The back is an intricate structure of bones, muscles, and other tissues that form the posterior part of the body’s trunk, from the neck to the pelvis. The centerpiece is the spinal column, which not only supports the upper body’s weight but houses and protects the spinal cord — the delicate nervous system structure that carries signals that control the body’s movements and conveys its sensations. Stacked on top of one another are more than 30 bones — the vertebrae — that form the spinal column, also known as the spine. Each of these bones contains a roundish hole that, when stacked in register with all the others, creates a channel that surrounds the spinal cord. The spinal cord descends from the base of the brain and extends in the adult to just below the rib cage. Small nerves ("roots") enter and emerge from the spinal cord through spaces between the vertebrae. The spaces between the vertebrae are maintained by round, spongy pads of cartilage called intervertebral discs that allow for flexibility in the lower back and act much like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column.

Starting at the top, the spine has four regions:
• the seven cervical or neck vertebrae (labeled C1 - C7),
• the 12 thoracic or upper back vertebrae (labeled T1 - T12),
• the five lumbar vertebrae (labeled L1 - L5), which we know as the lower back, and
• the sacrum and coccyx, a group of bones fused together at the base of the spine.

The lumbar region of the back, where most back pain is felt, supports the weight of the upper body. Tuberculous spondylitis is a very rare disease, but it can result in bone destruction, kyphotic deformity, spinal instability, and neurologic complications unless early diagnosis and proper management are done.

1. Lumbar strain - Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward.

2. nerve irritation - This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results.

3. Lumbar radiculopathy - Lumbar radiculopathy is nerve irritation that is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration ("wear and tear") of the outer ring of the disc, traumatic injury, or both.

4. Bony encroachment - Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include:
     • Foraminal narrowing
     • Spondylolisthesis (slippage of one vertebra relative to another)
     • Spinal stenosis (compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal) Spinal stenosis can cause lower-extremity pains that worsen with walking and are relieved by resting (mimicking the pains of poor circulation).
     • Spinal-nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities

5. Conditions of the bone and joints.- Bone and joint conditions that lead to low back pain include those existing from birth (congenital), those that result from wear and tear (degenerative) or injury, and those that are due to inflammation of the joints (arthritis).

6. Other causes of low back pain include kidney problems, pregnancy, ovary problems, and tumors.

7. Uncommon causes of low back pain include Paget's disease of bone, bleeding or infection in the pelvis, infection of the cartilage and/or bone of the spine, aneurysm of the aorta, and shingles.

1. Numbness and tingling of the lower extremities
2. Incontinence of urine or stool
3. Inability to walk without worsening pain
4. Lower extremity weakness
5. Atrophy (decreased in size) of the lower extremity muscles
6. Rash
7. Fever
8. Chills
9. weight loss
10. Abdominal pains
11. Burning on urination
12. Dizziness
13. Joint pain
14. Fatigue

1. blood Tests
2. urine tests
3. plain film X-ray tests
4. CAT scanning
5. MRI scanning
6. bone scanning
7. electromyograms (EMGs)
8. nerve conduction velocities (NCVs)

Using analgesics -nonsteroidal anti-inflammatory drugs (aspirin, naproxen, and ibuprofen), are taken orally to reduce stiffness, swelling, and inflammation

1. Strength to the back –
     • Strengthen back and abdominal muscles.
     • Movement therapy to improve coordination and develop proper posture and muscle balance.
     • Maintaining and building muscle
     • Gentle exercises that help keep muscles moving and speed the recovery process.
     • stretching exercises
     • Swimming
     • walking
     • Yoga
     • Preventing recurrence of the injury
2. Modalities for pain relief.
3. Proper bed rest and postural re-education.
4. Spinal Manipulations.
5. Traction

• Always stretch before exercise or other strenuous physical activity.
• Don’t slouch when standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced.
• At home or work, make sure your work surface is at a comfortable height for you.
• Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for a long period of time, rest your feet on a low stool or a stack of books.
• Wear comfortable, low-heeled shoes.
• Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface.
• Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed.
• Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting.
• Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.
• If you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.