March 14, 2014

By Roseline Adindu:

What is pain? Pain results when there is a feeling of ache or distress around a particular part of the body or mind. When distortions in the spinal column or organs of the body interfere with nerve transmissions, and felt by the nerve receptors, pain is perceived.

Nature of pain: Pain can be sharp, dull, shooting or throbbing in nature.

Location of pain: Pain can be superficial or deeply seated; it can be localized, generalized or referred.

The bones of the back are 33 in number. They start from the neck region to the anus, forming a column called the spinal or vertebral column. The bones of the neck are 7 in number; these are called cervical vertebrae.  The thoracic vertebrae are 12 in number and they gave attachment to the ribs. Below the thoracic vertebrae are the low back bones called lumbar vertebrae which are 5 in number, followed by the 5 sacral vertebrae fussed as one. Finally are the coccygeal vertebrae; they are 4 in number but fussed as one. Each of these bones has a central opening called vertebral canal or foramen through which the spinal cord passes. Between the vertebrae are fibrocartilagenous pads called intervertebral disc which separate one vertebra from the other. There are smaller openings in – between the bones called intervertebral foramen through which the spinal nerves that convey impulses to and fro the spinal column pass. Other structure around are the ligaments and tendons connecting bone to bone.

Low back pain occurs when pain is felt around the lumbar region (L1L5). Pain could also be referred to the lower limbs depending on the level of nerve that was entrapped.

1.The Spinal column as mentioned above to constitutes the core of the locomotor apparatus and is the key to the posture of the trunk.

2. The spinal columns transmits the weight of the upper portions of the body,.

3. It provides a stable central point for the attachment of the bones and muscles of the upper limbs.

4.  It serves as an excellent shield for the spinal cord with its adjacent spinal nerves.

About 80% of the entire population suffers from low back pain during their active lives and within this period, they are unable to perform their regular activities because of back pain. It affects people of all ages between ages 18-80.

Back Pain is not a diagnosis but a symptom. Different schools of thought have different views about the causative agents. Some say it originates from the spine, that is if there is mechanical distortion or mal-alignment of the vertebrae along the vertebral column which interferes with nerve transmission and functions along the spinal nerve and spinal cord. However, causative agents may be outside the spine e.g., chronic cough, unexplainable weight loss over a period of time, difficulty in urination. Generally, referred pain could take origin from internally-situated organs which can send pain to the low back based on their dermatones and nerve distributions. Pain at the low back as a result of trauma e.g. road traffic accident, a fall on the back, etc, could cause mechanical deformation or chemical irritation. When there is tissue damage, there could be irritation of chemical substances around that side, further accumulation of chemicals can irritate the pain receptors, hence pain is perceived. For e.g., pain of a chemical origin is always felt as dull and constant ache. When pain is aggravated by activity, it shows that the origin is mechanical breakdown of the spine.



a. Postural dysfunction: This occurs when there is stress on the spine or over- stretching of the ligaments and muscles which get tired. Joint nerves are put under pressure. Back ache could occur when people lie on soft foam and sit and even stand wrongly thereby distorting the normal curvature of the spine, hence pain.

b.Intervertebral disc: Problem such as prolepses or rupture of the disc which could be as a result of trauma to the spine.

c.Sciatica: This results when there is injury, pressure on the sciatic nerve which is the main nerve that supplies the lower limbs.

d.Arthritis: Degenerative changes along the spine and facet joint inflammation within the joint and growth of bones spur asteophytes which are significant features of osteoarthritis.

e. Weakness of deep abdominal muscles: This can cause pain at the low back.

f. Pelvic Inflammatory Diseases : When pelvic inflammatory diseases are not well treated, other medical conditions not properly handled, this can refer pain to the back.



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