Back pain

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Back pain
Spinal column curvature-en.svg
Different regions (curvatures) of the vertebral column
Specialty Orthopedics

Back pain (Latin: dorsalgia) is pain felt in the back. It may be classified as neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia (tailbone or sacral pain) based on the segment affected. [1] The lumbar area is the most common area affected. [2] An episode of back pain may be acute, subacute or chronic depending on the duration. The pain may be characterized as a dull ache, shooting or piercing pain or a burning sensation. Discomfort can radiate to the arms and hands as well as the legs or feet, [3] and may include numbness [1] or weakness in the legs and arms.

Contents

The majority of back pain is nonspecific and idiopathic. [4] [5] Common underlying mechanisms include degenerative or traumatic changes to the discs and facet joints, which can then cause secondary pain in the muscles and nerves and referred pain to the bones, joints and extremities. [3] Diseases and inflammation of the gallbladder, pancreas, aorta and kidneys may also cause referred pain in the back. [3] Tumors of the vertebrae, neural tissues and adjacent structures can also manifest as back pain.

Back pain is common; approximately nine of ten adults experience it at some point in their lives, and five of ten working adults experience back pain each year. [6] Some estimate that as many of 95% of people will experience back pain at some point in their lifetime. [2] It is the most common cause of chronic pain and is a major contributor to missed work and disability. [2] For most individuals, back pain is self-limiting. Most people with back pain do not experience chronic severe pain but rather persistent or intermittent pain that is mild or moderate. [7] In most cases of herniated disks and stenosis, rest, injections or surgery have similar general pain-resolution outcomes on average after one year. In the United States, acute low back pain is the fifth most common reason for physician visits and causes 40% of missed work days. [8] It is the single leading cause of disability worldwide. [9]

Classification

Back pain is classified in terms of duration of symptoms. [10]

  1. Acute back pain lasts <6 weeks
  2. Subacute back pain lasts between 6 and 12 weeks.
  3. Chronic back pain lasts for greater than 12 weeks.

Causes

There are many causes of back pain, including blood vessels, internal organs, infections, mechanical and autoimmune causes. [11] Approximately 90 percent of people with back pain are diagnosed with nonspecific, idiopathic acute pain with no identifiable underlying pathology. [12] In approximately 10 percent of people, a cause can be identified through diagnostic imaging. [12] 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. [13]

Common causes
Cause% of people with back pain
Nonspecific90% [8]
Vertebral compression fracture4% [14]
Metastatic cancer0.7% [8]
Infection0.01% [8]
Cauda equina0.04% [15]

Nonspecific

In as many as 90 percent of cases, no physiological causes or abnormalities on diagnostic tests can be found. [16] 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. [10] 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. [17] Treatment of sensitization may involve low doses of antidepressants and directed rehabilitation such as physical therapy. [18]

Spinal disc disease

Spinal disc disease occurs when the nucleus pulposus, a gel-like material in the inner core of the vertebral disc, ruptures. [19] Rupturing of the nucleus pulposus can lead to compression of nerve roots. [20] 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. [20] 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. [19] [21] 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. [22]

Lumbar disc herniation Disc herniation -- Smart-Servier.png
Lumbar disc herniation

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.[ clarification needed ] [15] Bladder incontinence is seen in later stages of cauda equina syndrome. [23]

Degenerative disease

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. [24] The space between the vertebrae becomes more narrow, resulting in compression and irritation of the nerves. [25]

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. [26] 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.

Infection

Common infectious causes of back pain include osteomyelitis, septic discitis, paraspinal abscess and epidural abscess. [19] Infectious causes that lead to back pain involve various structures surrounding the spine. [27]

Osteomyelitis is the bacterial infection of the bone. Vertebral osteomyelitis is most commonly caused by staphylococci. [19] 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.

