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Back problems

The back is prone to a range of problems, most of them caused by poor muscle tone, obesity and lack of regular exercise. The spine is made up of 32 bones called vertebrae that are stacked together to form a loose ‘S’ shape. The cervical spine, located in the neck, comprises the top seven vertebrae. The following 12 vertebrae make up the thoracic spine (the ribcage area), and five vertebrae comprise the lumbar region (lower back). Finally, the remaining bones make up the sacrum (which ‘joins’ the spine to the pelvis) and the coccyx (tail bone). Each vertebra is cushioned by spongy tissue or cartilage (intervertebral discs). The spinal cord runs the length of the spine to the lumbar region, where it branches out into a series of nerves that ultimately lead into the legs. The spine is held together by a mesh of connective tissue called ligaments. Complex layers of muscle provide structural support and allow movement.

Common back problems
Some of the more common back problems include:

  • Backache
  • Soft tissue injuries
  • Disc problems
  • Sciatica
  • Structural problems
  • Disease
  • Fracture.
Around 80 per cent of people in Western countries suffer from backache at least some of the time. Backache can be caused by a wide range of events including injury, inflammation or muscle tension. In most cases, backache is caused by a number of lifestyle factors working in combination including obesity, poor muscle tone, sedentary lifestyle and bad posture.

Soft tissue injuries
A sprain is a joint injury characterised by tearing of the ligaments, while a strain is an injury to muscle or tendons. Usually, the underlying causes of soft tissue injuries are similar to those of backache; an out-of-condition back is more susceptible to sprains and strains.

Disc problems
The invertebral discs are spongy cushions found between the vertebrae. As we age, these discs dry out and harden, making them prone to injury. The term ‘slipped disc’ is misleading. The disc doesn’t actually move out of place, but cracks its tough outer shell, which allows the softer insides to ooze out. This is called a disc bulge or prolapse.

Sciatica is nerve pain arising from the sciatic nerve that runs from the spine into the buttock and down the back of the leg. The cause is usually a disc bulge or prolapse pressing on the spinal (intervertebral) nerve. Other causes include narrowing of the nerve tunnel between discs due to osteoarthritis.

Structural problems
Kyphosis is an excessive outward curve of the thoracic vertebrae, which is sometimes referred to as ‘hunchback’. Scoliosis is an excessive sideways curve that can affect either the thoracic or lumbar regions of the spine. Causes of kyphosis and scoliosis include birth defects, lifelong bad posture, and certain diseases that affect the integrity of the bones, such as osteoporosis.

Back problems are more likely to be caused by lifestyle factors such as inactivity than by serious disease. Some of the diseases that can affect the spine include:
  • Ankylosing spondylitis - a disease that causes inflammation and pain in spinal joints and limb joints.
  • Arthritis - especially osteoarthritis, a condition characterised by the breakdown of cartilage that normally cushions two joints.
  • Cancer - bone cancer either originates in bone tissue (quite rare) or is caused by the spread of cancer cells from an original tumour somewhere else in the body.
  • Osteoporosis - a disease characterised by thinning of the bones.
A broken bone (fracture) occurs when a force exerted against bone is stronger than the bone can structurally withstand. Some diseases, such as cancer or osteoporosis, make fractures more likely.

Treatment options
In most cases of chronic back pain the first and most important treatment is to keep active and resume normal activities as soon as possible - work, sport and recreation. Treatment for back problems depends on the specific condition, but generally can include:
  • Keep active - resume normal activities as soon as possible, including work, sport and recreation.
  • Time - in many cases, a back injury will heal by itself if given enough time and care.
  • Medication - including painkillers, anti-inflammatory drugs and epidural injections.
  • Weight loss - being overweight or obese loads the back with unnecessary strain.
  • Strength training - a tight ‘girdle’ of muscle can reduce back pain and the risk of future injury.
  • Low impact exercise - aerobic activities that don’t jolt the spine are best, such as swimming, cycling or weight training.
  • Physiotherapy.
  • Chiropractic.
  • Surgery - in severe cases, it may be necessary to undergo surgery. The techniques depend on the condition. For example, surgery for a ruptured disc involves removing the fragments that may be pressing on nerves. Degenerative conditions may benefit from surgery to fuse problematic vertebrae, which minimises movement.
Where to get help
  • Your doctor
  • Physiotherapist
  • Chiropractor.
Things to remember
  • The back is prone to a range of problems, most of them caused by poor muscle tone, obesity and lack of regular exercise.
  • Some of the more common back problems include backache, soft tissue injuries, disc problems, sciatica, structural defects, disease and fracture.
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Article publication date: 21/03/2003
Last reviewed: 31/03/2004

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