If you suffer from back pain, you are far from being alone. Four out of five adults experience the symptoms of low back pain at least once in their lifetime. Your back is a complex structure made up of 33 vertebrae, over 30 muscles, numerous ligaments, joints, and inter-vertebral discs. Any of these anatomical structures can cause discomfort if injured or adversely affected and the pain can be truly debilitating.

Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine. Pain arising from abnormalities of organs within the abdomen, pelvis, or chest may also be felt in the back. For this reason, it is very important to have a professional medical assessment prior to undergoing any treatment.

Muscular tears or strains are the cause of most back pain. This happens when an unexpected force, twist, or pull is applied to one or several of the muscles in your back. As a result, several tears occur in the muscle. These muscular tears or strains cause pain felt in the back. 

Ligamentous tears or strains are another common cause of back pain. These occur when the ligaments of your back are stretched more than they were designed to be. Sprains often occur along with muscular strains.

Herniated or prolapsed discs result in back pain by compressing your spinal nerves where they exit the spinal column. Incorrect lifting where the disc has taken the load of the lift can cause these injuries. This happens when the core stabilizers are not switched on and results in a radiating pain, which is felt at the site of injury and along the course of the affected nerve. Sciatica, for example, is a type of this type of pain.

Spinal Stenosis is another cause of back pain. It occurs more commonly in people over 50 years old. The term refers to a narrowing of the spinal canal. Spinal stenosis has many causes including thickened ligaments along the spinal canal, bony spurs, and enlarged joint cartilage from arthritic changes. This condition often results in back pain, which is worse with extended periods of weight bearing or walking, and there is usually a large amount of radiating pain down through the buttocks and into the legs. Surgery is sometimes necessary to correct this disorder.

Degenerative Disc Disease (DDD) is a condition caused by the gradual deterioration of the discs between the vertebrae of the spine. The degeneration of the disc that occurs in Degenerative Disc Disease is also referred to as spondylosis.

Spinal Osteoarthritis affects the joints of the spine. As with spinal stenosis, it is found more commonly in people over 50 years of age. Osteoarthritis of the spine occurs when there are degenerative changes in the discs between the vertebrae. Without this cartilaginous cushion, our bones begin to rub against each other. As this disorder progresses your bones develop spurs and your ligaments become thick and it is this process, which leads to spinal stenosis as described above.

Facet Joint Osteoarthritis occurs when there is a breakdown of cartilage between the facet joints, which are located on the sides of the vertebra. Facet joint osteoarthritis causes pain, stiffness, and a loss of mobility in your back. This results in inflammation, swelling and stiffness which in turn causes chronic back pain especially with movement.

Osteoporosis is a common cause of back pain especially in women. It is a disease characterized by progressive loss of bone density and occurs when bones lose minerals, such as calcium, more quickly than the body can replace them, leading to a loss of bone thickness (bone mass or density). This results in thinning of bone tissue making one more susceptible to fractures, or broken bones. The bones of your spine are especially affected in this disorder. Injury from falls, lifting of heavy objects, or even the force of sneezing can result in painful vertebral compression fractures. Osteoporosis usually has no signs or symptoms until a fracture happens - this is why osteoporosis is often called the 'silent disease'.

Fibromyalgia is another common cause of chronic back pain. It is a rheumatic condition characterized by widespread soft tissue pain, fatigue, sleep disturbance, and the presence of evenly distributed areas of tenderness. It is diagnosed according to the number (& places) of symptoms presenting and is a name given to a collection of  these symptoms and it seems to make the body’s pain perception system oversensitive to pain. There is no cure but symptoms can be managed.

As you can see, there are so many possible reasons as to why you might be suffering from the pain in your back so it is important to have it checked out by your physiotherapist.  It is comforting to know that it is usually not due to any serious disease. Most episodes of back pain get better with conservative treatment which must be followed through to the end --- according to your physio’s advice.

If your back pain is not the result of an injury like whiplash, a nasty fall or accident, it is probably caused through back strain; exerting undue pressure on your back muscles.  This can be due to:

• Incorrect footwear.
• Bad posture.
• Being Overweight --- just a 4kgs of extra weight puts pressure on our backs. In some ways it is worse because the strain is constant.
• Being Dehydrated --- dries out your spinal discs, muscles and tendons, making them less flexible or supple than they should be.
• Being Stressed! Sometimes back pain is a psychosomatic response to stress.
• Poor core stability (previous article)
• Poor overall body muscle tone

Treatment

Back pain is a symptom, thus treatment needs to focus on the underlying cause of the problem to alleviate the symptoms as much as possible and to reduce the likelihood of symptom recurrence.

Your Actively Ageing Physiotherapist will be best equipped to help you with your back pain and will be diligent about referring you on to appropriate specialists if needs be.

On the whole, you will be guided through an appropriate treatment program right through to the point where you have regained the strength and mobility required to ward off further recurrences.
As you will be told, sleeping with a pillow between your knees while lying on one side may increase comfort. Another good sleeping position is lying on your back with a pillow under your knees.

You will definitely need to build core strength, as this is critical in trunk control and reducing the effects of back pain.

You will be advised and taught how to exercise specifically for your condition so that you can return to normal activities and work.

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