Spinal Pain: An Introduction
Spinal pain is a common health problem affecting tens of millions of Americans each year. The back is a very complex structure which contains many different types of tissues. Because the complex structure of the back, and because of the fact that there are so many parts involved, it is extremely complex to properly diagnose back pain problems. Where is the pain coming from? Is it coming from the joints? Is it coming from the muscles? Is it coming from the discs?
This is why it is imperative that you need to undergo a proper work up (consultation and examination) by a doctor who specializes in back pain problems. A proper examination involves checking range of motion, posture, checking the integrity of each joint, palpating the muscles to detect spasms or trigger points, checking the alignment of the spine and pelvis, doing orthopedic and neurological tests and checking the functional strength & stability of the back. From doing these tests, the doctor can zero in on the precise area of trouble and can diagnose your problem with a high degree of accuracy.
Back pain comes in many forms. Sometimes the pain feels like a deep dull ache. It can also feel sharp & stabbing (especially during motion). There is also throbbing pain, electrical pain, and pain that may radiate into your buttocks, down your leg, or around your rib cage. The quality of the pain gives us important clues as to what tissues & structures may be involved – which again allows us to arrive at the correct diagnosis and ultimately a proper treatment plan to get you well.
Is your back stiff and sore when you wake up from your sleep? Does it hurt more when you stand for extended periods of time? Is it worse when you’re sitting in a chair? After walking for a period of time, does it feel like a vice has clamped down on your lower back? Each person’s back pain is unique and has a specific cause. We need to know these kinds of details to fix the problem.
The spine is a very complex structure and is composed of 24 moveable bones (called vertebrae), the sacrum & coccyx (tail bone), 23 inter-vertebral discs (which act as shock absorbers between the bones), hundreds of muscles and tendons, the central nervous system (brain stem & spinal cord), the peripheral nervous system, the protective covering of the central nervous system (called the meninges), 9 common ligaments, fascia (the protective covering of the muscles), blood vessels, lymphatics, and various other connective tissues.
Our examination is thorough and precise enough to allow us to detect precisely which tissue (or tissues) are causing the back pain. Sometimes the problem is caused by functionally weak muscles. Sometimes it may be coming from the joints. It could be caused by a herniated disc.
Additional testing – including x-ray, MRI (magnetic resonance imaging) or CT (computerized tomography) may be required to allow the doctor to visualize and diagnose hidden problems. When we order imaging, we send patients to a local outpatient imaging center. Your tests are then read and interpreted by a board certified medical radiologist. We will then sit down with you, show you the images, explain the results and answer any questions you may have.
The spine has 24 movable bones called vertebrae. In between these vertebrae is a shock-absorbing cushion called an inter-vertebral disc. The disc is mostly composed of water. The inter-vertebral disc has two regions. The outer part is called the “annulus fibrosus”. The inner part is called the “nucleus pulposus”. The outer “annulus” looks like concentric rings (like the annular growth rings of a tree), or layers of an onion. It is a very tough ligamentous material. The inner “nucleus” is very soft – and is often compared to the center of a jelly donut.
This close-up bird’s-eye image shows the relative anatomy and position of the inter-vertebral disc to the spinal nerves and spinal cord (yellow structures). The spinal cord is the larger yellow structure in the middle. These discs cushion the spine against the shocks which occur as you move. Discs are subject to injury, disease and degeneration. Certain activities and types of work increase the risk of discs being damaged or deteriorating. When the soft interior material of the disc pushes out through a fissure, tear or weakening in the outer layer, the disc is said to be herniated.
Herniated discs are also called protruding, bulging, ruptured, prolapsed, slipped, or degenerated discs. There are fine distinctions between these terms, but all really refer to a disc that is no longer in its normal condition and/or position. Herniated discs cause pain by impinging on (intruding upon, irritating, and pinching) and even injuring nerves in the spinal column.
Occasionally an MRI (magnetic resonance imaging) study is needed to visualize the herniated disc.
A herniated lumbar disc may send pain shooting down through your buttock and thigh into the back of your leg (sciatica). Cervical disc herniation may cause pain in the shoulder, arm, and hand. Herniated discs can cause muscle weakness, make it hard to get up when you’ve been sitting or lying down, cause pain when you strain to do something, even when you cough or sneeze. They sometimes produce pain in the lower right side of the abdomen.
Sciatica (or sciatic neuritis) is irritation and inflammation of the great sciatic nerve (the largest nerve in the body). The sciatic nerve originates from the lumbo-sacral spine and travels down the leg all the way to the great toe. Sciatica is characterized by pain that travels along the pathway of the nerve. The quality of the pain may be dull, sharp, burning or electrical. It may also be accompanied by numbness, tingling and the feeling of “pins and needles” (similar to little electric shocks). The symptoms may vary in intensity (how severe) and in the frequency (how often).
Sciatica is generally caused by compression of the sciatic nerve. This compression may be due to lumbar spine misalignments, bulging or herniated discs, pregnancy & childbirth, tumors and non-spine disorders such as diabetes, constipation or even sitting on one’s wallet in the back pocket.
A proper diagnosis involves a thorough medical history, a physical examination (including a focused neurological examination of the spine and lower extremities), imaging studies (such as x-ray and MRI) and if medically necessary – some electrodiagnostic testing (to check for peripheral nerve damage).
Stenosis means a narrowing in the spine. There is less room which means the delicate nervous tissues (such as the spinal cord, spinal nerves, etc..) are getting compressed. The most common areas for this to occur are the lower (lumbar) spine and the upper (cervical) spine.
Two Types of Stenosis:
- Primary stenosis: Congenitally small spinal canal: you’re born this way, and have the problem all your life.
- Acquired stenosis: This occurs as a result of degenerative changes throughout your life. This would include osteoarthritis, herniated disc, ligament changes, spinal tumors, trauma and dwarfism. Age is a factor with stenosis. The older you get, the higher your chances are of experiencing some kind of spinal stenosis based symptom.
Spinal stenosis can lead to numbness, tingling, cramping, radiating pain and weakness in the arms and/oror legs as well as a loss of balance. There is also a possibility of a loss of bowel or bladder function (a very rare condition called cauda equina syndrome).
If you’ve been having chronic back pain, you need help. Call us today for a complimentary, no obligation consultation. This involves completing some new patient paperwork & then coming in to speak to the doctor about your problem. There is no cost for this. After reviewing your medical history (and specific information about your problem), the doctor will spend 10-20 minutes (one-on-one) with you discussing your problem.
Are You Ready To Live a Full, Pain-Free Life Again?
Call us today to schedule a free consultation, and determine if you are a good candidate for treatment. Our team looks forward to meeting you and creating a plan that will relieve your spinal pain and improve your quality of life.
To schedule a consultation, call us at 412-595-7332