Symptoms of Upper Back Pain

Many cases of upper back pain (or mid-back pain) are caused by problems affecting the soft tissues in your spine (eg, muscles, nerves, ligaments, and tendons). Sprain, strain, and muscle tension are common soft tissue injuries that may cause pain and other symptoms in your upper and middle back. This article describes symptoms of upper back pain, including the red flags you should never ignore.
Sprain, strain, and muscle tension are common soft tissue injuries that may cause pain and other symptoms in your upper and middle back. Photo Source: 123RF.com.

Most Upper Back Symptoms Relate to Your Spinal Muscles

Because upper pain is closely linked to soft tissue injuries, the most common symptoms affect your spinal muscles:

• Stiffness
• Spasm
• Pain (ranging from dull to sharp)
• Tightness
• Tenderness when the injured area is touched
• Headache

Some people with upper or mid-back pain feel pain when they sneeze or cough. Similarly, you may also feel upper back pain when you take a deep breath because the vertebrae (the spinal bones) in your upper back (also known as the thoracic spine) are connected to the ribs. However, severe pain when breathing may be a sign of a more serious medical condition (you can read more on this below).

Though upper back pain symptoms generally occur anywhere along the spine between the base of the neck (cervical spine) and bottom of the ribs, you may also feel upper back pain in your shoulders and neck. That’s because all your muscles are connected, so if it’s a muscle problem causing your upper back pain, the other muscles in your shoulders and neck can be affected.

Upper back pain symptoms can stem from several causes. Poor body mechanics, twisting movements, poor posture, improper lifting techniques, carrying a heavy load (eg, wearing a heavy backpack), or repetitive movements are common culprits. Traumatic events (eg, a fall or car accident) may also lead to upper back pain. But there are many other possible causes of upper back pain, and your doctor will help determine the underlying cause of your pain to find the solution.

In most cases, upper back pain does not indicate a serious medical problem. However, some symptoms warrant urgent medical care.

What Upper Back Symptoms Warrant a Trip to the Doctor?

Most bouts of upper back pain gradually go away on their own or with conservative at-home treatment (eg, over-the-counter medication). However, some symptoms are more serious than others and require swift medical attention.

Call your doctor if you experience any of the following upper back pain symptoms:

• Severe, persistent upper or mid-back pain that develops suddenly
• Pain that is progressively worsening
• Pain that hasn’t gone away in a week
• Pain that is interfering with your daily life (eg, forces you to call in sick to work)
• Pain that isn’t responding to conservative treatment (eg, anti-inflammatory medication, ice/heat therapy, and massage)
• Neurologic symptoms (eg, numbness, tingling, weakness, loss of bowel/bladder control, and/or electric shock-like pain in your arms and/or legs)

In rare cases, upper back pain is indicative of a serious and/or painful medical problem, including lung cancer, kidney stones, or spinal infection.

Additionally, because the thoracic spine is linked to the ribs, some people with upper back pain report sharp pain when filling their lungs with air to take a deep breath. Though this symptom may be benign, it could also be a sign of a blood clot. If you feel faint, short of breath, or a spike in upper or mid-back pain when you take a deep breath, see your doctor immediately to rule out a potentially life-threatening pulmonary embolism.

Finally, it’s especially important to see a doctor after you’ve endured a traumatic injury, such as a fall. Even if you aren’t experiencing any back pain, you should be evaluated by a physician to ensure your spine did not sustain damage (eg, a spinal fracture in your upper back).

Upper Back Symptoms: When in Doubt, See Your Doctor

Because the thoracic spine isn’t as susceptible to certain spinal disorders (namely those that affect the intervertebral discs and spinal joints) as the cervical spine or lumbar spine (low back), some people may think it’s immune to pain or other problems. This certainly isn’t the case.

Common symptoms of upper back pain—like muscle pain, stiffness, and tightness—are often caused by poor body mechanics or spinal injury. But in very rare cases, upper back pain is a sign of a more serious medical issue. If your upper or mid-back pain just won’t go away or if it’s interfering with your daily life, call your doctor. He or she will get to the root of your upper back pain, create a treatment plan for you, and help you learn ways to potentially prevent it in the future.

Do you have stabbing pain in your upper back?

How many times have you had a stabbing pain in your upper back that increased with breathing or rolling in bed? Or even felt like s sharp pain into your heart when you take a deep breath? Or maybe felt a tension in a specific point in near your spine after sitting all day behind the desk? All what I mentioned are some of the signs and symptoms related to interscapular pain, imagine a muscle as small as the rhomboids can cause all of this!

Before digging into more details let’s go back to the anatomy of this muscles:
Location:

The rhomboid muscle group (composed of the rhomboid major and rhomboid minor muscles) is found lying deep to the Trapezius muscle, between the spine and the scapula in the mid- back region.

Function:

The rhomboid muscles function is to position the scapula during various movements of the shoulder and arm.

Muscle Actions:

Scapular adduction (pulling the shoulder blade towards the spine) as well as scapular elevation and rotation to smoothen the shoulder movement.

Antagonist:

Pectoralis major & serratus anterior. Excess muscle tension in the pectoralis muscles and inhibition of serratus anterior are common and will often overload the rhomboid muscles. This relationship allows trigger point activity to spread easily between these muscle groups.

Synergistic Muscle Groups:

Levator scapule, upper trapezius, middle trapezius fibers, latissimus dorsi. Those muscles help the rhomboids in their movement and share similar biomechanical functions with them, and may become overloaded if they are unable to perform their workload due to trigger point activity or injury. Which will eventually overload the rhomboids and cause trigger points.

Treatment:

The treatment is usually based on the medical practitioner perspective, some of them would prefer myofascial release, others would needle the rhomboids, and some will adjust the ribs or the thoracic spine. Well from my point of view all of them works! All of these techniques do have an effect of the muscle tension and trigger points, but are they enough? This is the main reason behind this article, why does it happen again and again no matter how many times the patient receive treatment? And why is it very common nowadays?

If we think of the body as a mechanical system integrated together and understood how it functions in motion, only then we can realize that localized treatment will not be enough for the mechanical injuries as we will be treating the symptoms not the causing factors.

Since this injury is common and non-traumatic, then what is the reason behind it? If we noticed the antagonist muscles work on the shoulder movement and some of the synergist works on the neck movements.

Due to our daily living posture requirements we end up by developing wrong postural habits in the way we are sitting behind the desk, scrolling in our mobiles, driving cars, watching TV any many more tasks that we do on daily basis. All the wrong habits will lead up to a rounded shoulders and text neck position, which eventually will end up with weak and inhibited rhomboids causing interscapular pain! What I am trying to deliver here is local rhomboids treatments are not enough for such condition especially for people who suffer from recurrence interscapular pain.

From my own point of view, Releasing and stretching the chest muscles which are main cause of the rounded shoulder position, and activating the deep neck flexors which are inhibited by the text neck position, as well as facilitating the Serratus anterior for more efficient scapular motion while the shoulder is in motion are absolutely crucial to be included in the treatment plan, however postural tips and instructions are as important as any other therapeutic exercise.

An In-Depth Overview of Low Back Pain

1. How Common Is Lower Back Pain?
2. What Are the Causes of Lower Back Pain?
3. Importance of An Accurate Diagnosis
4. Mechanical Lower Back Pain
5. Inflammatory Lower Back Pain
6. Lower Back Pain Caused by Infection
7. Fractures and Lower Back Pain
8. Lower Back Pain and Cancer
9. Referred Pain to the Lumbar Spine
10. Chronic Lower Back Pain
11. When Are Certain Diagnostic Tests Necessary?
12. Treatment Options for Acute Lower Back Pain
13. Surgery for Lower Back Pain
14. Summary
15. Useful Links and References

Two out of every three adults suffer from low back pain at some time. Back pain is the No. 2 reason adults visit a doctor and the No. 1 reason for orthopedic visits. It keeps people home from work and interferes with routine daily activities, recreation, and exercise. The good news is that for 9 out of 10 patients with low back pain, the pain is acute, meaning it is short-term and goes away within a few days or weeks. There are cases of low back pain, however, that take much longer to improve, and some that need evaluation for a possible cause other than muscle strain or arthritis.

Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and/or range of motion, or an inability to stand straight.

What Structures Make Up the Back?[1]

The back is an intricate structure of bones, muscles, and other tissues that form the back, or posterior part of the body’s trunk, from the neck to the pelvis. At the center is the spinal column, which not only supports the upper body’s weight but houses and protects the spinal cord – the delicate nervous system structure that carries signals that control the body’s movements and convey its sensations. Stacked on top of one another are about 30 bones – the vertebrae – that form the spinal column, also known as the spine. Each of these bones contains a roundish hole that, when stacked in line with all the others, creates a channel that surrounds the spinal cord. The spinal cord descends from the base of the brain and extends (in the adult) to just below the rib cage.

Vertebrae are bones that form the spinal column. Small nerves (“roots”) enter and come out from the spinal cord through spaces between the vertebrae. Because the bones of the spinal column continue growing long after the spinal cord reaches its full length in early childhood, the nerve roots to the lower back and legs extend many inches down the spinal column before exiting. This large bundle of nerve roots was dubbed by early anatomists as the cauda equina, or horse’s tail. The spaces between the vertebrae are maintained by round, spongy pads of cartilage called intervertebral discs that allow for flexibility in the lower back and act much like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column.

Starting at the top, the spine has four regions:

• The seven cervical or neck vertebrae (labeled C1-C7)
• The 12 thoracic or upper back vertebrae (labeled T1-T12)
• The five lumbar vertebrae (labeled L1-L5), which we know as the lower back, and
• The sacrum and coccyx, a group of bones fused together at the base of the spine.

Image courtesy of www.SpineUniverse.com

The vast majority of patients experience back pain because of mechanical reasons. They strain a muscle from heavy lifting or twisting, suffer a sudden jolt in a car accident, experience stress on spinal bones and tissues resulting in a herniated disc, or suffer from osteoarthritis, a potentially painful degeneration of one or more joints. Common causes for low back pain are as follows:

• Mechanical or Functional Injury (97%)
• Inflammation
• Fracture
• Active Infection
• Neoplastic
• Referred Pain

To choose the safest and most effective therapy, doctors need to consider the full spectrum of possible underlying issues, such as inflammatory conditions, fracture, infection, as well as some serious conditions unrelated to the back that radiate pain to the back.

The physician will need to take a careful medical history and do a physical exam to look for certain red flags that indicate the need for an X-ray or other imaging test. In most cases, however, imaging such as X-ray, MRI (magnetic resonance imaging), or CT (computerized tomography) scan is unnecessary.

There may also be certain clues in a patient’s medical history. Low back, nonradiating pain is commonly due to muscle strain and spasm. Pain that radiates into the buttock and down the leg may be due to sciatica, a condition in which a bulging (protruding) disc presses on the sciatic nerve, which extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This nerve compression causes pain in the lower back radiating through the buttocks and down one leg to below the knee, often combined with localized areas of numbness. In the most extreme cases, the patient experiences weakness in addition to numbness and pain, which suggests the need for quick evaluation.

A persistent shooting or tingling pain may suggest lumbar disc disease. A pain that comes and goes, reaching a peak and then quieting for a minute or two, only to reach a peak again, may suggest an altogether different cause of back pain, such as a kidney stone.

During the physical exam, the doctor may ask the patient to move in certain ways to determine the area affected. For example, the patient may be asked to hyperextend her back, bending backwards for 20 to 30 seconds, to see if that movement causes pain. If it does, spinal stenosis, a narrowing of the canal that runs through the vertebrae and houses the spinal nerves, may be the cause.

When tumor or infection are suspected, the doctor may order blood tests, including a CBC (complete blood count) and sedimentation rate (an elevated sedimentation rate indicates inflammation).

Age and Gender Issues

Age and gender are important factors to consider when diagnosing low back pain. In a young patient, a benign tumor of the spine called an osteoid osteoma may be the culprit. Inflammatory bowel disease in young people can be connected with spondylitis (inflammation in the spinal joints) and sacroiliitis (inflammation in the sacroiliac joint where the spine meets the pelvis). Low back pain from disc disease or spinal degeneration is more likely to occur as people get older. Conditions such as abdominal aneurysm (a widening of the large artery in the belly) or multiple myeloma (a tumor that can attack bone) are also considered in older individuals.

Osteoporosis and fibromyalgia are much more common triggers of back pain in women than in men. Osteoporosis is a progressive decrease in bone density that leaves the bones brittle, porous and prone to fracture. Fibromyalgia is a chronic disorder that causes widespread musculoskeletal pain, fatigue, and multiple “tender points” in the neck, spine, shoulders, and hips.

Because it represents 97% of cases, mechanical low back pain deserves to be discussed first. To determine the factors that bring out the pain, the doctor will consider the following causes of mechanical low back pain:

• Muscle strain
• Spondylolisthesis (slippage of one vertebral body on the next)
• Herniated disc (the discs, or pads, that act as shock absorbers between the vertebrae can bulge into the space containing the spinal cord or a nerve root and cause pain)
• Osteoarthritis (a common form of arthritis in which the cartilage that cushions the joints breaks down and bony spurs form in the joint, causing pain and swelling. )
• Spinal stenosis (caused by a narrowing of the bony canal and predisposes some people to pain related to pressure on the spinal nerves or the spinal cord itself.)

Low back pain that gets worse with sitting may indicate a herniated lumbar disc (one of the discs in the lower part of the back). Acute onset, that is, pain that comes on suddenly, may suggest a herniated disc or a muscle strain, as opposed to a more gradual onset of pain, which fits with osteoarthritis, spinal stenosis, or spondylolisthesis.

Although comparatively few patients have low back pain due to inflammation, the problem can be life long and can impair function significantly. The good news is that treatments can help essentially all patients, and can lead to major improvements.

Seronegative spondyloarthropathies are a group of inflammatory diseases that begin at a young age, with gradual onset. Like other inflammatory joint diseases, they are associated with morning stiffness that gets better with exercise. Sometimes fusion of vertebrae in the cervical or lumbar regions of the spine occurs. Drugs called TNF-alpha blocking agents, (such as etanercept, infliximab and adalimumab) which are used for rheumatoid arthritis, are also used to treat the stiffness, pain, and swelling of spondyloarthropathy, when the cases are severe and not responsive to traditional medications.

People who have spondyloarthropathy have stiffness that is generally worst in the morning, and have decreased motion of the spine. They also can have decreased ability to take a deep breath due to loss of motion of the chest wall. It’s important for the physician to look for problems with chest wall expansion in patients with spondyloarthropathy.

Treatment for inflammatory back pain includes stretching and strengthening exercises. If there is chest wall involvement, chest physiotherapy is important. Avoiding pillows under the neck when sleeping can help the cervical spine – if it fuses – to fuse in a less debilitating position. Nonsteroidal anti-inflammatory agents are useful. In patients with more severe disease, the drugs used are typically sulfasalazine and methotrexate. If the patient is not doing well despite trying these medications, TNF-alpha blockers, appear to provide benefit in such spondyloarthropathies as ankylosing spondylitis and psoriatic arthritis. Etanercept (Enbrel®), adalimumab (Humira®), infliximab (Remicade®), Golimumab (Simponi®) and certolizumab (Cimzia®) are the five anti-TNF agents presently approved by the FDA for use in this condition. These agents clearly improve the patient’s ability to move and function. More study is needed to see whether these medications can prevent fusion of the spine, over the long run.

