unknonw, combined causes most likely chronic vs acute upper vs lower risk factors theories pain-spasm-pain cycle
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Ref 5, 6 \= strain? separate? sudden MVA, sports check for red flags poor body mechanics, posture - overuse??
degenerative disc disease ref 10
Facet Joint Disorder
Ref 7, also in resources (better) 2 change subhead
resource 3?? psychogenic depression
muscle weakness, bowel or bladder tetanus, osteo ankylosing spondylitis