Back pain, a common yet often misunderstood ailment, affects individuals from all walks of life, manifesting in various forms ranging from mild discomfort to debilitating pain. This article explores the numerous causes of back pain while offering insights into its symptoms, diagnoses, and a plethora of non-surgical treatment methods.
Whether it’s a sharp spasm triggered by an extreme physical exertion or a chronic ache stemming from osteoporosis, this article provides an in-depth understanding of the different types of back pain and practical advice for managing and potentially alleviating symptoms altogether.
Muscle or Ligament Strain: Repeated Heavy Lifting or Sudden Awkward Movements
One of the common causes of back pain is muscle or ligament strain. This type of injury is defined by sudden lower back pain or spasms in an area of the lower back feeling sore to the touch (1). These injuries are typically able to be managed with non-surgical methods such as heat, ice, and anti-inflammatory medications (2). In fact, more than 90% of patients who experience this type of pain completely recover and just about everyone will suffer from it at some point in their lives (3).
Injuries like this can be caused by a variety of factors including:
- Extreme Physical Exertion
- Bending or Crouching Repeatedly
- Lifting Heavy Objects Incorrectly
- Emotional Stress
- Improper Posture
- Being Overweight or Out of Shape
- Sitting in the Same Position for Extended Periods of Time
- Or even, a Severe Cough
This type of injury will typically feel like pain or stiffness in the back that worsens when bending, stretching, coughing or sneezing and can even sometimes feel like an electric shock down the extremity. As mentioned in the previous section, bed rest does not work for healing this type of injury. Rather, it is recommended that using ice, heat, painkillers, support, and physical therapy are the best route. However, it’s also important to remember that previous levels of physical activity should only be resumed when symptoms are no longer occurring. Pushing too far before the injury is fully healed could lead to chronic back pain and permanent injury.
Bulging or Ruptured Disks: A Hidden Culprit
A herniated disk, also known as a bulging, slipped, or ruptured disk, occurs when a fragment of the disk nucleus is pushed out into the spinal canal through a tear or rupture (4). An unpleasant but accurate metaphor for understanding this would be to think about jelly being squeezed out of a jelly donut (5).
These herniations can occur at any part of the spine but are most common in the lower back or lumbar spine. There are cases of herniations in the neck or cervical spine, but this only tends to occur about 8% of the time. For the most part, pain due to a slipped disk will improve in 6 weeks as the herniation shrinks. However, this depends upon the person and the seriousness of the symptoms.
The spinal canal has very limited space, so when a herniation occurs, the disk will typically press up against spinal nerves, causing pain. Symptoms can vary greatly depending upon where the herniation occurs as well as the size of it. But, if the disk isn’t pressing on any major nerves, the individual may not experience any back pain at all. If it does, however, begin to press up against a nerve, this may cause extreme pain, or even numbness or weakness in a seemingly unrelated area of the body where the affected nerve travels to.
Herniated disks can occur spontaneously, especially in older individuals or those who fall into one or more of the categories mentioned as a potential risk factor above. However, this herniation can usually be seen as a sign of early degeneration, so make sure to see a doctor to ensure that there aren’t any underlying causes of the slipped disk. However, in most cases, doctors will typically prescribe non-steroidal anti-inflammatory medications and only consider surgery if other treatment options do not work.
Arthritis: Not Just Your Grandparent’s Disease
There are many different types of arthritis that can affect different parts of the body, but Osteoarthritis is the most common type of arthritis to affect the spine and back specifically (6). Additionally, while the cause of general spinal arthritis is mostly unknown, Osteoarthritis is known to be caused primarily by wear and tear. Since the vertebrate in the back move so much daily, the spine is especially susceptible to the kind of wear and tear seen in Osteoarthritis cases (7).
Most people assume that older individuals are the only ones who experience issues with arthritis. However, arthritis, especially Osteoarthritis, can occur in individuals of all ages. While younger people may not have as much natural degeneration, they may experience an onset due to a trauma or injury experienced (8). Additionally, while the condition can occur anywhere along the spine, it is most frequently found in the lower back and the neck. The joints in the lower back tend to carry most of the weight daily, and the neck is the part of the spine that sees the most movement.
Additional types of arthritis that can occur in the back include:
- Rheumatoid arthritis: Caused by an auto-immune disorder.
- Ankylosing spondylitis: May cause inflammation at the base of the spine, causing a hunch in the back in severe cases.
- Psoriatic arthritis: Associated specifically with psoriasis either prior to or after manifestation of arthritis.
- Reactive arthritis: Typically triggered by an infection in the body that has traveled to the spine.
- Enteropathic arthritis: Associated specifically with IBD (Irritable Bowel Disease) and tends to sync with IBD flare ups.
- Other forms of spondyloarthritis include undifferentiated spondyloarthritis (when symptoms don’t match any of the known types) and juvenile spondyloarthritis (when symptoms begin in childhood).
