Back Pain

To understand what causes back pain, you must have an understanding of the anatomy of the spine. The spine is made up of twenty four segments called vertebrae, and is divided into three sections: the first seven (7) vertebrae make up the cervical spine (neck); the next twelve (12) vertebrae, which have a rib attachment on both sides make up the thoracic spine (torso); and the last five (5) vertebrae, which are the largest make up the lumbar spine (lower back).

Each vertebra, with the exception of the first one directly underneath the skull, consists of a vertebral body in the front and a pair of smaller facet joints in the back. Connecting the vertebrae together (except the first two) at the vertebral bodies are very tough ligaments better known as discs. The vertebral bodies bear most of the weight (about 80%) of the body when standing upright. The facet joints bear the other 20% and primarily function to allow controlled movement (bending, rotating).

There are five (5) muscle layers surrounding the spine: the multifidi, rotators, erector spinae, iliocostalis, and quadratus lumborum. These muscles work synergistically to move and support the spine. Although bending forward at the waist doesn’t look all that complicated, it is a highly complex sequence of events: the central nervous system (brain and spinal cord) coordinate the precise intensity and timing of contraction of each muscle group to make the spine move as intended.

Sprains and strains (injury to muscle fibers, tendons and or ligaments) – When the load exceeds the strength of soft tissue structures, they tear. When soft tissue is injured, inflammatory products are released, which leads to swelling and pain.

Arthralgia/Facet Syndrome – Facet joint surfaces are imbedded with nerve endings underneath the cartilage. If this cartilage layer wears thin from degenerative joint disease or from trauma like whiplash, the nerve endings will be irritated, causing pain.

Disc herniation – The disc has an outer layer called the annulus, and an inner, jelly-like material called the nucleus pulposus. If the annulus fibers weaken, the nucleus can “escape,” puncturing through the annulus. This usually occurs from a lifting incident, or may gradually occur over time without any specific trauma. If the nucleus protrudes and presses on a nerve root, this can cause radicular pain (pain radiating down the leg, usually the back and side of leg). In severe cases, sensation and muscle strength in the leg are affected.

Annular Disc Tears – The annulus is made of concentric rings of collagen, a design very much like a slice of onion. Sometimes a fissure develops between two of these rings, and an inflammatory reaction develops. This type of pain is deep within the spine and hurts with movement, especially rotating (twisting) at the waist.

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