Back pain (also known as "dorsalgia") is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine. The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain. It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may radiate into the arm and hand, in the upper back, or in the low back, (and might radiate into the leg or foot), and may include symptoms other than pain, such as weakness, numbness or tingling.

Chronic Lumbago

Chronic Lumbago is mild to severe pain or discomfort in the area of the lower back that has lasted for more than 3 months. It is common among younger people who engage in hard physical work and also among people of retirement age.

Symptoms include:

• Mild to severe pain across the lower part of the back, which sometimes travels into the buttocks.
• A stiff neck, due to muscle spasm.
• Difficulty in bending forward and leaning back.
• A possible change in posture due to the severe pain and spasms.
• A tingling sensation or a feeling of numbness in the back, buttocks or down along one or both legs.

What causes it?

Identifying the exact cause of lumbago is very difficult. It can be caused by a variety of conditions such as a slipped disc, scoliosis, osteoporosis or, more rarely, by tumours or infection in the spinal area. It is usually only possible to pinpoint the exact cause of lumbago in about 30% of cases. The majority of those where another cause is not found are believed to be due to muscle sprain.

Ankylosing Spondylitis

Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. Chronic inflammation in these areas causes pain and stiffness in and around the spine. This can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis, which results in a loss of mobility of the spine. The symptoms are pain and stiffness in the low back, upper buttock area, neck, and the remainder of the spine. The onset of pain and stiffness is usually gradual and progressively worsens over months. Occasionally, the onset is rapid and intense.

The sacroiliac joints are located in the low back where the sacrum (the bone directly above the tailbone) meets the iliac bones (bones on either side of the upper buttocks). Ankylosing spondylitis is also a systemic rheumatic disease, meaning it can affect other tissues throughout the body. Accordingly, it can cause inflammation in or injury to other joints away from the spine, as well as other organs, such as the eyes, heart, lungs, and kidneys. It is 2-3 times more common in males than in females. In women, joints away from the spine are more frequently affected than in men. Ankylosing spondylitis affects all age groups, including children. The most common age of onset of symptoms is in the second and third decades of life. It is thought to be genetically inherited. Pain and stiffness is often worse in the morning, or after prolonged periods of inactivity. Motion, heat and a warm shower can provide pain relief. Because ankylosing spondylitis often affects patients in adolescence, the onset of low back pain is sometimes incorrectly attributed to athletic injuries in younger patients.*

Ankylosing Spondylitis Treatment

A common treatment regimen involves medication, physical therapy exercises, good posture practices, and other treatment remedies such as applying heat/cold to help relax muscles and reduce joint and back pain. In severe cases of AS, surgery may also be an option. Medication will help control the pain and provide relief. Exercises can help create better posture and flexibility as well as help lessen the pain.

How a Herniated Disc Causes Pain

The spine is made up of a series of connected bones called "vertebrae". Discs hold one vertebra to the next, and act as a cushion between the vertebrae. The disc is made of a tough outer layer called the "annulus fibrosis" and a gel-like centre called the "nucleus pulposus." As you get older, the centre of the disc may start to lose water content, making the disc less effective as a cushion. This may cause a displacement of the disc’s centre through a crack in the outer layer. This is known as a herniated or ruptured disc.

Most disc herniations occur in the bottom two discs of the lumbar spine, at and just below the waist. A herniated lumbar disc can press on the nerves in the spine and may cause pain, numbness, tingling or weakness of the leg called "sciatica". Sciatica affects about 1-2% of all people, usually between the ages of 30 and 50.

A herniated lumbar disc may also cause lower back pain, although back pain alone (without leg pain) can have many causes other than a herniated disc

Chronic back pain is a very extensive condition in industrialised countries and the most common reason for functional limitation in people under the age of 45 years. Chronic Back Pain is commonly defined as pain in the back that persists for longer than three months. Generally it is caused by degenerative or traumatic conditions of your spine. Chronic back pain is a disorder that evolves over time and results in a very complex collection of signs and symptoms. It greatly reduces an individual’s productivity and psychological performance to an extent far beyond that of acute back pain. Of the estimated 70% of people who experience lower back pain during their lifetime, an estimated 8% develop chronic back pain.

