CAUSES OF BACK PAIN

Back pain can be caused by many different diseases and conditions. Some of these
conditions can be very serious but fortunately they are for the most part uncommon. These
serious conditions include; cancer, tumors, neoplasm, inflammatory arthritis and infection.
Several common conditions that can cause back pain are listed below.
COMMON CAUSES OF BACK PAIN

 FRACTURES AND DISLOCATIONS

 DEGENERATIVE DISC DISEASE
 DISC HERNIATION AND BULGING DISC
 OSTEOARTHRITIS/DEGENERATIVE JOINT DISEASE
 FACET SYNDROME/SYNOVITIS /CAPSULITIS
 STENOSIS
 SPONDYLOLISTHESIS
 FIBROMYALGIA SYNDROME (FMS)
 SPRAINS/ STRAINS

FRACTURES AND DISLOCATIONS

Fractures and dislocations can occur anywhere in the body. The vertebral bodies which help
support the weight of the upper body can break resulting in a compression fracture. These
types of fractures can be very painful and even disabling.
It is important for the physician to determine the nature of these fractures. Some fractures
can be caused by dangerous or serious conditions such as cancers, malignancies, or
advanced osteoporosis. These are called pathological fractures. Other types of fractures
may occur through traumatic events.
A dislocation is a term used to describe a condition where a joint has been disrupted and
has separated to the point where the two adjacent bones are no longer aligned or touching.
When a joint is dislocated the spine becomes unstable and is unable to protect the spinal
cord or nerves.
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DEGENERATIVE DISC DISEASE
Degenerative Disc Disease (DDD) is a natural condition of the body that causes
deterioration of the intervertebral discs. This is a gradual process that may compromise the
spine. Although DDD is relatively common, its effects are usually not severe enough to
warrant significant medical intervention. The intervertebral disc is one structure prone to
degenerative changes associated with aging. Long before Degenerative Disc Disease can be
seen radiographically, biochemical and histologic (structural) changes occur. Over time the
collagen (protein) structure of the annulus fibrosis weakens and may become structurally
unstable. Additionally, water and proteoglycans(PG) content decreases. PGs are molecules
that attract water. These changes are linked and may lead to the disc's inability to handle
mechanical stress.
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HERNIATED DISC
Herniation of the nucleus pulposus (HNP) occurs when the nucleus (gel-like substance)
breaks through the annulus fibrosis (tire-like structure) of an intervertebral disc (spinal
shock absorber). Injury to the disc may result in pain, numbness, tingling or loss of muscle
strength. Disc injuries in the neck region may affect the arms or hands while disc injuries in
the low back may affect the legs or feet. People between the ages of 30 and 50 appear to
be vulnerable because the elasticity of the disc and water content of the nucleus decreases
with age.
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FACET SYNDROME
Facet syndrome is a common spinal disorder affecting the posterior joints that results in
pain, stiffness and inflammation. Increased stress at the facets results in stretching of the
ligamentous capsule, deterioration of the smooth cartilaginous surfaces and increased
friction at the joint. In facet syndrome, the symptoms of pain, discomfort and weakness
frequently localize to the spine, nonetheless a small percentage may be felt in the
extremities or other body areas.
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FORAMINAL STENOSIS
The spinal nerves pass through openings on the side of the spine called intervertebral
foramen. Foraminal stenosis occurs when these openings are smaller than normal. This
condition can be the result of injury, degenerative change or congenital anomaly. The
smaller opening may result in compression of the nerve. This irritation often causes
symptoms of numbness, weakness, burning or tingling in the involved extremity. Long
standing or severe stenosis may result in a functional loss.
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SPINAL STENOSIS
Spinal stenosis is a condition where the size of the spinal canal is reduced. This may lead to
compression of the spinal cord. Symptoms often include pain, numbness, tingling and
weakness. Severe cases may actually cause loss of function and may even lead to disability.
Spinal stenosis is more common in patients over fifty years of age. Many factors can cause
stenosis including injury and degenerative change.
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FIBROMYALGIA
Fibromyalgia is a chronic disorder associated with widespread soft tissue pain, tenderness
and fatigue. A person with fibromyalgia will experience pain when up to 18 specific areas
called tender points are pressed. Pushing carefully on these specific points during an
examination causes discomfort or pain. The pain of fibromyalgia is more than normal
muscle aches common after physical exertion. Fibromyalgia often can be severe enough to
disrupt a person's daily work and activities. The cause of fibromyalgia is not known.
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OSTEOPOROSIS
Osteoporosis is commonly called the "fragile bone disease." It is due to loss of bone density
caused by a deficiency in such bone-building nutrients as calcium, vitamin D and other
vitamins and minerals. The most common complication of osteoporosis is compression
fracture. In people with advanced osteoporosis, compression fractures can occur as the
result of simple daily activities such as bending, carrying heavy loads, or a minor fall.
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OSTEOARTHRITIS (DJD)
Osteoarthritis, also called degenerative joint disease (DJD), is the most common type of
arthritis. OA can occur in almost any joint of the body but most commonly occurs in the
fingers, hips, knees and spine. Over time changes occur within the smooth cartilaginous
surfaces of the joint. These changes lead to a loss of elasticity and the cartilage becomes
stiff or brittle making it susceptible to injury. This will lead to stiffness, pain and crepitation
at the joint. Advanced cases may actually result in significant damage to the bone itself.
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SPONDYLOLISTHESIS
Spondylolisthesis occurs when one vertebrae slips forward (translation) in relation to the
adjacent vertebrae. Stability is inversely proportional to the degree of translation. The
ability of a vertebrae to ?slip? in relation to its neighbor can be caused by many factors,
including facet or disc degeneration, trauma or a defect in a region of the vertebrae called
the pars interarticularis. Severe cases may result in spinal cord or nerve compression and
can require surgical intervention.
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SPRAIN/STRAIN
Sprains and strains are two of the most common causes of back pain. They can be caused
by trauma, overuse, lack of conditioning, and improper body mechanics. The term sprain is
used when this injury occurs in a ligament. Conversely, strain is used when the affected
tissue is muscle or tendon. Typically, patients will complain of increased pain with activity
and relief at rest. Treatment will often include a period of rest followed by a therapeutic
exercise program to increase flexibility and strength.
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BACK ANATOMY
The spinal column consists of 33 individual bones termed vertebrae. These vertebrae are
stacked upon each other and form the four regions of the spine.
The cervical spine is divided into two sections. The upper cervical region consists of the C1
and C2 specialized vertebrae that are responsible for turning the head. The lower cervical
region consists of C3 through C7 and allows for bending of the neck.
The thoracic region consists of T1 through T12. This area forms the trunk of the body and
provides a site of attachment for the rib cage. The thoracic spine and rib cage offer
protection for the vital organs of the body.
The lumbar region consists of L1 through L5 this area forms the low back which is
responsible for supporting the weight of the upper body and movement of the trunk.
The sacral region consist of the S1 through S5 segments which are fused together and the
tail bone called the coccyx.

