of disc herniations will occur at L4-L5 (lumbar segments 4 and
5) or L5-S1 (lumbar segment 5 and sacral segment 1), which causes
pain in the L5 nerve or S1 nerve, respectively.
L5 nerve impingement
from a herniated disc can cause weakness in extension of the big toe
and potentially in the ankle (foot drop). Numbness and pain can be
felt on top of the foot, and the pain may also radiate into the rear.
S1 nerve impingement
from herniated disc may cause loss the ankle reflex and/or weakness
in ankle push off (e.g. patients cannot do toe rises). Numbness and
pain can radiate down to sole or outside of foot.
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