There are three sections of vertebrae or bones in the spine called the lumbar vertebrae (lower back), thoracic vertebrae (upper back) and cervical vertebrae (neck). In each area, there are vertebrae meeting with a disc in between them, which acts as a shock absorber, and joints on either side. Ligaments hold the joints together and musculature controls the movement. The spinal cord runs through the spinal canal and nerve roots exit through a foramen on each side at each level.
Due to the number of anatomical structures and the curvature differences between the sections of the spine, there are many types of back pain that can result in a painful condition.
Some patients will require doctors to diagnose them and determine the need for surgery. However, if treated properly, most patients can resolve their back pain with physical therapy and exercise.
Types of Back Pain
Mechanical Back Pain
In mechanical back pain, the pain is occurring because of the way the system of structures is moving together. The pain is generally in one area and can come and go or be consistent. It can be sharp, dull, or throbbing. Facet joint injuries, muscle strains or misalignment of key structures through joint tension or muscle length imbalances can be causes of mechanical back pain.
Structural Back Pain
Structural back pain occurs when there is damage or congenital defect (something you are born with) to one of the structures of the back. It can occur through acute injury or be a result of chronic repetitive stress or the aging process.
Muscle or Ligament Damage
When muscles or ligaments are stretched beyond where they like to go, they can become strained or even torn. A damaged soft tissue will produce inflammation, muscle spasm and scar tissue, which can all contribute to pain.
A herniated disc occurs when the disc that sits between two vertebrae receives enough stress, either through acute injury or long-term wearing or degeneration, that it bulges. When a disc bulges, it can reduce space for a nerve root to exit the spinal cord and cause pain.
Arthritis can be one of two types: Osteo or Rheumatoid. Osteoarthritis is the gradual wearing away or degeneration of the joint surfaces with repetitive stress or aging. Rheumatoid arthritis is an autoimmune condition where the body attacks its own joint surfaces. Both result in improper movement, stiffness, and pressure on other structures in the area.
Osteoporosis is the reduction in bone mineral content that can make your bones weaker, leading to other structural damage and pain.
Referred pain is pain that originates in one area but is felt in another.
Radicular pain is pain that occurs when a nerve root or nerve roots are compressed as they exit the spinal canal. Patients will feel searing or like an electrical shock that will travel the pathway of the affected nerve. The nerve root can be compressed by the occlusion of space in the tiny hole or foramen, where it exits from the spinal cord. This can happen because of a herniated disc, spinal stenosis (or the degenerative wearing down of bone/cartilage in the foramen), or spondylolisthesis (a fracture in part of the vertebrae bones).
Acute pain is pain that affects patients suddenly either through injury or sudden movement.
Chronic pain tends to develop slowly in patients because of repetitive stress or the aging process.
If all physical factors are eliminated, there are still a small percentage of patients that will have back pain resulting from other causes, sometimes originating in the brain. Psychological factors may need to be considered and addressed with the patient. Depression and lack of sleep can both make any type of pain worse and treatment for these issues may be an important part of diagnosis and correction of back pain.
What to do if you have Back Pain
As a patient, your first step should be to have your back pain assessed by a Physiotherapist or Athletic Therapist.
A medical history should be taken followed by a thorough assessment of the underlying cause of your symptoms. A pain diagnosis should be reached, and a treatment plan should be created that is patient specific.
The treatment plan should focus on symptom management as well as treating the cause of the back pain and addressing any tension or weakness through a stretching and strengthening program. Other treatments such as manual therapy and needling or acupuncture should be considered. After a few weeks or less of treatments, mobility should be restored to the point that more intense strengthening can be done to further eliminate pain and prevent future problems.
How common is back pain?
Back pain is one of the most common medical problems. It is a leading cause of disability around the world. (https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906)
What are the symptoms of back pain?
