الخميس، 3 يناير 2013

Causes and effects of back pain Common causes of back pain

Causes and effects of back pain Common causes of back pain 
Common causes of back pain

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Stress factors

The symptoms of simple back pain often occur suddenly and can be triggered by a particular movement, but the causes may have been building for some time.

Some of the most common causes of stress and strain on the spine include:

Poor posture - slouching in chairs, driving in hunched positions and standing badly
Lifting incorrectly
Sleeping on sagging mattresses
Being unfit
Generally overdoing it - over tiring muscles and not using a gradually increasing work or sports programme. Not warming up or cooling down before and after exercise will also cause muscle pain
Inactivity and the wrong sort of movement are usually at the root of simple back pain.

Inactivity makes the muscles go slack and weak so they are unable to support the back properly. This leaves the back more vulnerable to damage when certain movements put too much strain on one area.

Often, the problem is caused by a strain or tear to the muscles, tendons or ligaments around the lower spine. In turn, this can produce painful muscle tension and spasm.

Even a minor problem can cause a lot of pain when you stand, bend or move around. Pain sometimes comes on suddenly, sometimes gradually, but usually it only lasts a few days or up to a week.

Work-related back problems

The spine is not suited to sitting in front of a computer or behind the wheel of a car for long periods. Poor posture plus lack of muscle strength and sitting for long periods in one position will result in muscle spasm and pain. Stiffness may occur as the muscle fibres become inflamed and stick together or there is local swelling. Awkward movements and bad posture cause musculoskeletal disorders which affect the full length of the spine, from the neck to lower back, as well as the shoulders, arms and fingers.

Head and neck strain

Tension in the supporting muscles of the neck, caused by physical or emotional stress, makes them tight and uncomfortable. This tension is most often felt in the upper back and back part of the neck.

Tension or stress headaches may be experienced, with discomfort and pain spreading from the upper back and neck over the head. This causes the sensation of something pressing on the top of the head or being wound tightly around it.

Tiredness, trying to read small words on a screen and the pressure of deadlines all put our muscles under pressure - not just the muscles in the neck and back, but our eyes, too. Eye strain causes tired eyes, which then find it harder to perform.

Lower back pain

Lower back pain is an increasingly common problem. An injury may be responsible, but often it's the consequence of poor posture or an awkward twisting movement, bending or reaching - or a combination of these, along with inactivity which results in stiffness and poor flexibility. Being overweight, especially if excessive, also adds to the discomfort and pain.

The muscles and ligaments supporting the spine become traumatised, bruised or inflamed. Most lower back pain doesn't result from injury to the bones of the spine, but from the strain and pressure put on the tissues whose job it is to support the spine.

Repetitive strain injury

Repetitive strain injury (RSI) is caused by repeated overuse and injury to the muscles of the hands, wrists, arms and shoulders.

Symptoms may take months, even years, to develop. Initially, only a slight ache may be felt, but as RSI progresses more marked pain interferes with everyday activities.

Long periods of work without a break, sitting on an uncomfortable seat or at a poorly arranged workstation, make RSI more likely.

Computer keyboards and mice, gaming handsets, hand-held games, mobile phones and PDAs can all be culprits.

Modern technology isn't solely responsible - anyone who uses certain muscles repeatedly can get RSI. This includes factory assembly-line workers, musicians, tailors and cleaners.

Carpal tunnel syndrome

The repetitive overuse of hand tendons, local inflammation, fluid retention, emotional stress and poor posture may contribute to reducing the space in the wrist tunnel through which the median nerve passes.

Pressure on this nerve can result in carpal tunnel syndrome. Symptoms include discomfort, numbness, pins and needles, and sometimes pain in the thumb, index, middle and ring finger (on the side next to the middle finger).
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Common risk factors of back pain
The following make work-related muscle and spine problems more likely:

Being unfit, and so having weak para-spinal muscles unable to support the spine when lifting
Being overweight
A job involving lifting, bending or moving heavy objects - poor lifting posture is a common cause of back problems
Being seated in one place for long periods of time
Frequent use of a telephone without a headset
High levels of stress, anxiety and tension, which increase muscle tension throughout the body and the chance of a sudden sprain
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Diagnosing the cause of back pain

It's often difficult for doctors to find the exact cause of back pain that's due to muscle or ligament damage in the lumbar area. That's why it's often called non-specific low back pain.