Cancer

Spread of cancer to the bone or spinal cord can lead to back pain. Bone is one of the most common sites of metastatic lesions. Patients typically have a history of malignancy. Common types of cancer that present with back pain include multiple myeloma, lymphoma, leukemia, spinal cord tumors, primary vertebral tumors and prostate cancer. [14] Back pain is present in 29% of patients with systemic cancer. [19] Unlike other causes of back pain that commonly affect the lumbar spine, the thoracic spine is most commonly affected. [19] The pain can be associated with systemic symptoms such as weight loss, chills, fever, nausea and vomiting. [19] Unlike other causes of back pain, neoplasm-associated back pain is constant, dull, poorly localized and worsens with rest. Metastasis to the bone also increases the risk of spinal-cord compression or vertebral fractures that require emergency surgical treatment.

Autoimmune

Back pain can be caused by the vertebrae compressing the intervertebral discs. Discogenic Pain.png
Back pain can be caused by the vertebrae compressing the intervertebral discs.

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.

Referred pain

Back pain can also be referred from another source. Referred pain occurs when pain is felt at a location different than the source of the pain. Disease processes that can present with back pain include pancreatitis, kidney stones, severe urinary tract infections and abdominal aortic aneurysms. [10]

Risk factors

Heavy lifting, obesity, sedentary lifestyle and lack of exercise can increase the risk of back pain. [2] Cigarette smokers are more likely to experience back pain than are nonsmokers. [28] Weight gain in pregnancy is also a risk factor for back pain. In general, fatigue can worsen pain. [2]

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. [29] [30] [31] [32]

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. [33]

Diagnosis

Diagnostic work-up for acute back pain. Acutebackpainworkup.png
Diagnostic work-up for acute back pain.

Initial assessment of back pain consists of a history and physical examination. [35] Important characterizing features of back pain include location, duration, severity, history of prior back pain and possible trauma. Other important components of the patient history include age, physical trauma, prior history of cancer, fever, weight loss, urinary incontinence, progressive weakness or expanding sensory changes, which can indicate a medically urgent condition. [35]

Physical examination of the back should assess for posture and deformities. Pain elicited by palpating certain structures may be helpful in localizing the affected area. A neurologic exam is needed to assess for changes in gait, sensation and motor function.

Determining if there are radicular symptoms, such as pain, numbness or weakness that radiate down limbs, is important for differentiating between central and peripheral causes of back pain. The straight leg test is a maneuver used to determine the presence of lumbosacral radiculopathy, which occurs when there is irritation in the nerve root that causes neurologic symptoms such as numbness and tingling. Non-radicular back pain is most commonly caused by injury to the spinal muscles or ligaments, degenerative spinal disease or a herniated disc. [11] Disc herniation and foraminal stenosis are the most common causes of radiculopathy. [11]

Imaging of the spine and laboratory tests is not recommended during the acute phase. [19] This assumes that there is no reason to expect that the patient has an underlying problem. [36] [19] In most cases, the pain subsides naturally after several weeks. [36] People who seek diagnosis through imaging are typically less likely to receive a better outcome than are those who wait for the condition to resolve. [36]

Imaging

Magnetic resonance imaging (MRI) is the preferred modality for the evaluation of back pain and visualization of bone, soft tissue, nerves and ligaments. X-rays are a less costly initial option offered to patients with a low clinical suspicion of infection or malignancy, and they are combined with laboratory studies for interpretation.

