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Almost half of all people living in the industrialized world experience some form of chronic or recurring back pain. Around 80 percent of all people report having suffered from back pain at some time during the past two years. After cardiovascular disease, chronic back pain is the most common reason for worker disability and early retirement.
Why is back pain so common?
There are many reasons. These include repetitive stress injuries, bad posture, poor core musculature, trauma, muscle spasms, stress, work activity, disc injuries, age-related wear and tear, sedentary lifestyles, etc. To add insult, we are humans that walk upright and are constantly exposed to the affects of gravity, which may make existing back problems worse because of the increased load (pressure) on the discs, ligaments, tendons, and other tissues.
Where exactly does it hurt?
The spine is divided into three major sections: the cervical spine, the thoracic spine and the lumbar spine. Each section is associated with distinct problems and kinds of pain. In this section, we will be review thoracic and lumbar pain.
Thoracic Spine: While the range of motion in the thoacic spine is very limited by the ribs, it is also receives vital support from the ribs. This is why the thoracic spine is far less often a source of pain. However, the costovertebral articulations – the points of attachment between the ribs and the thoracic vertebrae – represent a weak spot in the thoracic spine. These joints are subject to continuous motion on account of respiration. That is why the pain originating in this area of the spine tends to radiate into the thoracic cavity. The intensity of this pain sometimes leads people to believe they are experiencing the onset of a heart attack.
Lumbar Spine: Most cases of back pain originate in the lowest section of the spine, known as the lumbar spine. Although the lumbar spine carries the entire weight of the torso, the vertebral bodies that are expected to carry this weight are smaller than the vertebral bodies in the other sections of the spine.
The vertebrae in our lumbar spine are exposed to tremendous stress when we are in an upright position. The intervertebral discs that act as a buffer and spring lose a portion of their fluid every day and shrink, or flatten out, as a result. While the fluid in the discs is replenished at night while we sleep in a horizontal position, the degree to which the discs are replenished diminishes as we grow older and the shrinkage becomes a permanent condition.
This condition leads to a decrease in muscle tension. In response, the lumbar spine arches forward (i.e. the hollow of our backs becomes more pronounced), effectively creating additional loading for itself. This can cause a core pain that radiates outward in the shape of a belt.
The lumbar spine also defines an area in which movement extends from the rump into the legs. The muscles involved here include the iliopsoas and the adductors. This is why it is necessary to consider the hips and the legs when arriving at a diagnosis.
With time, continual stress and strain can lead to serious disc injuries. The lumbar spine is the most common site of disc herniation. When a disc herniates or ruptures, a part of it presses out against one of the large nerves in the spine, causing intense pain that often radiates down into the legs.
One type of back pain is referred to as discogenic pain. This type of pain is thought to arise when the lumbar intervertebral discs begin to deteriorate and when blood vessels and nerves grow into the disc tissue, resulting in an increase in the internal pressure.
While the causes of back pain are as various as they are complex, they are usually related to degenerative processes that occur in connection with wear and tear and/or from abnormal loading of the spine, such as with bad posture.
The Most Common Spinal Diseases
- Wear (osteoarthritis) in the joints of the spine (facet joint osteoarthritis)
- Vertebral disc protrusion
- Vertebral disc herniation
- Foraminal stenosis
- Spinal canal stenosis
- Vertebral disc deterioration (discogenic pain)
- Osteoporosis and vertebral body fractures
- Osteochondrosis
- Spondylolithesis
Each of these various conditions may cause back pain, and may occur in combination with others. Some of the conditions can trigger very complex pain responses, with pain occurring simultaneously in the back, legs, buttocks and chest.
Risk Factors
The chances that an individual will one day suffer from serious back pain are
influenced by several factors. Genetic disposition, inappropriate posture, repetitive motion and obesity can play a role. A lack of physical activities is almost always involved because the spine is supported by the muscles in the back and stomach. If these groups of muscles are too weak, then back pain will be virtually unavoidable.
Diagnosis and Treatment
The first thing to do is arrive at a diagnosis by investigating the possible causes. This begins with a comprehensive orthopedic examination, weight-bearing X-rays, a functional analysis, and diagnostic imaging if needed, such as computed tomography (CT scan) or magnetic resonance imaging(MRI) to confirm or rule out any findings. Neurological examinations may be necessary in individual cases, along with NCV/EMG studies (analyzes nerve and muscle integrity). Other accompanying factors such as rheumatic conditions or other diseases will also have to be taken into consideration.
Traditional Back Pain Treatment
Most back pain, even chronic back pain, is typically treated with medication, rest, physical therapy or, in some cases, surgery. Unfortunately, none of these back pain treatments address the underlying problems – AND they all have negative side effects. Medications of course have potential side effects and drug interactions. Rest tends to worsen and prolong the symptoms. Exercise and physical therapy put additional stress on already over-taxed joints and muscles. And surgery typically involves either removing part or all of a vertebra or disc, or fusing multiple vertebrae together – which often leads to other back problems in the future.
The downsides of these traditional treatments can easily be avoided with a safe, drug-free approach to healing back pain.
It is certainly true that the medical approach is sometimes necessary, and even back surgery has its place of course. But, according to some studies, most spinal surgery for acute lower back problems should be rarely performed. Many people who have had back surgery report a recurrence of their symptoms within a year or two of the operation and may return to the operating table. In some cases, the surgery makes no difference whatsoever. In other cases, it does bring long-term relief.
At AVCHC we believe that a better approach is to find the CAUSE of the back pain
first and foremost, versus only treating symptoms, which is the case when medication is used as the only treatment modality. The latter approach is short-sighted and hardly ever solves the true problem longer term. We analyze a variety of diagnostic findings including loss or excessive lumbar or thoracic curve, abnormal loading of the spine, an abormal sacral tilt, dropped foot arches as a contributor to low back pain, core strength deficiencies, muscular trigger points that refer pain, and compressed disks…..just to name a few.
Additionally, a thorough neurological examination is performed to determine which part of the nervous system is not functioning properly. In many low back pain patients, for example, a high mesencephalic output is noted.
There are three parts to the brain stem: top, middle, and lower. The mesencephalon is the top part of the brain stem. A high output of the mesencephalon will cause a variet of abnormal physciological responses, some which may affect back pain. Along with a high mesenphalic output, the low back pain patient may have a decreased output of the cerebellum. The cerebellum is in the back part of the brain, and it controls all of the involuntary spinal musculature.
No matter what the condition, it is imperative that a thorough and comprehensive exam is performed to determine the exact nature of the condition.
In our 4,000 sq. foot facility, we are prepared to treat most back conditions safely and effectively. Our unique approach of treating back pain based on NEUROLOGY (brain-based therapy, NCV/EMG testing, etc.), STRUCTURE (posture correction, spinal adjustments, decompression, etc.), FUNCTION (ATM2 (see picture below), core training, therapeutic exercise, etc), and METABOLIC CONSIDERATIONS (targetted nutrition based on lab work) allows us achieve wonderful results with our patients.
Do you have back pain? Give us a try….
Rick Duenas, DC, NASM-CPT
Interested in our No-Charge Consultation? Click on the link to find out more.
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