Back ache

Back symptoms are the most commom cause of disability in patients above 45 years of age.
Types of back pain
Local pain is caused by stretching of pain-sensitive structures that compress or irritate sensory nerve endings. The site of the pain is near the affected part of the back.

Pain referred to the back may arise from abdominal or pelvic viscera. The pain is usually described as primarily abdominal or pelvic but is accompanied by back pain and usually unaffected by posture. The patient may occasionally complain of back pain only.

Pain of spine origin may be located in the back or referred to the buttocks or legs. Diseases affecting the upper lumbar spine tend to refer pain to the lumbar region, groin, or anterior thighs. Diseases affecting the lower lumbar spine tend to produce pain referred to the buttocks, posterior thighs, or rarely the calves or feet. Provocative injections into pain-sensitive structures of the lumbar spine may produce leg pain that does not follow a dermatomal distribution. This "sclerotomal" pain may explain some cases of back and leg pain without evidence of nerve root compression.

Radicular back pain is typically sharp and radiates from the lumbar spine to the leg within the territory of a nerve root . Coughing, sneezing, or voluntary contraction of abdominal muscles (lifting heavy objects or straining at stool) may elicit the radiating pain. The pain may increase in postures that stretch the nerves and nerve roots. Sitting stretches the sciatic nerve (L5 and S1 roots) because the nerve passes posterior to the hip. The femoral nerve (L2, L3, and L4 roots) passes anterior to the hip and is not stretched by sitting. The description of the pain alone often fails to distinguish between sclerotomal pain and radiculopathy.

Pain associated with muscle spasm, although of obscure origin, is commonly associated with many spine disorders. The spasms are accompanied by abnormal posture, taut paraspinal muscles, and dull pain.



Causes of Back and Neck Pain



Congenital/developmental
Spondylolysis and spondylolisthesisa
Kyphoscoliosisa

Spina bifida occultaa

Tethered spinal corda

Minor trauma
Strain or sprain
Whiplash injuryb

Fractures
Traumatic—falls, motor vehicle accidents
Atraumatic—osteoporosis, neoplastic infiltration, exogenous steroids
Intervertebral disk herniation
Degenerative
Disk-osteophyte complex
Internal disk disruption
Spinal stenosis with neurogenic claudicationa

Uncovertebral joint diseaseb

Atlantoaxial joint disease (e.g., rheumatoid arthritis)a

Arthritis
Spondylosis
Facet or sacroiliac arthropathy
Autoimmune (e.g., anklyosing spondylitis, Reiter's syndrome)
Neoplasms—metastatic, hematologic, primary bone tumors
Infection/inflammation
Vertebral osteomyelitis
Spinal epidural abscess
Septic disk
Meningitis
Lumbar arachnoiditisa

Metabolic
Osteoporosis—hyperparathyroidism, immobility
Osteosclerosis (e.g., Paget's disease)
Vascular
Abdominal aortic aneurysm
Vertebral artery dissectionb

Other
Referred pain from visceral disease
Postural
Psychiatric, malingering, chronic pain syndromes



aLow back pain only.

bNeck pain only.

STRAIN AND SPRAIN

The terms low back sprain, strain, or mechanically induced muscle spasm refer to minor, self-limited injuries associated with lifting a heavy object, a fall, or a sudden deceleration such as in an automobile accident. These terms are used loosely and do not clearly describe a specific anatomic lesion. The pain is usually confined to the lower back, and there is no radiation to the buttocks or legs. Patients with paraspinal muscle spasm often assume unusual postures

Lumbar Disk Disease

This is a common cause of chronic or recurrent low back and leg pain . Disk disease is most likely to occur at the L4-L5 and L5-S1 levels, but upper lumbar levels are involved occasionally. The cause is often unknown; the risk is increased in overweight individuals. Disk herniation is unusual prior to age 20 and is rare in the fibrotic disks of the elderly. Degeneration of the nucleus pulposus and the annulus fibrosus increases with age and may be asymptomatic or painful. Genetic factors may play a role in predisposing some patients to disk degeneration. The pain may be located in the low back only or referred to the leg, buttock, or hip. A sneeze, cough, or trivial movement may cause the nucleus pulposus to prolapse, pushing the frayed and weakened annulus posteriorly. With severe disk disease, the nucleus may protrude through the annulus (herniation) or become extruded to lie as a free fragment in the spinal canal.


TREATMENT


treatment of the back pain depends on the underlying condition.prains and strain may be releived b y simple rest of the involved muscle.disk prolapse in some conditions need surgery.cervical spondylosis is very prevalent now a days and it is charecterized by relapses and emissions even we use the treatment