Imaging is not warranted for most patients with acute back pain. Without signs and symptoms indicating a serious underlying condition, imaging does not improve clinical outcomes in these patients. Four to six weeks of treatment is appropriate before consideration of imaging studies. If a serious condition is suspected, MRI is usually most appropriate. Computed tomography is an alternative if MRI is contraindicated or unavailable. [37] In cases of acute back pain, MRI is recommended for those with major risk factors or clinical suspicion of cancer, spinal infection or severe progressive neurological deficits. [38] For patients with subacute to chronic back pain, MRI is recommended if minor risk factors exist for cancer, ankylosing spondylitis or vertebral compression fracture, or if significant trauma or symptomatic spinal stenosis is present. [38]

Early imaging studies during the acute phase do not improve care or prognosis. [39] Imaging findings are not correlated with severity or outcome. [40]

Laboratory studies

Laboratory studies are employed when there are suspicions of autoimmune causes, infection or malignancy. [41] [42] Laboratory testing may include white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). [11]

CT scan of the spine, showing calcification of the longitudinal posterior ligament. Ossifikation Ligamentum longitudinale posterius BWS - CT axial und sagittal.jpg
CT scan of the spine, showing calcification of the longitudinal posterior ligament.

Because laboratory testing lacks specificity, MRI with and without contrast media and often, biopsy are essential for accurate diagnosis [37]

Red flags

Imaging is not typically needed in the initial diagnosis or treatment of back pain. However, if there are certain "red flag" symptoms present, plain radiographs (X-ray), CT scan or magnetic resonance imaging may be recommended. These red flags include: [43] [11]

Prevention

Moderate-quality evidence exists that suggests that the combination of education and exercise may reduce an individual's risk of developing an episode of low back pain. [44] Lesser-quality evidence points to exercise alone as a possible deterrent to the risk of the condition. [44]

Management

Nonspecific pain

Patients with uncomplicated back pain should be encouraged to remain active and to return to normal activities.

The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible, to restore the individual's ability to function in everyday activities, to help the patient cope with residual pain, to assess for side effects of therapy and to facilitate the patient's passage through the legal and socioeconomic impediments to recovery. For many, the goal is to keep the pain at a manageable level to progress with rehabilitation, which then can lead to long-term pain relief. Also, for some people the goal is to use nonsurgical therapies to manage the pain and avoid major surgery, while for others surgery may represent the quickest path to pain relief. [45]

Not all treatments work for all conditions or for all individuals with the same condition, and many must try several treatment options to determine what works best for them. The present stage of the condition (acute or chronic) is also a determining factor in the choice of treatment. Only a minority of people with back pain (most estimates are 1–10%) require surgery. [46]

Nonmedical

Back pain is generally first treated with nonpharmacological therapy, as it typically resolves without the use of medication. Superficial heat and massage, acupuncture and spinal manipulation therapy may be recommended. [47]

  • Heat therapy is useful for back spasms or other conditions. A review concluded that heat therapy can reduce symptoms of acute and subacute low-back pain. [48]
  • Regular activity and gentle stretching exercises is encouraged in uncomplicated back pain and is associated with better long-term outcomes. [11] [49] Physical therapy to strengthen the muscles in the abdomen and around the spine may also be recommended. [50] These exercises are associated with better patient satisfaction, although they have not been shown to provide functional improvement. [11] However, one review found that exercise is effective for chronic back pain but not for acute pain. [51] Exercise should be performed under the supervision of a healthcare professional. [51]
  • Massage therapy may provide short-term pain relief, but not functional improvement, for those with acute lower back pain. [52] It may also offer short-term pain relief and functional improvement for those with long-term (chronic) and subacute lower pack pain, but this benefit does not appear to be sustained after six months of treatment. [52] There do not appear to be any serious adverse effects associated with massage. [52]
  • Acupuncture may provide some relief for back pain. However, further research with stronger evidence is needed. [53]
  • Spinal manipulation appears to provide similar effects to other recommended treatments for chronic low back pain. [54] There is no evidence it is more effective than other therapies or sham, or as an adjunct to other treatments, for acute low back pain [55]
  • "Back school" is an intervention that consists of both education and physical exercises. [56] [57] There is no strong evidence supporting the use of back school for treating acute, subacute, or chronic non-specific back pain. [56] [57]
  • Insoles appear to be an ineffective treatment intervention. [58]
  • While traction for back pain is often used in combination with other approaches, there appears to be little or no impact on pain intensity, functional status, global improvement or return to work. [59]

Medication

If nonpharmacological measures are ineffective, medication may be administered.

