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                            THE CAUSES OF BACK PAIN 
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       In the previous anatomy lesson we described structure. In this 
       section we take that knowledge and focus on CAUSE. 

       With a structure as complex as the spine and its supporting 
       muscles, tendons and nerves you might suspect that there could 
       be hundreds of causes of backache and back pain. Amazingly, the 
       list is small and concise. But consider that for each cause 
       listed below there may be a different therapy to alleviate each 
       specific back pain. 
       
       Backache and back pains can arise from the following sources: 
       
       Chronic or Severe Trauma such as prolonged sitting, twisting, 
       strain or sudden mechanical injuries. Poor posture or curvature 
       of the spine.  Stress or Fatigue. A "slipped" or ruptured disc. 
       Pregnancy. Birth or congenital defects. Arthritis. Systemic 
       diseases. Hormonal imbalance and aging. Tumors or infections of 
       the back or spine. 

       Lets back up a bit. 
       
       A list this short suggests that a backache is probably due to a 
       single isolated problem. In reality back pain may derive from 
       multiple causes. One cause can frequently lead to several others 
       if treatment or correction is not taken. 
       
       For example poor posture and muscle fatigue from sitting at a 
       computer terminal for extended periods of time may give way to 
       muscle fatigue which, over several years, may lead to muscle 
       weakness and loss of tone. A sudden twist or impact might then 
       rupture an intervertebral disc which would not have otherwise 
       suffered damage if muscle tone were healthy. 
       
       Another example. 
       
       Stress and fatigue at work may set the stage for chronically 
       tense back and abdominal muscles. Pain begins due to muscle 
       fatigue or spasm. Poor posture develops to attempt to compensate 
       for the pain. Over years, the poor posture can place extreme 
       pressure on the intervertebral discs, causing them to gradually 
       collapse in size. Lets examine each specific back pain cause... 
       
       Posture and spinal curvature. 
       
       Perhaps the most common cause of back pain is poor posture which 
       causes incorrect spinal curvature when standing, sitting or 
       moving about. You will recall in our previous anatomy lesson 
       that the spine has four curves. Two primary curves which arch to 
       the rear and are common to all four legged animals. The two 
       forward bending curves are unique to man and are found at the 
       level of the neck, the cervical curve, and the level of the 
       lower lumbar vertebrae, the critical lumbar curve. 
       
       Since the primary curves are a result of bony vertebral shape, 
       they are relatively stable and rarely cause problems. The 
       secondary curves are due to the positions and shapes of the 
       flexible and more delicate intervertebral discs and thus can 
       change with time, injury or disease. Poor posture can 
       dramatically increase or decrease pressures on the discs. If 
       poor posture is continued over many years, unusual stresses are 
       placed on the supporting muscles, tendons and ligaments. 

       Chronic or severe Trauma. 

       Sudden trauma causes a lot of lost time on the job. Any sudden 
       injury such as a fall, sudden twist, or blow to the back falls 
       into this category. Chronic trauma is more subtle. One example 
       could be years of poor posture at a desk or job site. Poor 
       sleeping posture or an old mattress could would be another 
       example. Driving a car and maintaining poor posture also 
       produces chronic trauma. At a certain point in time the 
       supporting structure of your back cannot stand the continued 
       strain and pain occurs. In chronic trauma, the more severe the 
       pain, the more severe the probable underlying injury. 

       Arthritis. 

       Arthritis in the classic sense simply means an inflammation of a 
       joint. Three types of arthritis can attack the bones and joints 
       of the back. 1) Rheumatoid arthritis involves the delicate 
       lining or synovium of a joint which begins to grow and destroy 
       the flexible cartilage. In its most severe form, rheumatoid 
       arthritis leads to the destruction of the joint cartilage and 
       the gradual fusing of the vertebrae together. 2) Osteoarthritis 
       is by far the most common arthritic disease. Simplifying the 
       process a bit, this form of arthritis is simply the wear and 
       tear process of old age. The delicate surfaces and tissue of the 
       intervertebral joint slowly wear down and become stiff. 3) Gouty 
       arthritis can be traced to a chemical metabolism problem which 
       allows excessive uric acid to circulate in the blood stream. 
       Crystals of uric acid then collect in specific joints such as 
       the back or the classic "gouty big toe" and extreme pain occurs. 
       Gouty arthritis is rare but has been reported in medical 
       literature. 
       
       Ruptured or "slipped" disc. 

