In the past few years, doctors have been taking a closer look at backaches. More and more patients seem to be gripped with this very uncomfortable complaint.

Backaches have a huge variety of names, most of which are both inaccurate and confusing. Fibrositis, myositis, muscle strain, a chill in the kidneys, torn muscles, are but a few of the hackneyed terms that have been bandied around for decades.

Today a fairly straight-forward mechanical cause more accurately described as “nerve root pressure” is claimed by main doctors to be the main cause of pain and discomfort in aching backs.

This means that the pressure of some description is being exerted on the root of a nerve as it leaves the spinal canal from the huge nerve cord that travels down the spinal column.

Between each adjoining vertebral bone a nerve is given off, and supplies tissues and organs in the near vicinity.

Two special areas are of particular significance. In the lower neck (cervical) region and upper chest (thoracic or dorsal) region, large nerve roots are given off to join together to form the major nerves of the upper limbs.

Lower down in the back, in the so-called “lumbosacral” region, very large branches are also formed which link together to form the giant sciatic nerve which supplies the lower limbs.

The significance of nerve root pressure at any level of the spinal vertebrae, and particularly in the upper cervicodorsal region and the lower lumbosacral region is that significant symptoms may occur as a direct result of the pressure.

Not only will symptoms (usually pain) be produced locally, but symptoms may arise in the area to which the nerves travel. This is like a telephone line. Impulses starting at one end are rapidly transmitted to the other.

From a practical point of view, nerve root pressure in the neck area may produce a sore neck, shoulders, and upper back pain. At the same time, pain or tingling sensations may be felt anywhere down the arm, elbow, wrist, hand, and even fingers.

Not only pain may be experienced, but odd sensations may occur such as general irritation, sensations of “pins and needles.” numbness, and so forth. These are often referred to as paraesthesia, altered sensations from those usually experienced in normal good health.

In low back nerve root pressure, the common problem called “sciatica” occurs. This can be represented by low back pain. Or it may be shown as pain (often very severe) anywhere along the route of the giant sciatic nerve. This may extend through the buttocks, groin, thighs, knees, the lower part of the leg, into the feet, and even toes. Usually one side is affected more than the other, or it may solely be on one side.

Continuous pressure in these key areas may become serious if they are left untreated. Loss of power in the limbs, reduced reflex activity, and other long-term symptoms may become established.

In other parts of the back, other muscle intermediate groups may be affected. Some claim that internal organs may also be affected by nerve root pressure at different levels.

Besides these manifestations, there is a multitude of other causes for back pains. Direct bruising from injury may take place. Overstretched muscle fibers from sudden straining and lifting may have occurred. The old-fashioned claim of “chills” in cold, wet inclement weather may be more of a cause than is currently believed.

In women, certain gynecological causes are claimed to give rise to backache. Kidney and urinary complaints and infections are fairly well-known causes in others.

Diseases of the bone themselves, or of the joints are also notorious: arthritis, gout, and a serious condition called spondylitis are well-known causes of backache that may be long term and gradually progressive.

Actual hone diseases are also capable of producing pain, as the bony structure is gradually destroyed. Paget’s disease, TB of the bone, osteoporosis (commoner in older women) are some of the conditions in which this can happen.

The treatments advocated for backache are varied in range and nature. Often the diagnosis is relatively simple, particularly when a sudden strain or injury precedes the onset of pain. However, often the doctor wishes to be as accurate as possible in his diagnosis and will order an X-ray of the part specifically affected. This will indicate if there is any serious underlying disease present. It may also show if any gross “disc” lesion is present, an increasingly popular diagnosis.

The appropriate treatment can then be started. However, many back X-rays are perfectly normal, despite the intense pain. Causes for nerve root pressure can be many and varied.

Often simple bed rest is adequate. Several days lying on a firm mattress in the most comfortable position will bring relief automatically. Physiotherapy in the form of heat may assist. Analgesics are often prescribed.

Spinal manipulation can often bring prompt effective relief to many with nerve root pressure. In fact, it is amazing how rapidly relief can be gained by a few deft manipulations by an experienced operator.

Some doctors inject local anesthetics or steroid drugs. In persisting cases that do not respond after weeks of medical therapy, surgery is sometimes carried out. Various “disc” operations are done, particularly if there is serious nerve involvement. Nerves are sometimes cut in an operation called “rhizolysis” popular in the US recently. Disc injections using the enzyme chymopapain also has its advocates and success stories.

It largely depends on your own doctor and his preferences. Most lines of treatment bring considerable pam relief to many patients.

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