The Bureau of Labor Statistics estimates that over one million workers suffer from a back injury each year. One national survey compiling data from the U.S. Dept of Health and Human Services, the National Center for Health Statistics, and the Centers for Disease Control and Prevention showed that twenty-one million of all 2006 physician office visits were related to back issues. Back injuries are also common in sports, with some studies estimating back injuries comprising up to 20% of all sport-related injuries.
Back Pain - Back Injuries
Anatomy Of The Back
There are many important structures in the back that contribute to normal bending and rotational movements. The bones (vertebrae), nerves, tendons, ligaments, muscles, and other supporting structures in and around your spine are essential for normal functioning.
The spine is designed so that vertebrae (the bones in the spine) are stacked atop each other as they run down the length of the center of the neck and back. As the spine descends, it’s divided into three sections: the seven vertebrae of the cervical spine (neck area), the 12 vertebrae of the thoracic spine (upper back area), and the five vertebrae of the lumbar spine (lower back area). The lumbar and thoracic vertebrae form a movable support structure that protects the delicate spinal cord and internal organs from injury. The basic design of each vertebra in the thoracic spine and lumbar spine is fairly consistent, with the overall size of each increasing as the spine descends. There’s a body, which is the large flat circular section. There are three bony processes (two transverse processes and one spinous process) that protrude from the back of the vertebrae for muscles to attach. The foramen (hole) formed by the three processes, which is where the spinal cord passes.
In between each of the vertebrae are discs that provide a cushion like padding. The jelly-like center of a disc is called the nucleus pulposus. The outer protective ring is called the annulus fibrosus.
Multiple nerves branch from the spinal cord between each of the vertebrae.
Vertebrae have two facet joints that connect the back of each vertebra with it’s neighboring vertebra.
There are many ligaments in the upper and lower back that attach bone to bone. The ligamentum flavum is a strong ligament connecting the posterior surface of each vertebra. The interspinous ligaments are between each spinous process. The interverse ligaments connect the transverse processes of neighboring vertebrae together. The anterior and posterior longitudinal ligaments are long stabilizing ligaments that run down the back and front of the vertebra bodies. The supraspinous ligament is the ligament that attaches to the tip of each spinous process.
There are also a number of deep and superficial muscles in the upper and lower back. The most often involved in back injuries are the deep transversospinalis muscles (rotatores, multifidus, semispinalis) and the deep erector spinae muscles (iliocostalis, lentissimo, and spinalis). The main larger muscles of the back are the quadratus lumborum and latissimus dorsi
What Causes Back Pain?
When any of the above structures are injured or not functioning to their full potential, it can cause back pain. The structures of the back may be injured or suffer the effects of degenerative processes from any number of events: a slip or fall, car accident, sport-related accident, workplace accident, or even from everyday activities that involve repetitive movements. Depending on the precise injury, back pain may range from intermittent to constant and from a dull ache to a sharp pain. There are some common risk factors for back pain:
* the natural degenerative effects of getting older (over 30)
* being overweight or obese
* poor physical conditioning and/or lack of physical fitness
* certain occupations and hobbies that require lifting, pulling, pushing, twisting, bending, prolonged sitting or standing, and such
* frequently participating in contact sports
What Are Some Common Types Of Back Injury And Sources Of Back Pain?
Spondylolisthesis
This is a condition where one of the spinal vertebrae slip forward (anterolisthesis) or backward (retrolisthesis) in relation to their neighboring vertebrae. There are five different types based on the causative factor of the slippage. Dysplastic spondylolisthesis is caused by a congenital malformed facet. Isthmic spondylolisthesis involves a defect in the pars interarticularis ( a part of the vertebra between articular processes). The defect is often from repetitive hyperextension motions. Degenerative spondylolisthesis affects the joints between vertebrae and is caused by arthritic cartilage degeneration. Traumatic spondylolisthesis occurs after a direct trauma to the upper or lower back. A fracture to the front portion of any of the vertebrae can cause the affected vertebra to slip forward. Pathologic spondylolisthesis is the rarest form and is caused by either bone tumors or metabolic bone disease.