Reactive arthritis syndrome is one of the forms of spondyloarthropathy. It is a form of arthritis that occurs in reaction to an infection somewhere in the body, and it carries its own set of signs and symptoms. The doctor will look for:

• Skin rashes, gastrointestinal or urinary problems, eye inflammation, mouth sores
• Joint pain in the arms or legs, in addition to back pain.
• Infections (salmonella, Shigella, campylobacter, C. difficile, chlamydia)

Reactive arthritis is treated similarly to ankylosing spondylitis and psoriatic arthritis, with sulfasalazine and methotrexate, and, if necessary, TNF-alpha blockers. If there is any clue to infection at the time the arthritis starts, such as infectious diarrhea or infection of the genitourinary tract, these conditions will be treated. However, even with treating the underlying infection, reactive arthritis can continue. This is because reactive arthritis is an inflammatory reaction to an infection, and the inflammation can continue after the infection is gone.

Infections of the spine are not common, but they do occur. The doctor will ask about the usual signs and symptoms of infection, especially when back pain is accompanied by fever and/or chills. Dialysis patients, IV drug users, and patients who have recently had surgery, trauma, or skin infections are at risk for infections of the spine. Infections of the spine can be caused by a number of agents, most commonly bacteria. Doctors will first test for the presence of bacteria, then give antibiotics.

Fractures of the spine are often very difficult pain problems and indicate the possible presence of osteoporosis (a bone disease marked by a progressive loss of bone density and strength, making the bones brittle and vulnerable to breaking). In patients with severe osteoporosis, spinal fractures can occur with no early warning and no significant trauma – the patient does not have to fall to fracture a vertebrae.

Patients with spinal compression fractures experience spasms and very high pain levels.

In patients with low back pain where the cause is difficult to determine, especially for elderly patients with osteoporosis, a fracture in the sacrum (the bone between the two hip bones) may be the cause of the pain. A standard X-ray or bone scan may not show a sacral fracture. Imaging techniques such as CT scan or MRI (magnetic resonance imaging, which depicts both soft tissue and bone) can often reveal these fractures.

It is very important that patients with acute lumbar compression fractures be tested for osteoporosis. A bone density study is needed, unless the patient has no other osteoporosis risk factors and has had a very high impact fracture. Studies have shown that many patients with fractures in the U.S. are discharged from hospitals with no plans for management of their bone density problems, which then are left to worsen.

If osteoporosis is found, many treatments are available, including calcium, vitamin D, and a number of prescription drugs. The variety of agents available to treat osteoporosis is large enough that an agent can generally found for each patient, even if other medical problems make one or another of the agents wrong for them. Once bone density is measured, a decision as to long term osteoporosis management can be made.

Although pain can be very intense, it is best for patients with lumbar fracture to resume activity as soon as possible. This is especially true for elderly patients, who can too easily become weakened, and develop other complications, if mobility is reduced for too long. Opioids (narcotic medications) might be needed for pain control, for a brief period.

Cancer involving the lumbar spine (low back) is rare. However, in people who have a prior history of cancer, for example, in the breast or prostate, or who have weight loss or loss of appetite along with back pain cancer needs to be considered.

Night pain can be a clue to cancer in the spine. A benign tumor called osteoid osteoma, which most often affects young people, causes pain that tends to respond well to aspirin. Multiple myeloma is a malignancy that occurs when the plasma cells in the bone marrow begin spreading uncontrollably. It is most common in older people, and can cause pain in many parts of the spine. When tumor or infection are suspected, blood tests may be ordered, including a CBC (complete blood count especially to detect anemia), sedimentation rate (an elevated sedimentation rate indicates inflammation, tumor or infection), and protein electrophoresis (which is a screening test for myeloma).

Pain in the area of the lumbar spine may be due to important problems that are actually unrelated to the back. Referred pain occurs when a problem in one place in the body causes pain in another place. The pain travels down a nerve. For example, a pinched nerve in the neck may cause pain that is felt in the arm or hand. Sources of referred pain may include abdominal aneurysm (enlarged artery in the belly), tubal pregnancy, kidney stones, pancreatitis, and colon cancer. Clues to these maladies include pain that waxes and wanes over a short period, with frequent peaks of intense pain, weight loss, abnormalities found during abdominal exam, and trace amounts of blood in the urine.

When back pain continues for more than 3 months, it is considered chronic. It often progresses and can have a major impact on one’s ability to function. For some patients, physical therapy with local heat or ice application (10-15 minutes on and 10 minutes off), combined with a home exercise program and education in proper positions for lifting and other movement techniques can make a major difference. Patients must learn to tolerate a certain degree of pain, or they may allow themselves to become more disabled than necessary. Patients at the Hospital for Special Surgery have had success with “graded exercise” to work through the pain, gradually increasing the exercise quota at each session so they can learn to tolerate more exercise in spite of the pain, and get back to work and activities. More details are provided in the article The Goals of Physical Therapy for Low Back Pain.

There is concern within the medical community that high-tech imaging methods, such as CT scan and MRI, are overused for acute low back pain. Often, these sensitive imaging techniques reveal asymptomatic abnormalities in the lumbar spine that are not the cause of the patient’s pain. In one study, volunteers with no history of back pain were given MRIs and 90% of those over age 60 had degenerative disc disease. MRIs that show abnormalities in the lumbar region that cause no symptoms for the patient are not helpful.

X-ray

The Agency for Health Care Policy and Research established guidelines for acute low back pain in 1994. The federal agency suggests there are eight red flags in low back pain that indicate the need for an X-ray:

• Age is over 50
• History of malignancy
• Fever or weight loss or elevated ESR
• Trauma
• Motor deficit
• Litigation/compensation
• Steroid use
• Drug abuse

These red flags identify patients who are more likely to get infection, cancer or who have a fracture, i.e., the patients are less likely to have a simple muscle strain. (Litigation compensation was included because Worker’s Compensation cases generally require X-ray.) If none of these red flags exists, an X-ray and other studies may be delayed for one month, during which time 90% of patients with acute back pain will feel better.

MRI or CT Scan

The presence of red flags for infection, fracture, or more serious disease will likely require an MRI or CT scan. Also, if symptoms last longer than a month and surgery is being considered, imaging is necessary. When a patient has had prior back surgery, imaging beyond X-ray is reasonable.

If a patient has signs of cauda equina syndrome, a serious injury to the spinal cord, causing symptoms such as leg weakness, perineal numbness (numbness between the inner thighs) and difficulty urinating), permanent neurological damage may result if this syndrome is left untreated. If clues to this syndrome are present, an MRI, or at minimum, a CT scan, is urgently needed.

Blood Tests

When tumor or infection are suspected, blood tests may be ordered, including a CBC (complete blood count especially looking for anemia) and sedimentation rate (an elevated sedimentation rate indicates inflammation).

Most low back pain is due to muscle strain and spasm and does not require surgery. To treat the pain, medications such as acetaminophen (Tylenol), nonsteroidal anti-inflammatory agents (such as aspirin, naproxen, and ibuprofen), gabapentin or pregabalin and opioids can be used. NSAIDs suppress inflammation, pain and fever by inhibiting certain inflammation-causing chemicals in the body. Acetaminophen reduces pain and fever, but does not inhibit inflammation. Gabapentin and pregabalin, medications that have been used for antiseizure activity, also has the ability to block pain. Opioids (such as codeine) provide pain relief and may be prescribed to manage severe acute and chronic back pain. However, opioids have many problems, such as habituation, constipation and lightheadedness, and are avoided when possible and used for the shortest possible duration. Epidural injection is an option if the back pain does not respond to these treatments. Each person is different in terms of response to medication.

In contrast with popular wisdom, numerous studies have shown that bed rest beyond 2 to 3 days is not helpful. Patients should resume activities as soon as possible. Exercise is an effective way to speed recovery and help strengthen the back and abdominal muscles. Exercise also helps reduce the risk that the back pain will return. Doctors or physical therapists should provide a list of exercises to do at home. It is also important to learn lifting techniques and exercises to reduce worksite injuries. Lumbar corsets are only appropriate if helpful in the work setting. Routine use of lumbar corsets may weaken core strength (spinal and abdominal muscles) and delay recovery. Spinal manipulation can be effective for some patients with acute low back pain.

