What Causes Back Pain?
Why is the back such a pain? Dr. Rob gives tips to put the pain behind you.
Raise your hand if you have ever had back pain. If my readers are a representative sample, 85% of you are raising your hand. Now, to avoid getting funny looks, please put your arm down or pretend you are stretching. I don’t want my readers getting a reputation.
Back pain is one of the top reasons people visit the doctor, and it costs an estimated $100 billion in the US each year. If one of your New Year’s resolutions was to exercise, back pain is an important topic, as nearly 75% of people who injure their back give up sports and physical activity. It certainly ended my Olympic pole-vaulting dream.
The Anatomy of the Back
Before I talk about the causes of back pain, I first need to discuss the anatomy of the back. Your back is made up of three main parts:
The spine, which is the load-bearing beam of your body. It’s made up of bones called vertebrae that are stacked on top of each other.
The spinal cord, which is the cable system of the body. It carries information back and forth between the brain and the rest of the body in the form of electrical impulses.
The back muscles, which extend the length of the spine, stabilizing it and giving it movement when needed.
The bones in your spine aren’t just stacked up like Legos; between each vertebra is a soft piece of cartilage called an interverterbral disc. These discs serve two purposes:
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Shock absorber: the discs act as cushioning so that the bones don’t grind on each other
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Separator: because of the discs the vertebra are far enough apart to be able to bend. The muscles around the spine do the work of bending.
Nerves and the Back
As you may know, the brain is connected to the nerves in your body via the spinal cord. Motor nerves take the messages from the brain and tell the muscles to move and the body’s organs to do what they do. Sensory nerves collect info from the outside world and send it to the brain. The points where these nerves connect to the spinal cord are called nerve roots. The motor and sensory nerves connect to the spinal cord after entering the spine through little holes between each vertebra. When a person “pinches a nerve,” it is these nerve roots that are affected. Click here for more on pinched nerves.
What Causes Back Injury?
The most common back injury happens when you ask the back muscles to do more work than they should be doing. Back muscle injury happens either by a single incident of poor judgment, or by repeatedly asking them to do something they aren’t strong enough to do. The single incident goes something like this:
“Ah, look on the ground,” says the brain. “There’s a bag full of lead. If I pick it up I can show how strong I am and win back some of the macho points I lost trying to pass a football with my kid.”
“I can’t lift that!” the back muscles protest, “didn’t you listen in physics class about fulcrums, levers and torque? We are barely strong enough to pick up a TV remote, let alone a bag of lead.”
“Physics, Schmysics! Do as I say!” commands the brain. “I am your master and you must do as I say.”
The muscles obey with the predicted outcome of injury, and possibly even muscle tear (depending on the stupidity of the brain). No macho points are gained.
Why Does a Back Injury Hurt?
I guess it goes without saying that back pain hurts, but what makes it hurt so much? There are three sources of the pain: injury, spasm, and inflammation. Injury happens when you bend over and pick up that bag of lead; muscles are stretched or torn, both of which cause immediate pain.
The next thing that happens is muscle spasm. When not working, muscles are usually relaxed. When doing their work, muscles shorten, or “tighten up.” When injured, muscles become tight, and prolonged tightness causes pain.
The last thing that happens is inflammation, which is the body’s way of fixing the injury. White blood cells are sent to do the site of injury, releasing substances that speed repair. Some of these substances, however, cause pain. The process of inflammation is slow, not peaking until 48 to 72 hours after the injury. That is why you hurt so much in the days after strenuous exercise. When old guys like me pretend we are young and fit, we injure our muscles. Even if we don’t hurt immediately after exercise, the next few days are reminders of our non-young status.
What is a Pinched Nerve?
Sometimes the inflammation caused by the injury causes inflammation of the nerve root that is between two vertebrae. When the nerve root is inflamed, it causes pain to go down the nerve that joins with the spinal cord at that level. The nerve roots in the lower back (which is the most common place for injury) bundle together to form a large nerve called the sciatic nerve. This nerve extends down the leg via the buttock and the back of the thigh.
Nerve root inflammation associated with a muscle injury is experienced as an achey dull pain in the butt that goes down the back of the thigh. That is called sciatica, and it’s more painful than it is dangerous when it happens along with significant pain in the back. It’s more worrisome when the nerve root is injured by a herniated disc or by arthritis in the back, which present with sciatica without significant back pain. I’ll cover all that in a future article.
How Do You Treat Back Pain?
So what should you do if you have back pain caused by an injury to a muscle? The good news is that by resting, keeping active, and avoiding bags of lead, the back will heal on its own after a few weeks. Treatments revolve around treating the pain, and include:
Heat and ice – heat relaxes muscle spasm, whereas ice reduces inflammation. Both can give you temporary relief, and either is OK.
Medication – medications for back pain focus on inflammation, muscle spasm, and the pain itself. For minor pain, OTC medications like ibuprofen are often enough, but sometimes, stronger medications are required.
Massage and manipulation – massage, physical therapy, and chiropracty are examples of massage and manipulation. Massage relaxes the muscles, whereas physical therapy strengthens other muscles that can take the stress off of the muscles causing pain. I was not trained in chiropracty, so I won’t promote or discourage it, but many people do find it helps a lot.
Quick and Dirty Tips for Back Pain
So here are my quick and dirty tips regarding back pain:
Tip 1: Be Careful
Don’t pretend you can do things you can’t. Only lift things that you know you can handle, and lift by squatting rather than bending over.
Tip 2: For Muscular Back Injury, Do the Following:
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Take anti-inflammatory pain medications (and check out Nutrition Diva’s episode about foods that fight inflammation).
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Use Ice and heat
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Don’t let your back get stiff. Back exercises can help people get better much faster. I’ll put a link to some exercises at the bottom of this article.
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Get sleep. Sleep lets your muscles relax, so if your pain is keeping you up, the muscles might not loosen up. Combination pain and sleep medications are useful for this, and your doctor can give you something stronger if over-the-counter medications aren’t enough.
Tip 3: Talk To Your Doctor For Any of the Following:
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Back pain or sciatica that is severe
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Pain that persists despite you taking measures to get it better
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Pain that has sudden onset with no clear cause
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Weakness or numbness in your legs
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Loss of control of bowels or bladder (which could signify damage to the spinal cord)
Back Pain Summary
My take-home message is that most back pain goes away without major treatment, and most treatment involves improving symptoms. And please don’t insist on x-rays or MRI scans, as they are only useful in limited circumstances.
If exercise really is one of your goals but you suffer from back pain, click here for a great Get-Fit Guy episode on that subject.
If you have questions you want answered, send them to housecalldoctor@quickanddirtytips.comcreate new email. You can find me on Twitter as @housecalldoc and on Facebook under “House Call Doctor.”
Let me remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!
Back Pain image courtesy of Shutterstock