Back Pain
Back pain is a very common complaint among people of all age groups. It is, however, more commonplace among people in their thirties and onward. Back pain can be disabling and places a burden on relationships, brings emotional distress, problems with intimacy and work-related concerns.
Understanding the anatomy of the spine is useful. Back pain is mostly due to degenerative (wear and tear) changes in the spine and is usually part of a progressive disease. Thus, the underlying problem responsible for back pain will slowly but surely worsen over time. It is therefore of paramount importance that treatment is focused on supporting the structures of the back and to prevent excessive stress on the spine. Back pain can be acute or chronic. Chronic back pain is pain that lasts for more than three months. There are three types of spinal pain: mechanical back pain, referred back pain and sciatica.
Mechanical back pain
This is pain that is caused, as the name suggests, by the mechanics of movement. There are muscles, tendons, vertebrae, discs and joints between the vertebrae, nerves and other structures that can cause pain. Mechanical pain is based on inflammation of these structures and the aggravation of this inflammation by movement. The main source of mechanical back pain, however, is the joints between the vertebrae called the facet joints. This pain is typically increased by certain movements. Turning over in bed and getting out of bed in the morning can be difficult. The pain usually improves with movement, but certain movements, like arching your back, typically makes it worse. It is frequently associated with referred pain, in other words pain that is experienced at a site distant to the source of the inflammation.
Referred back pain
This is pain that spreads from the inflamed tissue in the lower back along nerves to other parts of the body. This would frequently be experienced in the area of the hips, the thighs and even between the shoulder blades. This is directly associated with mechanical back pain. It should not be confused with sciatica. The patterns of referred pain frequently overlap somewhat with sciatica, which can be confusing in making the diagnosis of the type of pain.
Sciatica (Radicular pain)
Radicular pain is frequently due to a slipped disc. This is pain that is caused by a pinched nerve and the pain will travel down the length of the nerve and be most severe at the distal point of the nerve, but can manifest at any point along the length of the nerve. When the nerve, for instance between the fourth vertebra and the fifth vertebra, is being pinched, the pain will be sensed at the ankle and on the top of the foot, as this is where the nerve ends up. It is typical that referred pain spreads to the upper leg, but sciatica would normally spread beyond the knee. Apart from the compression of the nerve root, there is usually also inflammatory changes in the nerve root that leads to pain. A pinched nerve is diagnosed with a MRI scan and may require surgery. We have a handy guide of what the terms on a MRI scan reports means here. Although surgery is very effective in loosening nerves that are being pinched and fixing unstable areas of the spine, it almost always leads to increased stress on the rest of the spine and is believed to speed up the wear and tear of the spine. The main aim of treating spinal pain should always be to support the normal biological recovery processes of the body. Surgery is always the last option and the aim of surgery would be to relieve the symptoms and to maintain the normal bio-mechanical stability of the spine.
Treating Back pain
Adjusting everyday activities, or the activities of daily living, reduces stress on the spine. Exercises that focus on core stability, pelvis girdle balance and spinal alignment are very useful in combination with pain-killers and anti-inflammatory medication. Exercises should be bio-mechanically safe and encompass full range of motion. Pain procedures such as nerve blocks, epidural steroid injections, facet blocks and radiofrequency rhizotomies are very successful in the treatment of back pain. Surgery such as decompression, discectomy and fusion are rarely required.
Neck Pain
Neck pain is a very common complaint among people of all age groups. It is, however, more commonplace among people in their thirties and onward. Neck pain is mainly due to degenerative or wear and tear changes in the spine and is most often part of a progressive disease. It means that the underlying problem responsible for neck pain will slowly but surely get worse in time. It is therefore of paramount importance that treatment focuses on supporting the structures of the neck and to prevent excessive stress on the spine. There are three types of neck pain: mechanical neck pain, referred pain and radicular pain.
Mechanical neck pain
This is pain that is caused, as the name suggests, by the mechanics of movement. The underlying pathology is a genetic weakness in cartilage but injuries, such as whiplash injuries can contribute. There are muscles, tendons, vertebrae, discs and joints between the vertebrae, nerves and other structures that can cause pain. Mechanical pain is based on inflammation of these structures and the aggravation of this inflammation by movement. The main source of mechanical neck pain is, however, the joints between the vertebrae called the facet joints. This pain is typically increased by certain movements. Turning and bending the neck is uncomfortable and frequently associated with crunching sounds and a feeling of stiffness. It is often worse on the one side. It is frequently associated with referred pain. There are a great number of people suffering from mechanical neck pain who have associated headaches. This is most frequently caused by inflamed joints which in turn cause the muscles of the neck to go into spasm. These muscles are attached to the head and cause headaches by pulling on the head. This is the same way that stress headaches are caused. There are other causes of mechanical neck pain as well. The treatment of mechanical neck pain focuses mainly on treatment of the facet joints and the inflammation located in these joints as well as the effects of that inflammation, such as muscle spasm. Medical treatment would include the use of anti-inflammatory medication, pain medication and muscle relaxants. Manual treatment would include pressure point therapy, massage therapy, physiotherapy and chiropractic therapy. Non-surgical management would include radiofrequency rhizotomies, local blocks and facet blocks. Mechanical neck pain that is associated with spinal instability may be treated by performing a posterior neck fusion.
Referred pain
This is pain that spreads from the inflamed tissue in the neck along nerves to other parts of the body. This would frequently be the head, shoulders, between the shoulder blades and even behind the eyes. This is directly associated with mechanical neck pain. It should not be confused with radicular pain.
Referred pain is a frequent cause of headaches. The nerves that supply the skin of the head come directly from the neck and pain can spread along these nerves. The treatment for referred pain is the same as for mechanical neck pain, since the cause is the same in both cases and based on inflammation of tissue.
Cervicogenic headaches
These headaches are secondary to the wear-and-tear in the discs and joints of the neck and is frequently misdiagnosed as stress headaches or migraine. They can be very successfully treated without surgery by performing facet blocks and rhizotomies.
Radicular pain
A slipped disc is frequently the cause. This is pain that is caused by a pinched nerve and the pain will travel down the length of the nerve and be most severe at the distal point of the nerve, but can manifest at any point along the length of the nerve. When the nerve, for instance, between the fifth neck vertebra and the sixth neck vertebra is being pinched, the pain will be experienced at the thumb and index finger as this is where the nerve ends up. Both the physical compression of the nerve root and the inflammatory changes in and around the nerve root are responsible for the pain. A pinched nerve may require surgery. Although surgery is very effective in loosening nerves that are being pinched and fixing unstable areas of the spine, it almost always leads to increased stress on the spine and is believed to speed up the wear and tear of the spine. The main aim of treating spinal pain should always be to support the normal biological recovery processes of the body. Surgery, anterior cervical discectomy, is always the last option and the aim of surgery would be to relieve the symptoms and to maintain the normal biomechanical stability of the spine and related structures.