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60-403: Back pain is a common medical condition, generally benign in origin. The central feature of the human back is the vertebral column , specifically the length from the top of the thoracic vertebrae to the bottom of the lumbar vertebrae , which houses the spinal cord in its spinal canal , and which generally has some curvature that gives shape to the back. The ribcage extends from the spine at

120-538: A cause can be identified through diagnostic imaging. 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. In as many as 90 percent of cases, no physiological causes or abnormalities on diagnostic tests can be found. Nonspecific back pain can result from back strain or sprains, which can cause peripheral injury to muscle or ligaments. Many patients cannot identify

180-438: A deep group. The superficial group, also known as the appendicular group, is primarily associated with movement of the appendicular skeleton. It is composed of trapezius , latissimus dorsi , rhomboid major , rhomboid minor and levator scapulae . It is innervated by anterior rami of spinal nerves , reflecting its embryological origin outside the back. The intermediate group is also known as respiratory group as it may serve

240-602: A higher risk of experiencing back pain during pregnancy. It may be severe enough to cause significant pain and disability in as many as one third of pregnant women. Back pain typically begins at approximately 18 weeks of gestation and peaks between 24 and 36 weeks. 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. Biomechanical factors of pregnancy shown to be associated with back pain include increased curvature of

300-402: 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

360-449: A narrow strap behind the neck and a narrow strap behind the middle of the back, so that it is mostly backless. This design resembles many bikini tops, although it covers the chest more and may cover some, all or even none of the abdomen at the front. It has been suggested that the neckline's appeal stems from the fact that "it eliminated the need for spoiling the back detail with straps, leaving an uninterrupted area of skin to expose to

420-496: A person across the back with a whip was both a common form of punishment of criminals, and a common means of forcing slaves to work. As well, self-flagellation, as in self punishment, may include the use of whipping oneself. This is one method of mortification, the practice of inflicting physical suffering on oneself with the religious belief that it will serve as penance for one's own sins or those of others. While more moderate forms of mortification are widely practiced—particularly in

480-462: A possible deterrent to the risk of the condition. 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

540-425: A respiratory function. It is composed of serratus posterior superior and serratus posterior inferior . Like the superficial group, it is innervated by anterior rami of spinal nerves. The deep group, also known as the intrinsic group due to its embryological origin in the back, can be further subdivided into four groups: The deep group is innervated by the posterior rami of spinal nerves . The lungs are within

600-565: A result of trauma but in many cases can be asymptomatic. Common infectious causes of back pain include osteomyelitis , septic discitis , paraspinal abscess and epidural abscess . Infectious causes that lead to back pain involve various structures surrounding the spine. Osteomyelitis is the bacterial infection of the bone. Vertebral osteomyelitis is most commonly caused by staphylococci . Risk factors include skin infection, urinary tract infection, IV catheter use, IV drug use, previous endocarditis and lung disease. Spinal epidural abscess

660-492: 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

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720-538: A source of pain. Back pain is the second most common type of pain in adults (the most common being headaches). By far the most common cause of back pain is muscle strain. The back muscles can usually heal themselves within a couple of weeks, but the pain can be intense and debilitating. Other common sources of back pain include disc problems, such as degenerative disc disease or a lumbar disc herniation , many types of fractures, such as spondylolisthesis or an osteoporotic fracture, or osteoarthritis . The curvature of

780-497: Is a major contributor to missed work and disability. 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. 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

840-437: 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. 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. For patients with subacute to chronic back pain, MRI

900-507: Is commonly caused by severe infection with bacteremia . Risk factors include recent administration of epidurals, IV drug use or recent infection. 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 . Back pain

960-470: Is holding the dress or shirt up. If a bra is worn with a halter top, it is generally either strapless or of halterneck construction itself, to avoid exposing the back straps of a typical bra. A halter top is a type of sleeveless shirt similar to a tank top (by the American English definition) but with the straps being tied behind the neck. In another style of the halter top, there is only

1020-406: 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

1080-452: Is no reason to expect that the patient has an underlying problem. In most cases, the pain subsides naturally after several weeks. 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. 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

1140-404: Is nonspecific and idiopathic . 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. Diseases and inflammation of the gallbladder , pancreas , aorta and kidneys may also cause referred pain in the back. Tumors of

1200-474: 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: 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. Lesser-quality evidence points to exercise alone as

1260-420: Is present in 29% of patients with systemic cancer. Unlike other causes of back pain that commonly affect the lumbar spine, the thoracic spine is most commonly affected. The pain can be associated with systemic symptoms such as weight loss, chills, fever, nausea and vomiting. Unlike other causes of back pain, neoplasm -associated back pain is constant, dull, poorly localized and worsens with rest. Metastasis to

