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General Information

Back Pain

Back and neck pain are one of the most common events in the lives of human beings. It is something that nearly 80% of people have sometime in their lives. If you are having back pain, even though it may be very painful, for most people it will not cause permanent damage. Next to the common cold, it is the most frequent reason people visit their doctors. It is:

  • The sixth most costly medical condition
  • The second most usual reason for visiting the doctor, next to the common cold
  • The second leading cause of disability
  • The most usual reason people miss work

Most people simply get over an episode of back pain within two three weeks and their lives simply go on. For those who are not getting better, more consideration should be given to additional treatment.

What causes back pain?

There is not a straightforward answer to this question. Most people have what is called ‘non-specific’ back pain, meaning we are not totally certain what causes the pain.

Back pain can appear in a number of ways. The pain might be sudden and sharp or dull and constant. It might be happen for no apparent reason:

  • Getting out of a chair
  • Twisting to reach something behind you
  • A sudden sneeze
  • Bending over to tie your shoes

Some back pain is intermittent, meaning the pain or intensity comes and goes. This is the most common kind and generally gets better on its own.

Doctors generally identify back pain in three categories:

  • Acute – pain that lasts less than six (6) weeks
  • Subacute – pain that lasts less than 12 weeks
  • Chronic – pain that has lasted longer than 12 weeks.

Some back pain is persistent, with a constant intensity, sometimes waking you up at night. This kind of back pain needs medical attention because the pain might be caused by something more serious.

The pain could be caused by:

  • Herniated or bulging disc
  • Narrowing of the canal through which the spinal nerves pass
  • Arthritis of the spine
  • Sudden strain or sprain

If back pain is accompanied by progressive numbness of the arms or legs, or you have incontinence (bowel or bladder release), you should seek emergency medical help right away!

Where Back Pain Begins

Often times it begins quite unexpectedly

The spine is made up of 33 bones (24 that have motion) called vertebrae beginning at the skull and ending at the tailbone.With the exception of the sacrum and tailbone, each of the vertebrae has a cushioning shock absorber between them called the disc.

The spinal column is designed to protect the spinal cord inside a canal. At each level of disc, nerves exit the spinal cord and go to different parts of the body allowing you to sense the things around you like temperature or touch, and movement like walking or throwing.

There can be a number of places back pain begins.It might be bad posture, a bulging disc, strained muscle, or a nerve that is pinched.Wherever it begins, and whatever the cause, treatment should be sought if it persists beyond six (6) weeks.

Degenerative Disc Disease

What is a degenerative disc?

The bones of the spine, called vertebrae, are separated by fluid filled spacers called vertebral discs.These spinal cushions act to absorb shock from movement.They also provide separation between the discs to allow nerves from the spinal cord to exit to the body.Degenerative discs are the natural aging process of the spine. As the body ages, wear and tear of the discs lead to a decrease in disc height and they are sometimes injured.

Common characteristics:

  • Often time’s degenerative discs contribute to chronic back pain (pain lasting longer than 12 weeks).
  • When disc space becomes narrower, nerves exiting the spinal cord may become compressed causing pain that often radiates down the leg or arm.
  • Sometimes a piece of the disc might break off irritating a nerve root or getting caught in the spinal canal.This can lead to significant pain.
  • Symptoms are NOT always pain. They maybe numbness or tingling of the legs or arms.


Herniated Disc and nerve root compression

What is an intervertebral disc?

The disc is a fluid filled (mostly water) cushion made up of two parts. The outside, called the annulus, is made of cartilage woven together like plywood and the inside, the nucleus, is made up of a gelatin like material. It is sometimes described as being like a ‘jelly-filled donut.’

What is a herniated disc?

  • Sometimes a herniated disc is called a ‘slipped disc.’ This is actually incorrect because the disc doesn’t actually slip, it remains in place but sometimes bulges (bulging disk) or actually breaks open (fully herniated disc)
  • Herniated discs can happen in the neck as well as the low back, and often come with symptoms that radiate down the legs or arms and into the toes and fingers.
  • Most discs herniate toward the back and lateral side of the annulus. This can make sitting or bending particularly uncomfortable.
  • Very seldom bowel or bladder problems or a progressive weakness in the arms or legs might occur.This requires urgent and immediate medical attention!

How is a herniated determined?

  • A good physical examination will strongly suggest a herniated disc, and is the most important first step.
  • Magnetic resonance imaging (MRI) can determine the extent of a disc herniation and provides information with which your doctor can decide the treatment pathway.

What is radiculopathy?

Radiculopathy is a term to describe pain that is in the leg or arm as a result of the compression of a nerve.It can also be due to bone spurs or osteoarthritis.

How is a herniated disc treated?

  • The first step is to determine how serious the herniation is, meaning how much does it affect the patient’s life.
  • Most herniated discs will resolve on their own with some conservative treatment (e.g. medication and moderate exercise).
  • Persistent symptoms might require aggressive physical therapy.
  • If all attempts to resolve the symptoms fail, minimally invasive surgical decompression may provide relief.
  • Surgical indications include: severe and unrelenting pain, progressive neurological symptoms or the development of bowel or bladder problems.

Spinal Stenosis

What is spinal stenosis?

  • Stenosis is the abnormal narrowing of a passage of the body. In the case of spinal stenosis, it is a narrowing of the spinal canal putting pressure either on the spinal cord or spinal nerves. This can happen from bony spurs that develop or a reduction of disc space, both of which lead to pressure on the cord or nerves.
  • Spinal stenosis is mostly seen in people after the age of 50 with the onset of degenerative disc disease.
  • Sometimes spinal stenosis is congenital (from birth), and small changes in the bony structures of the spine can cause significant problems

How is spinal stenosis determined?

  • Patients with spinal stenosis typically complain of leg pain that gets worse with walking.
  • Often patients will get relief by sitting or leaning forward.
  • Spinal stenosis is most often determined through regular X-rays. CT myelograms and MRIs can often help.

How is spinal stenosis treated?

  • Initial treatment includes medications, steroid injections and possibly narcotic medications.
  • Sometimes physical therapy to strength the back muscles can help.
  • Decompression surgery can also be helpful when other treatments have been tried and failed.