Lower back pain is the most common form of all chronic pain. Many things can cause this pain — muscle strain or spasm, sprains of ligaments (which attach bone to bone), joint problems or a disc injury. The most common cause is using your back muscles in activities you are not used to, such as heavy lifting or doing maunal work. Unexpected events such as taking a fall or a car accident can also cause low back pain.

Lumbar Lordosis is an exaggerated inward curvature of the lower back region. This condition can vary in severity from mild to moderate and in some cases severe. The more severe the condition the more visibly obvious it is. It might create an appearance of a hollowed out lower back and protruding buttocks.

Lumbar Spinal Stenosis

The vertebrae are the bones that make up the lumbar spine (low back). The spinal canal runs through the vertebrae and contains the nerves supplying sensation and strength to the legs. Between the vertebrae are the intervertebral discs and the spinal facet joints. The discs become less spongy and less fluid filled with age. This can reduce disc height and bulge the hardened disc into the spinal canal. The bones and ligaments of the spinal facet joints can thicken and enlarge, due to arthritis, also pushing into the spinal canal. These changes cause narrowing of the lumbar spinal canal, which is known as spinal stenosis. This can cause pain or numbness in the back and/or legs, or cramping in the legs.

Symptoms often worsen with prolonged standing or walking. Symptoms may come and go, and may vary in severity when present. Bending forward or sitting increases the room in the spinal canal and may lead to reduced pain or complete relief from pain.

Lumbar Spinal Stenosis Treatment *

If your doctor determines that lumbar spinal stenosis is causing your pain, he or she will usually try non-surgical treatments at first to control this. These treatments and remedies may include anti-inflammatory medications (orally or by injection) to reduce associated swelling or analgesic drugs to control pain. Physical therapy exercises may be prescribed with goals of improving your strength, endurance and flexibility so that you can maintain or resume a more normal lifestyle. Spinal injections (such as an epidural injection of cortisone) may be prescribed.

Lumbosacral pain is caused due to muscular tightness in the lower region of the back. This results in poor posture with abnormal compensatory muscle tightness and pain in the lumbosacral region of the back. Pain can be caused by an injury or a degenerative condition such as arthritis.

Lumbosacral Arthritis

Lumbar and lumbosacral arthritis affects the lower back and pelvic girdle, causing lower back pain, inflammation, and the loss of motion in those areas. With lumbar and lumbosacral arthritis, the normally soft discs between the vertebrae of the lower back gradually lose their elasticity and their ability to cushion the bones effectively.

Beginning at about age 20, the discs of the spine begin to lose their elasticity and become dehydrated.  The lumbar discs become less supple and lose some of their height.  This alters the position of the vertebrae and the connecting ligaments, sometimes leading to tears in disc tissue. Bony spurs may develop on the vertebrae, representing further degeneration of the spine.

While the exact cause of lumbar and lumbosacral arthritis is not known, some degeneration of the spine is thought to be the result of the normal aging process.  Sometimes an old injury or a direct blow to the spine will add to the arthritis. People who are overweight, sedentary or have suffered back injuries are at greater risk. Those whose occupations require heavy lifting, long periods of sitting or driving, or other repetitive pressures on the backbone are also at risk of arthritis in this part of the spine.

Lumbosacral Arthritis Treatment

Proper treatment can provide relief from the pain. There are remedies that can help you control this pain. While many people with chronic low back pain are tempted to limit their physical activity and exercises, this is ill advised. You may find that you need to rest more frequently, but exercise should become part of your daily regimen. By increasing physical fitness, your back may become stronger and you may increase your overall feeling of well-being. You should work with your doctor or physiotherapist on developing an exercise program designed to strengthen your lower back.

Osteochondrosis refers to any disease that affects the progress of bone growth by killing bone tissue. Osteochondrosis is seen only in children and teens whose bones are still growing. Symptoms can include: Painful swelling, Walking difficulties, foot pain or tenderness, knee pain, pain when exercising.

Sacroiliac Joint Dysfunction

The Sacroiliac Joint (or SI Joint) is the joint between the sacrum and the ileum (one of the bones on the pelvis). The movement in this joint is very little. Sacroiliac Pain can occur secondary to the following diseases: ankylosing spondylitis, Paget’s disease, or tuberculosis. More commonly, Sacroiliac Pain occurs from dysfunction - either stresses on the joint or too much movement (hyper mobility). If the joint is hyper mobile, pain occurs anytime the joint is displaced.