Symptoms can vary depending upon the type of arthritis as well as the severity, but can include:
- Back and Neck Pain
- Stiffness and Lack of Flexibility
- Swelling and Tenderness
- Grinding Feeling when Moving the Spine
- Pain, Swelling, and Stiffness in Other Areas of the Body
- Whole Body Weakness and Fatigue
- Pain or Numbness in the Arms or Legs
Just as symptoms can vary, so will treatments. Some treatments that doctors may utilize include:
- Pain Medications
- Steroid Injections
- Physical Therapy
- Hot and Cold Compresses
- Electrostimulation Devices
- Nutritional Supplements
- Surgery, in Severe Cases
Skeletal Irregularities: When Your Spine Throws You a Curve
Another reason for back pain to occur lies in the structure of the spine. “Abnormal curvature in the spine can put it out of alignment” (9) causing pain and spinal deformity. These abnormalities can be seen in a variety of ways across the board. So, they have been categorized into age groups for purposes of diagnosis and treatment.
Infantile abnormalities are most commonly associated with neurodegenerative disorders like cerebral palsy, tethered spinal cord, and myelomeningoceles and only show up in individuals less than three years old. Sometimes surgery is necessary for these cases, however, with infantile and juvenile (ages 3-10) abnormalities, doctors typically use bracing techniques to allow the child as much growth as possible prior to the surgeries (10).
The next age group of individuals experiencing spinal irregularities is defined as the “Adolescent Idiopathic”. This group consists of individuals from ages 10-17 who are experiencing spinal irregularities mostly in the thoracic spine. Unfortunately, it is unclear what exactly causes this type of spinal abnormality, however, except in the most severe of cases, it is typically not painful. Adult abnormalities, however, are typically associated with pain and nerve compression due primarily to the degenerative arthritis in the lumbar spine of aging individuals.
In addition to categorization based on age group, spinal abnormalities are further categorized into two separate types: Sagittal Deformities and Scoliosis. Sagittal Deformities are what a doctor might see from the side, whereas scoliosis irregularities are deformities that show up when looked at from behind.
Some Sagittal Deformities include:
- Kyphosis: A deformity where the spine curves outwards, creating a hunchback.
- Chin on Chest Syndrome: A type of cervical and upper thoracic Kyphosis that is so severe, that the chin drops to the chest.
- Lordosis: A rare deformity in which the lower back curves inwards excessively.
- Flatback Syndrome: A deformity in which the lower back loses its natural curve entirely.
Scoliosis on the other hand, is a side-to-side curve of the spine classified by severity and age group of the affected individual. Younger individuals with scoliosis will often experience little to no pain at all. Whereas adult scoliosis is often accompanied by pain ranging from mild to severe. In particularly serious cases, the scoliosis of the spine can interfere with the spinal cord itself or off shooting nerve roots. This might cause pain, weakness, numbness, or tingling down one or more extremities.
All types of spinal deformities can typically be treated with pain meds, physical therapy, and certain types of braces. However, surgery will be considered in severe cases where:
- The patient experiences severe pain that is not resolved through non-invasive treatments.
- The spinal deformity is progressing.
- The resulting deformity has become unbearable to the patient.
- The deformity has caused compression of the spinal cord and/or nerve roots.
- The deformity has resulted from fractures.
- The condition will likely continue to progress even after skeletal growth is complete.
Osteoporosis: The Silent Strength Stealer
Osteoporosis is a disease that develops when bone mass decreases; quite literally osteo (bone) porosis (porosity), bones full of holes. This condition occurs when the creation of new bone can no longer keep up with the loss of older bone (11). This can happen for a wide variety of reasons, but some common risk factors include age, hormone levels, and even smaller body frames. However, how likely an individual is to develop osteoporosis depends partly on how well they retained bone mass obtained in youth.
The primary concern when it comes to osteoporosis is how much easier it is to break a bone when they become weak and brittle. These breaks, caused even by a fall or mild coughing or bending, can occur anywhere, but are most common in the spine (12). This broken or collapsed bone in the spine, results in back pain, a loss of height over time, a stooped posture, and even easier breaks in the future.
Medication is the most popular way to manage pain over time but there has been success with heat and ice, physical therapy, braces and support, acupuncture, acupressure, and massage therapy (13). Though, from a preventative standpoint, there are things that individuals can do to reduce their risk of osteoporosis, including:
- Upping Calcium Intake
- Active Lifestyle
- Avoiding Excessive Alcohol Consumption
- Avoiding Tobacco Use
For additional information on treatment options, please see "The Ultimate Guide to Understanding Back Pain: Causes, Symptoms, and Effective Treatments".
Additionally, if you or someone you know would like additional information about how ARPwave NeuroTherapy can help with back pain, please click here to schedule a call with one of our physical therapists.
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