Back pain is one of humanity’s most frequent complaints. Acute lower back pain (also called lumbago) is the fifth most common reason for doctor’s visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year. Back pain(also known as “dorsalgia”) is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.
The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain. It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may be radiate into the arm and hand, in the upper back, or in the low back and might radiate into the leg
and foot and may include symptoms other than pain, such as weakness, numbness or tingling. The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can cause pain to radiate to the extremities.
CAUSE
Causes of neck & back pain can be degenerative, whiplash, acute or chronic disc lesions, wry neck, postural syndromes, fibromyalgia or sacroiliitis etc.
1. Back pain can be divided anatomically: neck pain (cervical), upper back (thoracic) pain, lower back (lumbar) pain or tailbone (sacral/coccygeal) pain. Shown as pelvic on picture.
2. By its duration: acute (less than 4 weeks), sub-acute (4 – 12 weeks), chronic (greater than 12 weeks).
3. By its cause: Mechanical, postural, infectious, cancer, etc.
Approximately 98% of back pain patients are diagnosed with nonspecific acute back pain which has no serious underlying pathology. However, secondary back pain which is caused by an underlying condition accounts for nearly 2% of the cases. Underlying pathology in these cases may include matestatic cancer, spinal osteomyelitis and epidural abscess which account for 1% of the patients.
Also, herniated disc is the most common neurological impairment which is associated with this condition, from which 95% of disc herniations occur at the lowest two lumbar intervertebral level.
SYMPTOMS
There are several potential sources and causes of neck & back pain.
One potential source of back pain is skeletal muscles of the back. Potential causes of pain in muscle tissue include muscle strains (pulled muscles), muscle spasm and muscle imbalances – the patient describe a muscular type pain felt in any part of the back or neck, which improves with applying heat.
Another potential source of low back pain is the synovial joints of the spine (e.g. zygapophyseial joints / facet joints). These have been identified as the primary source of the pain in approximately one third of people with chronic low back pain, and in most people with neck pain following whiplash. In these cases, patients experience pain closer to the spine itself and movement may be limited.
There are several common other potential sources and causes of back pain: these include spinal disc herniation and degenerative disc disease, spondylolisthesis, osteoarthritis (degenerative joints disease) and spinal stenosis, trauma, cancer, infection, fractures and inflammatory disease. Radicular pain or nerve pain(sciatica) is distinguished from ‘nonspecific’back pain, and may be diagnosed without invasive diagnostic tests. Pain radiates into the hip or leg and can occur without any pain or discomfort being experienced in the back itself. Pain can be of a high intensity and constant and might not react to pain medication.
TREATMENT
The main goal when treating neck & 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 to 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 be the the only option- however this is the last way out and will be confirmed by numerous diagnostic tests including x-rays, MRI etc. Only a minority of back pain patients require surgery.
Not all treatments are effective for all conditions or all individuals – many find that they need to try several treatment
options. The present stage of the condition (acute or chronic) is also a determining factor in the choice of treatment.
Exercises can be an effective approach to reducing pain, but should be done under supervision of a licensed health professional. Physiotherapy consisting of spinal manipulation, manual therapy, dry needling and exercise, including stretching and strengthening (with specific focus on the muscles which support the spine – core stability) is effective. Taping might even be used. Education and attitude adjustment as well as postural correction and ergonomic evaluation are important
⦁ Pregnant Women
Since the use of medication is very limited for pregnant women, physiotherapy can be a very useful therapy treating a variety of conditions including:
– Lower Back Pain
– Sacroiliitis: The sacroiliac joints link your pelvis and lower spine. They’re made up of the sacrum — the bony structure above your tailbone and below your lower vertebrae — and the top part (ilium) of your pelvis. There are sacroiliac joints in both the right and left sides of your lower back. Strong ligaments hold these joints in place – these ligaments soften during pregnancy in preparation for the birth process. The sacroiliac joints support the weight of your upper body when you stand. These joints often become inflamed during pregnancy due to strain caused by the extra weight carried and altered posture.
– Abdominal Strengthening,
– Sinusitis,
– Headaches
– Carpal Tunnel Syndrome. Refer to hand and wrist pain Physiotherapists do manual therapy which is safe through-out your pregnancy.
Breast Tenderness and Mastitis(milk fever) can also be treated post delivery utilising ultrasound and laser therapy etc.