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Your hips are your body’s powerhouse. You rely on them to jump, run, pick things up, and get in and out of your car. But if your hips or their surrounding muscles are tight or weak, other parts of your body from your ankles to your lower back have to step in to handle the load. That imbalance can make even the simplest activities challenging or painful…….Continue reading….

By : Alyssa Ages

Source: The Age

Critics:

There are many causes of back pain, including blood vessels, internal organs, infections, mechanical and autoimmune causes. Approximately 90 percent of people with back pain are diagnosed with nonspecific, idiopathic acute pain with no identifiable underlying pathology. In approximately 10 percent of people, a cause can be identified through diagnostic imaging.

Fewer than two percent of cases are attributed to secondary factors, with metastatic cancers and serious infections, such as spinal osteomyelitis and epidural abscesses, accounting for approximately one percent. In as many as 90 percent of cases, no physiological causes or abnormalities on diagnostic tests can be found. Nonspecific back pain can result from back strain or sprains, which can cause peripheral injury to muscle or ligaments.

Many patients cannot identify the events or activities that may have caused the strain. The pain can present acutely but in some cases can persist, leading to chronic pain. Chronic back pain in people with otherwise normal scans can result from central sensitization, in which an initial injury causes a longer-lasting state of heightened sensitivity to pain. This persistent state maintains pain even after the initial injury has healed.

Treatment of sensitization may involve low doses of antidepressants and directed rehabilitation such as physical therapy. Spinal disc disease occurs when the nucleus pulposus, a gel-like material in the inner core of the vertebral disc, ruptures. Rupturing of the nucleus pulposus can lead to compression of nerve roots. Symptoms may be unilateral or bilateral, and correlate to the region of the spine affected.

The most common region for spinal disk disease is at L4–L5 or L5–S1. The risk for lumbar disc disease is increased in overweight individuals because of the increased compressive force on the nucleus pulposus, and is twice as likely to occur in men. A 2002 study found that lifestyle factors such as night-shift work and lack of physical activity can also increase the risk of lumbar disc disease. Severe spinal-cord compression is considered a surgical emergency and requires decompression to preserve motor and sensory function.

Cauda equina syndrome involves severe compression of the cauda equina and presents initially with pain followed by motor and sensory. Bladder incontinence is seen in later stages of cauda equina syndrome. Spondylosis, or degenerative arthritis of the spine, occurs when the intervertebral disc undergoes degenerative changes, causing the disc to fail at cushioning the vertebrae. There is an association between intervertebral disc space narrowing and lumbar spine pain.

The space between the vertebrae becomes more narrow, resulting in compression and irritation of the nerves. Spondylolithesis is the anterior shift of one vertebra compared to the neighboring vertebra. It is associated with age-related degenerative changes as well as trauma and congenital anomalies. Spinal stenosis can occur in cases of severe spondylosis, spondylotheisis and age-associated thickening of the ligamentum flavum.

Spinal stenosis involves narrowing of the spinal canal and typically presents in patients greater than 60 years of age. Neurogenic claudication can occur in cases of severe lumbar spinal stenosis and presents with symptoms of pain in the lower back, buttock or leg that is worsened by standing and relieved by sitting. Vertebral compression fractures occur in four percent of patients presenting with lower back pain.

Risk factors include age, female gender, history of osteoporosis, and chronic glucocorticoid use. Fractures can occur as a result of trauma but in many cases can be asymptomatic. Common infectious causes of back pain include osteomyelitis, septic discitis, paraspinal abscess and epidural abscess. Infectious causes that lead to back pain involve various structures surrounding the spine.

Osteomyelitis is the bacterial infection of the bone. Vertebral osteomyelitis is most commonly caused by staphylococci. Risk factors include skin infection, urinary tract infection, IV catheter use, IV drug use, previous endocarditis and lung disease. Spinal epidural abscess is commonly caused by severe infection with bacteremia. Risk factors include recent administration of epidurals, IV drug use or recent infection.

Inflammatory arthritides such as ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis and systemic lupus erythematosus can all cause varying levels of joint destruction. Among the inflammatory arthritides, ankylosing spondylitis is most closely associated with back pain because of the inflammatory destruction of the bony components of the spine. Ankylosing spondylitis is common in young men and presents with a range of possible symptoms such as uveitis, psoriasis and inflammatory bowel disease.

Heavy lifting, obesity, sedentary lifestyle and lack of exercise can increase the risk of back pain. Cigarette smokers are more likely to experience back pain than are nonsmokers. Excessive weight gain in pregnancy is also a risk factor for back pain. In general, fatigue can worsen pain. A few studies suggest that psychosocial factors such as work-related stress and dysfunctional family relationships may correlate more closely with back pain than do structural abnormalities revealed in X-rays and other medical imaging scans.

Back pain physical effects can range from muscle aching to a shooting, burning, or stabbing sensation. Pain can radiate down the legs and can be increased by bending, twisting, lifting, standing, or walking. While the physical effects of back pain are always at the forefront, back pain also can have psychological effects. Back pain has been linked to depression, anxiety, stress, and avoidance behaviors due to mentally not being able to cope with the physical pain.

Both acute and chronic back pain can be associated with psychological distress in the form of anxiety (worries, stress) or depression (sadness, discouragement). Psychological distress is a common reaction to the suffering aspects of acute back pain, even when symptoms are short-term and not medically serious.

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