Other nonsurgical treatments for lower back pain include IntraDiscal Electrothermal Therapy (IDET), nucleoplasty, and radiofrequency lesioning. [Learn more]

Because the vast majority of patients recover from their low back pain with little help from a doctor, the rationale behind choosing surgery must be convincing. Eighty percent of patients with sciatica recover eventually without surgery.

Severe progressive nerve problems, bowel or bladder dysfunction and the cauda equina syndrome (described above) make up the most clear-cut indications for back surgery. Back surgery will also be considered if the patient’s signs and symptoms correlate well with studies such as MRI or electromyogram (a diagnostic procedure to assess the electrical activity in a nerve that can detect if muscle weakness results from injury or a problem with the nerves that control that muscle).

In the most serious cases, when the condition does not respond to other therapies, surgery may well be necessary to relieve pain caused by back problems. Some common procedures include:

• Discectomy – removal of disc material that has herniated
• Spinal fusion – a bone graft that promotes the vertebrae to fuse together
• Spinal laminectomy – removal of the lamina to create more space and reduce irritation and inflammation

To get an in-depth look at surgical procedures for lower back pain, visit HSS Spine Center.

Ninety-seven percent of back pain will have a mechanical cause and most will get better quickly. The other potential causes will need to be considered early on, because many of these other causes of back pain require very specific approaches to nonsurgical or surgical therapy. Many patients do not need X-rays because their pain does not last long. Many more do not need CT or MRI scan, which are overly sensitive and often reveal abnormalities not related to the patient’s pain. CT and MRI can be extremely useful when patients have continuing or severe symptoms or neurologic abnormalities.

Careful, early attention to obtain the correct diagnosis will maximize the success of the treatment chosen for the individual patient. When back pain is associated with fever, loss of leg sensation or strength or difficulty with urination, quick medical attention is required. Where back pain is mechanical, patients can exercise and learn lifting and movement techniques for prevention of future episodes. Multiple pain management procedures such as epidural steroid injection are available, and a number of types of surgical procedures are available for people where conservative measures are not effective.

The Goals of Physical Therapy for Low Back Pain, Hospital for Special Surgery, Hector Lozada, PT, DPT, OCS, Robert Turner, PT, OCS, MS, Theodore R. Fields, MD, FACP, January 19, 2017.

Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health. Reviewed, July 26, 2003.

Deyo RA, Weinstein JN, Low Back Pain, N Engl J Med, Vol 344, No. 5, Feb 1, 2001, pp 363-370.

1, 2. Excerpted from Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health

Updated: 9/29/2016

Authors

What Causes Burning Back Pain?

Having the sensation of burning back pain can be very annoying and quite debilitating. There are many reasons why back pain develops, and the nature of the pain can be an important clue for physicians seeking a diagnosis.

While back pain symptoms vary from patient to patient, having a back pain burning sensation is often the result of muscle tightening, causing them to warm up and even display a reddish appearance of the skin.

Burning back pain causes

Burning back pain causes due to spinal problems: Our spines are comprised of several intervertebral discs that sit in between the vertebral bones. These discs can become damaged due to degeneration or injury. When one of these discs bulges out from its normal position, it is called a disc herniation and can lead to back pain. The lower back, also called the lumbar region, is considered more vulnerable to degeneration, injuries, and other disorders. This is thought to be because this area is more heavily stresses during the day and is highly involved during activates such as lifting heavy weights and sports.

Burning back pain causes due to skeletal defect: The shape of the spine affects your posture. The spine was subject to skeletal or bony deformities that could have a negative effect on our posture, leading to the development of back pain. Conditions such as scoliosis, kyphosis, or lordosis can change spinal musculature and even compress spinal nerves, resulting in burning back pain.

Burning back pain causes due to muscle spasms and strains: Overstretching, tearing, or injuries to the muscles in the back can result in a sudden spasm or strain. These typically occur when lifting heavy objects or during sudden movements that strain muscle beyond their normal range. Repeated strain or injury of the back can cause its muscles to become weak over time, making them more vulnerable to spasms.

Burning back pain causes due to injuries: Severe burning back pain can be the result of direct injuries to the soft tissue supporting the spine. Sometimes, an injury may cause discomfort at a later time. Continued stress on injured spinal column structures, such as spinal discs or nerves, can lead to burning back pain.

Back muscle pain: Often confined to a specific region on the back, these types of back pain are often perceived as an increase in temperature in the affected muscles. It is possible that a buildup of toxic chemicals in the back muscles or an inflammatory process is causing this burning sensation.

Oxygen deprivation back pain: Due to a lack of blood supply that would normally deliver oxygenated blood to tissues. When blood supply becomes restricted or cuts off completely, tissue damage or even death is often imminent. Damage to muscles may be experienced as heat, tingling, weakness, and numbness.

Chemical radiculitis: An inflammatory condition of the nerve root. It can be caused by rupture of the annulus fibrosus (exterior of the intervertebral disc) and dissemination of disk fluid along the nerve root sheath. This condition is a reaction to repeated injury of the spinal column. This may commonly be seen in those who lift heavy loads for a living.

Burning back pain prevention

Having sharp burning pain in the back region can be a distressing occurrence, but it can be prevented to a certain degree. Various exercises, avoiding potential back hurting hazards, and using common sense are all methods for good burning back pain prevention. However, it is a good idea to speak to a medical professional if your current back pain symptoms are not the result of some underlying condition. The following are some tips to help prevent you from developing burning back pain:

Exercise helps to

• Improve posture
• Strengthen the back and improve flexibility
• Lose or maintain weight
• Provides stability to avoid falls

Tips for lifting and bending

• Get someone to help you if an object is too heavy or awkward to hold
• Give yourself a wide base of support by spreading your feet apart
• Stand as close as possible to the object when lifting it
• Bend at your knees, not at your waist.
• Tighten your stomach muscles when lifting or lowering an object to provide stability
• Hold the object as close to your body as you can.
• Lift using your leg muscles not your back
• As you stand up with the object, do not bend forward.
• Avoid twisting when bending for the object, lifting it up, or carrying it.

Other tips:

Avoid standing for long periods. Those whose occupations rely on them standing, try to take any opportunity to sit or lean to take the stress off your back from standing

• Avoid wearing high heels. Instead, invest in a comfortable shoe with adequate support
• When staying seating for long periods of time, make sure that your chair has a straight back with an adjustable seat and back, armrests, and a swivel
• seat.
• Place a small pillow or rolled towel behind your lower back while sitting or driving. This will provide lumbar support for long drives
• If you drive long distance, taking a break by stopping to take a walk every hour or so will help you aboding straining your back muscles.
• Quit smoking.
• Lose weight.
• Do exercises to strengthen your abdominal muscles on a regular basis as it works your core which provides the rest of your body with stability.

Diagnosis and treatment of burning back pain

Burning back pain will be obvious when it occurs, often prompting individuals to find an immediate remedy as soon as they can. If you are confident that you know the reason you develop the burning back pain is caused by physical stress, using commonly found remedies can be of great help. The following are some easy to do treatments can do on our own:

• Stop and avoid doing the inciting activity that caused your burning back pain for a few days.
• Apply heat or ice to the area.
• Take over-the-counter pain relievers such as ibuprofen or acetaminophen.
• While sleeping, try to sleep in fetal position curled up. Place a pillow between your knees to relieve pressure.

If you suspect that the source of your back pain is something more serious, as in the case of a herniated disc, seeing a doctor right away is highly recommended. The doctor will fully evaluate your spine and perform imaging tests such as X-rays and MRIs to get a clearing diagnosis. Treatment for serious back injuries will often make use of stronger pain relievers, physical therapy, and other therapies to help get you back to normal.

