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By Louis Neipris, M.D., HealthAtoZ writer
Two people may be diagnosed with a herniated disc between the fourth and fifth lumbar vertebrae - one a 24-year-old football player hurt when tackled and the other a 55-year-old librarian who felt terrible sharp pain after bending over to pick up a piece of paper. There are many factors leading to back pain, from lifestyle to hereditary characteristics. Several combinations of factors contribute to varying degrees. Six main factors underlying back pain include:
- Age.
- Underlying disease process.
- Poor posture.
- Excess weight.
- Sedentary lifestyle.
- Stress.
Age
Many older adults suffer from arthritis that involves one or multiple vertebrae (back bones) partially due to disc degeneration. Intervertebral discs provide cushioning and flexibility between vertebrae and lose some of their fluid. However, it's not known why some older people with a lot of back problems are more prone to pain than others.
Posture
The relationship between our backbones and their respective ligaments and tendons determines posture. Good posture is established by conscious effort, habit and heredity. Constant energy exerted by muscles around the spine help balance the vertebrae against gravity all the time, even when we sleep. Consciousness of how we hold our bodies when walking and sitting significantly helps to minimize strain against gravity and motion. Your mother was right when she said, "Don't slouch!" and "Stand up straight!" Whether due to bad habits or a hereditary condition, when posture is poor, back problems often result.
Underlying disease
Diseases may affect vertebral bones. Arthritis and cancer (especially when a tumor spreads to the spine) can impinge on the spinal cord and nerve roots, causing pain or other symptoms.
Excess weight
There is a natural curve of the lower spine or lumbar region (the third curve in the "S"). However, abdominal fat tends to pull the lumbar spine forward and downward resulting in "lordosis." The heavier we get in the mid-section, the greater weight we carry in the already vulnerable lower back. Unlike the thoracic spine, where ribs add protection - like the ribbed ceiling of a Gothic cathedral - the cervical or neck region and lower back are more vulnerable to stress and strain. The cervical spine tends to be injured when we come to a sudden stop, such as acceleration/deceleration injuries (whiplash). The lower back, over time, becomes vulnerable even to the usual, everyday demands of bending and walking.
Sedentary lifestyle
When out of shape, our muscles, including those that support the spine, atrophy or weaken from lack of use. Strong abdominal muscles provide additional protection to the lower back.
Stressful life
There are two types of stress: good stress and bad stress. When the reactions to the demands of every day life are extreme, our body reacts by tightening muscles. Our jaw muscles contract, our fists may clench and the back muscles tighten as though gearing up to flee. Unfortunately, all the extra muscle effort leaves less energy for our back to work smoothly doing the delicate balance of protecting the spine while permitting the flexibility and range of motion we tend to take for granted. The back's ready-or-not-stressful state is a set-up for injury, as stiff back muscles cannot work efficiently.
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External Sources
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The National Institute of Neurological Disorders and Stroke
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The American Academy of Orthopaedic Surgeons
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This article was reviewed and updated June 2007.
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