Back Pain Causes
The spine is like a great athlete at peak performance – magnificently
formed and perfectly equipped to perform a pentathlon of important activities:
- Bearing your body weight
- Balancing and supporting your head
- Anchoring your ribs and lower extremities (legs)
- Protecting the spinal cord
- Letting you move freely in almost any direction
How Does Back Pain Affect Your Life?
Back pain seems to have a domino effect on everything in your life. For
starters, when your back hurts, it’s difficult to focus on anything else.
Whether you’re sitting at your desk or on your sofa, it’s hard
to get comfortable. You might have trouble sleeping, which can make you
less productive at work and sour your mood. If driving and walking are
difficult, you might participate in fewer social activities, which could
leave you feeling isolated and perhaps depressed. You may avoid activities
that intensify your pain, such as mowing the lawn or walking the dog.
As a result, your overall health – not to mention that of your dog
– may suffer.
If you’re reading this page, you undoubtedly already know how miserable
back pain can be. You just want to know what to do about it. On this site
you’ll find extensive information about many different back pain
conditions and syndromes: symptoms, diagnosis, treatment options, and more.
But first, let’s discuss some of the terminology you’ll encounter
as you learn about your condition.
Classification of Back Pain
Back pain can be discussed in terms of its location, how long the pain
has lasted, what’s causing it, and which structures are affected.
Usually these categories overlap.
For example, let’s say you have degenerative disc disease of the
lumbar spine. That single diagnosis tells us the cause of the pain (a
degenerative process, such as aging), the structures affected (discs),
and the duration (chronic, because by definition, degenerative processes
develop gradually).
Location of Back Pain
Centuries ago, anatomists divided the spine into the cervical, thoracic,
lumbar, sacral, and coccygeal regions. We still use those anatomic segments
today to classify back pain on the basis of its location. Pain most often
originates in the cervical (neck) or lumbar (lower back) portions of the
spine, but any part of the spine can be affected.
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Cervical Spine Pain - The cervical spine consists of seven vertebrae, or vertebral bones,
separated by intrathoracic discs. Because it must support the weight of
the head and neck, the cervical spine contains more muscles than any other
segment. Its gentle curvature helps distribute weight evenly to each of
the seven vertebrae. This part of the spine is more mobile – in
other words, flexible – than either the thoracic or lumbar portions
of the spine. (The bones of the sacrum and coccyx are fused and thus have
no mobility.)
-
Thoracic Spine Pain - The word
thoracic refers to the thorax, or chest. That makes sense, because each of the
12 thoracic vertebrae is attached to a pair of ribs, forming the thorax,
or rib cage. The thoracic spine also serves as a point of attachment for
the trunk muscles and ligaments, protects the spinal cord and spinal nerves
at the thoracic level, and works with your cervical and lumbar spine to
support your body weight and allow movement.
-
The thoracic segment, however, is the least flexible part of the spine.
The vertebrae are arranged loosely enough to facilitate rotational motion
and allow the chest wall expansion necessary for breathing. But they must
be spaced tightly enough to protect the vital organs within the chest.1 This taut structure is relatively immobile compared with the cervical
and thoracic portions of the spine. For more information on the thoracic
spine, see
Thoracic Disc Disease.
-
Lumbar Spine Pain - The lumbar spine is the lower back. It consists of five vertebrae, along
with intervertebral discs, ligaments, muscles, and other supporting structures.
Because it’s at the bottom of the pile, so to speak, the lumbar
spine bears more weight than the portions of the spine above it. That’s
why the vertebral bones in this region are bigger than those in the thoracic
and cervical spine, becoming progressively larger at each level as you
go down. This arrangement allows you to bend forward, backward, and sideways,
but not to rotate.
Duration of Back Pain
How Long Does Your Back Pain Last?
Back pain itself and the conditions that provoke it are often characterized
in terms of their duration. The spine’s performance slump can happen
gradually, as you might expect, or it can happen suddenly, like when
Tiger Woods suddenly lost his juju. Keep in mind that your doctor may use a somewhat
different definition of what acute or chronic means:
-
Acute Back Pain - According to the American College of Physicians (ACP), acute pain is
pain that lasts less than 4 weeks.
