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Back Pain

Five major categories:

1. Inflammatory and infectious disease
Arthritis (joint inflammation) involving the back or when germs enter into bone/joint and causes infection
Ankylosing spondylitis is seen in young men and causes low back stiffness and pain. Osteoarthritis and rheumatoid arthritis are the most common. Osteoarthritis is from joint degeneration due to wear and tear. Rheumatoid arthritis causes the destruction of the joints in the neck and causes pain.

2. Mechanical disorders
E.g. herniated intervertebral disc, wear and tear of spine, sciatica
About 50% of people show evidence of degenerative changes of the spine by 50 years old. Sometimes bony outgrowth irritates the nerves at lumbar spine. This and some other causes can lead to sciatica (irritation to the sciatic nerve, a nerve extending from back to leg).

3. Trauma
E.g. motor vehicle accident, contact sports, hitting against a hard surface, gun shot, or fall from height
The back is generally stable but may still suffer from trauma. Structures like ligaments, discs, muscles, vertebral body, or even spinal cord can be injured from trauma. Trauma involving different structures produces pain and various symptoms, depending what structures are involved.   

4. Tumors (less common)

5. Congenital abnormalities of the spine (less common)

Common Causes of Back Pain

The back is composed of five lumbar vertebrae. These vertebrae form a “C” shaped (lordotic) curve when look from the side. It connects the thoracic and the sacral region of the body. The lumbar spine is movable, yet it supports the weight of the upper body. The back protects the spinal cord and has a greater surface area compare to others.

The spinal cord is located within the spinal column. It brings information from the brain to the body. Spinal nerves are nerves that arise from the spinal cord. They go through holes between vertebrae towards the legs.

The intervertebral disc is located between each vertebra. The disc acts as shock absorber (cushions) during walking, running and jumping.  Under pathological conditions, these discs protrude out of their space, and cause pain by putting pressure on the spinal cord or nerves around it.

The spinal column needs soft tissue to support its integrity. Ligaments and muscles are the two major supporters of the spinal column. The ligaments keep the column in place under normal circumstances. It can be a source of back pain when it is inflamed or sprained.  

Muscles at the back also provide support to the vertebral column. Weakness of back muscles, especially the deep muscles, can lead to pain in the back. Tight muscle can lead to pain as well.  Injury to the back muscles would cause pain also.
Basic Back Anatomy
History taking and physical examination are commonly used by doctors and physical therapists to evaluate back pain. Physical examination involves feeling and looking at neck movements and testing nerve and muscle integrity.  These two components are often sufficient to rule out serious illnesses and gives clues to for diagnosis.  
When the cause is still uncertain, doctors can use radiographic examinations to assist them to make diagnosis.

Back Pain Diagnosis

Back Pain Physical Therapy

Heat– relieve pain
Ice- control inflammation
Electrotherapy– control pain
Ultrasound– control pain, relief muscle spasm, improve circulation
Manual therapy— manual maneuvers to relieve pain and correct posture
Therapeutic exercises— ex to control pain, improve alignment
Education—educating client to improve on posture, lifestyle change, ergonomic advice (i.e. modify settings at job/home)
Acupuncture—helps to relieve pain, relieve muscle spasm and accelerates recovery

Back Pain Prevention

Key points for back pain prevention
-Proper lifting techniques
-Avoid poor posture, keep spine properly aligned
-Exercise regularly, keep proper body weight,
 -Reduce mental stress

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