BACK PAIN
Back pain is one of the most common reasons people self-treat and/or seek medical care. It will affect approximately three in four adults during their lifetime. It is caused, directly or incidentally, by a significant number of health conditions, which may make teasing out the root cause of back pain exceedingly difficult. Many cases are self-limiting and go away on their own, but some cases linger for months or even years.
What Are the Parts of the Spine?
Learning about spine anatomy can help you understand your back pain on a deeper level. There are three main areas of focus: the cervical (neck), thoracic (upper back) and lumbar (lower back) spine.
Between the neck and tailbone, there are 24 levels of the spine. This includes vertebral bodies, intervertebral discs, bilateral facet joints, stabilizing ligaments, supportive muscular structures, the spinal cord, and nerve roots as well as blood vessels. The “spine” is more than the sum of its parts, and its anatomic complexity can lead to multiple different disease processes.
Vertebrae are a series of small bones that make up the backbone to which the muscles attach, each separated by an intervertebral disc. Every vertebra is made up of two parts: an anterior vertebral body that protects the spinal cord and nerve roots and a posterior vertebral arch which accommodates the canal and also safeguards the spinal cord.
Back muscles fall into three groups:
- Intermediate muscles make up something called the erector spinae, which includes the longissimus, iliocostalis, and spinalis muscles. These muscles help to flex/extend and laterally bend the spinal column.
- Intrinsic muscles stabilize the vertebral column and are located underneath the erector spinae; also known as the “deep” muscles of the back and control the movement and posture of the vertebral column.
- Superficial muscles are directly underneath the skin and attach to the bones of the shoulder, aiding in neck and shoulder movements along with controlling upper limb movements.
There are several other parts of the spine worth considering when you are identifying your back pain. These include:
- Ligaments and tendons. While tendons are part of the muscular structure attaching a muscle to bone, ligaments attach bone to bone with no intervening muscle. Both ligaments and tendons contain elastic fibers.
- Intervertebral discs, which act as miniature shock absorbers that sit between vertebrae and prevent bone-on-bone friction. Discs can naturally degenerate over time.
- Facet joints, which are hinge-like joints that connect each of the vertebra to the one above it and the one below it. They provide the optimal combination of mobility and stability: Each vertebra can move independently, but since they’re all connected the spine can act as a whole. There are four facet joints per vertebra—two on top and two on the bottom.
What Are Some Different Types of Back Pain?
The first thing you should probably know about back pain is that it can last anywhere from a few days to years, and that timeline makes a big difference in how your pain is diagnosed and treated.
- Acute back pain is defined as severe but lasting a short time, usually seven to 10 days.
- Subacute pain can last from two to six weeks.
- Chronic back pain usually occurs every day and sticks around for longer than six to eight weeks. It can be severe and last months or even years, but may be characterized as mild, deep, achy, burning, or electric-like.
Beyond the when, there’s also the where. Mechanical pain means that the source of your pain may lie in the facet joints, discs, soft tissues, or vertebrae.
Back pain that travels into another part of the body, such as the leg, may be consider radicular pain, particularly when it radiates below the knee. This scenario is commonly called a lumbar radiculopathy (e.g., sciatica). Fortunately, not all occurrences of back pain include leg pain.
Back Pain Risk Factors
The two biggest “modifiable” risk factors for back pain are obesity and smoking. The increased mechanical forces that your spine joints and supporting structures are subjected to with obesity can lead to early acceleration of degenerative changes as well as increased inflammatory pain within the joints themselves. Smoke causes an adverse impact on the vascular system and is associated with increased severity and frequency of back pain. Smoking impairs the delivery of nutrients to structures in the spine and can also make healing from back injuries or surgery more difficult and less effective.
Other risk factors include:
- Age
- Fitness level
- Genetics
- Jobs or activities
- Sedentary lifestyle
Back Pain Causes
There are several diseases, disorders, and illnesses that can cause back pain. They fall into a few broad categories.
Structural Issues
Structural issues are, collectively, a top cause of back pain. We can define structural issues as any condition that affects the spinal column itself or any part. This includes a diverse array of structures and tissues, including:
- The vertebrae
- The intervertebral discs
- The facet joints
- The spinal canal
- Soft tissues (muscles and ligaments)
Conditions that can be considered structural issues include:
- Herniated Disc
- Arthritis
- Degenerative Disc Disease (DDD)
- Facet joint arthropathy
- Compression and Wedge Fractures
- Spondylolisthesis (spinal instability)
- Spinal Stenosis
- Lumbar Radiculopathy
- Cauda Equina Syndrome
Sprains and Strains
Many experts believe that sprains and strains are the most common cause of back pain, especially acute episodes that resolve by themselves. Strains are injuries to the muscle or the tendon that connects it to bone, while sprains are injuries to ligaments, which connect bones
Movement and Posture
People in modern Western society sit a lot. A sedentary and inactive lifestyle can cause a whole host of problems, not least of which is back pain. Because of its potentially negative effects on your overall health, it is often said that “Sitting is the new smoking.”
Movement (or lack thereof) and posture problems such as “tech neck” may cause one or more structure problems, muscle strains, or other back-pain-causing condition. Other incorrect movement and posture patterns can include:
- Lifting incorrectly (with the back instead of the legs)
- Excessive or awkward bending and twisting
- Long periods of sitting, standing, or driving
- Poor office work habits
Pregnancy and Back Pain
Between 50% and 80% of pregnant women experience back pain. This greater susceptibility to back pain is the result of a number of factors, including:
- Weight gain
- A shift in the center of gravity
- Hormonal changes resulting in ligamentous laxity
Back Pain Symptoms
The hallmark symptom of back pain is pain anywhere in the back—either along the spine or off to the sides, and in the cervical, thoracic, or lumbar regions. This may or may not include symptoms (pain, numbness, tingling) radiating down the arms or legs.
Other Symptoms
Sometimes, back pain doesn’t show up alone. Other symptoms can appear along with it, and there are some that can be concerning. While pain radiating in the legs is a fairly common symptom that accompanies back pain, others can be concerning, including:
- Bowel or bladder issues
- Fever
- A recent injury
- Sudden and unexplained weight loss
- Weakness, numbness, or tingling in legs
When to See Your Doctor
The symptoms listed above may indicate a medical emergency. At the very least, call your doctor right away, but be prepared to head to the ER.
Additionally, if you’re experiencing pain for longer than a few weeks, or pain that doesn’t go away even though you’re treating it, you should speak with your doctor to find out what’s causing your back pain.
Diagnosing Back Pain
Whether you back pain falls into the “seek urgent medical care” list above, or you are following your gut reaction that says, “Go see your doctor,” below is what you can expect.
- A review of your medical history, including immediate family members who have back problems. Some back problems (e.g., degenerative arthritis, scoliosis, osteoporosis) have a genetic component.
- Discuss when back pain started, what you were doing when pain began, current pain severity and characteristics (e.g., stabbing, burning), how pain may have changed since it began, and other questions.
- Physical examination including a comprehensive musculoskeletal and neurological examination.
After a thorough review, your doctor may order an X-ray, CT scan, or MRI. Sometimes lab tests are ordered too. Keep in mind that an accurate diagnosis is essential to a well-developed treatment plan.
Once a proper diagnosis is made for your condition, your doctor will then discuss and plan with you an appropriate treatment plan to alleviate the issue. Please check out http://www.ntxortho.com/ for more information or call North Texas Orthopedics and Spine at 817-527-0397
Back pain is one of the most common reasons people seek medical care. It affects approximately three in four adults during their lifetime. It is caused by a number of health conditions, which may make teasing out the root cause of back pain exceedingly difficult.