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1320-722: 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. Early imaging studies during the acute phase do not improve care or prognosis. Imaging findings are not correlated with severity or outcome. Laboratory studies are employed when there are suspicions of autoimmune causes, infection or malignancy. Laboratory testing may include white blood cell (WBC) count , erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Because laboratory testing lacks specificity, MRI with and without contrast media and often, biopsy are essential for accurate diagnosis Imaging

1380-527: Is the fifth most common reason for physician visits and causes 40% of missed work days. It is the single leading cause of disability worldwide. Back pain is classified in terms of duration of symptoms. There are many causes of back pain, including blood vessels, internal organs , infections , mechanical and autoimmune causes. Approximately 90 percent of people with back pain are diagnosed with nonspecific, idiopathic acute pain with no identifiable underlying pathology. In approximately 10 percent of people,

1440-468: Is typically exposed frequently by many types of shirts in woman's fashion, and even the more conservative shirts and blouses will reveal the lower back. This happens for a variety of reasons- the lower waist area is a pivot point for the body and lengthens and arches as a person sits or bends. Secondly, woman's fashion typically favors tops that are waist length, allowing the back to be left bare during slight movement, bending or sitting. The back also serves as

1500-580: Is typically used as a last resort, when serious neurological deficit is evident. 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. Surgery may sometimes be appropriate for people with severe myelopathy or cauda equina syndrome . 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

1560-445: The cauda equina and presents initially with pain followed by motor and sensory. Bladder incontinence is seen in later stages of cauda equina syndrome. 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. The space between

1620-424: 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 . Disc herniation and foraminal stenosis are the most common causes of radiculopathy. Imaging of the spine and laboratory tests is not recommended during the acute phase. This assumes that there

1680-415: The nucleus pulposus , a gel-like material in the inner core of the vertebral disc, ruptures. Rupturing of the nucleus pulposus can lead to compression of nerve roots. 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. The risk for lumbar disc disease is increased in overweight individuals because of

1740-403: 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. Some estimate that as many of 95% of people will experience back pain at some point in their lifetime. It is the most common cause of chronic pain and

1800-671: The Catholic Church—self flagellation is not encouraged by mainstream religions or religious leaders. A well-known instrument used for flagellations is the infamous Cat 'o Nine Tails , a nine-corded whip with one handle enabling a much more effective whipping than would be possible with only one lashing at a time. Back pain 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

1860-540: The Germanic words meaning "that by which anything is held". Halter is part of the German word for bra, Büstenhalter . The halter style is used with swimsuits , to maximize sun tan exposure on the back and minimize tan lines . It is also used with dresses or shirts , to create a backless dress or top. The neck strap can itself be covered by the wearer's hair , leaving the impression from behind that nothing

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1920-535: The United States. In the United Kingdom in 1998, approximately £1.6 billion per year was spent on expenses related to disability from back pain. Haltertop Halterneck is a style of women's clothing strap that runs from the front of the garment around the back of the neck, generally leaving the upper back uncovered. The name comes from livestock halters . The word "halter" derives from

1980-410: The baby pressing on the sacral plexus and lumbar plexus in the pelvis. 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

2040-553: The back provides support for the head and trunk of the body, strength in the trunk of the body, as well as a great deal of flexibility and movement. The upper back has the most structural support, with the ribs attached firmly to each level of the thoracic spine and very limited movement. The lower back (lumbar vertebrae) allows for flexibility and movement in back bending (extension) and forward bending (flexion). It does not permit twisting. The back comprises interconnecting nerves, bones, muscles, ligaments, and tendons, all of which can be

2100-402: The back that typically cannot be reached to be scratched is sometimes named acnestis . An itch there can be irritant, leading to the development and use of backscratchers . Many English idioms mention the back, usually highlighting it as an area of vulnerability; one must "watch one's back", or one may end up "with one's back up against the wall"; worse yet, someone may "stab one in

2160-603: The back", but hopefully a friend "has got one's back". " Wetback " is a derogatory name in American English for immigrants who cross the US-Mexico border illegally (purportedly swimming though the Rio Grande ). The back is also a symbol of strength and hard work, with those seeking physical labor looking for "strong backs", and workers being implored to "put their back into it". Historically, flagellation of

2220-432: The bone also increases the risk of spinal-cord compression or vertebral fractures that require emergency surgical treatment. 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

2280-414: The case of spinal stenosis. A foraminotomy or foraminectomy may also be necessary, if the vertebrae are causing significant nerve root compression. 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 . Total disc replacement can also be performed, in which