A common misconception is that bed rest is the best course of action, but it is often not recommended if no serious signs of back pain are present, such as loss of bladder or sphincter control. Instead, staying active and with limited bed rest have been shown to promote back pain recovery.

Relieving Upper and Middle Back Pain|Ramsay Health UK

The upper and middle back, known as the thoracic spine, is composed of 12 vertebrae with discs that separate each and absorb shock, and muscles and ligaments that hold the spine together.

Upper and middle back pain can occur anywhere from the bottom of your rib cage up to the base of your neck. It is not as common as low back pain or neck pain as the vertebrae don’t flex or move as much as the bones in your lower back or neck. However, like many other types of back pain, upper and middle back pain can range from aching and stiffness to a sharp or burning sensation.

What causes upper and middle back pain?

Upper and middle back pain may be caused by:

• Overuse of, or injury to, the muscles, ligaments and discs that make up the thoracic spine. Examples include a fall or jolting from a car accident, being hit hard in the back, lifting or carrying something too heavy, reaching to put objects on a high shelf, carrying a heavy backpack over just one shoulder,repetitive throwing, bending or twisting or even forceful coughing or sneezing can cause back muscle pain.

• Poor posture. Slumping or slouching when you sit or stand, especially when using a computer for a long time.

• Pressure on the spinal nerves from problems such as a herniated disc.

• A fracture of one of the vertebrae.

• Osteoarthritis from the breakdown of protective cartilage that cushions your facet joints in the spine. Often caused by the discs degenerating that results in the vertebrae grinding and wearing down.

• Myofascial pain or muscular irritation of your connective tissue that protects and covers a muscle or group of muscles. This is often caused by overuse or deconditioning of these muscles.

How can I treat mild to moderate upper and middle back pain?

If you are looking for back pain solution to treat mild to moderate upper and middle back pain, in most cases, you’ll be able to manage it at home:

1. Exercise and stretches

Stretching and an active lifestyle are often recommended to help reduce back pain and speed the recovery process following an injury. Improving ­flexibility through stretching is also an excellent way to avoid future injuries¹.

As upper back pain is related to large muscles in the shoulder area, exercise to stretch and strengthen the muscles of your back, shoulders, and stomach are largely recommended. These muscles help support your spine. Exercise will also strengthen the muscle groups that support your mid-back to help relieve back muscle pain. Both specific exercises and stretches for this region together with general exercise, such as swimming, walking, cycling, are recommended. Strong muscles can help improve your posture, keep your body in better balance, decrease your chance of injury and reduce pain.

Regular yoga or Pilates sessions can also help relieve back muscle pain as they incorporate a number of positions and moves that use the upper and middle back muscles. Stretching exercises are best after a workout when your muscles are warmed up. You should take a break from exercise and stretching if your back hurts a lot, but try not to let too much time pass before you get moving again. Instead it’s good to return to your activities slowly.

2. Benefits of Movement

There are many benefits of exercising if you are experiencing upper and middle back pain. These include:
• A reduction of muscle spasm and tension
• Improved blood flow which will reduce inflammation and provide nutrients to the area in pain
• Better soft tissue mobility
• Increased confidence to complete everyday activities
• A reduction in anxiety and emotional stress
• After 10 minutes of exercise, the brain produces ‘happy chemicals’ that have a calming effect on nerves²
It’s best to speak to your doctor or physiotherapist about the kinds of exercises you can do to stretch and strengthen the muscles in your back, shoulders,and stomach.

3. Preventing upper and middle back pain through exercise

Back stretches when done on a regular basis will help prevent back pain. They support you in maintaining back mobility, joint health, sustaining good posture and keeping your discs moving and altering their position to minimise stress.

Exercising regularly will help keep weight gain and obesity at bay which can cause strain on the back and ultimately lead to back pain.

4. Painkillers

Over-the-counter pain medicines can reduce pain and swelling. Acetaminophen (for example, Tylenol) will provide pain relief. Nonsteroidal anti-inflammatorydrugs (NSAIDs) such as Ibuprofen, Aspirin and Motrin can reduce pain and swelling.

5. Ice or heat

Heat or ice is often used to reduce pain, stiffness and swelling in middle and upper back pain. Heat can reduce pain and stiffness whilst ice can help reduce pain and swelling.

6. Manual and physical therapy

Manual therapy includes massage or spinal manipulation. It helps reduce muscle tension and pain in the back and improve blood flow.

Your physiotherapist may use specific exercises combined with massage to relieve your upper and middle back pain. They will also advise you on exercises and stretches to do at home to aid relief of your pain and to offer support for this area.

7. Acupuncture

Acupuncture involves putting tiny needles into your skin at certain points on the body to promote healing and pain relief. It can help relieve upper and middle back pain by concentrating on certain points on the back.

8. Practice good posture

Poor posture puts stress on your back and can cause upper and middle back pain. Try to stand or sit tall, keeping your back as straight as possible and balance your weight evenly on both feet. Don’t slump or slouch. When sitting, keep your shoulders rolled back and be sure to adopt suitable positions when using computers and driving. For example if you spend a lot of time at a computer, at home and at work, make sure the screen is at eye level, never below and not too far away so that you have to reach to it. Again if you spend a long time in the car raise the steering wheel and sit closer to it

9. Sleeping

An uncomfortable position or uncomfortable bed while sleeping / at night could lead to upper and middle back pain or exacerbate the pain you’re experiencing. Try to find a comfortable sleeping position and use pillows to maintain this position whilst you’re asleep if needed. A relatively firm mattress may also be beneficial as a soft mattress doesn’t give your back proper support. According to the Sleep Council a mattress should be changed every 7 years³.

10. Learn ways to reduce stress

Stress can make your pain feel worse. Learning ways to reduce your stress may result in reduced pain. You could try deep breathing and relaxation exercises or meditation.

11. Stay positive

Although it can be difficult to be cheerful or optimistic if you are in pain, it’s important to stay positive because this can help you recover faster⁴.

How to relieve upper and middle back pain in pregnancy

Pregnancy can cause middle and upper back pain. Between 50 and 70 percent of pregnant women will experience back pain during pregnancy. The American Pregnancy Association (APA) states that back pain can manifest at any point during a pregnancy, although it usually occurs during the third trimester when the weight of the baby is approaching its maximum⁵. An increase in hormones that affect spinal ligaments, an altered centre of gravity that places excessive strain on back tissues, additional body weight, poor posture and increased stress are all factors of pregnancy related back pain.

Middle and upper back pain during pregnancy can interrupt your activities of daily living and cause restless sleep.

Exercise may offer a back pain solution and ease some relief if you suffer from middle and upper back pain in pregnancy. It’s advisable to get some advice from an antenatal exercise specialist who can tailor your exercise programme for your specific needs to support and help strengthen your back. You should avoid sleeping on your back.Try to sleep on your left side, and use a support pillow under your knees. A support belt under your abdomen may also help and make sure you get plenty of rest.

What to do if your pain gets worse

If your pain worsens and you’re finding it difficult to do daily activities you should consult your doctor. It may be that you may need to take a prescription pain medicine or have diagnostic tests to determine the cause of your pain. Your doctor may refer you to a Physiotherapist or an upper and middle back pain specialist. If surgery is required it usually involves removing what is causing the pain and then fusing the spine to control movement.

If you would like to read further orthopaedic blogs, don’t hesitate to view our orthopaedics posts section.

About back and spinal treatments at Ramsay Health Care 

Ramsay Health Care offers a comprehensive range of diagnostic assessments and treatments for upper and middle back pain including radiology services,osteopathy, physiotherapy, pain management clinics, rheumatology, injection therapies and surgery.

Our experienced health professionals including Chartered Physiotherapists offer one to one advice for your tailored treatment and exercises plan to help relieve your upper and middle back pain.

