Back Pain in Different Areas: Causes, Symptoms, Treatment

Pain can occur in any section of the spine from the cervical, thoracic, lumbar, sacralm to the coccygeal. 

The pain shoots or radiates and moves to another part of the body.

The back is a large part of the human body that includes various anatomical structures, such as bones, joints, cartilage, tendons and muscles.

What causes back pain?

Frequently occurs in non-serious conditions. However, sometimes it hides a more serious disease or damage to the spine.

It is also associated with other symptoms, depending on the triggering cause, such as tingling, muscle weakness or sensory impairment.

Higher rates of back pain are attributed to a sedentary lifestyle. Some pathological spinal changes are caused by ageing and natural wear and tear, yet others by genetic predisposition or injury.

Of course, there are many specific causes.

80 to 90% of the population will have experienced back pain at least once in their lifetime.

It is a problem that limits a person's ability to work, causes suffering, and in some cases even lead to invalidity.

The pain may be acute, i.e. sudden, and subside within a few days, or chronic, persisting for a long time, years, sometimes even a lifetime.

The spine

The spine is the support of the body, it bears the weight of the upper part of the body. It ensures movement and has a protective function, as the spinal canal houses the spinal cord.

The vertebrae, intervertebral discs, small joints, ligaments and muscles are part of the spine. All of these components work together and the result is the ability to perform normal and everyday activities.

The anatomy of the spine:

• vertebrae - 33 or 34
  • cervical - 7, 
    • vertebrae Cervicales from C1 to C7 
  • thoracic - 12, 
    • vertebrae Thoracicae from Th1 to Th12
  • lumbar - 5, 
    • vertebrae Lumbales from L1 to L5
  • sacral - 5 or 6, 
    • vertebrae Sacrales S1 to S5 (S6), together forming the os sacrum - the sacrum
  • coccygeal - 4 or  5,
    • vertebrae Coccygeae Co1 - Co4 (Co5)
• there are 23 intervertebral discs
  • from the intervertebral space starting at C2 and C3 to L5 and S1
  • they absorb shock and other physical forces and ensure movement
• ligaments or fibrous connective tissue
  • short ligaments - they fix the individual vertebrae
  • long ligaments - they strengthen the whole spine
• intervertebral joints - these are the tiny articulating surfaces that are responsible for movement
  • in addition, they define a certain range of movement
  • thus preventing excessive flexion or rotation of the spine and damage to the spine
• muscles form a muscular corset, which has a movement and fixation role
• special connections - an example is the sacrum and coccyx
  • the sacral vertebrae have grown into the sacrum, which connects to the pelvis
  • the coccyx is similarly formed by the firm connection of the vertebrae

The spinal cord is housed in the spinal canal as in a case. It has spinal nerves that conduct nerve impulses from the periphery to the spinal cord and brain and back to the peripheral parts of the body.

The spinal cord extends from the brain and runs from the first cervical vertebra to the second lumbar vertebra, i.e. from C1 to L2. It is approximately 40 to 50 centimetres long and about 1 cm thick.

Outlying spinal nerves - spinal nerves form spinal segments = 31.

• 8 cervical
• 12 thoracic
• 5 lumbar
• 5 sacral
• 1 coccygeal

Each is responsible for conducting nerve impulses, information to another part of the body or organ and back to the brain. Different types of fibers conduct different information. 

By type of innervation:

• muscle - myotome
• skin - dermatome
• internal organs - viscerotome
• bones, ligaments and joints - sclerotome

The fusion of viscerotome + dermatome creates Head's zones. This gives rise to the phenomenon of the spread of nerve symptoms, as well as pain, from the internal organs to the skin area. 

A well-known example is, when a heart attack

spreads pain to the neck, mouth area, but also to

the arm, to the hand and the little finger.

Depending on which part of the nervous system in a given region has been damaged, symptoms occur and their spread throughout the body. Thus, back pain can move to the lower limb on the basis of spinal nerve oppression by the disc.

And another example is...

When the spinal cord is damaged, muscle control is impaired, i.e. paralysis occurs. This can be full or partial.

Read on and learn more: 

What are the most common causes that trigger back pain? 

Some of the main symptoms. 

Available diagnostics. 

And also briefly about treatment options.

What causes back pain?