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 The vertebral bodies are the weight bearing structures of the spinal column. The vertebrae
range in size in accordance with the distribution of weight in the body. Near the head the
cervical vertebrae are smaller and the larger lumbar vertebrae are located near the waist.
The spine is arranged in a series of curves which act as a spring absorbing and distributing
biomechanical stress. In the cervical and lumbar regions there are C-shaped curves with the
opening towards the back of the body. These are called the lordotic curves. The curve in the
thoracic and sacral regions open towards the front of the body. These are termed kyphotic
curves.
The vertebral segments that are stacked on each other form a vertical tunnel which protects
the spinal cord and nerves. This tunnel is referred to as the spinal canal. The spinal cord is a
large collection of nerve fibers that extend from the brain through the spinal canal. The cord
conducts nerve impulses, acting as a highway between the brain and the body.
As nerves branch off the spinal cord, they exit the spinal column and form the peripheral
nerves.
Together, the peripheral nerves and cord are responsible for processing all movements,
sensations and other body functions. Damage or pressure on the spinal cord or nerves can
cause symptoms of numbness, tingling, burning, pain, pressure, weakness or in severe
cases, a loss of function below the site of injury.
The basic component of the vertebral column is called the functional spinal unit. The
functional spinal unit is composed of two vertebral segments and the disc between them.
This basic structure allows for movement, stabilization, and redistribution of weight through
the body using a three joint system. In the front of the functional spinal unit there is one
large joint that looks like a sandwich with two vertebral bodies on either side and a large
cartilaginous disc in the middle. The intervertebral disc acts as a cushion or shock absorber
between the vertebrae. The disc has numerous layers of tough fibrous tissue called the
annulus fibrosis. In the center there is a gel-like substance called the nucleus pulposus. A
healthy disc will have its fluid rich gelatin fully contained within the walls of its fibrous
tissue. This supports the bodies weight during seated positions. In the back of the functional
spinal unit there are two specialized joints on either side that prevent movements that could
damage the spinal cord and nerves and support the weight of the body during standing
postures. The joints of the back are held together by fibrous ligaments and other connective
tissues that support and help stabilize the spine.
The muscles are the engines that power the back during movements and help stabilize the
trunk on the pelvis. Tendons are a specialized type of connective tissue that attaches
muscle to bone.
The back is a dynamic structure with dedicated and specialized tissues designed to support,
protect, and allow for movement of the body.

TESTING FOR BACK PAIN

Medical Evaluation and Diagnostic Testing procedures should be performed prior to
beginning any treatment in order to determine the treatment process that will be most
effective. The following describes some of the evaluation testing procedures that can be
performed to help confirm the cause of back pain.
The causes of back pain can be very complex, and there are many structures in the lower
back that can cause pain. The following are used to test for the cause pain:

 X-RAYS - An X-Ray provides an image that can be used to evaluate bones, joints and degenerative
lesions in the spine.
 CAT SCAN (CT) - Used primarily when problems are suspected in the bones or when a patient can?t
obtain an MRI.
 MAGNETIC RESONANCE IMAGING (MRI) The most common test to evaluate the lumbar spine.
Evaluates:
o Vertebral bones
o Discs
o Joints
o Nerves
o Soft tissues
 MYELOGRAM - where dye is injected into the spinal column and then the area is flexed and x-rayed.
 DISCOGRAPHY - Discography is a diagnostic procedure used to determine the level of the painful disc.
 EMG - The EMG/Nerve Conduction Study is a useful test to study the nerves in the arms and legs.
 BONE DENSITY - Bone density testing is fast, painless, and noninvasive. During a test, patients lie
fully clothed on a padded treatment table while the machine scans one or more areas of bone. The
entire test normally takes only minutes.
 BONE SCAN - A Bone scan in Nuclear Medicine is a procedure which involves two steps:
The patient is asked to arrive 3 hours before their actual scan to receive an injection of a small
amount of radioactive tracer that is "tagged" to a calcium like material. Usually the tracer is injected in
a vein in the arm of the patient. In some instances, other sites of injection are used especially for
those patients that had difficult veins to find. The "radiopharmaceutical" has no side effects and
because of this, the patient can be released from the department for 3 hours to give the calcium time
to circulate and be taken up by the bone. There are no dietary restrictions so the patient may eat
before and after the injection.
After the three hours has elapsed, the patient returns to the Nuclear Medicine department for their
scan. The patient is placed on a table a head to toe scan is performed by a "gamma camera".