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Low back pain
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===Back structures=== {{multiple image | align = right | image1 = Illu vertebral column.svg | width1 = 200 | alt1 = The lumbar region in regards to the rest of the spine | caption1 = The five lumbar vertebrae define the lower back region. | image2 = ACDF oblique annotated english.svg | width2 = 200 | alt2 = The nerve and bone components of the vertebrae | caption2 = The structures surrounding and supporting the vertebrae can be sources of low back pain. | footer = }} The lumbar (or lower back) region is the area between the lower ribs and gluteal fold which includes five lumbar [[vertebrae]] (L1βL5) and the sacrum. In between these vertebrae are [[fibrocartilage|fibrocartilaginous]] [[intervertebral discs|discs]], which act as cushions, preventing the vertebrae from rubbing together while at the same time protecting the [[spinal cord]]. Nerves come from and go to the [[spinal cord]] through [[intervertebral foramina|specific openings]] between the vertebrae, receiving sensory input and sending messages to muscles. Stability of the spine is provided by the ligaments and muscles of the back and abdomen. Small joints called [[zygapophysial joints|facet joints]] limit and direct the motion of the spine.<ref name=floyd_2008>Floyd, R., & Thompson, Clem. (2008). ''Manual of structural kinesiology''. New York: McGraw-Hill Humanities/Social Sciences/Languages. {{ISBN?}}{{page needed|date=July 2021}}</ref> The [[multifidus muscle]]s run up and down along the back of the spine, and are important for keeping the spine straight and stable during many common movements such as sitting, walking and lifting.<ref name=salzberg_2012 /> A problem with these muscles is often found in someone with chronic low back pain, because the back pain causes the person to use the back muscles improperly in trying to avoid the pain.<ref name=freedman_2010>{{cite journal | vauthors = Freeman MD, Woodham MA, Woodham AW | title = The role of the lumbar multifidus in chronic low back pain: a review | journal = PM & R | volume = 2 | issue = 2 | pages = 142β6; quiz 1 p following 167 | date = February 2010 | pmid = 20193941 | doi = 10.1016/j.pmrj.2009.11.006 | s2cid = 22246810 }}</ref> The problem with the multifidus muscles continues even after the pain goes away, and is probably an important reason why the pain comes back.<ref name=freedman_2010 /> Teaching people with chronic low back pain how to use these muscles is recommended as part of a recovery program.<ref name=freedman_2010 /> An intervertebral disc has a [[Nucleus pulposus|gelatinous core]] surrounded by a [[Annulus fibrosus disci intervertebralis|fibrous ring]].<ref name=hughes_2012>{{cite journal | vauthors = Hughes SP, Freemont AJ, Hukins DW, McGregor AH, Roberts S | title = The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain | journal = The Journal of Bone and Joint Surgery. British Volume | volume = 94 | issue = 10 | pages = 1298β1304 | date = October 2012 | pmid = 23015552 | doi = 10.1302/0301-620X.94B10.28986 | url = http://www.boneandjoint.org.uk/highwire/filestream/61400/field_highwire_article_pdf/0/1298.full-text.pdf | access-date = 25 June 2013 | archive-url = https://web.archive.org/web/20131004234019/http://www.boneandjoint.org.uk/highwire/filestream/61400/field_highwire_article_pdf/0/1298.full-text.pdf | archive-date = 4 October 2013 }}</ref> When in its normal, uninjured state, most of the disc is not served by either the [[circulatory system|circulatory]] or [[nervous systems]] β blood and nerves only run to the outside of the disc.<ref name=hughes_2012 /> Specialized cells that can survive without direct blood supply are in the inside of the disc.<ref name=hughes_2012 /> Over time, the discs lose flexibility and the ability to absorb physical forces.<ref name=borczuk_2013 /> This decreased ability to handle physical forces increases stresses on other parts of the spine, causing the ligaments of the spine to thicken and bony growths to develop on the vertebrae.<ref name=borczuk_2013 /> As a result, there is less space through which the spinal cord and nerve roots may pass.<ref name=borczuk_2013 /> When a disc degenerates as a result of injury or disease, the makeup of a disc changes: blood vessels and nerves may grow into its interior and/or herniated disc material can push directly on a nerve root.<ref name=hughes_2012 /> Any of these changes may result in back pain.<ref name=hughes_2012 />
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