Low back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain in the lower back. Pain in the lower back can restrict mobility and interfere with normal functioning and quality of life.
Neck pain is pain that occurs in the area of the cervical vertebrae in the neck. Because of its location and range of motion, the neck is often left unprotected and subject to injury.
Pain in the back or neck area can be acute, which comes on suddenly and intensely, or chronic, which can last for weeks, months, or even years. The pain can be continuous or intermittent.
Fortunately, most episodes of back pain will heal with time: approximately 50% of patients will feel relief from low back pain within two weeks, and approximately 90% within three months, regardless of the treatment.
The majority of episodes of acute back pain are due to a muscular strain and these will usually resolve with time because muscles have a good blood supply to bring the necessary nutrients and proteins for healing to take place.
Even with today’s technology, the exact cause of back and neck pain can be found in few cases. In most cases, back and neck pain may be a symptom of many different causes, including any of the following:
For patients with low back pain that lasts longer than three months, or patients with predominantly leg pain, a more specific and definable problem for the pain should be sought. There are several very common causes of low back pain and leg pain:
In younger adults (20-60 year olds) the disc is likely to be the pain generator and conditions may include:
In older adults (over 60 years old), the source of back pain or leg pain is more likely to be the facet joints or osteoarthritis, and back conditions may include:
In addition to the above, there are several miscellaneous causes of back pain.
While neck pain is less prevalent than lower back pain, there are several cervical spine conditions that may cause neck pain, arm pain and other symptoms, including:
Additionally, there are several miscellaneous causes of upper extremity pain related to conditions of the cervical spine.
he back and spine are designed to provide a great deal of strength, protecting the highly sensitive spinal cord and nerve roots, yet flexible, providing for mobility in all directions.
However, there are many different parts of the spine that can produce back pain, such as irritation to the large nerve roots that run down the legs and arms, irritation to small nerves inside the spine, strains to the large back muscles, as well as any injury to the disc, bones, joints or ligaments in the spine.
Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Chronic back pain is typically described as lasting for more than three months.
Back pain can take on a wide variety of characteristics:
Other than pain, back pain symptoms may include weakness, numbness or tingling.
Fortunately, most forms of back pain get better on their own: approximately 50% of patients will experience back pain relief within two weeks and 90% within three months.
If the pain lasts for more than a few days, is getting worse, does not respond to back pain remedies such as a short period of rest, using ice or heat, lower back pain exercises and over-the-counter pain relievers, then it is usually advisable to see a back doctor. There are two instances in which emergency medical care is needed:
Fortunately, these conditions are rare.
By far the most common cause of lower back pain is a muscle strain or other soft tissue damage. While this condition is not serious, it can be severely painful. Typically, lower back pain from a muscle strain will get better within one to three weeks.
Treatment usually involves a short period of rest, activity restriction, use of hot packs and/or cold packs for local discomfort, and pain medication. Over the counter pain medication used to treat muscle strain may include acetaminophen (e.g. Tylenol), ibuprofen (Advil), Motrin, or naproxen (e.g. Aleve). Prescription pain medications may be recommended for severe back pain.
Typically, younger individuals (30 to 60 year olds) are more likely to experience back pain from the disc space itself (e.g. lumbar disc herniation or degenerative disc disease). Older adults (e.g. over 60) are more likely to suffer from pain related to joint degeneration (e.g. osteoarthritis, spinal stenosis).
In some instances, a patient may experience more noticeable leg pain as opposed to back pain as a result of certain conditions in the lower back, including:
It is important to know the underlying condition that is causing the low back pain, as treatments will often differ depending on the causes of back pain.
The following may help to prevent back and neck pain:
The cause of back pain can usually be diagnosed with a detailed description of one’s symptoms. The description of back pain symptoms, along with one’s medical history (and possibly diagnostic testing), will usually lead to a diagnosis of a general cause (such as back strain), or a specific condition (such as a herniated disc).
Back sprain or strain symptoms generally include:
Lower back pain from a muscle strain usually will get better within one to three days.
Symptoms that are part of a diagnosable chronic condition can include:
There are many more conditions can cause lower back pain, leg pain and other symptoms; the intention of this article is to highlight the most common ones.
There are a few symptoms that are possible indications of serious medical conditions, and patients with these symptoms should contact a doctor immediately:
There are many risk factors for back pain, including aging, genetics, occupational hazards, lifestyle, weight, posture, pregnancy and smoking. With that said, back pain is so prevalent that it can strike even if you have no risk factors at all.
Patients with one or more of the following factors may be at risk for back pain:
Aging. Over time, wear and tear on the spine that may result in conditions (e.g., disc degeneration, spinal stenosis) that produce neck and back pain. This means that people over age 30 or 40 are more at risk for back pain than younger individuals. People age 30 to 60 are more likely to have disc-related disorders, while people over age 60 are more likely to have pain related to osteoarthritis.
Genetics. There is some evidence that certain types of spinal disorders have a genetic component. For example, degenerative disc disease seems to have an inherited component.
Occupational hazards. Any job that requires repetitive bending and lifting has a high incidence of back injury (e.g., construction worker, nurse). Jobs that require long hours of standing without a break (e.g., barber) or sitting in a chair (e.g., software developer) that does not support the back well also puts the person at greater risk.
Sedentary lifestyle. Lack of regular exercise increases risks for occurrence of lower back pain, and increases the likely severity of the pain.
Excess weight. Being overweight increases stress on the lower back, as well as other joints (e.g. knees) and is a risk factor for certain types of back pain symptoms.
Poor posture. Any type of prolonged poor posture will, over time, substantially increase the risk of developing back pain. Examples include slouching over a computer keyboard, driving hunched over the steering wheel, lifting improperly.
Pregnancy. Pregnant women are more likely to develop back pain due carrying excess body weight in the front, and the loosening of ligaments in the pelvic area as the body prepares for delivery.
Smoking. People who smoke are more likely to develop back pain than those who don’t smoke.
The bottom line that everyone should remember is that if one is in doubt, consult a doctor. If back pain is getting worse over time, does not feel better with rest and over the counter pain remedies, and/or involves neurological symptoms then it is advisable to be evaluated by a back pain doctor.
In general, if the pain has any of the following characteristics, it is a good idea to see a physician for an evaluation:
The following back pain symptoms may be indications of a serious medical condition and anyone with these should seek immediate medical care:
People should also seek prompt medical attention if other unexplained symptoms accompany their back pain, such as fever, history of cancer, recent unexplained weight loss, pain that is so bad it awakens them from sleep, or pain after a trauma.
Diagnostic tests can indicate if a patient’s back pain is due to an anatomic cause. However, because diagnostic tests in and of themselves are not a diagnosis, arriving at an accurate clinical diagnosis requires any test to be to be correlated with the patient’s back pain symptoms and physical exam.
The most common diagnostic tests include:
Injections may also be used to help diagnose certain types of pain. If an injection of a pain relieving medication into a certain spot in the spine provides back pain relief, than it confirms that is the area causing pain.
If you are experiencing back or neck pain the team of physicians and staff members at TOCA (The Orthopedic Clinic Association) are here to help! For more information you can read more about our Neck & Spine Physicians and The Spine Center at TOCA for non-operative and operative procedures. For questions or to schedule an appointment with our orthopedic spinal surgery and general musculoskeletal physical medicine and rehabilitation specialists call: 602-277-6211!
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