Oh My Aching Back

Back pain is one of the most common ailments that any of us experience. It has been stated that at least 80 to 90% of the population will at some time during their life experience a significant episode or period of back pain. For some unfortunate persons, the pain can last for months or years and be extremely disabling.

Why these problems occur is often mystifying, not only to the person who is experiencing the aching back, but also to physicians treating them. One reason is that the back is such a complicated structure compared with the other joints. It is an extremely complicated subject and not one that we intend to solve in an article written for a web site health library. Nonetheless, I wish to try to shed light on why spines actually hurt.

One observer stated that we know more about the inner workings of molecules than we do about what happens to your back when you bend over to tie your shoes.

The spinal bones or vertebrae, as they are called, are from a substance standpoint no different than other bones in that they are composed of the same material such as calcium carbonate and calcium phosphate. Each vertebra has many projections and attachments for muscles, ligaments and discs and a generous supply of veins, arteries and nerves. The anatomy is indescribably complex, which makes study of the spine very difficult.

To look at the anatomy of the spine, one would think that all spines are all the same and they are, in the sense of how the anatomy actually looks. There are, of course, a few anatomical variations, but basically the vast majority of a person's spinal structure is amazingly similar.

But, spines do not all work the same way. We each seem to have a pattern in the way our spine performs, in the way bones move and muscles contract, etc. The brain actually controls this movement. But, if muscles contract out of sequence, forces on the spine may become unbalanced and there may be an overload of tendons or muscles. That may be a major component of pain coming from the lower back.

Researchers are still trying to figure out what the safest lifting techniques are. Ignoring good advice in this regard can cause strained muscles in the back or even worse. It is very difficult to be sure which lifting styles cause problems with backs in individual persons.

It has been noted that back pain seems to come and go in those people who experience it. That is not to say that it may not be present a majority of the time; however, there do seem to be some periods during which the pain is not present. In about 10% of back pain sufferers, however, this is not the case. A percentage of back pain sufferers - perhaps as much as 10% - do not experience periods of pain relief. Their pain is present all of the time. This presents problems that not only affect the body, but the mind, also. Chronic pain can lead to periods of anxiety, depression and extended periods of time off work. It has always been known that the longer a person is off work, especially for back trouble, the less likely it is that they will return to work.


One of the most common causes of back pain is poor posture and poor body mechanics. This places unusual stress on the ligaments and muscles in the lower back which leads to pain. When people are overweight, particularly if they carry the weight in the abdominal region, this makes the abdominal muscles very weak and inadequate and they cannot function in their important role of stabilizing the trunk and assisting the back muscles. Another extremely common cause of lower back pain is wear and tear changes in the discs and small articular facet joints which are behind the discs at each vertebral level. These small joints have many nerve endings around them and if wear and tear changes are present, they can become very painful. The ligament tissues which contain the disc can actually separate or tear and disc material can bulge outward, sometimes even pressing on nearby nerves. This phenomenon has probably given rise to the term "pinched nerve".

Narrowing of the lower spinal canal where nerves need to pass through to get to the legs is known as spinal stenosis. (See Online.Orthopaedic library article on spinal stenosis). This condition is usually found in patients in their 60's or 70's. Tumors, both benign and malignant, are sometimes causes of pain and require very careful investigation. Other causes include arthritis of the spine, infections, and fractures which can occur insidiously, especially in patients with osteoporosis.

It has been known that smokers seem to have an inordinate amount of back pain, certainly greater than their percentage in the general population.

Unfortunately, discovering the exact cause of a particular patient's back pain can be, in some cases, quite difficult. Patients usually assume if they go to a doctor they will get a precise analysis and technological fix, it has been said.

Nobody can see your aching back. Only you know how it feels. It is one of the most common problems that lead patients to see their doctor and one of the most poorly understood medical and orthopedic problems that exist.

The back is a marvel of engineering on one hand, but seemingly a house of cards on the other.

In a separate Online Orthpaedics articles we will cover the appropriate treatments for various back conditions.