Mechanical Back Pain: Causes and Treatment Approaches

Introduction

Mechanical back pain is one of the most common musculoskeletal complaints worldwide, affecting individuals across all age groups. It accounts for a significant proportion of healthcare visits and economic burden due to lost productivity. Unlike back pain caused by systemic conditions such as infections, malignancies, or inflammatory diseases, mechanical back pain arises from dysfunctions in the spine's structural components, including muscles, ligaments, intervertebral discs, and facet joints.

Causes of Mechanical Back Pain

Mechanical back pain can be attributed to several underlying factors, including:

1. Muscle Strains and Ligament Sprains

   • Overuse, poor posture, and sudden movements can strain muscles and ligaments, leading to pain and stiffness.

2. Intervertebral Disc Degeneration

   • Ageing leads to the gradual breakdown of intervertebral discs, reducing their ability to cushion vertebral movements.

3. Facet Joint Dysfunction

   • The facet joints provide stability and facilitate motion; degeneration or inflammation can result in localized pain.

4. Spinal Stenosis

   • Narrowing of the spinal canal can compress nerve roots, causing pain, numbness, and weakness.

5. Spondylolisthesis

   • Vertebral slippage can place stress on the spine, leading to lower back pain and nerve irritation.

6. Sacroiliac Joint Dysfunction

   • Inflammation or malalignment of the sacroiliac joints can contribute to lower back and pelvic pain.

Treatment Approaches for Mechanical Back Pain

Management of mechanical back pain follows a stepwise approach, beginning with conservative therapies and progressing to minimally invasive interventions when necessary.

1. Conservative Management

• Activity Modification: Avoiding activities that exacerbate pain while maintaining mobility to prevent stiffness.

• Medications:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief and inflammation control.

  • Muscle relaxants for acute muscle spasms.

  • Analgesics such as acetaminophen for mild pain.

• Heat and Cold Therapy:

  • Ice packs can reduce inflammation in the acute phase.

  • Heat therapy helps relax tight muscles and improve circulation.

2. Physiotherapy

Physical therapy is crucial for restoring function and preventing recurrence. Key components include:

• Manual Therapy: Mobilisation and manipulation techniques to improve joint function.

• Exercise Therapy:

  • Core strengthening to support spinal stability.

  • Stretching to enhance flexibility.

  • Aerobic conditioning to improve overall physical fitness.

• Postural Training: Education on ergonomics and proper body mechanics to reduce strain on the spine.

3. Minimally Invasive Interventions

When conservative measures fail to provide relief, minimally invasive procedures can be considered.

• Medial Branch Blocks and Facet Joint Injections:

  • Local anaesthetic and corticosteroids are injected near the medial branch nerves that supply the facet joints, providing pain relief.

• Foraminal Nerve Blocks:

  • Injection of corticosteroids and local anaesthetic into the foraminal space to reduce inflammation and nerve irritation.

• Radiofrequency Ablation (RFA):

  • Uses heat to disrupt pain signals from the medial branch nerves, offering longer-lasting relief.

• Spinal Cord Stimulation (SCS):

  • Implantation of a device that delivers electrical impulses to the spinal cord to modulate pain perception.

Conclusion

Mechanical back pain is a prevalent condition with a wide range of underlying causes. Management should be individualised, starting with conservative treatments such as physiotherapy and medications, progressing to minimally invasive procedures when necessary. Early intervention and a multimodal approach are key to preventing chronicity and improving patient outcomes.

References

1. van Tulder M, et al. (2006). "Treatment of Low Back Pain: A Comprehensive Review." The Lancet, 367(9523), 726-734.

2. Chou R, et al. (2018). "Nonpharmacologic Therapies for Low Back Pain: A Systematic Review." Annals of Internal Medicine, 168(3), 171-183.

3. Cohen SP, et al. (2013). "Medial Branch Blocks and Radiofrequency Ablation for Chronic Lumbar Facet Joint Pain: A Comprehensive Review." Anesthesiology, 118(1), 145-161.

4. Kapural L, et al. (2016). "Spinal Cord Stimulation for Chronic Pain: An Evidence-Based Review." Pain Medicine, 17(4), 820-831..