Back Pain

What is Back Pain?

Back pain or backache is the pain felt in the back that may originate from muscles, nerves, bones, joints or other structures in the spine. Back pain is one of the most common medical problems experienced by most people at some time in their life. It can be acute, usually lasting from a few days to a few weeks, or chronic pain, lasting for more than three months.

Characteristics of Back Pain

Back pain can occur as a dull constant pain or a sudden sharp pain. Back pain may be confined to one area or may radiate to other areas such as the arm and hand, the upper back, or the lower back, and might radiate into the leg or foot.

Related Symptoms

Other than pain you may have weakness, numbness or tingling in your arms or legs caused from damage to the spinal cord.

Risk Factors for Back Pain

Athletes participating in sports such as skiing, basketball, football, ice skating, soccer, running, golf or tennis are at greater risk of developing back pain. During these sport activities, the spine needs to bear more stress, take up more pressure, undergo twisting and turning, as well as bodily impact. This may cause strain on the back that can result in back pain. Athletes are at high risk of back pain both from trauma and from overuse injuries, especially in sports requiring hyperextension.

Causes of Back Pain

Common causes of back pain in athletes include:

  • Musculoligamentous strain: It is the most common sports injury caused by injury to the soft tissues around the spine
  • Spondylolysis: It is most commonly found in athletes who participate in sports such as gymnastics, pole-vaulting, and football. All these activities require frequent hyperextension of the lumbar spine
  • Spondylolisthesis:It is a condition of the spine which occurs when one vertebra is displaced or has slipped forward over the other below it
  • Herniated nucleus pulposus: When injury occurs, the central core of the disc is pushed through a tear in the outer hard layer of the disc, causing a bulge and pressing on nearby nerves. If the herniated disc presses on a spinal nerve, it can cause back pain.

Other causes include growth-related problems such as scoliosis and Scheuermann's kyphosis.

Diagnosis of Back Pain

Your physician will diagnose back pain by asking appropriate questions or by taking a history of your problem and examining your spine. A complete examination includes examination of the signs of unusual curves of the spine, a rib hump, a tilted pelvis, and tilting of the shoulders and a test of your sensations. Other diagnostic tests may be needed to confirm the diagnosis.

Treatment for Back Pain

Treatment for back pain is usually non-surgical and includes:

  • Anti-inflammatory medications, or NSAIDs are recommended to provide relief from pain.
  • Cold packs, heat packs or both, applied to the back will help to ease much of the discomfort and relieve stiffness as well the pain.
  • Sleeping with the pillow between the knees while lying on one side or placing the pillow under your knees when lying on your back may help relieve back pain.
  • Exercises to strengthen your trunk and back muscles.

These measures help to relieve your back pain, however, in certain conditions the pain may not be resolved and may require surgical treatment. Your physician will decide on the appropriate surgery based on several factors.

Spondylolisthesis

Spondylolisthesis is the displacement of vertebral disc from the spinal column. Outward (forward) displacement is termed as anterolisthesis and inward (backward) displacement is termed as retrolisthesis. This condition is often preceded by spondylolysis, a degenerative condition of the vertebra.

Based on the cause of displacement, five subtypes of spondylolisthesis are identified, they are:

  • Dysplastic spondylolisthesis
  • Isthmic spondylolisthesis
  • Degenerative spondylolisthesis
  • Traumatic spondylolisthesis
  • Pathologic spondylolisthesis

Among the various subtypes of spondylolisthesis, the two most common forms commonly observed are dysplastic spondylolisthesis and isthmic spondylolisthesis

Dysplastic spondylolisthesis – This subtype is a congenital condition, present at birth, and is caused because of abnormal bone formation of the facet part of the vertebra resulting in spondylolisthesis.

Isthmic spondylolisthesis – This type of spondylolisthesis occurs because of a defect in the pars interarticularis part of the vertebra. This is more common in athletes and gymnasts as they often suffer from overuse injuries.

Signs and symptoms that suggest spondylolisthesis in patients include:

  • Lower back pain
  • Stiffness in the back and tightening of the hamstring muscles from spasms
  • Pain in the thighs and buttocks
  • Decreased range of motion of the lower back
  • Pain and weakness of the legs or numbness because of nerve compression
  • Loss of control on bowel or bladder function by severe nerve compression
  • Increase in lordosis curve, also called swayback
  • Kyphosis (round back)

The cause for spondylolisthesis is multifactorial; the common causes are overuse injuries of spine, congenital abnormalities, trauma, bone disorders and fractures.

Treatment for spondylolisthesis is based on the diagnosis made by collecting medical & family history, a physical examination, and radiographic scans. During the diagnosis, the severity of displacement is also assessed which is expressed as grade I to IV. In mild conditions and for symptomatic relief, conservative treatments including medications, bracing and physical therapy are recommended. In severe cases, surgical correction with decompression laminectomy followed by spinal fusion is recommended. The procedure involves removal of a portion of vertebra compressing the nerves and other vertebra followed by removal of disc between the vertebrae and fusion of adjacent vertebrae. Fusion surgery is performed to confer stability to the spine. Following the surgery, your surgeon recommends physical therapy and rehabilitation programs to regain strength to the surrounding bones & muscles as well as to make you active soon.

  • American Academy of Orthopedic Surgeon
  • California Orthopaedic Association
  • Western Orthopaedic Association
  • American Medical Association
  • American Society for Surgery of the Hand
  • North American Spine Society
  • American Orthopaedic Society for Sports Medicine
  • Methodist Hospital of Southern California
  • San Gabriel Valley Medical Center
  • Garfield Medical Center
  • Alhambra Hospital Medical Center