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NINDS-funded studies are contributing to a better understanding of why some people with acute low back pain recover fully while others go on to develop chronic low back pain. Brain imaging studies suggest that people with chronic low back pain have changes in brain structure and function. In one study, people with subacute back pain were followed for one year. Researchers found that certain patterns of functional connectivity across brain networks correlated with the likelihood of pain becoming chronic. The findings suggest that such patterns may help predict who is most likely to transition from subacute to chronic back pain. Other research seeks to determine the role of brain circuits important for emotional and motivational learning and memory in this transition, in order to identify new preventive interventions.

Obesity – According to a study posted in the Journal of American Epidemiology, overweight and obese people had a higher prevalence of low back pain than non-overweight individuals.1 Psychological/emotional stress Osteoporosis or bone loss (as measured by the Z-score and not the young adult-based T-score)

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Sitting has been shown to have a higher low back compressive load than standing [26] and deviation from the neutral posture has been linked with increased static muscular effort [3,4]. While past efforts have been made at designing back rest/seat pan combinations that promote a neutral spine [27], lumbar support pillows often do not account for the pelvis and may push the body forward on the seat pan [17]. While several investigators have studied the effect of various lumbar support pillows on asymptomatic individuals [15-17], the current study investigated the effect of a lumbar support pad that accounted for the posterior pelvic bulk on the posture and comfort of healthy individuals and patients with LBP.

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If the doctor or patient suspects some injury to the back, tests may be ordered. Also, if the doctor suspects the back pain might be due to an underlying cause, or if the pain persists for too long, further tests may be recommended.

Several risk factors exist for the development of low back pain, including prolonged sitting and flexed spinal curvature. Several investigators have studied lumbar support devices and spinal curvatures in sitting, however few have investigated a pain population and reported a quantitative measure of comfort. The purpose of the current project was to determine whether a lumbar support pillow, outfitted with a cut-out to accommodate the bulk of posterior pelvic soft tissue volume, is more effective than a standard chair in promoting a neutral spinal posture and improving subjective and objective measures of comfort in healthy individuals and patients with low back pain.

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Back pain is a symptom. Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine. Pain arising from abnormalities of organs within the abdomen, pelvis, or chest may also be felt in the back. This is called referred pain. Many disorders within the abdomen, such as appendicitis, aneurysms, kidney diseases, kidney infection, bladder infections, pelvic infections, and ovarian disorders, among others, can cause pain referred to the back. Normal pregnancy can cause back pain in many ways, including stretching ligaments within the pelvis, irritating nerves, and straining the low back. Your doctor will have this in mind when evaluating your pain.

Medications: A wide range of medications are used to treat acute and chronic low back pain. Some are available over the counter (OTC); others require a physician’s prescription. Certain drugs, even those available OTC, may be unsafe during pregnancy, may interact with other medications, cause side effects, or lead to serious adverse effects such as liver damage or gastrointestinal ulcers and bleeding. Consultation with a health care provider is advised before use. The following are the main types of medications used for low back pain:

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In addition, the objective measure of comfort was improved in the current study with use of the pillow. The radius of the CoP shifting was lower for the lumbar support condition versus the standard chair in healthy individuals and in patients with LBP. However, the objective changes were not accompanied by subjective improvements, as the current study found no significant effects in reported comfort. While past studies have indicated that 30 minutes of sitting is adequate to determine comfort levels [22], it is possible that longer use of the device would have yielded more significant results. Carcone and Keir [17] noted subjective improvements in the middle lower back and upper back when using a lumbar support pillow for 15 minutes, however, the magnitude of the changes was small and clinical benefit is unknown.

Don’t try to lift objects that are too heavy. Lift from the knees, pull the stomach muscles in, keep the head down and in line with a straight back. When lifting, keep objects close to the body. Do not twist when lifting.

Back pain can be divided into non-radicular pain and radiculopathy. Radiculopathy occurs when there is irritation in the nerve root, causing neurologic symptoms, such as numbness and tingling. Disk herniation and foraminal stenosis are the most common causes of radiculopathy.[8] Non-radicular back pain is most commonly caused by injury to the spinal muscles or ligaments, degenerative spinal disease, or a herniated disk.[8] Spondylosis, or spinal degeneration, occurs when the intervertebral disc undergoes degenerative changes, causing the disc to fail at cushioning the vertebrae. The space between the vertebrae becomes more narrow, resulting in compression and irritation of the nerves.[14]

In his “Myths and Misconceptions about Psoas Major: Where is the Evidence?” Comerford states, ”There is almost no evidence for psoas being short; it does not produce significant movement in the spine; it has a significant stability role for the lumbar spine, the sacroiliac joint, and the hip; and, like the TvA, the psoas has been shown to have delayed activation in the presence of LBP.” So again, delay in psoas activation is a symptom of back pain, not a cause.

It is not clear whether men or women have higher rates of low back pain.[7][8] A 2012 review reported a rate of 9.6% among males and 8.7% among females.[8] Another 2012 review found a higher rate in females than males, which the reviewers felt was possibly due to greater rates of pains due to osteoporosis, menstruation, and pregnancy among women, or possibly because women were more willing to report pain than men.[7] An estimated 70% of women experience back pain during pregnancy with the rate being higher the further along in pregnancy.[94] Current smokers – and especially those who are adolescents – are more likely to have low back pain than former smokers, and former smokers are more likely to have low back pain than those who have never smoked.[95]

Tired of lower back pain? Million suffer from the pinching tightness in the lower back as a constant reminder of our sedentary lifestyle. Whether it is hours of sitting at the desk hunched over a computer or a long tedious commute to work, sitting for extended periods of time can wreak havoc on your poor spine.

Exercises: In acute back pain, there is currently no evidence that specific back exercises are more effective in improving function and decreasing pain than other conservative therapy. In chronic pain, studies have shown a benefit from the strengthening exercises. Physical therapy can be guided optimally be specialized therapists.

Even the diagnosis of back pain can involve some chicanery. Spine surgeons told Ramin that in an estimated 80% to 85% of cases, they can’t point to a person’s source of pain with accuracy, although they can see something abnormal on an X-ray or MRI. That’s because studies have shown that most people are walking around with bulging or worn out discs, but feel nothing, so these indicators on an MRI aren’t always meaningful.

Opioid analgesics: These drugs are considered an option for pain control in acute back pain. The use of these medications is associated with serious side effects, including dependence, sedation, decreased reaction time, nausea, and clouded judgment. One of the most troublesome side effects is constipation. This occurs in a large percentage of people taking this type of medication for more than a few days. A few studies support their short-term use for temporary pain relief. Their use, however, does not speed recovery.

“We’re sitting for 50 to 60 hours per week,” she says. We sit at our desks, in our cars, at the dinner table, and we sit to write email messages from bed at night. “We think three hours of exercise on the weekend will undo the problems that creates,” she laments. Even standing desks aren’t the easy out, as standing the wrong way all day can lead to different issues. Her mantra: “The best posture for sitting is always the next posture.”

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