Hertfordshire Spine Clinic Mr Sajjad Mushtaq

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. Back pain can be acute, usually lasting from a few days to a few weeks or chronic, lasting for more than three months.

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

Anatomy

Lumbar Spine Anatomy

The spine, also called the back bone, plays a vital role in stability, smooth movement and protection of the delicate spinal cord. It is made up of bony segments called vertebra with fibrous tissue called intervertebral discs between them. The vertebra and discs form the spinal column from the head to the pelvis, giving symmetry and support to the body.

The spine can be divided into 4 parts: cervical, thoracic, lumbar and sacral region. The thoracic spine has an outward curve called kyphosis, whereas the lumbar spine has a slightly inward curve, which is called lordosis.

The lumbar spine is composed of the lower 5 vertebrae, which have been numbered L1–L5. The lowest vertebra of the lumbar spine (L5) is connected to the top of the sacrum, which is a triangular bone present at the base of the spine fitting into the two pelvic bones. In some cases, an extra or sixth lumbar vertebra may be present.

Causes of 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 more pressure, undergo twisting and turning, as well as bear more 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.

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.

Investigations

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.

Spinal Conditions

Lumbar Stenosis

Lumbar stenosis is the compression of spinal nerves caused by narrowing of spinal canal and it is one of the common causes of low back pain. Spinal stenosis can also affect the spine in neck region. The symptoms include back pain, burning or aching type of pain in buttocks that radiates to the legs (sciatica), weakness in the legs or "foot drop”.

Lumbar Herniated Disc

Herniated disc is a condition in which the outer fibres (annulus) of the intervertebral disc are damaged causing the soft inner material of the nucleus pulposus to rupture out of its space. A herniated disc, common in the lower back (lumbar spine) occurs when there is a tear in the outer lining of the disc (annulus fibrosus).

Sciatica

The sciatic nerve is a large nerve that originates in the lower back, running along the hip and back of the leg and branching off at the knee. Compression or damage of this nerve can cause pain that radiates from your lower back to the buttocks, to your legs. The intensity of pain varies from mild pain to sharp or burning pain. This may also be associated with numbness, tingling, muscle weakness or burning sensation in the hip, leg and foot. The pain is usually intensified with prolonged sitting, and exaggerated by coughing, laughing or sneezing.

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