If we ask ourselves the question that what can make our backs hurt, we come across quite a wide range of triggering causes.

In connection with this issue, we encounter frequent complications that have only a functional basis.

However, the causative agent may also be a structural change. Also other diseases. Summarizing, we get three basic possibilities.

Pain may come from:

1. functional blockade of the spinal segment
2. structural damage to the vertebra, disc, joint, ligaments and muscles
3. disease of another organ or area close to the spine

Table: 15 causes of back pain

What difficulties accompany back pain?

Spinal pain often occurs together with other ailments. Some can be endured, others limit a person in daily activities.

Back problems immobilize, incapacitate. Sometimes it's for a short time, other times long term and the most severe conditions for life.

Symptoms are:

1. acute - short term up to 1 month
2. subacute - 1 to 3 months
3. chronic - long-term, persisting for more than 3 months, years or a lifetime

Most commonly affected areas:

1. lumbar area with low back pain 60% of cases
2. cervical spine 30 % 
3. thoracic segment 10 %

1. Acute block

It has a functional basis and most often affects the cervical and lumbar spinal areas. It is then also referred to as acute cervical spine block or lumbago.

It includes:

• sudden pain
• sharp and stabbing pain
• pain is aggravated by movement
• restriction of spinal mobility
• relief posture - block posture, e.g. head sideways
• muscle stiffening
• nausea
• dizziness
• pain shooting into the head
• tinnitus

It can be caused by a sudden movement, turning the head to the side, bending quickly into a forward bend or lifting loads with the legs straight in the knees. But also after waking up and lying in the wrong position.

In this context, we can come across several terms that have similar features:

1. Cervicocranial syndrome - CC syndrome
   • neck and head pain
   • restriction of head movement
   • muscle stiffening
2. Cervicobrachial syndrome - CB syndrome
   • the pain moves from the neck:
     • on the shoulders, the neck
     • upper limbs
   • pseudoradicular character, i.e. has no precise boundaries
   • stiffening of the neck muscles
   • pain impairs neck and upper limb movement
3. Cervicovestibular syndrome - CV syndrome
   • cervical vertigo
   • neck pain with dizziness
4. chronic neck pain
   • long-term incidence
   • rather blunt character

2. Pain in the thoracic spine

The thoracic spine is less often affected. This is due to its reinforcement with the ribs, which connect here and form the rib cage. The latter protects the vital organs.

Behind the pain is mainly a block of the intervertebral joints, the joints of the ribs, or pain originating from between the ribs.

Pain in the chest area:

• pain in the thoracic spine
• radiation between the blades
• radiating to the front of the chest
  • often mistakenly referred to as cardiovascular problems and heart attacks
• stiffening of the muscles of the spine

For example:
Sharp and stabbing pain under the right or left shoulder blade, 

aggravated by movement, position, or with deeper breathing,

not typical of a heart attack and will be an extra-cardiac cause.

Sometimes it is caused by disease of other organs lodged in the chest. Examples are lung diseases, shingles - neuralgia in herpes zoster, cardiovascular diseases. Also inflammation or gall bladder stone.

Read teh article on chest pressure, which may be accompanied by pain in the middle of the back.

3. Pain in the lower back, sacral area

It is the difficulties emanating from this broad locality that occur most frequently. The cause can be the spine itself, but also numerous intra-abdominal organs.

It is referred to as Low Back Pain.

Examples of symptoms are:

• pain in the lower back, hips, lower back, buttocks, area above the buttocks
• worsening of movement difficulties
• block position at lumbago
• can be long-term and recurrent
• the pain can spread to
  • groin area
  • abdomen and lower abdomen
  • lower limbs
    • also in the case of sciatica, or sciatic neuralgia
• radicular pain
  • well circumscribed pain spread
  • lack of sensations
  • weakening of the muscles of the lower limb
  • disorder of reflexes

For example, diseases of the digestive system can be responsible for the pain transferred to this area. Examples are inflammation of the intestine, gallbladder problems or cancer.

The urinary - excretory system can be affected by inflammation of the kidneys, urinary tract or bladder.
In renal colic, kidney stoney or bladder stones are responsible.
Nausea, straining to vomit or vomiting may be associated.
Of course, pain in the abdomen, sacrum and flank, moving to the groin up to the scrotum.
Similarly in case of prostate disease in men.