Some of the highest qualified and experienced orthopaedic, rheumatology and pain management consultants in the UK work with Ramsay Health Care to provide the best individual healthcare for your needs.

Please contact us if you would like to discuss your back pain solution in more detail.

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References

¹ http://www.acatoday.org/pdf/BackPainExercise.pdf

² https://backcare.org.uk/news/myth-exercise-is-dangerous-for-back-pain

³ http://www.sleepcouncil.org.uk/

⁴ http://www.nhs.uk/conditions/Back-pain/Pages/Introduction.aspx

⁵ http://americanpregnancy.org/pregnancy-health/back-pain-during-pregnancy/

3 Rare but Severe Conditions that Might Affect You

These little known back pain conditions have their roots in inflammation.

Injuries, abnormalities, and gradual wear and tear can lead to the development of severe spine pain. With straining, twisting, and spraining, soft tissues around the spine can become inflamed, causing pain and muscle spasms over time. This pain can be very debilitating and cause a patient to significantly reduce their day-to-day activities. The severe pain that accompanies the following rare spine conditions detailed below can affect you or a loved one. Being knowledgeable about these conditions can help you to speak to your doctor if you feel you may have similar symptoms.

Arachnoiditis

Inflammation is the body’s protective response to infection or injury, but when there are no foreign invaders to fight off, the immune system can damage its own tissues. Arachnoiditis means inflammation of the arachnoid, which is the middle layer of the spinal canal covering. This covering is like a pipe that encompasses the spinal cord, nerve roots (known as the cauda equina), and protective fluid that flows inside the canal. The prevalence of arachnoiditis is not officially known, but approximately 11,000 new cases occur each year.

The clinical term most often used for arachnoiditis today is adhesive arachnoiditis (AA), which means that the spinal canal covering has attached itself to nerve roots by adhesion. Factors such as aging, other chronic spinal conditions, obesity, lack of exercise, and genetics can lead AA to become more prominent. Historically, arachnoiditis has been caused by tuberculosis or syphilis infections, a puncture or injury to the spinal canal covering (including through obstetric epidurals, spinal injections, or spinal taps), surgery, trauma, viral infections. exposure to the toxic dyes used in myelograms, and preservatives used in epidural anesthesia or injections. The most common causes of AA are slipped or protruding discs, spinal canal stenosis (narrowing), osteoporosis, kyphoscoliosis (abnormal curvature of the vertebrae), and arthritis.

Medical interventions to treat a chronic spine disorder can inadvertently accelerate the inflammatory and adhesion process, according to Forest Tennant, MD, DrPH, intractable pain specialist and Editor Emeritus of PPM. Unfortunately, AA may cause severe neurologic damage and pain as it progresses and becomes a neuroinflammatory disease, entrapping nerve roots and destroying nerve cells. Fortunately, new magnetic resonance imaging (MRI) done with contrast dye now permits physicians to look for and diagnose AA in its early stage.

Common symptoms of adhesive arachnoiditis can include leg weakness, bizarre sensations (eg, bugs crawling) on legs and feet, and bladder and bowel dysfunction. Pain associated with the condition can be accelerated or relieved by changing positions; patients often cannot sit for very long and may find relief by lying on the floor, for example.

“In the past, adhesive arachnoiditis was considered a hopeless, progressive, and debilitating disease that could only be treated by symptomatic pain relief,” said Dr. Tennant. “Today, however, new therapeutic drugs, such as ketamine and low-dose naltrexone, and measures to help pull apart the scarred areas of the spinal cord such as stretching and massage therapy are bringing relief and recovery to these patients.” More on this rare disorder.

Inflammation on the spine can cause several rare but severe conditions that result in pain. (Source: 123RF)

Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that affects the spine, causing fusions of the bones and joints. The disease leads to stiffness, immobility and, in severe cases, changes in posture (such as kyphosis, which is the abnormal positioning of the upper spine into a “hunched back”). According to the John Hopkins Arthritis Center, recent population estimates indicate that the prevalence of AS in the United States is approximately 0.2% to 0.5%, and occurs more frequently in men than women (2:1). Age of disease onset usually peaks in the second and third decades of life. In addition, approximately 80% of patients with AS experience symptoms at around 30 years of age, while only 5% will present with symptoms around 45 years of age.

For most patients, an acute painful episode is followed by temporary remission when symptoms subside. However, patients may have severe pain and stiffness for long periods and others may develop AS-related symptoms in other parts of the body, such as anterior uveitis (inflammation) in the eyes. Most AS sufferers produce a genetic marker protein called the human leukocyte antigen B27 (HLA-B27), but many individuals with this marker never get AS while others can develop the condition without having the protein. According to the John Hopkins Arthritis Center, the prevalence of AS increases to approximately 5% among patients who are HLA-B27 positive.

Treatments for AS include pharmacologic agents that help to reduce inflammation as well as physical therapy and exercise to stay flexible and mobile. First-line medications to treat pain often include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. Another class of drugs indicated for AS includes the disease-modifying antirheumatic drugs (DMARDs). These medications, which include methotrexate and sulfasalazine, work slowly to help reduce inflammation and slow the progression of the disease. Newer, promising agents include tumor necrosis factor (TNF) blockers, which suppress the body’s response to TNF, a chemical that causes inflammation, and may help slow the progression of AS. Available TNF blockers include infliximab, etanercept, adalimumab, certolizumab, and golimumab.

Transverse Myelitis

Transverse myelitis refers to inflammation that spans across the same section of the spinal cord, which may occur as a side effect of an infection such as Lyme disease or measles, or an autoimmune disease such as lupus or multiple sclerosis (MS). The annual incidence of transverse myelitis ranges from 1.34 to 4.6 cases per million and it occurs more often in females than males, with the highest cases being those between ages 10 and 19, and 30 and 39. Approximately 1,400 new cases of transverse myelitis are diagnosed each year, with 33,000 Americans having some type of disability resulting from the condition.

The inflammation causes damage to the area around the nerves, potentially resulting in scarring that blocks nerve impulses and leads to physical problems. Symptoms of transverse myelitis include back or neck pain, weakness or abnormal sensations in the arms or legs, or a loss of bladder or bowel control.

Treatment with corticosteroids, plasma exchange therapy (also known as plasmapheresis, often described as “blood cleansing” via transfusion), antiviral medication, pain medication, or immunosuppressants may relieve symptoms. Physical and occupational therapists are also provided to help patients relearn how to perform day-to-day activities. Most recovery occurs within three months, but recovery may take a year or more. About one-third of patients will recover completely after an episode of transverse myelitis. Another third may have lingering difficulties in walking, numbness or tingling, and bladder and bowel problems. Yet another third may need a wheelchair and ongoing assistance with activities.

Get the Help You Need

Although these conditions are relatively rare, anyone who experiences pain, weakness, or abnormal sensations in the back or neck, or even in their arms or legs, should talk to their doctor to get a proper diagnosis and seek out the necessary treatment provided above.

Updated on: 12/12/18

Arachnoiditis: An Overview

Thoracic Back Pain | Symptoms, Causes and Treatment

How common is thoracic spine pain?

Researchers were asked to find out how many people got back pain and came back with the answer ‘between 4 and 72 people out of 100’. Political pollsters who had never before heard such pinpoint forecasting immediately hired these researchers to predict the outcome of the next general election.

The truth is that unless the question is asked in exactly the same way, different surveys will give different answers. It’s known that teenage girls are particularly prone to thoracic back pain. The dreaded backpack is undoubtedly to blame. Why anyone thought it was a good idea to get rid of school lockers and make children drag a hundredweight of books to and from school on their backs every day, I have no idea.

Who gets thoracic spine pain?

