Lumbago

Back pain is the most common syndrome that affects not only athletes of all categories, but also all people in general.

It is statistically proven that at least 70% of the population will suffer from back pain at least once. Jokingly, it is said that back pain is the price that man pays for his transition from quadrupedal to bipedal (homoerectus) posture!

But what exactly is back pain?

Back pain is pain that is supposed to originate from the back of the body, delimited by the spinous process of the 12th lumbar vertebra.^u thoracic vertebra, up to the imaginary line that connects the two iliac crests at the back of the pelvis. Low back pain is a syndrome. The main symptom is pain in the area in question, while a number of other symptoms are often mentioned, such as paresthesia, numbness or burning pain and others. There may be many obvious signs, but there may also be none (psychogenic low back pain)!

Epidemiologically, age and gender do not appear to play a significant role, while perhaps

It is worth dwelling on the statistical vagaries of back pain. For example:

Back pain occurs more frequently in people of low economic status, i.e. it prefers the poor.

It does not discriminate by race, as it occurs equally frequently in all races.

People who are divorced, separated, and widowed suffer from back pain more often than those who are currently married or have never been married!

From an economic perspective, back pain is particularly damaging. In the U.S., for example, 601% of trauma and orthopedics spending is spent on treating back pain, which means 16 out of 24 billion dollars!

It is also estimated that more than 501% of the working population will suffer from back pain during their work. If we take into account the fact that 6.21% of the working population will suffer for approximately 2 weeks, we realize that 60 million working days are lost in England, for example, at a financial cost of approximately 350 million British pounds!

So we understand why our dedication to back pain will be relatively long and will be completed in 2 issues.

But in order to understand our body better, we need to know it from the inside, which is why a little anatomy is necessary. However, the complexity of the area requires a simpler explanation in order to be understood. So we start from the most general to the most detailed.

Here we can see the lumbar spine (LSS) from behind. It is characteristic how many muscles are located in the area and attach to various parts of the vertebrae, thus providing dynamic stability. We point out that this is the first layer of muscles and above them there are several more, larger and stronger.

From the same position we see even deeper and without the posterior formations of the vertebrae, the spinal cord and the spinal nerve roots that form behind the vertebrae.

The spinal cord is particularly sensitive and that is why it is so protected by a complex of bones, ligaments and muscles.

Here, the image shows us the anterior side of the lumbar spine where we can distinguish the vertebrae with their discs and the nerve plexuses of the lumbar and sacral bones.

Notice that from each root comes a pair of nerves which join with nerves from other roots and form anastomoses. These connections will eventually give us large nerves such as the sciatic nerve which appears as the largest in our diagram.

Here we see a lumbar vertebra. The solid part that looks like an oval is the body of the vertebra, where the intervertebral disc will be placed on it. The body is oriented towards the abdomen. Then, a hole is observed through which the spinal cord passes. In blue we see the upper articular surfaces that articulate with the vertebra below, while the two lateral protrusions are transverse processes and finally the spinous process that stands out on its own and we can often feel it with our finger on our back.

Here we now see a lumbar vertebra with its intervertebral disc. In the center (N) is the nucleus of the disc, while peripherally to the nucleus is the annulus fibrosus (A). The disc is located at the top of the body of the vertebra below and is in contact with the bottom of the body of the vertebra above, joining the two vertebrae together.

Finally, we see a view of the intervertebral disc. In black, the nucleus is located in the center, which consists of approximately 88% of water. Its purpose is to move accordingly in order to relieve the spine from large loads.

The fibrous ring, which is located peripherally to the nucleus, is depicted as it is, that is, in layers facing opposite directions from each other, and its purpose is to protect the nucleus from any externalization outside the disc.

Finally, we observe a more complete picture where the disc (1), the spinal cord (3), a spinal root (N.R) and the joint formed between the transverse articular processes (Facet Joint) (6) are visible.

Now that we have some idea of the lumbar spine, we can now examine how its anatomical elements function during movement.

Observing the relationship between the movements of the intervertebral disc and the spinal column, we will notice that during the upright position, the disc, as well as the disc nucleus, are in the middle position. During extension, the bodies of the two adjacent vertebrae converge from behind, pushing the disc towards the abdomen, while during flexion the opposite happens.

The intervertebral disc remains in place when no pathology arises (which we will refer to in the next issue) and a very important group that participates in the passive stabilization of the spine and the disc are the ligaments. We can see the ligaments collectively in the image below:

Notice how wide and fitted onto the disc the anterior longitudinal ligament (anter. longit. ligam) is, as well as the posterior longitudinal ligament (post. longit. ligam) and how many other ligaments are located in this small area.

As we saw above, extension causes convergence of the posterior parts of the disc body, thus causing lordosis. Let us not forget, however, that the pelvis, since it is connected to the spinal column, is also related to it in terms of movement, and the hips, since they affect the position of the pelvis, indirectly affect the spinal column. With such an example, we will close, thus completing the 1^The part of the presentation of back pain.

We therefore observe that during normal standing, the lumbar spine is in a normal lordosis. This lordosis can be largely eliminated by bending one hip, essentially changing the position of the pelvis.