A Primer on Back Pain
A Range of Conditions That Often Don’t Require Major Orthopedic Surgery
Musculoskeletal pain is a broad term. It refers to any pain affecting the bones, muscles, tendons, ligaments and nerves. It can come on suddenly with severe symptoms, be acute or chronic, and be either localized to one area of your body or widespread.
The most common type of musculoskeletal pain is lower back pain. According to the National Institute of Health, about 80 percent of adults experience low back pain at some point in their lifetimes.
It is the most common cause of job-related disability and a leading contributor to missed workdays. In a major survey, more than a quarter of adults reported experiencing low back pain during the past three months.
The good news is that if you are suffering with musculoskeletal pain, there are a wide range of options to treat it that don’t require major orthopedic surgery. Main Line Spine considers the full spectrum of these options when treating its patients.
What Causes Lower Back Pain?
Your lower back is subject to a lot of mechanical stress and strain. This happens because the weight in your upper body is supported by your spine. The spine is made up of more than 30 small bones called vertebrae stacked on top of one another. A spongy piece of cartilage, called a disc, sits between each vertebra. It acts as a shock absorber, preventing the bony vertebrae from grinding against one another as the body moves.
The vast majority of low back pain is mechanical in nature. As we age, the discs in our spine can gradually wear away and shrink, a condition known as degenerative disc disease or spondylosis. The National Institute of Health outlines some of the examples of mechanical causes of low back pain to include:
- Sprains and strains account for most acute back pain. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from twisting or lifting something improperly, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can also be painful.
- Intervertebral disc degeneration is one of the most common mechanical causes of low back pain, and it occurs when the usually rubbery discs lose integrity as a normal process of aging. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. As the discs deteriorate, they lose their cushioning ability.
- Herniated or ruptured discs can occur when the intervertebral discs become compressed and bulge outward (herniation) or rupture, causing low back pain.
- Radiculopathy is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on this nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
- Sciatica is a form of radiculopathy caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve not only pain, but numbness and muscle weakness in the leg because of interrupted nerve signaling. The condition may also be caused by a tumor or cyst that presses on the sciatic nerve or its roots.
- Spondylolisthesis is a condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column.
- A traumatic injury, such as from playing sports, car accidents, or a fall can injure tendons, ligaments or muscle resulting in low back pain. Traumatic injury may also cause the spine to become overly compressed, which in turn can cause an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted to the spinal cord. When spinal nerves become compressed and irritated, back pain and sciatica may result.
- Spinal stenosis is a narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
- Skeletal irregularities include scoliosis, a curvature of the spine that does not usually cause pain until middle age; lordosis, an abnormally accentuated arch in the lower back; and other congenital anomalies of the spine.
With these and so many other potential causes and types of musculoskeletal pain, it’s best not to assume your pain is simply overuse or old age. Like most conditions, the earlier the problem is identified, the better the treatment options and outcomes. The first step is to talk to a Physical Medicine and Rehabilitation specialist at Main Line Spine and describe your pain as best you can. If you’d like to request an appointment, call (610) 337-3111.