The region between the neck and the lower back, often referred to as the back, is a common area where pain complaints arise due to its location between the chest and abdominal regions. The back, being densely packed with muscles, is also highly susceptible to the effects of factors such as poor posture, prolonged periods of sitting, and heavy lifting, often related to occupational and postural factors. It is one of the most frequently reported musculoskeletal areas causing discomfort, following lower back pain.

Causes of Back Pain Pain originating from muscles, bones, joints, and ligaments in the back region: Among these, it is essential to highlight pain arising from incorrect posture and sustained working positions, as well as pain resulting from heavy lifting. Improper sleeping postures and poor-quality mattresses are also factors that come to mind when considering causes of back pain. Spinal disc herniation (slipped disc) in the back region: Since the back area is not as mobile as the shoulder and lower back regions, the probability of disc herniation is relatively lower. Neck and lower back issues: Pain in the back area can be felt in both the neck and lower back complaints. Infections in the spinal bones (such as tuberculosis), traumatic processes like fractures, tumoral formations, and collapse due to bone loss are reasons that should always be considered. Diseases originating from organs in the chest cavity: Lung diseases, accumulation of fluid in lung membranes, adhesions, heart pain, diseases of the major blood vessels in this area, and esophageal problems like reflux can also lead to back pain. Diseases originating from abdominal organs: Aortic aneurysms, kidney diseases, gallbladder and bile duct diseases, stomach disorders (ulcers, perforation, etc.), and pancreatic diseases are causes of back pain. Infections: Particularly when shingles affects the back region, the symptoms may manifest solely as back pain until lesions appear. Scoliosis (spinal curvature), kyphosis (hunchback), and other spinal deformities can also cause back pain by disrupting the mechanics of the spine. Diagnosis of Back Pain

Looking at the aforementioned causes, it becomes evident how challenging diagnosing back pain can be. When dealing with back pain patients, symptoms such as weight loss, weakness, fever, and nighttime pain should be inquired about. These symptoms might indicate significant causes like infection, tumor, or inflammatory rheumatic disease underlying the pain. In the assessment of lung diseases, night sweats, cough, respiratory distress, and fever should also be considered. The presence of pain during exertion might point towards heart and lung conditions. Signs related to the digestive system should also be examined. Sometimes, patients might not mention these symptoms, assuming they are unrelated to their back pain. Pain or burning sensation during urination might indicate kidney and urinary tract problems.

During the examination, both the neck and lower back should be assessed, along with all the spinal vertebrae and associated structures. The patient should undress so that conditions like shingles can be observed. The back area, especially around the shoulder blades, contains trigger points related to myofascial pain syndrome, and it should be evaluated whether these trigger points contribute to the radiating pain in the back.

In cases of back pain, since there are numerous diseases that could be diagnosed, the diagnosis can be supported with radiography and MRI. Blood tests can be conducted to rule out organ problems, rheumatologic diseases, and infections, while urine tests can be done to rule out kidney issues.

Red Flags for Seeking Medical Attention in Cases of Back Pain Severe trauma experienced within the last 3 months Presence of an immune-compromising disease Prolonged use of corticosteroids Night sweats Back pain worsening during the night Breathing difficulties Weight loss Loss of height Increase in back pain Back pain resulting from minor trauma and sudden movements in individuals with osteoporosis Pain lasting for more than a month Numbness, weakness, and urinary incontinence threshold in the legs Treatment of Back Pain

In cases of back pain, identifying the underlying cause of the pain is the key to effective treatment. If the patient has a lung infection or a tumoral formation, a fracture due to bone loss, or a gallstone, the pain will persist regardless of any interventions. Therefore, treating the underlying disease is of primary importance.

In the presence of pain originating from structures in the back region, the following treatment methods can be recommended:

  1. Measures to Reduce Pain

Medications: Medications can be used to alleviate back pain. Pain relievers/anti-inflammatory drugs, muscle relaxants, adjunctive medications, and weak opioids can be used for this purpose. These medications can be taken orally or applied externally in the form of gels/creams.

Rest: Rest is another treatment method. Since the back carries the load of the upper body, rest can be beneficial by reducing the load on the area. Short-term bed rest and the use of back braces can be recommended for this purpose.

Complementary medicine methods: Complementary medicine methods like acupuncture, neural therapy, ozone therapy, mesotherapy, and prolotherapy can be used to control back pain. In our clinic, we utilize acupuncture, neural therapy, and ozone therapy among these treatments. These three methods are preferred due to their low side effect profile, rapid pain control ability, and holistic approach that also offers possibilities for treating other systems that could cause back pain.

Physical therapy: The combined use of physical therapy tools in cases of back pain is a well-established and successful treatment method that has been used for many years. By reducing muscle spasms, decreasing edema, and increasing blood flow, physical therapy can help control pain in the lower back.

Manipulation, mobilization: Manipulation and mobilization can be applied in patients diagnosed with back segment blockage.

  1. Exercises and Back Protection Techniques

In cases of back pain, exercise becomes as effective as medication after the acute phase. The aim of exercise is to strengthen the back muscles, lengthen muscles that have shortened due to spasms, and stretch ligaments. This leads to the formation of a balanced and natural corset around the back.

Alongside exercises targeting the back, aerobic exercises that involve large muscle groups and increase heart rate and respiration should also be performed. These exercises also contribute to weight control. Moreover, they increase the production of endorphins, also known as happiness hormones, which not only improve mood but also reduce pain. Examples of such exercises include running, walking, swimming, and dancing. The patient should engage in the exercise they enjoy the most. For the desired effects to occur, aerobic exercises should be performed for at least 8 weeks.

Exercises that enhance body flexibility, such as Pilates and yoga, can also be performed. During these exercises, it is recommended to avoid movements that cause pain and to gradually increase exercise intensity. When performing exercises at a gym without medical supervision, the relevant instructor should be informed of the situation. Similarly, gradual intensity increase, avoidance of improper heavy lifting, and prevention of movements that cause pain are recommended.

Back protection techniques should be taught for both daily activities and occupational tasks. Thus, the patient’s profession and the bodily movements associated with it should be understood. If necessary, ergonomic adjustments should be made, and patients should be educated on this aspect as well.

Back pain can stem from secondary issues related to neck and lower back problems, pathologies of the spinal vertebrae and surrounding tissues, and pain referred from organs within the chest and abdomen. Especially in working individuals, back pain attributed to fatigue should be investigated to determine whether the pain is truly caused by muscle soreness from fatigue or if there is an underlying issue. In elderly individuals with osteoporosis, silent spinal fractures, infections of all kinds, problems in the rib cage and major vessels within the chest and abdomen should all be considered across a wide spectrum. In patients without internal organ issues, along with treatments like neural therapy, acupuncture, ozone therapy, and dry needling, exercises that strengthen and stretch the back and abdominal muscles, evaluations of factors causing pain due to poor posture and work environment, and efforts to resolve them should also be carried out.