Non-specific low back pain of mechanical origin is the second only to the common cold as a cause of self-limiting symptoms and disability in the community.
It has been calculated that more than three-quarters of world’s population experience the back pain at some times in their lives.
More than 90% of episodes of low back pain are of mechanical origin and most resolve spontaneously within 1-2 weeks. In about 30% of patients episodes can last as long as a month but chronic low back pain of 3 months’ duration accounts for less than 3% of all cases.
Mechanical low back pain is particularly associated with occupations that involve heavy lifting, bending or twisting and also whose jobs involve awkward static posture or prolonged driving are also at increased risk.
Herniated disk ‘syndrome’
An acquired condition most commonly affecting active middle-aged adults, classically occurring after a minor trauma or torsion stress of the vertebral column, punctuated by the sensation of a ‘snap’, which corresponds to a prolapse of the nucleus pulposus into the nerve roots or spinal cord, causing progressive and distal radiation of pain; the backache subsides as the sciatica ‘syndrome’ develops with its sensorimotor consequences
Signs and symptoms:
Symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue that become involved. They can range from little or no pain if the disc is the only tissue injured, to severe and unrelenting neck or low back pain that will radiate into the regions served by affected nerve roots that are irritated or impinged by the herniated material. Often, herniated discs are not diagnosed immediately, as the patients come with undefined pains in the thighs, knees or feet. Other symptoms may include sensory changes such as numbness, tingling, muscular weakness, paralysis, paresthesia, and affection of reflexes. If the herniated disc is in the lumbar region the patient may also experience sciatica due to irritation of one of the nerve roots of the sciatic nerve. Unlike a pulsating pain or pain that comes and goes, which can be caused by muscle spasm, pain from a herniated disc is usually continuous or at least is continuous in a specific position of the body.
It is possible to have a herniated disc without any pain or noticeable symptoms, depending on its location. If the extruded nucleus pulposus material doesn’t press on soft tissues or nerves, it may not cause any symptoms. A small-sample study examining the cervical spine in symptom-free volunteers has found focal disc protrusions in 50% of participants, which shows that a considerable part of the population can have focal herniated discs in their cervical region that do not cause noticeable symptoms.
Typically, symptoms are experienced only on one side of the body. If the prolapse is very large and presses on the spinal cord or the cauda equina in the lumbar region, affection of both sides of the body may occur, often with serious consequences.