Be careful not to confuse spondylolisthesis with spondylosis, which is degenerative osteoarthritis of the joints between the spinal vertebrae, or ankylosing spondylitis, which is a form of chronic inflammation of the spine and the sacroiliac joints in the lower back.
Lumbar and Thoracic Strains
A strain is an injury to a muscle that results when the muscle is abnormally stretched or torn. Strains commonly occur during lifting something too heavy, excessive or prolonged exercise, and occasionally from a direct trauma while the muscle is contracted. Strains are graded one through three based on the degree of injury to the muscle. A grade one strain involves the muscle fibers being stretched and possibly having a few microscopic tears. A grade II strain involves a moderate amount of muscle fibers being torn and some noticeable loss of muscle function. A grade three strain is extensive to complete tearing of the muscle fibers with significant to complete loss of muscle function.
Lumbar and Thoracic Sprains
Much like a strain, this is an overstretching and tearing injury. However, a sprain involves one or more ligaments in the upper or lower back. Sprains are also graded one through three based on the degree of stretching and/or tearing.
Bulging, Herniated, Or Ruptured Disc And Complications
The discs between the vertebrae are much like jelly donuts in that there is an outer shell (annulus fibrosus) and jelly-like center (nucleus pulposus). Normal wear and tear, injury, or disease processes can cause damage to the disc. The spinal discs frequently slightly bulge with age. This usually doesn’t produce any pain. However, if the outer shell cracks due to degenerative processes, repetitive use or misuse, or trauma, then the jelly-like center may be forced outwardly. This is called a ruptured or herniated disc. The pain associated with a herniated disc occurs from the rupture compressing or placing pressure on the surrounding nerves.
Cauda equina syndrome is a serious complication of a ruptured disc that occurs when the jelly-like center is pushed into the spinal canal and compresses the lumbar and sacral nerve roots.
Sciatica is a condition occurring when the jelly-like center of a herniated disc presses on the sciatic nerve. This large nerve extends down the spinal column and has nerve fibers extending into the lower extremities. When it’s compressed, the nerve produces a wave of pain that can run from the low back all the way to the foot.
Thoracic And Lumbar Spine Fractures
Spinal fractures are serious injuries. Fractured vertebra are usually caused by high-force or velocity traumas, such as a vehicle accident, fall from a height, or direct blow during a contact sport. Certain conditions affecting the back, such as osteoporosis, infection, or tumor, may weaken the back and make it more prone to fracture.
Strengthening Exercises
These Low Back Exercises are ideal to build strength and flexibility.
Massage Treatment
These Low Back Massage Techniques are of great value in pain relief; circulation stimulation; dispersing blood and fluid accumulations; swelling reduction; and relaxing muscle spasms, especially when used alongside the Sinew Therapeutics liniments and soaks.
ACUTE STAGE SYMPTOMS AND TREATMENT
This stage is characterized by swelling, redness, pain, and possibly a local sensation of heat, indicating inflammation. If coolness makes your pain feel better, then the Acute Stage Treatment is recommended.
ACUTE STAGE SYMPTOMS:
The acute stage starts the moment an injury occurs and lasts until the swelling and inflammation are gone. The swelling is the result of the blockage of blood, tissue fluids and circulation in the back because their normal movement has been disrupted by the force of the injury. Just like cars back up behind a traffic jam, causing congestion, exhaust and overheating; blood and fluids back up behind the injured back, causing pain, inflammation, lumps and swelling.
The sensation of heat is due to the warming action of the blood and fluids overheating in the injured back as they back up and accumulate. Stiffness and decreased mobility are due to spasms in tendons and ligaments that have contracted reflexively beyond their normal range from the impact of the injury.
