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Back Pain


Introduction

Back pain is one of the most common medical problems, affecting 9 out of 12 people at some point during their lives. Acute back pain may be a sign of a serious medical concern, although this is not most frequently the underlying cause. Typical warning signs of a potentially life threatening problem are bowel or bladder incontinence or progressive weakness in the legs. Acute back pain is commonly described as a very sharp pain or a dull ache, usually felt deep in the lower part of the back and can be more severe in one area, such as the right side, left side, center, or the lower part of the back. The back pain that occurs after a specific trauma, such as a car accident or fall may indicate a bone fracture or other injury. It can range from a dull, constant ache to a sudden, sharp pain. Back pain is called chronic if it lasts for more than three months. Chronic back pain tends to last a long time and may not be relieved by standard methods of medical management.

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Symptoms

Back pain may exist in any one region of the back or in multiple areas at the same time. Pain can be localized to one side or it can be a band of pain wrapping across the width of the back. A backache can be intense in a small area or experienced in a radiating pattern, coming from a central "hot spot." The pain pattern might be tied to a certain movement or might be painful all the time. Pain can be a symptom all by itself or might be joined with other sensory sensations. The most common of these additional symptoms are numbness, tingling and weakness.

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Causes

The cause of back pain has most often been explored by the traditional medical community as being "structural" in nature. While there are certainly many incidences of back pain that are associated with strain and/or physical trauma to the area, more often than not the pain is caused by and/or exacerbated by other underlying factors. Below is a list of structural, physiological, biochemical and psychological causes of back pain:

  1. Tight Muscles. A tight muscle will cause a "pulling" effect that results in multi-system strain as it pulls on joints, tendons and ligaments. This will result in spinal malalignment, creating more pressure on vertebrate and disks.
  2. Weak Muscles. A weak muscle lacks the ability to provide proper support to the skeletal system. In many cases, this will cause postural imbalance in the back, neck and shoulders. Abdominal muscle weakness is one such muscle group that has been associated with back pain.
  3. Muscle Strain. Muscle strain is often caused by overuse of a muscle or overloading a muscle. When a muscle is stressed beyond its limits, injury occurs. A muscle strain (or pulled muscle) is an overstretched or torn muscle. With injury comes inflammation, which is part of the healing process. Inflammation causes pain and can also trigger muscle spasms. The severity of a muscle strain can range from mild to severe.
  4. Pelvic Malalignment. The pelvis may be malaligned due a wide range of reasons ranging from injury and muscular tightness to invasive surgical procedures and childbirth. When the pelvis is out of balance, it will create a strain on the entire skeletal system resulting in pain and discomfort.
  5. Bulging, Ruptured or Herniated Disks. Disks have a soft, gelatinous center surrounded by an outer ring. Trauma, strain, or degeneration may weaken the outer ring so that the center bulges through and impinges on nerve roots in the spine, or on the spinal cord itself. Usually bulging is considered part of the normal aging process of the disk and is therefore common to see on MRIs. A herniated disk, on the other hand, results when a crack in the tough outer layer of cartilage allows some of the softer material inside to protrude out of the disk. Herniated disks are also called ruptured disks or slipped disks may cause severe lower back pain that radiates to the buttocks, legs, and feet. There may also be a loss of feeling and mobility in the affected areas and ultimately weakness and atrophy of leg muscles.
  6. Osteoporosis. The effects of osteoporosis may first be seen in the spine. A loss of calcium and phosphate salts causes the bones to become porous, brittle, and easily broken. The vertebrae in the spine may compress, causing the back to become bent and resulting in such conditions as kyphosis (round back) or scoliosis (spinal curvature). The first signal is often a sharp pain in the lower back while lifting or bending, which usually indicates the collapse of a vertebra. Hormone balance and bone support through nutrition and exercise are essential in the prevention and treatment of osteoporosis.
  7. Suppressed Emotions. Toxic emotions such as anger, depression and emotional trauma have become increasingly significant to address for the alleviation of back pain. When the body is harboring repressed emotions, the muscles, joints, tissues and organs become containers for holding on to these feelings. Over time, these emotions cause blockages in the body and prevent the system from being able to carry out normal system pathways for homeostatic balance. Moreover, the pain management system is significantly affected by these blockages as the level of perceived pain exacerbates and the threshold for tolerating discomfort greatly declines.
  8. Nutritional Imbalances. A deficiency of specific vitamins and minerals has also been associated with back pain. Specifically, vitamin D, calcium and magnesium. Hormone imbalances associated with hyperthyroidism, amenorrhea and menopause may cause a loss of calcium necessary for bone support and pain management. In addition, a high glycemic diet may cause an increase in blood glucose which may result in an inflammatory reaction in vulnerable areas of the spine.
  9. Food Allergies or Sensitivities. When foods are poorly broken down due to lack of digestive enzymes or a poor quality diet, the barrier that prevents foods from attacking the immune system will break down. The result is a hyper reactive state in which the body perceives a foreign invader and trips the inflammation wires. Food allergies will typically manifest in the region of the body that is the most sensitive. If you have chronic digestive problems and back pain, then treating food allergies will be critical to alleviating your symptoms.
  10. Adrenal Insufficiency/Stress/Sleep/Biochemical Imbalances. When the body is under stress, the adrenal glands produce the stress hormone, cortisol. The automatic result of cortisol production will result in an inflammatory response. Adrenal stress will also cause and/or result from poor sleep and biochemical imbalances.
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When Do I Need to Go to My Doctor for Backpain?

