Also referred to as the spinal column, backbone or vertebral column.

The spine supports the trunk of the human body allowing it to stand upright and maintain balance. It protects the spinal cord, provides attachment for a number of muscles and the ribs, and helps to support the head and arms whilst allowing freedom of movement.

The spine is made up of 33 vertebrae which have discs of fibrous cartilage between them that act as shock absorbers and allow the back to move. The vertebrae are divided into 5 specific functional areas.

The Cervical Vertibrae is comprised of the first seven bones at the top of the spine. They are the smallest of the vertebrae which allows for a greater degree of flexion, extension, bending and turning of the head.

The next 12 vertebrae make up the Thoracic Spine. They attach to the ribs to form the rear anchor of the rib cage and, because the ribs limit the body’s movement to the side, their movement is mostly rotational with a small amount of movement forwards and backwards. Although larger than the cervical vertebrae, the canal through which the spinal cord passes is relatively smaller than that in the cervical or lumbar regions. This makes the spinal cord more vulnerable if there is a fracture in this area.

The Lumbar Vertebrae follow on from the thoracic vertebrae. The 5 vertibrae that make up this part of the spinal column are the largest and bear most of the weight of the body as well as attaching to many of the muscles of the back. The main movement of the lumbar vertebrae is bending forwards and backwards with some movement to the side.

The Sacrum is located at the bottom of the lumbar vertebrae and, in a child, is made up of 4 or 5 sacral vertebrae. After the age of 26 these bones fuse to form a single, triangular shaped bone which is located at the base of the lumbar vertebrae. The sacrum attaches to the pelvis, moves with it and forms its back wall.

The Coccyx, or tailbone, is made up of 3-5 bones which fuse together in adulthood. A number of muscles attach to the coccyx.

The nerves within the spinal cord are grouped together in different bundles called Ascending tracts and Descending tracts. The Ascending tracts relay information, such as the position of the joints, touch, pain and the temperature of the skin, back from the body to the brain. The descending tracts carry instructions from the brain to the body to control body functions and bring about movement.

The brain and spinal cord are called the Central Nervous System and the Spinal Nerves that branch out from the spinal cord to carry information to and from the rest of the body are referred to as the Peripheral Nervous System.

The spinal cord itself has 4 divisions and each division, with its spinal nerves, has responsibility for specific neurological functions.

• Cervical Nerves (neck) - supply movement and feeling to the arms, neck and upper torso
• Thoracic Nerves (upper back) - supply the torso and abdomen and are responsible for the muscles that play a part in breathing
• Lumbar Nerves and Sacral Nerves (lower back) - supply the legs, bowel and bladder, pelvis and sexual organs

Muscles and ligaments provide support for the spine, enable the body to function in an upright position and allow the torso to take up a variety of positions in order to perform different tasks and activities.

• Spinal ligaments - connect the vertebrae, assist in keeping the spine stable and preventing excessive movement. The most important ligaments are the anterior longitudinal ligament and the posterior longitudinal ligament which runs from the base of the skull to the sacrum at the base of the spine
• Muscles - make up the majority of the soft tissue that surrounds the spine, extending down the length of the spine and assisting it to bend, rotate and maintain its natural curve. The erector spinae is the largest of the many paraspinal muscles, and is responsible for keeping the body upright
• Spinal tendons - attach the muscles that support the spine to the vertebrae

Other Structures

• Muscle fascia - This is the thickened connective tissue that surrounds a muscle or groups of muscle. There are 4 types of fascia:-

• Superficial fascia lies directly beneath the skin
• Epimysium lies closest to the muscle
• Perimysium divides the muscle into fibres
• Endomysium covers each muscle fibre

• Skin - The skin on the back is thicker and has fewer nerve endings than that on any other part of the trunk
• Organs - The lungs fill the upper trunk and extend to the back of the ribcage. The kidneys sit beneath the muscles and below the end of the ribcage making them vulnerable to injury from a blow to the lower back

In most cases in most cases back pain is caused by a relatively minor problem but it may, in some instances, indicate a more serious disorder. Injury to the spine, spinal cord or the soft tissues that surround them can cause pain, function to be impaired and even permanent disability. Kidney infections and disease may also cause severe back pain.

Most people will suffer with some back pain at some point in their lives but most back pain occurs between the ages of 25 and 60 and affects both men and women equally.

• Road Traffic Accidents – Whiplash can affect both the neck and upper back muscles and an impact can cause problems to the lower and upper back muscles. Often these injuries do not become apparent until hours or in some cases a few days after the incident
• Falls – Falling awkwardly or slipping and twisting can cause damage to the spine or soft tissue that surrounds it
• Sports Injuries – Falling awkwardly doing gymnastics, trampolining or a fall from a horse may cause serious injury to the spine or soft tissue that surrounds it
• Work Accidents – Falling from a height i.e. scaffolding, roofs or ladders, or something heavy falling across a persons back. Lifting – Lifting weights incorrectly or without necessary assistance or equipment can cause slipped discs or pulled muscles
• Violent Assault – Injury to the head or face such as a punch or kick can cause spinal injury. A blow to the lower back may damage the kidneys