  • Non-steroidal anti-inflammatory drugs (NSAIDs) are typically attempted first. [47] NSAIDs have been proven more effective than placebo, and are usually more effective than paracetamol (acetaminophen). [60]
  • Long-term use of opioids has not been tested to determine whether it is effective or safe for treating chronic lower back pain. [61] [62] For severe back pain not relieved by NSAIDs or acetaminophen, opioids may be used. [63] Opioids may not be better than NSAIDs or antidepressants for chronic back pain with regard to pain relief and gain of function. [62]
  • Skeletal muscle relaxers may also be used. [47] Their short-term use has been proven effective in the relief of acute back pain. [64] However, the evidence of this effect has been disputed, and these medications do have negative side effects. [61]
  • For patients with nerve root pain and acute radiculopathy, there is evidence that a single dose of steroids, such as dexamethasone, may provide pain relief. [11]
  • Epidural corticosteroid injection (ESI) is a procedure in which steroid medications are injected into the epidural space. The steroid medications reduce inflammation and thus decrease pain and improve function. [65] ESI has long been used to both diagnose and treat back pain, although recent studies have shown a lack of efficacy in treating low back pain. [66]

Surgery

Surgery for back pain is typically used as a last resort, when serious neurological deficit is evident. [50] A 2009 systematic review of back surgery studies found that, for certain diagnoses, surgery is moderately better than other common treatments, but the benefits of surgery often decline in the long term. [67]

Surgery may sometimes be appropriate for people with severe myelopathy or cauda equina syndrome. [50] Causes of neurological deficits can include spinal disc herniation, spinal stenosis, degenerative disc disease, tumor, infection, and spinal hematomas, all of which can impinge on the nerve roots around the spinal cord. [50] There are multiple surgical options to treat back pain, and these options vary depending on the cause of the pain.

When a herniated disc is compressing the nerve roots, hemi- or partial-laminectomy or discectomy may be performed, in which the material compressing on the nerve is removed. [50] A mutli-level laminectomy can be done to widen the spinal canal in the case of spinal stenosis. A foraminotomy or foraminectomy may also be necessary, if the vertebrae are causing significant nerve root compression. [50] A discectomy is performed when the intervertebral disc has herniated or torn. It involves removing the protruding disc, either a portion of it or all of it, that is placing pressure on the nerve root. [68] Total disc replacement can also be performed, in which the source of the pain (the damaged disc) is removed and replaced, while maintaining spinal mobility. [69] When an entire disc is removed (as in discectomy), or when the vertebrae are unstable, spinal fusion surgery may be performed. Spinal fusion is a procedure in which bone grafts and metal hardware is used to fix together two or more vertebrae, thus preventing the bones of the spinal column from compressing on the spinal cord or nerve roots. [70]

If infection, such as a spinal epidural abscess, is the source of the back pain, surgery may be indicated when a trial of antibiotics is ineffective. [50] Surgical evacuation of spinal hematoma can also be attempted, if the blood products fail to break down on their own. [50]

Pregnancy

About 50% of women experience low back pain during pregnancy. [71] Some studies have suggested that women who have experienced back pain before pregnancy are at a higher risk of experiencing back pain during pregnancy. [72] It may be severe enough to cause significant pain and disability in as many as one third of pregnant women. [73] [74] Back pain typically begins at approximately 18 weeks of gestation and peaks between 24 and 36 weeks. [74] Approximately 16% of women who experience back pain during pregnancy report continued back pain years after pregnancy, indicating that those with significant back pain are at greater risk of back pain following pregnancy. [73] [74]