Symptoms vary widely and can be based on the location and underlying cause of the problem. A typical symptom list for back pain may include:
- Dull, aching, or sharp pain
- Tension or weakness in the back muscles or muscle strain of the back muscles
- Decreased range of motion
- Difficulty standing or sitting for extended periods of time
- Joint dysfunction
- Localized back pain
- Low back pain
- Numbness or tingling down one or both legs
- Nerve pain
- Referred pain
- Radicular pain
- Stabbing or shooting pain that radiates down the leg or legs
- Feeling worse with sitting, bending, lifting
- Feeling better when standing and walking for short durations
- Pain or weakness down one or both legs
- Tingling and pain in leg, or even numbness in severe cases
- Pain after prolonged periods of standing
- Pain after high impact activities like running or athletics
What areas of the back can be affected by pain?
The neck (cervical spine), upper back (thoracic spine) or lower back (lumbar spine) are the three areas of the back that can experience a back problem.
Within each area, there are vertebrae bones, muscles, tendons, ligaments, cartilage, discs, a spinal canal where the spinal cord sits and nerve roots exiting the spinal cord. When any of these structures are damaged, put on tension or impinged, back pain can result.
What are the common causes of back pain?
Some of the common causes of back pain or spine pain are:
Chronic pain in the back:
- Degeneration or arthritic breakdown of the spine
- Degenerative disc disease
- Kyphosis or Lordosis (excessively rounded back)
- Sacroiliac joint dysfunction
- Spinal disorders
- Spinal stenosis
- Scoliosis (curvature of the spine)
- Spinal tumors
- Repetitive stress
- Poor posture
Acute or traumatic injuries to the back:
- Car accident
- Bulging or herniated discs
- Muscle strains
- Soft tissue bruising
- Spinal compression
- Facet joint irritation
How do you know if back pain is muscular or spinal?
Your Physiotherapist will do a thorough assessment to determine the nature of your back pain. If further assessment is needed, your physical therapy practitioner may suggest that you talk to your doctor, who can request diagnostic tests, such as X-rays, MRI scans, or diagnostic injections to confirm the back problem.
How can I Fix my Back Pain?
Our treatment approach at Inertia Physio+ is manual and exercise therapy to reduce pain and inflammation, improve strength, range of motion, and encourage good posture.
Some physical therapy treatment options that we offer include but are not limited to:
- Trigger Point Dry Needling
- Massage Therapy
- Cranio-Sacral Therapy
- Athletic Therapy
- Myofascial Release
- Trigger Point Release
- Soft Tissue Release
- Active Isolated Stretching
- Muscle Energy Technique
- Mulligan Mobilization Techniques
- Joint Mobilization
- Fascial Chain Stretching
- Neural Mobilization
- Therapist Assisted Stretching Techniques, such as PNF
When should I see a doctor for my Back Pain?
In many cases, spine health and back pain can be addressed by a physical therapy practitioner such as a Physiotherapist or Athletic Therapist. If you have severe pain or your spine pain is lasting longer than expected or not responding to treatment or if your back pain includes other symptoms like numbness or weakness in your extremities, it may be time to consult your doctor to provide medical advice and diagnosis.
If medical conditions are left untreated, you could risk chronic discomfort, loss of motion, or even loss of sensation. You know your body best and should listen to it to determine what is right for you.
How do I Know if my Back Pain is Serious?
If any of these symptoms accompany your back pain, you should be treated right away. Call your doctor, Telehealth, or head to your closest emergency room because they could be an indication of a more serious condition or injury:
- High fever
- Pain resulting from a fall or severe blow to your back
- Sudden spike in pain, discomfort, numbness, or weakness
- Unexplained weight loss
- Severe stomach pain
- Bladder or bowel symptom
There are many common causes of back pain. One common cause is mechanical dysfunction. Another common cause is structural damage to the components of the spine.
A doctor or Physiotherapist or Athletic Therapist can help determine the cause of your back pain and suggest a treatment plan to get you feeling better. To prevent back pain, focus on good posture and lifting mechanics, activity, and healthy weight.