If you have new back pain, you should contact your doctor to see if you need further evaluation. There are also a few warning signs that may indicate a problem that needs immediate evaluation:

  • Your back pain persists beyond a few days
  • Your back pain awakens you at night
  • Your have difficulty controlling your bowels or bladder
  • You have a fever, chills, sweats, or other signs of infection
  • Any other unusual symptoms

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Natural Treatments

The natural approach to treating back pain is to identify the root source of the pain (online or in person). If you have ruled out major medical problems with your doctor and the diagnosis has been a muscle strain, weakness, pelvic malalignment or a tight muscle, you might benefit greatly from bodywork such as myofascial release, deep tissue massage, chiropractic, yoga and/or pilates. If you have seen limited improvements with these methods, then exploring your nutritional status and mind/body connection would be recommended. Nutritional intervention includes one or more of the following: food allergy testing, hormonal testing and rebalancing, adrenal stress testing, vitamin/mineral analysis and supplementation. Acupuncture, guided imagery, hypnotherapy, meditation and/or mind/body counseling are often recommended to help deal with suppressed emotions which may be causing blockages and pain.

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References

Brounstein, Art MD. Healing Back Pain Naturally. New York: Pocket Publishing, 2001.

Sarno, John, MD. The Mind-Body Connection. New York: Warner Books, 1991.

Back Pain. The Mayo Clinic, 2009. Available at: http://www.mayoclinic.com/health/back-pain/DS00171. Accessed on October 29, 2009.

Biyani, A. Andersson, G.B. "Low Back Pain: Pathophysiology and Management." J. Am. Acad. Ortho. Surg., March/April 2004; 12: 106 - 115.

Swenson R, Haldeman S. "Spinal manipulative therapy for low back pain." J Am Acad Orthop Surg. 2003 Jul-Aug;11(4):228-37.

Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006 Mar-Apr;6(2):131-7.

Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2005 Dec 20;143(12):849-56.

Slade SC, Ther MM, Keating JL. Trunk-strengthening exercises for chronic low back pain: a systematic review. J Manipulative Physiol Ther. 2006 Feb;29(2):163-73.

Steidl L, Ditmar R, Dostal A. Serum magnesium and calcium in patients with dorsalgias. Magnes Res. 2001 Sep;14(3):225-6.

Thomas KJ, MacPherson H, Ratcliffe J, Thorpe L, Brazier J, Campbell M, Fitter M, Roman M, Walters S, Nicholl JP. Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health Technol Assess. 2005 Aug;9(32):iii-iv, ix-x, 1-109.

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