Surveys to find out how many people have thoracic spine pain produce very variable results. For example, when asked whether they have ever had thoracic spine pain, one survey reported a result of 4 out of 100 people, whilst another said 72 people out of 100. It appears to be at its most common in children and teenagers, especially girls. Factors cited as causing thoracic back pain included backpack use, the height of school chairs, and difficulties with homework. Mental health problems seemed to be an associated factor. It also appeared to be common in the transition period between the early teens and late adolescence. Adults with thoracic back pain often have aches and pains elsewhere as well as difficulties going about their daily tasks.

Is it something to worry about?

The short answer, in most cases, is no. Most people with thoracic spine pain get better without treatment in a couple of weeks.

However, thoracic back pain is more likely to be due to a serious cause than pain in other areas of the spine. There is a whole list of things to look out for that might indicate there’s a problem. The sort of red flags I’m going on about include pain coming on shortly after an accident, having a condition that causes a wonky immune system, feeling generally unwell, or having pain that’s getting worse after a couple of weeks’ treatment.

Thoracic back pain symptoms

Thoracic spine pain is common, short-lived and of little consequence. However, it is also more likely than neck pain or low back pain to have a serious cause.

Thoracic back pain red flags

If you have thoracic spine pain, these are the alarm features to look out for:

• Recent serious injury, such as a car accident or a fall from a height.
• Minor injury or even just heavy lifting in people with ‘thinning’ of the bones (osteoporosis).
• Age under 20 or over 50 years when the pain first starts.
• A history of cancer, drug misuse, HIV infection, a condition that suppresses your immune system (immunosuppression) and use of steroids for a long time (about six months or more).
• Feeling generally poorly – for example, a high temperature (fever), chills and unexplained weight loss.
• A recent infection by a germ (bacterial infection).
• Pain that is there all the time, severe and getting worse.
• Pain that wasn’t caused by a sprain or strain (non-mechanical).
• Pain that doesn’t get better after 2-4 weeks of treatment.
• Pain that is accompanied by severe stiffness in the morning.
• Changes to the shape of the spine, including the appearance of lumps or bumps.
• Pins and needles, numbness or weakness of the legs that is severe or gets worse over time.
• Passing wee or poo accidentally (can indicate pressure on the spinal cord).

What are the causes of thoracic back pain?

The most common cause of thoracic back pain is inflammation of the muscles or soft tissues of the thoracic spine. This inflammation can occur for a number of reasons:

• A sudden sprain or strain (as in car accidents or sports injuries).
• Sitting or standing in a slouched position over time.
• Using a backpack.
• Sitting for a long time at a computer.
• Lack of muscular strength (couch potatoes beware!).
• Repeating a movement persistently that involves the thoracic part of the spine (as in sport or work): also called overuse injury.

Less common causes include:

• Narrowing of part of the spine (thoracic stenosis) – usually due to wear and tear.
• Slipped discs – these are common but rarely cause pain.
• Fractures of the vertebrae (the bony components that make up the spine).
• Osteoporosis.
• Spinal infection.
• Shingles (especially in people aged over 60 years).
• Spinal osteoarthritis.
• Ankylosing spondylitis – inflammation of the joints between the vertebrae.
• Scheuermann’s disease – an inflammation of the joints of the spine which results in spinal curvature.
• Spinal tumours.

It shouldn’t be assumed that all pain in the thoracic spine is coming from the spine itself. Other causes of pain in this area can include problems affecting the lung, the uppermost part of the gut (the oesophagus), the stomach, the gallbladder and the pancreas.

Will I need any tests?

If it’s a short-lived mild pain with an obvious explanation (for example, it came on after you took part in a tug-of-war contest), your doctor will probably suggest some treatment before arranging tests.

However, because back pain is more likely to be serious if it occurs in the thoracic area rather than in your neck or lower back, your doctor is likely to suggest tests if the pain persists, is severe, or is accompanied by any of the ‘red flag’ features mentioned in the section on Symptoms.

The tests will depend on the conditions that the doctor wants to rule out. They are likely to include blood tests such as a full blood count and inflammatory markers, and maybe a magnetic resonance imaging (MRI) scan. An ordinary ‘plain’ X-ray doesn’t give much information unless you have an unusual appearance of the spine or a fracture is suspected.

Thoracic back pain treatment

• You may not need any treatment as many cases settle down without it.
• If you have an underlying cause, this will need treatment of its own accord.
• If the pain is coming from a joint in the spine (a facet joint) this may be helped by an injection performed under X-ray vision (imaging-guided intra-articular injection).
• Surgery which opens the covering of the spinal canal (a procedure called laminectomy) to treat a slipped disc causing thoracic spine pain can be a dangerous operation. However, a less risky technique involving surgery through the skin (percutaneous thoracic intervertebral disc nucleoplasty) is sometimes performed.

What is the outlook for thoracic spine pain?

The outlook (prognosis) depends on the underlying cause, your age and your general fitness.

Many cases settle down in a few weeks but it should be remembered that pain in the thoracic spine is more likely than pain in the neck or lower back to have a serious cause.

90,000 Back pain

Unpleasant back pain can occur when lifting heavy objects, as well as with sudden body movements. It is important to know that such pain may be the first symptom of a serious illness. Let’s take a look at the main diseases that are accompanied by back pain and find out how to deal with such discomfort.

Diseases with back pain

Let’s single out the most basic diseases that begin with a sharp pain:

1. Radiculitis or inflammation of the sciatic nerve.
2. Scoliosis.
3. Overstrain of the back muscles.
4. Ligament sprain.
5. Spondylosis.
6. Kyphosis.
7. Lordosis.
8. Tumors of the spine.
9. Herniated disc.

When should I go to the hospital?

In order to prevent the occurrence of the above diseases, you need to contact a specialist in time. Here are additional symptoms after which you must go to a neurologist:

• Back pain has been going on for 2 weeks and is getting worse.
• After discomfort in the back, the legs in the knee area began to hurt.
• Severe seizures appear abruptly without much stress.
• The pain started after a certain back injury.
• Difficulty breathing during seizures.
• Pains are accompanied by fever and weakness.
• Cramps in the stomach and chest appear.

Why does back pain occur?

The main thing is to determine the cause of such trouble.If you eliminate it in time, then there is a chance that the disease will stop developing.

1. Constant sedentary work at the computer.
2. Daily stress.
3. Great physical activity on the back.
4. Overweight.
5. Frequent workouts in the gym without a trainer.
6. Long standing work.
7. Daily driving.

How to act in case of severe pain?

• Drink pain reliever immediately.
• See a doctor immediately.
• Go to bed immediately and try to relax as much as possible. Don’t get up until the pain subsides.
• Do not sit and bend forward during pain attacks.

Prevention of back pain

To prevent the development of the disease and pain attacks, it is enough to follow some of the recommendations:

1. Train yourself to warm up every day. It should not put a lot of stress on the spine.It is enough to make turns with the body, pull up and twist. Repeat the warm-up every morning and in intervals with extended sitting.
2. Buy a special orthopedic mattress and small pillows. Quality sleep affects the health of your back.
3. Do not load yourself with weights. Try to distribute any weight on two hands. It is best to purchase a backpack in which you can carry heavy things without harm to your health.
4. Forget about sudden movements.Perform any action slowly and calmly.
5. Train yourself to get up at least every hour after a long time at the computer. It is enough to take a break for 5 minutes and do a short warm-up.
6. Be sure to bend your knees when lifting heavy items off the floor. With straight legs, there is a great load on the spine.
7. Pay attention to posture, walk upright and do not slouch.

Severe back pain

Let us consider in more detail the diseases that cause sharp and severe pain:

• Radiculitis.Painful sensations are accompanied by slight tingling and burning sensations. Discomfort radiates to the leg and buttock. The pain gets worse when you walk or cough violently.
• Osteochondrosis. The seizure gets worse as soon as you lift something heavy. Sometimes pain occurs near the heart. In this case, you have osteochondrosis of the thoracic region.
• Herniated disc. Pain appears not only in the back, but also in one of the legs. It becomes harder to make side turns and normal bends.