Stresses to the SI Joint can occur from the following activities: persistent standing on one leg, falling on your “SITS” bone, swinging a golf club, lifting something, or even bending over. If the joint is hyper mobile, pain occurs anytime the joint is displaced. This occurs more commonly in females due to their joint structure, hormonal changes, and childbirth strains. Pain is experienced not only at the joint, but also in the muscles around the SI joint. Pain can also be present in the back of the thigh, in the lower abdomen, or in the groin. Coughing can increase symptoms at the SI joint. Diagnosis of this dysfunction is difficult to see on x-ray because there is very little movement at the joint. Physicians and physical therapists can confirm a diagnosis in their examination.*

Sacroiliac Joint Dysfunction Treatment

Doctors often begin by prescribing nonsurgical treatment for SI joint dysfunction. In some cases, doctors simply monitor the patient's condition to see if symptoms improve. Anti-inflammatory medications, such as ibuprofen and naproxen, are commonly used to provide pain relief, control, and reduce inflammation in the joint. Backrest may be required to help decrease inflammation and calm the muscle spasm. Some patient’s benefit from wearing a special brace called a sacroiliac belt. This belt wraps around the hips to hold the sacroiliac joint tightly together, which may ease your pain. Patients often work with a physiotherapist. They can assign positions and exercises to ease your symptoms. The therapist may design an exercise program to improve the strength and control of your back and abdominal muscles. Some therapists are trained in manipulative techniques and remedies that attempt to treat the pain in this manner. **

* DonTigny, Richard. “Mechanics and Treatment of the Sacroiliac Joint,” The Journal of Manual and Manipulative Therapy. Vol.1, No. 1, 1993, pp.3-12.

* www.eorthopod.com

Sciatica is caused by irritation of the sciatic nerve. The sciatic nerves are the largest nerves in the body and are about the size of your little finger. They come out of the spinal column low in the back and then go behind the hip joint, down the buttock, and down the back of the leg to the foot. Sciatica is low back pain combined with a pain through the buttock and down one leg. The pain usually goes past the knee and may go farther to the foot. Sometimes, weakness in the leg muscles occurs. Sciatica is different from other forms of low back pain because there are 2 sciatic nerves, and the pain is usually on 1 side. The pain is usually a shooting pain. It can also burn or tingle much like the feeling when your leg "goes to sleep." The pain can range from slightly annoying to totally unbearable. Some people have pain in one part of the leg and numbness in another part of the same leg.

Most sudden attacks of acute back pain are the result of overstretched muscles (strains) or ligaments (sprains). The pain may be most severe immediately after injury, or it may worsen gradually over a few hours. In most instances, back pain as a result of strain or sprain can be resolved following a conservative course of treatment—usually within two to six weeks—provided there are no serious underlying medical conditions. Identifying the cause of the pain, alleviating the pain— either at home or with your physician's help—and avoiding re-injury are key to the healing process.

Spinal stenosis is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves. This is usually due to the common occurrence of spinal degeneration that occurs with aging. It can also sometimes be caused by spinal disc herniation, osteoporosis or a tumour. In the cervical (neck) and lumbar (low back) region it can be a congenital condition to varying degrees. Spinal stenosis may affect the cervical, thoracic or lumbar spine. In some cases, it may be present in all three places in the same patient. Lumbar spinal stenosis results in low back pain as well as pain or abnormal sensations in the legs, thighs, feet or buttocks, or loss of bladder and bowel control.

Spinal Weakness can be caused by any number if injuries to the spine or can be as a result of an existing condition such as osteoarthritis. Weakness causes a decrease in the usual strength of the movements of the back. This can also affect one or both legs. Symptoms can include: numbness, pain, spasticity and paralysis.

Spondylarthrosis involves age and strain related wear and degeneration of intervertebral discs in the cervical spine and the posterior facet joints. The condition develops slowly, sometimes over several years. The developemnt of this condition is preceded by injuries or chronic microtraumas to the spine, by spinal strain, and by metabolic disorders, especially in the elderly. Symptoms can include: Pain and a tingling sensation