Biomechanical factors of pregnancy shown to be associated with back pain include increased curvature of the lower back, or lumbar lordosis, to support the added weight on the abdomen. [74] Also, the hormone relaxin is released during pregnancy, which softens the structural tissues in the pelvis and lower back to prepare for vaginal delivery. This softening and increased flexibility of the ligaments and joints in the lower back can result in pain. [74] Back pain in pregnancy is often accompanied by radicular symptoms, suggested to be caused by the baby pressing on the sacral plexus and lumbar plexus in the pelvis. [74] [72]

Typical factors aggravating the back pain of pregnancy include standing, sitting, forward bending, lifting and walking. Back pain in pregnancy may also be characterized by pain radiating into the thigh and buttocks, nighttime pain severe enough to wake the patient, pain that is increased at night or pain that is increased during the daytime. [73]

Local heat, acetaminophen (paracetamol) and massage can be used to help relieve pain. Avoiding standing for prolonged periods of time is also suggested. [75]

Economics

Although back pain does not typically cause permanent disability, it is a significant contributor to physician visits and missed work days in the United States, and is the single leading cause of disability worldwide. [8] [9] The American Academy of Orthopaedic Surgeons report approximately 12 million visits to doctor's offices each year are due to back pain. [2] Missed work and disability related to low back pain costs over $50 billion each year in the United States. [2] In the United Kingdom in 1998, approximately £1.6 billion per year was spent on expenses related to disability from back pain. [2]

Related Research Articles

<span class="mw-page-title-main">Intervertebral disc</span> Cartilage of spine

An intervertebral disc lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint, to allow slight movement of the vertebrae, to act as a ligament to hold the vertebrae together, and to function as a shock absorber for the spine.

<span class="mw-page-title-main">Sciatica</span> Lower back pain that extends down leg

Sciatica is pain going down the leg from the lower back. This pain may go down the back, outside, or front of the leg. Onset is often sudden following activities like heavy lifting, though gradual onset may also occur. The pain is often described as shooting. Typically, symptoms are only on one side of the body. Certain causes, however, may result in pain on both sides. Lower back pain is sometimes present. Weakness or numbness may occur in various parts of the affected leg and foot.

<span class="mw-page-title-main">Low back pain</span> Medical condition

Low back pain or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute, sub-chronic, or chronic. The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks.

<span class="mw-page-title-main">Lumbar spinal stenosis</span> Medical condition of the spine

Lumbar spinal stenosis (LSS) is a medical condition in which the spinal canal narrows and compresses the nerves and blood vessels at the level of the lumbar vertebrae. Spinal stenosis may also affect the cervical or thoracic region, in which case it is known as cervical spinal stenosis or thoracic spinal stenosis. Lumbar spinal stenosis can cause pain in the low back or buttocks, abnormal sensations, and the absence of sensation (numbness) in the legs, thighs, feet, or buttocks, or loss of bladder and bowel control.

<span class="mw-page-title-main">Back injury</span> Damage or wear to bones, muscles or other tissues of the back

Back injuries result from damage, wear, or trauma to the bones, muscles, or other tissues of the back. Common back injuries include sprains and strains, herniated discs, and fractured vertebrae. The lumbar spine is often the site of back pain. The area is susceptible because of its flexibility and the amount of body weight it regularly bears. It is estimated that low-back pain may affect as much as 80 to 90 percent of the general population in the United States.

<span class="mw-page-title-main">Spondylosis</span> Degeneration of the vertebral column

Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense it refers to spinal osteoarthritis, the age-related degeneration of the spinal column, which is the most common cause of spondylosis. The degenerative process in osteoarthritis chiefly affects the vertebral bodies, the neural foramina and the facet joints. If severe, it may cause pressure on the spinal cord or nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, imbalance, and muscle weakness in the limbs.