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Chronic Back Pain - The ACP defines chronic pain as pain that persists 12 weeks or longer.
-
Subacute - According to the ACP, subacute pain lasts from 4 to 12 weeks. “Subacute”
seems like a stuffy word for such a simple concept, but somehow the term
“nagging pain” just doesn’t have the same ring to it.
Cause (Etiology) of Back Pain
Back pain and conditions can be categorized according to its location:
-
Unknown (Idiopathic) - Pain and disorders of unknown origin are said to be idiopathic. The
word idiopathic comes from the Greek word idios, meaning “one’s
own.” In case you’re wondering, idiopathic does have the same
origin as the word idiot, but the words identity and idea are also derived
from idios.
-
Inherited or Congenital - Inherited conditions are genetic disorders passed from parent(s) to
child. For some disorders, certain environmental factors must also be
present in order for the defective genes to be expressed (in other words,
to cause signs and symptoms). But if such a condition is not baked into
your DNA, it can’t develop under any circumstances.
- A congenital condition is one that’s present from birth. It develops
during gestation (embryonic or fetal development). For example, fetal
exposure to pathogens, toxins, or adverse conditions, such as oxygen deprivation,
can cause congenital disorders. Genetic mutation can also occur during
gestation, so a congenital disorder might also be a genetic one. But it’s
not an inherited disease unless the faulty genes can then be passed down
from parent(s) to child.
-
Traumatic - “Traumatic” simply refers to injury (trauma). So traumatic
conditions are always acute, but they can produce pain that becomes subacute
or chronic.
-
Degenerative - A degenerative process is one that diminishes function. The process occurs
gradually, usually because of age, overuse, or other adverse influences.
For more information on spinal degeneration, see
Degenerative Disc Disease.
-
Other Disease - Back pain and disorders can, of course, be discussed in terms of specific
diseases and conditions. For example, disorders ranging from scoliosis
to osteoarthritis to cancer of the spine can cause back pain and neurological
dysfunction.
Affected Structures
Back pain can be categorized according to the structures affected, such
as the following:
-
Vertebrae - Vertebrae are the bones of the spine. They connect to one another at
the facet joints. Facet joints are synovial joints, just like the knees
or fingers. Thus they’re subject to lots of the same problems that
can affect other joints, such as osteoarthritis and bone spurs.
-
Discs - The intervertebral discs are the body’s shock absorbers. These
tough, fibrous discs lie between the vertebrae, separating them and facilitating
movement. Over time, the discs tend to lose water content and break down,
flattening out and becoming less able to distribute body weight. They
can bulge or herniate, putting pressure on spinal nerves or on the spinal
cord itself.
- But even if they stay put, disc degeneration can be problematic. Sometimes
the disc surfaces (endplates) begin to rub together, causing pain and
inflammation and encouraging the formation of bone spurs (osteophytes).
As they deteriorate, the discs can become less able to buffer the forces
of motion and impact, making everyday tasks painful.
-
Ligaments - Calcification of certain spinal ligaments can increase their size—a
condition called hypertrophy. These ligaments can encroach on the spinal
cord or spinal nerves.
-
Spinal Cord and Nerves - Spinal stenosis, the narrowing of the spinal canal, causes myelopathy.
Herniated discs, calcified ligaments (see Ligaments, above), bone spurs
(osteophytes), displaced (misaligned) vertebrae, or other structures can
compress either spinal nerves (causing radiculopathy) or the spinal cord
itself (causing myelopathy).
Dealing with Back Pain
Your spine is strong and resilient, just like you. In learning about your
condition, you’ve already taken an important first step toward relieving
your pain.
Keep reading. Ask questions. Take notes. Make sure you understand all your
options. Take your medication as prescribed. Wear your collar or brace.
Devote serious, sustained effort to your physical activity or stretching
or weight loss plan.
Let your doctor know if what you’ve tried already hasn’t worked,
and insist that together, you keep looking for a solution. Most important,
take advantage of the support systems around you—family, friends,
caregivers, neighbors, community services, and even insurance company
or Medicare representatives. You might be surprised.
Visit our
Conditions page to learn more.