Backache is an age-old phenomenon that has plagued mankind for thousands of years. Ancient Chinese, Egyptian, Greek and Roman history bears witness to this, with numerous references to the treatment of spinal problems using various ‘mechanical’ techniques. Fortunately techniques have progressed somewhat since those early times!
Why is back pain such a problem, costing individuals and companies billions in medical costs, lost man-hours and disability? Let’s look a little more closely at the causes and treatment options.
There are three main causes of backache or back pain. I’ll examine each of them briefly.
DISEASE RELATED CAUSES
Fortunately pathological causes of back pain are relatively rare. Pathological refers to a disease process, in this instance affecting the spine, or parts of the spine such as the discs, spinal cord or bony structures, that will then manifest as pain. An infective process (tuberculosis, bacterial infection), a destructive process (rheumatoid arthritis) or even cancer of the spine may be causing the problem.
Such disease processes, although they may initially be mild, usually progress fairly rapidly to the point of being debilitating. Often these conditions originate from a primary site somewhere else in the body. Tuberculosis often starts in the lungs, rheumatoid arthritis may have been evident in the joints of the hands, and the primary cancer site may have been the prostate or breast. When the spine becomes affected it is simply a progression of the original disease.
Treatment of these pathological conditions is essentially medical. Patients often complement medical management with nutritional or homeopathic intervention, meditation, energy ‘medicine’ and so on, and some have claimed miraculous ‘cures’. Each case has to be managed on its own merits, however, as there are many variables that can enhance the body’s self-healing and auto-regulatory processes.
INTER-VERTEBRAL DISC PROBLEMS
A more common cause of back problems, but still relatively rare, are the true inter-vertebral disc problems.
The inter-vertebral discs are the ‘cushions’ that are between each vertebra of the spine. They serve as the spine’s shock absorbing system and also enable some vertebral motion, specifically the ability to bend forwards and backwards. Individual disc movement is very limited, but considerable motion is possible when several of discs combine forces.
Inter-vertebral discs consist of a strong radial, tyre-like structure (called the annulus fibrosis) that surrounds the internal, softer material (called the nucleus pulposis).
Although both the annulus fibrosis and nucleus pulposus are composed of water, collagen, and proteoglycans (PGs), the amount of fluid (water and PGs) is greatest in the nucleus pulposus. The amount of water in the nucleus varies throughout the day depending on one’s activity.
The annulus fibrosis is subjected to varying forces depending on one’s posture and the type and intensity of one’s activities. As the years go by it tends to become more ‘brittle’ and the nucleus pulposus loses its water content. The annulus therefore becomes weaker and more prone to ‘tearing’. Once a tear has occurred, the pressure within the inter-vertebral space forces the disc to protrude through the tear. In very close proximity is a nerve root, exiting off the spinal cord, with which the protruding disc material (often referred to as a ‘slipped disc’) makes contact. Localized pain around the area will be experienced when the tearing of the annulus occurs. This is most common in the lower back and cervical spine or neck area.
The initial injury is usually treated conservatively, with rest, ice packs, anti-inflammatories and chiropractic treatment.
If the tear and resultant protrusion are large enough, nerve root compression will result in pain being referred along the distribution of the specific nerve that is involved. The area of referral will depend on the level of the protrusion. If it’s in the cervical or neck area, pain, tingling and/or pins and needles will be felt in the arm, and if it’s in the lower back or lumbar area they will be felt in the leg.
If the protrusion is severe enough, causing marked nerve root compression, the pain will be severe and debilitating. Coupled with this, and perhaps more serious, is the loss of muscle function that can occur if the compression is allowed to continue for too long.
In many cases even these more serious disc conditions can be managed conservatively. In some cases, however, surgery is needed to remove the offending piece of disc and prevent permanent nerve damage.
The third cause of back problems, and by far the most common, is mechanical sprain/strain syndrome, also referred to as ‘facet syndrome’.
Mechanical strains and sprains are responsible for the world wide epidemic of lower back pain. Where mechanical back problems are concerned there is good news and bad news. The good news is that far more often than not the problem is manageable and resolvable; however, it’s not curable.
In order to more fully understand the nature of mechanical back trouble it is necessary to have an appreciation of how the vertebra all fit together. The spinal column is made up of a number of vertebrae stacked one on top of the other. They are separated in the front by the disc and at the back by the vertebral joints or facets. The facet joints facilitate spinal mobility (without them we would have rigid spines) and are supported by ligaments, tendons, connective tissue and capsular structures. It is the facet joint(s) and their supporting structures that are prone to trauma, repetitive strain and the over-use of daily living.
FACTORS CONTRIBUTING TO MECHANICAL BACK PAIN
Mechanical back trouble rarely has just one cause. Multiple factors usually contribute to the onset of these problems, including an initial traumatic event such as lifting something awkwardly or that’s too heavy, repetitive strain (sitting at the computer or driving for hours), general over-use and, that dreaded word, stress.
If the spine and its articulations are subjected to regular trauma (sports such as squash, tennis, hockey and cycling, not to mention the contact sports), repetitive strain (movements that are repeated time and time again) and over-use (computer, driving), mechanical problems will tend to recur – which is why I suggest that they are not curable.
PREVENTING MECHANICAL BACK TROUBLE
Prevention is always better than cure, and when it comes to mechanical back trouble prevention refers to:
- Stretching and strengthening exercises – Pilates and yoga, for example
- Regular chiropractic treatment to ensure optimal spinal joint mobility and function
- Weight management
- De-stressing techniques.
Chiropractic is now well established and accepted as the primary modality for the treatment and management of mechanical pain syndromes affecting the spine. While chiropractic care has a far greater scope than just mechanical neck and back trouble (it includes other joints such as the shoulder, ankle and wrist, ‘whiplash’ injuries, headache syndromes, and so on), the mechanical sprain/strain conditions respond particularly well to chiropractic management.
In conclusion, then, the source, and initiating causes of backache, may be more complicated than is sometimes thought. Mechanical problems rarely resolve themselves, and if they do, it’s usually only for a short period after which they return, often worse than before and requiring protracted treatment.
Always consult with a health professional who is adequately qualified and registered to diagnose, treat and manage back conditions, and if the problem persists after repeated treatment consider further investigation and perhaps a second opinion.
Contact me for a consultation.