<span class="mw-page-title-main">Degenerative disc disease</span> Medical condition

Degenerative disc disease (DDD) is a medical condition typically brought on by the normal aging process in which there are anatomic changes and possibly a loss of function of one or more intervertebral discs of the spine. DDD can take place with or without symptoms, but is typically identified once symptoms arise. The root cause is thought to be loss of soluble proteins within the fluid contained in the disc with resultant reduction of the oncotic pressure, which in turn causes loss of fluid volume. Normal downward forces cause the affected disc to lose height, and the distance between vertebrae is reduced. The anulus fibrosus, the tough outer layers of a disc, also weakens. This loss of height causes laxity of the longitudinal ligaments, which may allow anterior, posterior, or lateral shifting of the vertebral bodies, causing facet joint malalignment and arthritis; scoliosis; cervical hyperlordosis; thoracic hyperkyphosis; lumbar hyperlordosis; narrowing of the space available for the spinal tract within the vertebra ; or narrowing of the space through which a spinal nerve exits with resultant inflammation and impingement of a spinal nerve, causing a radiculopathy.

<span class="mw-page-title-main">Cauda equina syndrome</span> Nerve damage at the end of the spinal cord

Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. Onset may be rapid or gradual.

<span class="mw-page-title-main">Traction (orthopedics)</span> Process for straightening broken bones

Traction is a set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system. There are two types of traction: skin traction and skeletal traction. They are used in orthopedic medicine.

<span class="mw-page-title-main">Spinal fusion</span> Immobilization or ankylosis of two or more vertebrae by fusion of the vertebral bodies

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Middle back pain, also known as thoracic back pain, is back pain that is felt in the region of the thoracic vertebrae, which are between the bottom of the neck and top of the lumbar spine. It has a number of potential causes, ranging from muscle strain to collapse of a vertebra or rare serious diseases. The upper spine is very strong and stable to support the weight of the upper body, as well as to anchor the rib cage which provides a cavity to allow the heart and lungs to function and protect them.

Failed back syndrome or post-laminectomy syndrome is a condition characterized by chronic pain following back surgeries. Many factors can contribute to the onset or development of FBS, including residual or recurrent spinal disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness, spinal muscular deconditioning and even Cutibacterium acnes infection. An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease.

<span class="mw-page-title-main">Spinal disc herniation</span> Injury to the connective tissue between spinal vertebrae

A spinal disc herniation is an injury to the intervertebral disc between two spinal vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatment may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including good posture.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

<span class="mw-page-title-main">Neck pain</span> Medical condition

Neck pain, also known as cervicalgia, is a common problem, with two-thirds of the population having neck pain at some point in their lives.

<span class="mw-page-title-main">Neurogenic claudication</span> Medical condition

Neurogenic claudication (NC), also known as pseudoclaudication, is the most common symptom of lumbar spinal stenosis (LSS) and describes intermittent leg pain from impingement of the nerves emanating from the spinal cord. Neurogenic means that the problem originates within the nervous system. Claudication, from the Latin word for to limp, refers to painful cramping or weakness in the legs. NC should therefore be distinguished from vascular claudication, which stems from a circulatory problem rather than a neural one.

Chiropractors use their version of spinal manipulation as their primary treatment method, with non-chiropractic use of spinal manipulation gaining more study and attention in mainstream medicine in the 1980s. There is no evidence that chiropractic spinal adjustments are effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including strokes and deaths, are rare.

<span class="mw-page-title-main">McKenzie method</span> Method of physical therapy

The McKenzie method is a technique primarily used in physical therapy. It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie. In 1981 he launched the concept which he called "Mechanical Diagnosis and Therapy (MDT)" – a system encompassing assessment, diagnosis and treatment for the spine and extremities. MDT categorises patients' complaints not on an anatomical basis, but subgroups them by the clinical presentation of patients.

<span class="mw-page-title-main">Spinal stenosis</span> Disease of the bony spine that results in narrowing of the spinal canal

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

<span class="mw-page-title-main">Sacroiliac joint dysfunction</span> Medical condition

The term sacroiliac joint dysfunction refers to abnormal motion in the sacroiliac joint, either too much motion or too little motion, that causes pain in this region.

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