What you need to know about Back Pain
This is a reprint of a blog post on www.academia.edu
Authors: Greg Millar, DC CCEP; Jamie Bunis DC, DC; Jack Langston, DC; Adam Shafner DC
Back Pain is really quite common. About 75% of all Americans will personally experience back pain at some time during their life. Ninety percent, 90%, of all Americans will know someone or have a family member with back pain. Behind the common cold it’s the second leading reason for missed work. The good news is that only 5% or less of back pain cases ever need surgery. Let’s say that another way, according to research 95% of all back pain is treatable without surgery.
The most common cause of back pain is from strains and sprains caused by stress, movements and repetitive motion. These pains are often caused by muscle and ligament pulls
and tears.
The back is a complex structure with 33 interlocking and communicating bones with interconnecting ligaments, muscles and intervertrabal disc. The problem in diagnosing the cause of back pain is the number of potential structures that can cause the problem.
How many times have we lifted, pushed, pulled, worked too hard or simply bent over and picked up a feather and had back pain? Back Attack!!! Back pain like this can be acute or chronic (more than 6 weeks). It ranges from an occasional dull ache to a sharp shooting, intense pain. Pain can occur with movement or just sitting still.
Another common cause of back pain, often worse as the day goes on, is from a bulging disc. The disc pain may or may not have associated radiating pain down an arm or leg. Yet another common cause of back pain, mostly felt in the morning, is often from degenerative facet pain. And still another back pain that radiates either into the anterior or front of the thigh or down the back of both legs and is relieved by sitting a few minutes is often associated with stenosis. (We often ask this person if they need to lean on a shopping cart while shopping.) The problem with diagnosing and treating back pain is that God’s design of the back is infinitely more sophisticated than our ability to diagnose.
The genesis or place of origin for back pain can also come from any one of a number of structures or multiple structures or problems at once. Rarely, do we see a patient that, let’s say; only has a bulging disc and does not have another source of pain at the same time. An example being: bulging disc pain and degenerative facet pain or sacral pain. We often tell our patients, if you don’t know what’s causing the pain, you can’t treat it. I know that sounds simple; but, it’s true.
The Anatomy of Your Back (Spine)
Your back, or spine, is made up of many parts. Your backbone, also called your vertebral column, provides support and protection. It consists of 33 vertebrae (bones). Some of these naturally fuse together as we grow. For most patients, we like them to know that there are 7 cervical or neck bones, 12 thoracic or mid back bones, 5 lumbar or low back bones and a triangle shaped bone at the bottom of the spine called a sacrum. There are discs between most of the vertebra that act like pads or shock absorbers. They also act like a washer giving space between the vertebrae bones for nerves to exit. Each disc is made up of a tire-like outer band called the annulus fibrosus and a gel-like inner substance called the nucleus pulposus. Together, the vertebrae bones and the discs provide a protective tunnel (the spinal canal) to house the spinal cord and spinal nerves. These nerves run down the center of the vertebrae and exit the spine to control the arms, hands and fingers, the hips knees, legs and feet as well as various other parts of the body.
Your back also has muscles, ligaments, tendons, and blood vessels. Muscles are layers of tissues that act as the source of power for movement and stability. Ligaments are the strong, flexible bands of fibrous tissue that link the bones together much like strapping tape. And tendons connect muscles to bones and discs. Blood vessels provide nourishment to the bones, muscles, ligaments and tendons; but, not to the discs. The discs themselves get their nourishment and eliminate waste from imbibition thru the bony endplate of the vertebrae above and below. Imagine your discs are like sponges that are being squeezed by the movement of the spine causing a sponge like uptake of fluids and nutrients and the outgo of waste.
Back pain may be a result of injury to any or all of these body parts. So again it’s important that your doctor take the time to examine you and determine all (or at least as many as he can) of the problem areas. Injury to the soft tissues (muscles, ligaments, tendons) results in sprains or strains, which may or may not be generally considered serious. However, injury to bones, nerves, or blood vessels may be much more serious. Finally, most common is a bulge of the annulus fibers of the discs themselves often causing secondary inflammation to a nerve or nerve root or directly pressing or compressing a nerve or even the spinal cord itself. If that were not enough, the outer layers of discs can get tears or cracks, allowing the annulus fibrosus to split and tear sometimes causing a leaky disc. And finally, the nucleus pulposus or center of the disc can tear or herniate and empty out its contents into the disc.
Any of these injuries can cause inflammation and pain. The pain can be localized or radiating. We like to say radiating pain from a bulging disc is like stepping on a dog’s tail and the other end barks. Wherever that nerve courses you may have pain.
Now you can see why it’s so difficult to properly diagnose and treat back pain. And we’ve just hit the tip of the iceberg. Add in a surgery or two and you’ve got a mess. But you’ve also got a real human being in pain that deserves someone to take the time to figure it out and treat the problem.