Back Pain Problems Classified by Location, Structure involved and Duration

Back pain is a very common condition among young adults and older individuals. About 80% individuals experience back pain at least once in their lives. It frequently causes absence from work, doctor visits and disabilities. 

There are numerous structures in the back. Pain may originate from any of them. Sometimes pain from other sites may be felt at back which is called referred pain. Back pain can also radiate to other sites like buttocks, thighs and legs. Structures commonly involved in back pain include:

  • Muscles: Sudden movement of the back/hip joint or long term heavy weight lifting may cause back muscle strain. Micro-tear of the muscle fibers or spasm of the strained muscle is the source of back pain. 
  • Ligaments: There are numerous ligaments that connect vertebral discs. Jerky movements of the back or weight lifting in improper way may cause ligament sprain. 
  • Intervertebral disks: These act as cushion and shock absorber between vertebral bodies. They can slip forward, backward or sideway causing spinal nerve root irritation and pain. These disks may also rupture and press on a nerve. 
  • Vertebral bodies: The density of bone reduces gradually with age. It is called osteoporosis. This process often causes remodeling of bone and thus abnormal shape such as bony protrusion leading to irritation of nearby structures. Sometimes there are compression fractures causing chronic pain. There may also be inflammation of bones known as arthritis. In this case tissue swelling and accumulation of fluid compress spinal cord and spinal nerves causing pain.
  • Spinal cord and spinal nerves: Spinal cord runs across the vertebrae and spinal nerves exit through gaps between adjacent vertebrae. Pain occurs when these delicate structures are irritated by compression or inflammation. Such irritation may originate within spinal cord/nerve itself or from surrounding structures. 
  • Pelvic organs: Organs of the lower abdomen or pelvis may be diseased and pain may be referred to lower back. Kidney stone is an example. Moreover, cancers of the abdominal organs may spread to vertebrae causing severe back pain. 
  • Lungs and heart: Angina or heart attack often causes pain between shoulder blades. Lungs diseases may also cause upper back pain. 

Types of back pain according to duration:

  1. Acute back pain: When back pain lasts less than 12 weeks, it is called acute pain. Usually muscle or ligament strain causes acute pain. It is mostly sharp and moderate to severe. 
  2. Subacute back pain: Later half of acute back pain duration (6 to 12 weeks) is known as subacute pain. Causes of subacute pain are similar to those of acute pain. 
  3. Chronic back pain: Back pain lasting more than 12 weeks is known as chronic pain. Usually degenerative diseases cause chronic back pain. 

Some specific types of back pain:

  • Severe aching pain in the lower back starting after sudden movement or weight lifting: Back muscle strain is the cause of this type of pain and occurs after sudden movement of the back, twisting or heavy weight lifting. This type of pain tends to be dull and aching with muscle spasms which may be severe enough to restrict normal walking. It aggravates on movement. Pain may be felt in the groin and buttock but it does not move to lower legs. There is local tenderness over affected muscles. 
  • Low back pain that radiates to thighs, legs and feet: Lumbar herniated disc is the cause in this type of pain. The herniated disc irritates femoral or sciatic nerve roots that serve lower limbs. When pain is felt in the front side of thighs and legs, it is known as lumbago. Pain prominently felt in the back side of thighs and legs is known as sciatica. Common characteristics of this pain include progressively increasing type of pain which is felt more in the leg and foot than in the lower back, frequently one sided (right or left leg), worsen after long periods of standing still or sitting and relieved on walking. It is accompanied by burning or tingling sensation and there may be feeling of tight rope in the leg muscles. Weakness and numbness of the legs indicate more severe condition.
  • Chronic low back pain aggravated by sitting: It is caused by degenerative disc disease. Lumbar intervertebral discs may be damaged and get inflamed. This causes instability of the vertebral column and pain, muscle spasm etc. Severity of the pain may vary from mild to disabling. It tends to be chronic and there are episodes of acute attack. Patient feels more discomfort while sitting which gets better after standing or walking. 
  • Dull and aching pain in the lower back aggravated by standing/walking: Isthmic spondylolisthesis causes this type of pain. It is a condition where a vertebra (usually L5) slips forward on the disc space below it. Pain results from instability and nerve root compression. There is sciatica like pain in the buttock and back of the thighs. Worsening of pain occurs while standing or bending backwards. Sitting makes the patient more comfortable. It may be difficult to touch toes due to tight hamstring muscles. Sometimes walking may provoke feeling of ropes in the back of the thighs.
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