Acute back pain

It occurs in the case of such diseases:

1. Lung diseases. If an attack is felt in the shoulder blades and in the chest. The temperature rises sharply and weakness appears throughout the body.
2. Lumbago. People who are engaged in physical labor on a daily basis are exposed to illness. If you stop giving loads, the pain will go away by itself in a week.
3. Diseases of the genitourinary system. In addition to back pain, the stomach begins to ache and the temperature rises.
4. Displacement of the discs in the spine. Appears after dislocations and severe fractures. May occur when lifting weights.
5. Renal colic. Sharp pain in the abdomen, which radiates to the genitals.

Other types of pain

• Chronic pain. It occurs with spondylosis. Pain not only in the back, but also in the back of the head and neck. There is weakness in the legs, sometimes a sharp numbness.
• Pain in the leg. This is a sign of inflammation of the sciatic nerve.Pain not only in the back and legs, but also in the buttocks, lower back and feet.
• Aching pain. Appears with myositis. The painful sensations are not strong, however, they last for a long time. The disease appears after severe hypothermia and stress on the back.

Diagnosis of back pain

To determine which of the above diseases begins to develop, the doctor must refer you to a diagnosis.

1. Ultrasound diagnostics.
2. Laboratory research and analysis.
3. MRI – magnetic resonance imaging.
4. ECG – electrocardiogram.

Back pain treatment

An experienced specialist will prescribe a set of procedures to completely relieve back pain. The most common treatments are:

1. Back massage . Thanks to the correct action on the back muscles, posture improves, tension and pain disappear.
2. Mud treatment . Healing mud is applied to the back and a wrap is done. It nourishes the tissues with minerals and nutrients and removes harmful toxins. After the procedure, the pain disappears.
3. Spine block . If inflammation occurs in a specific area of ​​the vertebral discs, the blockage can remove it. The doctor injects the drug with a syringe precisely into the area of ​​inflammation. This method allows you to get rid of severe pain in a few minutes and has a healing effect.

Conclusion

Now you know why back pain occurs and what diseases they prevent. We told you what kind of prevention should be so that unpleasant sensations never appear. However, at the first onset of pain, we advise you to immediately contact the Mogilev hospital №1. Specialists will be able to detect in time which disease is causing pain and prescribe a comprehensive, effective treatment. The main thing is to take responsibility for your health and then the pain will not bother you.

90,000 reasons, treatment – how to get rid of back pain

Back pain is a very common symptom among men and women, and it can occur regardless of the age of the patient. Depending on the nature of the pain, we can talk about the variability of pathological processes. Let’s take a look at some of the most common complaints.

Acute pain in the spine

One of the most frequent complaints at a doctor’s appointment is acute pain (sharp, cutting, sometimes becomes unbearable) in the spine, which occurs suddenly.As a rule, such a symptom can signal a herniated intervertebral disc, infringement of the roots of the spinal cord. In this case, the painful sensations can spread to other parts of the body, for example, radiate to the arm. Acute pain can last up to two weeks.

Dull pain

Dull pain can be a sign of spinal cord pathologies – multiple sclerosis, amyotrophic lateral sclerosis, myelitis. In addition, recurrent dull pain can be a manifestation of neoplasms in the area of ​​the spinal cord.

Pulsating back pain

In most cases, this symptom indicates some kind of inflammatory process. For example: tuberculosis of the spine, osteomyelitis of the vertebrae, etc. Often, throbbing pain indicates pathologies of the internal organs of the chest, abdominal cavity and small pelvis.

Aching pain in the spine

As a rule, aching or pressing pain in adults is of a prolonged nature, can be observed in chronic inflammatory processes in the muscles, ligaments or internal organs.If there is an exacerbation of pain during heavy lifting, physical overstrain, hypothermia or long immobility, then the cause of aching back pain above the lower back may be myositis, lumbago or intervertebral hernia.

Shooting pain

If it sometimes shoots in the back, pain covers and it is difficult to unbend – most likely, these symptoms are associated with sciatica, sciatica or displacement of the intervertebral disc.

90,000 treatment and diagnosis of causes, symptoms in Moscow

General description

The sacrum is a bone formation consisting of five fixedly connected vertebrae and connecting the lumbar spine, coccyx and pelvic bones.The sacrum has a pyramidal shape, the base of which faces upward and forms a joint with the fifth lumbar vertebra, the lateral sides form the sacroiliac joints, and the apex looks down and connects to the coccyx. The anterior surface of the sacrum has a concave shape and faces the pelvic cavity, while the posterior surface is facing outward and curved. The sacrum plays a significant role in the delivery process, which is why it is shorter, wider and less curved in women.

The main causes of pain in the sacrum

• Osteochondrosis of the lumbar spine;
• Herniated discs;
• Sacroiliitis – inflammation of the sacroiliac joint;
• Injuries and bruises of the sacrum and coccyx;
• Neoplasms;
• Gynecological diseases;
• Postoperative pain.

Diagnosis of pain in the sacrum

• X-ray (allows to assess the condition of bone structures, joints, articular cartilage along the width of the joint space)
• CT / MRI (allows for a more detailed assessment of the state of bone structures and joints in cases where radiography is insufficient, MRI visualizes soft tissues well)
• laboratory diagnostics (detects pathological changes in the blood, including markers of rheumatic diseases)
• Ultrasound (diagnostics of the abdominal cavity and small pelvis)

Treatment of pain in the sacrum in FNKTS

Treatment of sacral pain is aimed at diagnosing and eliminating the cause of pain.As a rule, this is a long process, therefore, symptomatic treatment is carried out in parallel, that is, anesthesia of the joint.

The approach to the treatment of sacral pain is complex and includes the work of a multidisciplinary team of doctors, including an orthopedic traumatologist, rehabilitation therapist, pain specialist, physiotherapist and other specialists.

Key treatments for sacral pain

• conservative therapy (selection of an effective and safe regimen of painkillers)
• minimally invasive techniques (treatment and diagnostic blockade, radio frequency denervation – RFD)
• Surgical Techniques
• auxiliary techniques (physiotherapy exercises, physiotherapy, manual therapy)

Conservative therapy

For each patient, an individual scheme of analgesic therapy is selected, based on the causes of the disease, the characteristics of the pain syndrome, possible contraindications and drug interactions.Throughout the treatment, the conservative therapy regimen is adjusted depending on the clinical situation.

Minimally invasive techniques

Healing blockade

Therapeutic blockade is performed by injecting an anesthetic into the area of ​​a peripheral nerve or spasmodic muscle. The blockade not only relieves pain, but also helps to relax muscles, normalize blood flow and improve tissue trophism.

Radio frequency denervation (RFD)

Radiofrequency denervation (RFD) is a modern and safe non-surgical method suitable for patients for whom other methods of treatment are ineffective or impossible.

When this procedure is used

• When conservative drug therapy is ineffective – when painkillers, even the most powerful ones, do not help enough or cannot be prescribed due to side effects;
• When waiting for an operation for a long time – often the patient finds himself in a situation where the operation has to wait for more than a few months. In this case, RFP can reduce the intensity of pain and make waiting for the operation more comfortable;
• If it is impossible to carry out the operation – when the presence of severe concomitant diseases or other reasons do not allow performing a radical surgery, RFD is the most effective and safest alternative;

How is RF denervation performed – RFD

After a standard examination by a specialist algologist, additional examination and diagnostics, if necessary, a decision is made to carry out radiofrequency denervation.

• The procedure is performed on an outpatient basis. Under sterile conditions, the doctor, under X-ray control, inserts special needles into the area to be treated. After the doctor makes sure that the tip of the needle is exactly in the right place, a local anesthetic is injected so that the denervation is painless. After that, a thin electrode is inserted through the channel of the needle, which is connected to a radio frequency generator and the tip of the needle is heated to a predetermined temperature.