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Back pain: symptoms, causes, diagnosis and prevention

by Scott Martin
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What is back pain?

Back pain, also known as lumbago or common lumbago, is a common reason for people to seek medical consultation. It is particularly common in people under the age of 65. Physical labor can contribute to back pain, but a sedentary lifestyle and stress can also be causes. Other factors that can lead to back pain include muscle tension, herniated discs, osteoarthritis, pregnancy, and osteoporosis. Emotional stress can exacerbate existing back pain.

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What are the symptoms of back pain?

Low back pain is pain that is experienced in the lower portion of the back, specifically in the lumbar region. It is typically caused by sudden or prolonged physical activity, or by maintaining a poor posture for an extended period of time. Low back pain is the most common type of back pain. It can manifest in different ways, including:

  • Compression of vertebrae linked to osteoporosis .
  • Sudden, intense pain in the lower back accompanied by muscle spasms, often occurring after a sudden movement or lifting a heavy load
  • Pain that radiates down one or both legs, which may be a sign of a herniated disc or sciatica
  • Inflammatory low back pain that gets worse at night, which may be a sign of inflammation or a tumour
  • Mechanical pain that occurs when using a joint, typically during the day.

Causes of low back pain

Back pain can have many origins, which can be classified into five families.

Mechanical problems

  • Postural defects when the back muscles are too weak. This situation leads to muscle contractures and an imbalance of the spine.
  • Muscle tension, aggravated by upsets (stress, anxiety, etc.).
  • Lesion of one of the discs located between the vertebrae, which may collapse or put pressure on the spinal cord or nerve roots (herniated disc) thus causing neck pain ( cervicobrachial neuralgia ), lumbago or sciatic pain.
  • Changes in the vertebral joints, age-related (arthrosis).
  • Malformations of the spine.
  • Back pain during pregnancy: one out of two pregnant women suffers from back pain. Belly weight increases and pregnancy hormones cause spinal ligaments to loosen.

The aftermath of back trauma

  • Elongations or lesions of the dorsal musculature, following a violent movement (“turn of the kidneys”) or a shock for example.
  • Vertebral fracture or collapse following a shock.

Inflammatory or infectious problems

  • Inflammatory disorders of the vertebral joints (spondyloarthritis), vertebrae and ligaments or muscles attached to them.
  • Rarely, infection of an intervertebral disc.
  • Intercostal shingles (infection of a nerve with the varicella virus ).

Painful radiation in certain illnesses

In this kind of case the pain, although felt in the back, comes from internal organs. Some examples:

  • Radiation of pain from the gallbladder or liver (hepatic colic).
  • Radiation of pain from a kidney (renal colic).
  • Irradiation of heart pain (infarction, angina pectoris, and pericarditis).
  • Irradiation of pancreatic disease.
  • Pain in the envelope of the lungs (pleurisy, pneumothorax).

So-called “functional” pain

Various factors can accentuate pre-existing back pain.

  • Back pain during menstruation.
  • Psychic or psychosomatic illnesses.
  • Pain related to irritation of a nerve located between the ribs.

What are the possible complications of back pain?

In many cases, back pain is mild and disappears on its own within a few days or weeks (in about 90% of cases, the pain resolves itself within six weeks). However, more than half of patients experience a recurrence of back pain within a year. Chronic back pain is defined as low back pain that lasts for more than three months despite treatment. It is estimated to affect about 10% of cases of low back pain. Chronic back pain can significantly impact daily activities and can lead to depression over time.

In some cases, back pain can be caused by complications such as a collapsed vertebra in people with osteoporosis.

What is the diagnosis?

During a clinical examination and interrogation, the doctor will check for any underlying conditions that could be causing the low back pain. They will look for factors such as a history of cancer, chest pain, prolonged use of corticosteroids, or fever. If none of these conditions are present, and the patient only experiences low back pain, the doctor may not automatically recommend additional testing. French and international medical societies generally agree that imaging tests are not necessarily needed during the acute phase of low back pain, which is typically between 4 and 6 weeks.

What are the measures to prevent back pain?

When back pain is due to mechanical or muscular problems, there are a number of simple measures to prevent it.

  • Stand up straight. Avoid bending your back. Get into the habit of squatting when you want to do something low to the ground, or when you lift a weight: the effort will be on your legs and not on your back. If you have to stand for a long time, try elevating one foot (on a small stool, shoebox, curb, etc.).
  • Carry loads close to the body. When carrying luggage, hold it as close to your body as possible. The farther it is, the more intense traction it subjects the spine to. In general, avoid carrying weights of more than 10 kilos.
  • Do not twist your spine. If you must lift a package to move it a short distance, avoid pivoting in a bent over position. Squat down, lift it using your legs while keeping your back straight and, once standing, turn around so that you are facing where you want to put it.
  • Adopt a correct posture while working. Choose a seat with good back support and sit comfortably with your back straight. Place a pillow or rolled up towel behind your lower back for extra support. If you sit for a long time, it’s a good idea to relax your back muscles from time to time by standing up, walking or stretching. Neck muscles should be regularly exercised, arm rolls, shoulder shrugs, head shakes, etc.
  • Dress appropriately. High heels lead to poor posture and artificial curvature of the spine; if you have frequent back pain, wear shoes that are low enough and provide good support.
  • Sleep comfortably. A firm mattress and a correct bed base prevent back problems. Make sure your neck is well supported during sleep. Some pillows promote neck muscle relaxation.
  • Play sports. Strengthening your back and developing strong abs unload the spine and its intervertebral discs. This is why it is important to train it well with special gymnastics or appropriate sport, such as swimming, gentle gymnastics and back muscle training. There are “back schools” where you learn to hold yourself correctly, to strengthen your back and abdominal muscles, and to relax.
    Australian and Brazilian researchers analysed several studies concerning the prevention of back pain. They showed that specific physical exercise(stretching, strengthening and toning of the abdominal belt and back muscles, exercises aimed at correcting bad postures, etc.), alone or with patient education, allows better prevention of back pain (find out more in the News of February 11, 2016).
  • Lose weight. Being overweight puts a strain on the spine and can therefore cause back pain.
  • In the car, learn to sit. To sit in a car, sit down with your back. Then tuck in one leg, then the other. To exit, proceed in reverse. Do not hesitate to use the back of the seat to help you get up.
  • Drive comfortably. If you have to make a long trip, place a small pillow in your lower back and change its position from time to time. Stop every two hours to take a few steps.

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