Parts of the spine and back include:
Vertebrae – These are bony structures of the back stacked on top of one another, protecting the spinal cord.
Spinal cord – Within the vertebrae there is a canal where a long bundle of nerves courses through running down the back.
Intervertebral discs – These are the cushion-like pads between the vertebrae that act like shock absorbers for the spine.
Ligaments – These are the tough but flexible tissue that help stabilize the vertebrae in place.
Tendons – These are cords of tissue that connects muscle to bone.
Muscles – The surrounding muscles help support your spine and upper body and help you move.
Myofascia: Fascia is tissue wrapped around muscle. There are nerve endings inside fascia.
Types of back pain
Bulging or herniated disks: The disks are cushions between the levels of the spine. The soft material inside the disk can either bulge or rupture, thereby herniating and pressing on the adjacent nerve. But it’s important to note that patients may have these findings on an MRI and have no back pain.
Myofascial pain: Pain originating from either in the muscle or its fascia is referred to as myofascial pain. These muscles usually have contracted areas (or knots) referred to as trigger points. When muscle fibers are contracted it slows the blood flow, and the resultant reduced oxygen to the area causes pain.
Ankylosing spondylitis (also known as axial spondyloarthritis): This is an inflammatory disease that can eventually result in some of the bones in the spine to fuse making it less flexible.
Degenerative disc disease: Aging of the spine causes the discs between vertebrae to deteriorate and break down. This may lead to other conditions such as spinal stenosis.
Spinal Stenosis: Osteoarthritis in the lower back can result in the narrowing of the space around the spinal cord that causes provocation of the nerves and pain symptoms.
Compression Fractures: These are fracture within the vertebrae. While it can occur as a result of injury, often it is related to osteoporosis causing the bones to become porous and brittle, making it more prone to painful breaks.
Risk factors for developing back pain
Age: The risk of back pain increase with age, starting around age 30.
Lack of Exercise: Weakened muscles in the back and core can result in additional stress on the spine leading to back pain.
Posture: Poor standing and sitting posture can place disproportionate stress on the spine and its surrounding structures.
Obesity: Excess weight will cause additional wear on the back.
Diseases: Inflammatory arthritis and cancer can both result in back pain.
Improper lifting: Using the back muscles instead of the legs can cause injury to the back.
Psychological conditions: Stress and anxiety can lead to muscle tension in the back. People with depression and anxiety have a greater risk of developing back pain.
Smoking: Smoking can diminish blood flow to the spine and its structures, contributing to slower healing. It can also increase the risk of osteoporosis. In some circumstances, smokers cough can lead to herniated disks.
Prevention
Proper posture: Avoid slouching when sitting or standing. Chairs should have back support and armrests. When standing for a prolonged period use a footstool to offload weight from the back.
Exercises: Walking, swimming and any aerobic exercise that doesn’t strain the back will result in the strengthening and improved endurance of the back muscles.
Exercises for muscle strength and flexibility: Strengthening the core muscle can help better support the back.
Lifting Restrictions: Use knees not back to lift. People with chronic back pain should not to lift more than 25 Ibs.
Healthy Eating: Maintaining a proper weight can help avoid undue strain to the back muscles.
Quit smoking: The more one smokes the higher the risk of back pain.
TESTS DONE FOR THE BACK
It’s important to note that the diagnosis of back pain is usually not made from looking at an x-ray or an MRI. Many patients have abnormalities on imaging and have no back pain. While imaging can provide clues and guidance, the symptoms have to correlate with image findings.
X-ray: These show good imaging of the bone. They are therefore good for visualizing arthritis or broken bones. They won't reveal problems related to the spinal cord, muscles, nerves or disks.
MRI or CT scans: These scans are good for imaging of soft tissue. They can show herniated disks, nerve compressions, or general problems related to bones, muscles, tissue, tendons, and ligaments.
Blood tests: These can help determine if an inflammatory condition or infection is causing the pain.
EMG or nerve studies: This test looks for compromise in the electrical impulses produced by the nerve. It can reveal if there is pressure on a nerve as a result of a herniated disk or arthritis causing narrowing of the nerve's exiting path.