In industrialised countries back pain problems limit physical abilities in people under forty-five years more than any other pathology. Chronic covers a problem persisting beyond three months, which is a typical healing time for bodily soft tissues which may be affected by the injury. There is a biological purpose to acute pain syndromes, to prevent us from continuing with an activity which is causing tissue damage and to force us to take care of the injury until it heals. Chronic pain syndromes have none of this useful biological function and appear to be without use.
Low back pain is a common occurrence and up to 20% of a nation's population may be affected by longer term or recurring bouts of pain without significant disability. Of the overall number with back pain problems around five to seven percent may fall into the severe category, exhibiting significant disability and inability to work. For this problem it is moderately frequent to employ surgical means and some of the delayed resolution of pain problems may be related to poor blood supply in spinal tissues.
Most back pain appears to be caused by traumatic events to the back or is secondary to degenerative changes which occur in the spinal discs and joints. The connection between the spinal pathology and the pain with which a patient is suffering is not completely clear as many disc prolapses and protrusions seen on MRI scanning are not symptomatic. There may be neurological and inflammatory reasons for back pain but these factors are not clear and so the pathology of low back pain overall is not well understood.
If imaging and other diagnostic studies do not reveal a plausible pathological reason for a person's back pain then it is very easy to question whether psychological factors are responsible. Although psychological factors combine in a complex way in the progress from acute back pain towards a disabling condition there is no good evidence that psychological factors can produce pain. The cause of the pain may just not be amenable to the forms of investigation now prevalent. Once the condition is present or developing however, and arguably even in the acute stage, it is vital to identify and deal with all the non-physical factors to attain the best outcome.
Claims for low back pain are highest in those occupations which involve repetitive heavy work such as operating heavy machinery, driving lorries and working on construction sites. The occurrence of back pain and sciatic leg pain appears to be high over the lifetimes of workers in work such as road construction. Sciatica only occurs in about 5% of low back pain cases but is one of the most frequent reasons for surgical management, with the L4/5 level being operated on most, followed closely by the L5/S1 level. In the United Kingdom surgery for sciatica is relatively low, but in the United States and other countries the numbers of such surgeries may be much higher.
It is in western industrialised countries that the levels of disability from chronic low back pain have become very high with typical social and economic consequences. No genetic factors have been distinguished between different races to explain the variation in causative mechanisms. The split between male and female sufferers is about equal and people report low back pain mostly in middle age when the large majority have evidence of spinal degenerative changes. Sciatica, closely related to disc changes, occurs mostly in the 30s and 40s with age 42 being the average age for lumbar discectomy.
The lumbar spine is the final flexible part of the spinal column whose function is to support the upper body and abdomen over the legs as we stand. The lumbar spine is designed to manage heavy loads compared to its size and transmits the weight via the sacroiliac joints to the sacrum and so on to the legs. The lumbar vertebrae have significant mobility and are designed to transmit load along the spine. The internal bone struts of cancellous bone form strengthened areas along the lines of typical stresses and the vertebral bodies get bigger as they go down due to the increased loads above. - 14130
Low back pain is a common occurrence and up to 20% of a nation's population may be affected by longer term or recurring bouts of pain without significant disability. Of the overall number with back pain problems around five to seven percent may fall into the severe category, exhibiting significant disability and inability to work. For this problem it is moderately frequent to employ surgical means and some of the delayed resolution of pain problems may be related to poor blood supply in spinal tissues.
Most back pain appears to be caused by traumatic events to the back or is secondary to degenerative changes which occur in the spinal discs and joints. The connection between the spinal pathology and the pain with which a patient is suffering is not completely clear as many disc prolapses and protrusions seen on MRI scanning are not symptomatic. There may be neurological and inflammatory reasons for back pain but these factors are not clear and so the pathology of low back pain overall is not well understood.
If imaging and other diagnostic studies do not reveal a plausible pathological reason for a person's back pain then it is very easy to question whether psychological factors are responsible. Although psychological factors combine in a complex way in the progress from acute back pain towards a disabling condition there is no good evidence that psychological factors can produce pain. The cause of the pain may just not be amenable to the forms of investigation now prevalent. Once the condition is present or developing however, and arguably even in the acute stage, it is vital to identify and deal with all the non-physical factors to attain the best outcome.
Claims for low back pain are highest in those occupations which involve repetitive heavy work such as operating heavy machinery, driving lorries and working on construction sites. The occurrence of back pain and sciatic leg pain appears to be high over the lifetimes of workers in work such as road construction. Sciatica only occurs in about 5% of low back pain cases but is one of the most frequent reasons for surgical management, with the L4/5 level being operated on most, followed closely by the L5/S1 level. In the United Kingdom surgery for sciatica is relatively low, but in the United States and other countries the numbers of such surgeries may be much higher.
It is in western industrialised countries that the levels of disability from chronic low back pain have become very high with typical social and economic consequences. No genetic factors have been distinguished between different races to explain the variation in causative mechanisms. The split between male and female sufferers is about equal and people report low back pain mostly in middle age when the large majority have evidence of spinal degenerative changes. Sciatica, closely related to disc changes, occurs mostly in the 30s and 40s with age 42 being the average age for lumbar discectomy.
The lumbar spine is the final flexible part of the spinal column whose function is to support the upper body and abdomen over the legs as we stand. The lumbar spine is designed to manage heavy loads compared to its size and transmits the weight via the sacroiliac joints to the sacrum and so on to the legs. The lumbar vertebrae have significant mobility and are designed to transmit load along the spine. The internal bone struts of cancellous bone form strengthened areas along the lines of typical stresses and the vertebral bodies get bigger as they go down due to the increased loads above. - 14130
About the Author:
Jonathan Blood Smyth, member of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Oxford. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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