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
“Back pain seems to effect everything in 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).
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.
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.)
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.
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.2
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:
According to the American College of Physicians (ACP), acute pain is pain that lasts less than 4 weeks.
The ACP defines chronic pain as pain that persists 12 weeks or longer.
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.
Back pain and conditions can be categorized according to its location:
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” simply refers to injury (trauma). So traumatic conditions are always acute, but they can produce pain that becomes subacute or chronic.
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.
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 neurologic dysfunction.
Back pain can be categorized according to the structures affected, such as the following:
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.
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.
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.