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Most people will experience back pain at some point in their lifetime and it is one of the commonest reasons for visits to the family doctor. 1,2 The pain can range from moderate to severe and debilitating but most episodes will get better on their own with little intervention, however recurrent back pain is common, occurring in 40 % of patients within 6 months. 1,2

Most back pain is caused by damage to the structural components of the spine and is called mechanical back pain. 2 Damage can be due to: 2

Muscle strains/Ligament sprains (≥ 70% of cases)

visuals: medial back muscles
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Joint or disc
degeneration (10%)

visual: compressed back disc
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Bone fractures (4%)

visual: backbones and vertebrae
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Pinched nerves (4%)

visual: compressed back disc
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When is back pain dangerous

How can I manage my back pain

Muscles/Ligaments

visuals: medial back muscles

Muscles can be strained (stretched unusually far or abruptly) and ligaments can be sprained (overstretching or tearing) e.g. when lifting a heavy object, or jumping or throwing. 3,4

Symptoms:

  • Pain and tenderness spread all over the muscles of the back 1,2
  • Pain worsens with movement and improves with rest 1
  • Pain may or may not extend into the buttocks 1,2
  • Stiffness and loss of range of motion of the affected muscle due to muscle spasm 5,6

Disc and facet joint degeneration

visual: compressed back disc

Degenerative changes can occur in the discs between the spinal vertebrae or in the facet joints of the spine. 1,2 These changes are referred to as spondylosis and are often due to osteoarthritis (OA) of the spine. 7 Risk factors for OA include advancing age, family history, obesity, female gender, and previous trauma. 8

Symptoms:

  • Pain is usually localised to one area of the back 2
  • Pain may or may not extend into the buttocks 1,2
  • May be accompanied by muscle spasm with pain and stiffness 6

Disc degeneration

As we age the discs between the vertebrae lose water, become thinner and develop small tears in their outer layer. The inner part of the disc may also bulge or herniated through these tears. Narrowing of the disc spaces and bulging or herniated discs may compress spinal nerves.  To stabilise the joint, bony outgrowths (osteophytes) develop to compensate for the increased stress on the joint. 6

Symptoms:

  • Pain is often worsened by bending forwards or with sitting 1

Facet joint degeneration

As the discs between the vertebrae thin, more pressure is put on the posterior (facet) joints of the spine. Wear and tear on these joints results in degenerative changes (osteoarthritis) with destruction of the cartilage, narrowing of the joint space, bony outgrowths (osteophytes) and possible compression of the spinal nerves. 6

Symptoms:

  • Pain is often worsened by bending backwards and standing or walking 1
  • Secondary muscle spasm with pain and stiffness 6

Bone Fractures

visual: backbones and vertebrae

Compression fractures usually occur following severe trauma e.g. falling from a height. If a person has osteoporosis (thinning of the vertebral bone) compression fractures can occur spontaneously or after mild trauma. 1

Symptoms:

  • Tenderness at the spinal level of the fracture 1
  • Pain worsens with bending forwards 1
  • Pain worsens when pulling up from a lying down to sitting position and from a sitting to a standing position 1

Pinched Nerve

visual: compressed back disc

Degenerative changes in the discs, vertebrae and facet joints can lead to irritation, impingement or compression of the spinal nerves. 1

Symptoms:

  • Pain radiates to the hip, thigh or to below the knee 1
  • Leg pain is greater than back pain 1
  • Pain worsens when sitting 1

References: 1. Casazza BA. Diagnosis and Treatment of Acute Low Back Pain. Am Fam Phys 2012;85(4):343-350. 2. Kinkade S. Evaluation and Treatment of Acute Low Back Pain. Am Fam Phys 2007;75:1181-1188. 3. Mayo Clinic. Sprains and strains. [online] [cited 2018 Apr 19]. Available from: URL: https://www.mayoclinic.org/diseases-conditions/sprains-and-strains/symptoms-causes/syc-20377938. 4. Davis S. Managing common sport injuries in the pharmacy. S Afr Pharm J 2017;84(5):35-37. 5. Perina DG. Mechanical Back Pain. Medscape [online] 2017 Jan 24 [cited 2018 May 3]. Available from: URL: https://emedicine.medscape.com/article/822462-overview. 6. Wheeler AH. Low Back Pain and Sciatica. Medscape [online] 2018 Jan 2 [cited 2018 May 3]. Available from: URL: https://emedicine.medscape.com/article/1144130-overview. 7. Goode AP, Carey TS, Jordan JM. Low Back Pain and Lumbar Spine Osteoarthritis: How Are They Related? Curr Rheumatol Rep 2013;15(2):305. Doi:10.1007/s11926-012-03050z. 8. Sinusas K. Osteoarthritis: Diagnosis and Treatment. Am Fam Phys 2012;85(1):49-56.

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