In many cases, the pain starts a day or two after an injury occurs, or the cause has been building up gradually over many years, which makes diagnosis even more difficult.

Local pain can result from muscle spasm, and can also cause local muscle spasm, worsening the pain and even worsening the root cause, such as poor posture.

Your doctor will examine you, ask you to try certain movements, and see what range of movement you have. He will look for spasm, stiffness, weakness and for any more worrying signs of neurological loss such as weakness, tingling and numbness in the limbs, altered sensation and altered reflexes. He may ask about whether your bladder and bowel is working normally, if you have noticed any loss of sexual function or any numbness in the saddle area.

If he is concerned that there may be nerve involvement he may organise more urgent X-rays or an MRI scan, but if there are no serious symptoms he may not feel these are indicated.
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Types of back pain

Acute or chronic


Doctors make a distinction between acute pain and chronic pain. Acute pain usually goes away quickly. It's useful, because it warns you of sources of harm and tells you to protect yourself while the body heals.

Chronic pain can be just as unpleasant but lasts much longer. If you have pain in the same place for 12 weeks or more, it's likely to be classified as chronic. Because it lasts so long, it's of less value as a warning.

Disc problems

In the spine, between the vertebrae, are small disc shaped cushions made of fibrocartilage, which protect the vertebra from rubbing directly on each other. Unfortunately the disc tissue can degenerate, especially as we age, causing the disc to dehydrate and stiffen. Although the disc itself has little nerve supply, the change in dynamic around the disc can cause increased pressure on the surrounding tissue, such as the nerve roots, which become inflamed and painful.

A sudden injury to the disc can also cause it to herniate or prolapse - where part of the disc suddenly protrudes, putting pressure on the local nerves or even the spinal cord. This is what people mean by a 'slipped' disc, although the main body of the disc hasn't actually slipped. (Rarely a vertebra can slip forward on another: this is called spondylolisthesis, which is not a slipping of the disc.)

Sciatica

Sciatica is the name given to pains running through the buttock or down the leg because the sciatic nerve from the spinal cord has been pinched or irritated by damage to the back - sometimes by disc degeneration or by a prolapsed disc pressing on it. Sciatica settles within 6-12 weeks in most people and all that is usually needed is analgesia, local heat and sometimes physiotherapy.

Facet joint problems

Spine movement is made possible by joints between the vertebrae consisting of two flat faces, or facets, on the bone. If these degenerate, the two halves of the joint grate against each other, causing inflammation and pain.

Osteoarthritis

Long-term degeneration of the joints makes them less able to withstand physical stress. This wear-and-tear problem affects most of us as we get age and can give rise to pain in some cases.

Inflammatory joint diseases

Many inflammatory diseases, such as ankylosing spondylitis and rheumatoid arthritis, cause the joints to become inflamed and seize up. This can either directly affect the joints in the back or cause problems with other joints that lead to pain in the back.

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Osteoporosis

Osteoporosis causes weakness in the bones, so they fracture easily. For patients with ospeoporosis the bones of the back and neck are often affected and compression fractures are a common cause of chronic back pain in these patients.

Various types of vertebral fractures are common after falls in the elderly, even if they do not have osteoporosis and acute back pain following a fall should be investigated, especially if there are any associated neurological changes such as bladder problems and altered sensation.

Osteoporosis is commoner in post-menopausal women and should be tightly managed to reduce the risks of fractures, by lifestyle changes such as increased activity, stopping smoking, supplements of calcium and vitamin D where indicated and also there are specific medications which slow the process such as the bisphosphonates and also HRT.

Referred pain

There are many diseases where pain is 'referred' to the back - the cause of the pain may be disease in the chest or abdomen but is felt as back pain. If you have acute or chronic back pain, your GP will examine you and check for conditions such as heart, kidney or liver disease and well as back problems.

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