Back and spine pain is one of the most common medical conditions that people seek guidance from health care professionals for. Approximately 80% of people will suffer from spine pain during their life, and many times without specific injury. The good news is most spine pain is caused and treated by mechanical treatment approaches. Mechanical pain is pain not caused by serious pathology such as tumor, infection, fracture, instability, cancer, or inflammation. Most cases do not require imaging or surgery. The most important (and frustrating) aspect of treating spine pain is that there is no single, one approach to all back pain. The key is finding the exact source of the pain, since each type of back problem requires different and specific treatment approaches.
Understanding pain
The science of pain continues to improve as we better understand the many causes of pain. Pain is not always directly related to a specific tissue being damaged. The cause of pain is different for everyone, as well as personal experience, so understanding the many causes of pain such as biological, psychological, social, and cultural are important to treating spine pain. Many times, people suffer from pain without any imaging test results showing anything as “positive” or present, and some images by x-ray or MRI will show marked damage or problems without ANY pain. How can that be? Pain is much more than finding soft tissue damage.
Spine pain can be localized only in the spinal area. This type of pain can be constant or related to the position of the spinal column and strain or imbalance on structures. Radicular pain refers to pain leaving the area or radiating into the arms or legs. This type of pain can be described as sharp, stabbing, numbing, tingling, or like the limb is falling asleep. Radicular pain is often described as “nerve pain,” or a pinched nerve at the spine level. Spine pain can also be caused by a specific group of muscles, ligaments, tendons, or soft tissue. This type of radiating pain usually feels like an ache, pull, throb, and will come and go when we use and relax the affected muscles.
Possible causes of back pain
The main sources of back pain are muscle strain, spinal stenosis, disc degeneration or bulge, osteoarthritis, and mechanical instability. Spinal stenosis is a narrowing of the space where the nerves exit the spinal cord and is closely related to arthritic changes. People usually suffer from increased pain with extension or backward bending activities when they have stenosis or arthritic type pain. This pain can be eliminated or decreased with improving mobility, strengthening the area around the spine, and flexion, or forward bending, activates and exercises. Or, another common issue is that stress causes back pain. Common types of back pain include the following:
- Herniated or bulging discs – This is another very common cause of spine pain, and is a common cause of nerve pain. The “disc” is a spongy packet of fluid and gel between each vertebra, or bone, in the spine that allows us to move and bend. When that disc degenerates or “bulges” from where it is supposed to be, it can cause serious pain, usually in a radicular pattern down the leg. Guided exercises and specific positioning and activities based on the direction of the herniated disc will first localize pain to the back area and eliminate leg pain, then will progress to eliminating the local back pain. This type of treatment is best from a physical therapist with specific training in mechanical back pain.
- Nerve root pain – Many times pain is due to a “nerve pinch” at the level of the spine. The facet joint, or space between two spine bones, is a common cause of nerve or arthritic pain. Arthritic pain can be achy or throbbing, and improves with light to moderate movement. When the nerve is involved, pain can leave the spine and go towards the arms or legs, and sometimes reach the hands or toes. Nerve pain can be difficult to describe, will often involve sharp, numbing, tingling, or stabbing.
- Thoracic or mid-back spine pain – This is less common due to the structure of the vertebrae in this region. Osteoporosis and osteopenia which or the weakening and loss of bone density can be found in this area and can cause pain without injury. A pathological fracture can happen with osteoporotic bone just from a simple cough.
- Sciatic nerve pain or sciatica – This is pain that is felt along the distribution of the sciatic nerve, located where the lumbar 4 and lumbar 5 bones meet. This type of pain can be felt from the spine to the foot as the sciatic nerve is the longest nerve in the body. If the nerve is irritated at the spine level, this is most commonly caused by a disc bulge, degeneration, or facet issue. We also suffer from sciatic pain at times when the nerve is irritated along the nerve, but below the area of the spinal column, most commonly in the region of the piriformis muscle. Treating sciatic pain involves a diagnosis of the cause of nerve irritation.
- Chronic pain – This is any pain lasting longer than 6 months. This type of radiating pain can be of any cause, does not require the patient to have a specific pathology, injury, or disease. Better understanding the personal pain experience, treating the cause of pain, and improving functional limitations with the use of movement and exercise are important to improving quality of life, and regaining prior levels of function.
- Cauda equina syndrome – These types of symptoms are caused by a pathology at the very end of the spinal cord where all of the spinal nerves exit and gather. Common symptoms are unexplained difficulty with bowel and bladder control, pain and numbness in both legs, loss of sensation and strength in the legs, and neurological symptoms. These types of symptoms require immediate medical attention. Treatment may require hospitalization and surgical consult to reduce the pressure being placed on the nerves located under the spinal cord.
What to do about your back & spine pain
In order to treat and reduce your back pain, it is essential to have a very clear picture of the cause(s) of the pain and the length of time that the symptoms have been occurring. “Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient’s clinical condition.” Source; United States Trends and Regional Variations in Lumbar Spine Surgery: 1992–2003
Since a high degree of spine pain is mechanical in nature and requires movement and exercise as well as specific manual techniques to effectively treat the cause of pain, it usually requires rehabilitation physical therapy. Physical therapists are some of the best health care professionals to empower and assist you to effectively treat your back and spine pain. Consulting with a physical therapist, especially therapists trained in mechanical diagnoses, such as the McKenzie method, are recommended to prescribed specific movements and exercises to treat your individual cause of spine pain. Physical therapists partner with physicians to offer the most comprehensive approach to treating all types of back pain prior to any consideration for surgical interventions. Back pain can be prevented, alleviated, eliminated, and gone forever… see a physical therapist today! Click HERE to find your closest Ivy Rehab Physical Therapy location and schedule an appointment.
Article by Jeffrey Vaisberg PT, DPT
Jeffrey Vaisberg PT, DPT Cert. MDT, SFMA, CWC. Progress Physical Therapy, Feasterville, PA