Lower back pain in women

Women can feel the onset of hormonal changes. Ovulation or menstruation can be accompanied by pain in the sacrum every month.

What happens in pregnancy?

Pain occurs as at the beginning, also in the higher month of pregnancy. The reason for this is not only hormonal changes, but also the growth of the uterus and fetus. 

Symptom of delivery?

Pain in the lower abdomen, pressure on the sacrum and the anus are signs of its onset. With the first childbirth, the time to delivery of the newborn may take longer. On the contrary, second and other births are mostly faster.

Pain in this locality can also manifest itself in gynecological diseases. Inflammation, cyst or tumor.

4. Other forms

Nocturnal pain in the spine, its stiffness and inflexibility are a symptom of rheumatic disease. Similarly, it is triggered by inactivity, for example, when lying down for a long time. Conversely, also excessive load.

Pain on one side of your back?

Problems can be one-sided, but also two-sided. It mainly depends on the triggering cause and the extent of the damage. The cause can be the spine itself, the vertebrae or discs, but also a tumour and an injury.

A good example of back pain on one side and on the flank is the already mentioned renal colic. It is caused by a stone, which, by movement, irritates the sensitive mucous membrane. Depending on the kidney affected, it hurts either on the right or on the left.

Pain on the right side of the abdomen and back can cause: 

Inflammation of the appendix, i.e. appendicitis. This is due to the placement of the worm-like appendage, which is variable from person to person, as is the length of the appendix itself.

Diagnostics

In addition to the medical history, a professional examination is important. For example, the doctor assesses the condition of the spine, posture, movement, reflexes or muscle strength.

Important imaging methods::

• X-ray
• CT
• MRI

It can be supplemented with EMG, EEG to exclude cardiac causes, laboratory examination of blood.

Several doctors from different disciplines, a general practitioner for adults or children, a neurologist, an orthopedist, a neurosurgeon, a radiologist, a physiotherapist, a rheumatologist, and a traumatologist in case of injuries, cooperate in the differential diagnosis. In some cases, a psychologist or psychiatrist.

What will help with back pain?

For acute pain, a short-term regimen, i.e. bed rest and limitation of physical activity, will help. Rehabilitation and physiotherapy should then be started.

Lying in bed should not last more than 3 days. 

Warming up with warm air, warmed pillows or warm plasters helps. Medicines and treatment supplements come in various forms such as ointments, gels, plasters, sprays.

Note: 
Apply dry heat.
Never take a hot shower or bath!

Complementary treatment is also necessary. Vitamins of group B, vitamin A, C, E help. Supplements for joint pain are suitable. 

Supportive treatment and physiotherapy includes thermotherapy, paraffin, thermophoresis, as well as cold application, electrotherapy, ultrasound, magnet, traction therapy or mobilisation techniques.

Regular exercise is necessary, namely:

• initially under the guidance of a trainer
• to strengthen the back muscles
  • corset muscle
  • pelvic floor muscles
  • core
  • and lower limbs
• helpful forms of treatment:
  • SM system
  • back schools
  • therapeutic gymnastics
  • yoga
  • pilates
  • swimming

Pharmacotherapy is symptomatic, i.e. focused on the symptoms.

Symptomatic treatment includes drugs to relieve pain, relax the muscles. For inflammation, antirheumatic drugs, and for infection, antibiotics. For long-standing problems, psychopharmaceuticals are also added.

Chronic pain requires evaluation by specialists in neurology or neurosurgery. Some conditions can be treated conservatively, others require surgical treatment.

Prevention

Prevention of aggravation of already present difficulties, but also general measures for avoidance.

The key measures are:

1. good bed + mattress + pillow + grid
2. sleeping position 
   • sleeping
     • do NOT sleep on your belly
3. sitting with the correct posture
4. have the correct posture at all times
5. sufficient physical activity
   • sports, such as swimming, cycling, running and other non-contact forms
   • walks, take them daily and they should be long enough
6. ergonomics at home and in the workplace
   • working environment - suitable desk and chair 
7. limit lifting loads and strain on the spine
   • learn the correct technique
8. rational nutrition, vitamins, minerals, medicines to support joints
9. weight reduction if overweight or obese
10. footwear