As ligaments and tendons stretch and tear, blood from ruptured blood vessels becomes trapped in the local tissues. As the trapped blood clots up, it sticks the tissues together creating adhesions. Adhesions cause pain, inflammation and restricted movement because the layers of tissue that used to slide smoothly across one another now adhere and snap which interferes with normal functioning. It is essential to break up clotted blood as quickly as possible to prevent adhesions and scar tissue from forming.
During the acute stage it is very important to restore normal circulation to the back, break up clotted blood and stagnant fluids, reduce swelling, and reduce the redness and heat associated with inflammation. By restoring the flow of blood, fluids, and circulation in the back, then pain is relieved, damaged tissues can regenerate with healthy functional tissue, and the back can strengthen and regain it's mobility.
ACUTE STAGE TREATMENT:
1. Apply the Sinew Herbal Ice on your back to reduce redness, swelling, and inflammation while dispersing accumulated blood and fluids to help restore normal circulation to the back. This first-aid treatment is used in place of ice to significantly speed up the healing process. It reduces the swelling and inflammation more effectively than ice, allowing you to more quickly regain range of motion. Acute Sinew Liniment can be used in-between applications.
Ice is not recommended because it does not help repair damaged tissues and keeps everything in the injured area frozen, causing the stagnation of blood and fluids and the contraction of muscles, tendons and ligaments. In Chinese sports medicine ice is not used and is considered a culprit in injuries that don’t heal well.
2. Massage your back with Acute Sinew Liniment to relieve pain, reduce swelling and inflammation, break up clotted blood and stagnant fluids, and stimulate circulation of blood and fluids to help cells quickly repair damaged tissues. Sinew Herbal Ice can be used in-between applications.
3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.
CHRONIC STAGE SYMPTOMS AND TREATMENT
This stage begins once the swelling and inflammation are gone, but you still feel pain, stiffness, weakness, and/or sensitivity in cold and damp weather. If heat makes your pain feel better, then the Chronic Stage Treatment is recommended.
CHRONIC STAGE SYMPTOMS:
The chronic stage begins once the swelling and inflammation are gone, but you still feel aching pain and stiffness. This is because there are still accumulations of stagnant blood and fluids in your back that are blocking circulation and blood supply to damaged tissues, creating residual pain, stiffness and weakness. You may actually feel hard nodules like sand in the tissue, indicating accumulation, calcification, and adhesions, which all cause pain, stiffness, and joint instability.
Your back may feel more sensitive to the cold and ache in cold and damp weather due to impaired circulation. When you move your back you may hear a clicking or popping sound from the tendons and ligaments slipping very slightly in and out of their natural alignment indicating weakness and joint instability, causing chronic pain and a cycle of reinjury. These symptoms are often the result of failure to treat the injury properly from the outset and overicing.
Increasing circulation and blood supply to the damaged tissues is very important in treating chronic injuries because tendons and ligaments do not have an extensive direct supply of blood. That is why chronic injuries can be slow to heal. Increasing local circulation also prevents cold and dampness from penetrating the injured area, preventing pain and stiffness.
During the chronic stage it is very important to break up remaining accumulations of blood and fluids, and increase circulation and blood supply to the damaged tissues. By increasing circulation and blood flow in the back, then pain and stiffness is relieved, and the tendons and ligaments can strengthen to restore stability.
CHRONIC STAGE TREATMENT:
1. Massage your back with Chronic Sinew Liniment to relieve pain and stiffness, strongly stimulate circulation and blood flow to damaged tissues, and promote the healing of overstretched tendons and ligaments. The Sinew Relaxing Soak can be used in-between applications.
2. Soak your back with the Sinew Relaxing Soak to relax muscles and tendons that are in spasm, ease joint pain and stiffness, and improve range of motion. The Sinew Relaxing Soak is particularly useful if you feel restricted mobility in your back. The soak can be used by saturating a towel in the liquid and applying it to your back. Chronic Sinew Liniment can be used in-between applications.
3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.