       The first question most folks consider when severe pain visits 
       is "do I have a slipped disc?" In fact this condition is 
       uncommon as a source of back pain. In addition this condition is 
       neither "a slipping" of a disc, nor is the structure even a disc 
       at all. In reality it is a joint (not a disc) which has ruptured 
       to some degree. As we saw in our previous anatomy lesson the 
       "disc" is composed of a complex layer of tissues and is not at 
       all shaped like a cylinder or disc. Intervertebral disc joint 
       problems can visit anyone of any age, but are certainly not the 
       most common cause of back problems. However, disc injuries are 
       certainly the source of severe pain unlike that caused by bad 
       posture or muscle stress. Don't jump to the conclusion that you 
       have a slipped disc at the first sign of pain. Chances are that 
       it is probably not the most immediate cause. However it is 
       important to understand that chronic trauma, fatigue and poor 
       posture can eventually lead to an intervertebral disc rupture in 
       time. 

       Congenital defect. 

       During pregnancy and gestation a fetus develops all anatomical 
       structures it will need during life. Defects of the spine can 
       and do occur. Additional intervertebral discs can be formed. 
       Some discs may form and then fuse together. The spinal cord can 
       develop outside the spinal column. Intervertebral discs may 
       develop in incorrect positions or at unusual angles. In some 
       cases these defects can be very slight and cause pain after 
       years of adulthood. Many of these "birth defects" are treatable 
       a rare few are not. 

       Tumors and infections of the back and spine. 

       Most of these conditions are rare. The back obviously contains 
       many sites where certain classic infections can take hold. 1) 
       Meningitis is an infection of the spinal cord within the spinal 
       canal. 2) Osteomyelitis refers to an infection of the bone. 3) 
       Spondylitis involves an infection of the spine. 4) Tuberculosis 
       of the spine. Rare today but quite common and still seen in 
       medical case studies. 5) Cancer and tumors. Statistically the 
       spine and its related bony structures are relatively low 
       incidence sites for tumor growth and cancer. Tumors or growths 
       can appear on the spinal cord itself which cause intense pain. 
       Sometimes tumors developing in other areas of the body can cause 
       "referred pain" into the area of the back and spine. 

       Systemic diseases. 

       Systemic means "system-wide." A systemic disease is not 
       localized in one part of the body. A strong cold or infection 
       with the flu virus is an example. Diseases such as 
       hyperthyroidism (thyroid gland), hyperparathyroidism 
       (parathyroid gland) and Cushing's disease (adrenal gland) are 
       systemic metabolic diseases which can cause back pain. 
       Curiously, certain vitamin deficiency diseases can produce back 
       pain such as lack of vitamins A or C which causes the disease 
       scurvy and lack of vitamin D which produces rickets. 
       
       Aging and related hormonal imbalance. 

       We all get older. The structures of the back react to this 
       process in unique ways. The intervertebral discs loose 
       flexibility, dry out and gradually become compressed and 
       narrower. Treatment, exercise and understanding of proper 
       therapy can slow down this process. In women, menopause and its 
       consequential hormonal changes can cause osteoporosis or loss of 
       bone mass. Also as one ages, senile osteoporosis begins which is 
       a natural decay of bone structure and mass, regardless of sex. 

       Referred Pain. 

       Pains in the back can be caused by disease, infection or strain 
       in another part of the body. Examples here are certain kidney 
       diseases (because of their close proximity to the back,) 
       pneumonia and, in women, a "tipped" uterus or womb. The reason 
       why the pain from these conditions is felt in the region of the 
       back is the close proximity of the nerve paths serving these 
       organs or regions to the same nerves as those which serve the 
       back. The brain mistakenly "translates" the pain as arising in 
       the back because of the proximity of mixed nerves in the same 
       region. 
       
       Fatigue and Stress. 

       This is the backache caused by stress or emotion. It can be 
       completely psychological with no direct organic cause. Fear, 
       mental stress from losing a job or spouse, or even having to pay 
       the bills can cause this type of back pain. Simple fatigue, 
       anxiety and overwork can also cause back pain when muscles 
       serving the back become fatigued or occasionally lock in painful 
       spasm when you are tired and or become anxious. This is the 
       backache literally caused by the brain itself. 
       
       This tutorial is merely a starting point! For further 
       information on back care and back pain, be sure to register this 
       software ($25.00) which brings by prompt postal delivery a 
       printed, illustrated guide to back pain written by a physician 
       plus two software disks. From the main menu select "Print 
       Registration Form." Or from the DOS prompt type the command  
       ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO 
       Box 1506, Mercer Island, WA 98040. If you cannot print the order 
       form, send $25.00 to the above address and a short letter 
       requesting these materials. End of chapter. 
              