2340-620: The daytime. Local heat, acetaminophen (paracetamol) and massage can be used to help relieve pain. Avoiding standing for prolonged periods of time is also suggested. 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. The American Academy of Orthopaedic Surgeons report approximately 12 million visits to doctor's offices each year are due to back pain. Missed work and disability related to low back pain costs over $ 50 billion each year in

2400-576: The events or activities that may have caused the strain. 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. Treatment of sensitization may involve low doses of antidepressants and directed rehabilitation such as physical therapy . Spinal disc disease occurs when

2460-420: The female back is a frequent theme in paintings, because the sensibilities of many cultures permit the back to be shown nude - implying full nudity without actually displaying it. Indeed, the practice of showing explicitness on the lower back has been performed for centuries. Certain articles of clothing, such as the haltertop and the backless dress , are designed to expose the back in this manner. The lower back

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2520-475: 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. Initial assessment of back pain consists of a history and physical examination. Important characterizing features of back pain include location, duration, severity, history of prior back pain and possible trauma. Other important components of

2580-437: The increased compressive force on the nucleus pulposus, and is twice as likely to occur in men. 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. 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

2640-611: 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 . 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 . Heavy lifting, obesity, sedentary lifestyle and lack of exercise can increase

2700-408: The largest canvas for body art on the human body. Because of its size and the relative lack of hair, the back presents an ideal canvas on the human body for lower back tattoos , mostly among young women. Indeed, some individuals have tattoos that cover the entirety of the back. Others have smaller tattoos at significant locations, such as the shoulder blade or the bottom of the back. The part of

2760-444: The lower back, or lumbar lordosis , to support the added weight on the abdomen. 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. Back pain in pregnancy is often accompanied by radicular symptoms , suggested to be caused by

2820-403: The nerve roots around the spinal cord. 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. A multi-level laminectomy can be done to widen the spinal canal in

2880-407: 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. 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

2940-476: 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. Not all treatments work for all conditions or for all individuals with

3000-424: The ribcage, and extend to the back of the ribcage making it possible for them to be listened into through the back. The kidneys are situated beneath the muscles in the area below the end of the ribcage, loosely connected to the peritoneum . A strike to the lower back can damage the kidneys of the person being hit. The skin of the human back is thicker and has fewer nerve endings than the skin on any other part of

3060-569: The risk of back pain. Cigarette smokers are more likely to experience back pain than are nonsmokers. Weight gain in pregnancy is also a risk factor for back pain. In general, fatigue can worsen pain. 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. Back pain physical effects can range from muscle aching to

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3120-404: 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. Back pain is generally first treated with nonpharmacological therapy, as it typically resolves without

3180-431: The segment affected. The lumbar area is the most common area affected. 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 , and may include numbness or weakness in the legs and arms. The majority of back pain

3240-416: The source of the pain (the damaged disc) is removed and replaced, while maintaining spinal mobility. 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

3300-509: 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. Risk factors include age, female gender, history of osteoporosis, and chronic glucocorticoid use. Fractures can occur as

3360-466: The spinal cord or nerve roots. 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. Surgical evacuation of spinal hematoma can also be attempted, if the blood products fail to break down on their own. About 50% of women experience low back pain during pregnancy. Some studies have suggested that women who have experienced back pain before pregnancy are at

3420-483: The top of the back (with the top of the ribcage corresponding to the T1 vertebra ), more than halfway down the length of the back, leaving an area with less protection between the bottom of the ribcage and the hips. The width of the back at the top is defined by the scapula , the broad, flat bones of the shoulders. The muscles of the back can be divided into three distinct groups; a superficial group, an intermediate group and

3480-504: The torso. With some notable exceptions (see, e.g., George "the Animal" Steele ), it tends to have less hair than the chest on men. The upper-middle back is also the one area of the body which a typical human under normal conditions might be unable to physically touch. The skin of the back is innervated by the dorsal cutaneous branches , as well as the lateral abdominal cutaneous branches of intercostal nerves . The intricate anatomy of

3540-554: The use of medication. Superficial heat and massage, acupuncture and spinal manipulation therapy may be recommended. There is poor evidence for the effectiveness of most interventional treatments (drugs and surgery) for back pain and hence non-interventional treatments should be prioritized in the vast majority of cases. If nonpharmacological measures are ineffective, medication may be administered. However, caution should be undertaken with medications as long-term results of painkiller usage are worse than short-term. Surgery for back pain

3600-458: The vertebrae becomes more narrow, resulting in compression and irritation of the nerves. 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

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