Why Does My Back Hurt?
There are many conditions and diseases that can cause back pain. Some conditions are more serious than others. Below are links to some of these conditions.
Herniated Disc (HNP)
A herniated disc occurs when the nucleus of the disc which is a gel-like substance breaks through the annulus fibrosus which is fibrocartilage. The intervertebral disc acts as a shock absorber for the spinal column. Injury to the disc may cause pain, numbness, tingling, and/or loss of muscle strength. Disc injuries in the neck may affect the upper arms and hands while injuries to the discs in the low back may cause leg and foot symptoms. Disc herniation occurs most often between the ages of 30 and 50 because the elasticity of the disc and fluid content of the nucleus decreases with age. (back to Top)
Degenerative Disc Disease (DDD)
Degenerative Disc Disease occurs naturally with aging. It is a gradual deterioration of the intervertebral discs. Usually DDD is not severe enough to necessitate medical treatment. Over time biochemical and structural changes occur. The collagen structure of the annulus fibrosus weakens. The water and proteoglycan content decreases. Proteoglycan molecules attract water so fluid content of the disc decreases. These changes affect the disc’s ability to handle mechanical stress. (back to Top)
Osteoarthritis (DJD)
Osteoarthritis or degenerative joint disease is the most common form of arthritis. It can occur in almost any joint in the body but is most common in the fingers, hips, knees, and spine. Gradually changes occur in the cartilaginous surfaces of the joint which leads to loss of elasticity. The cartilage becomes stiff or brittle, making it easier to injure. This leads to pain, stiffness, and crepitation at the joint. If changes are severe enough, damage to the bone may occur. (back to Top)
Foraminal Stenosis
The spinal nerves pass through openings between the vertebrae called intervertebral foramen. Foraminal stenosis occurs when these openings narrow. The narrowing can occur because of injury, degenerative disc disease, or congenital anomaly. When narrowing occurs there may be compression of the spinal nerve which may cause pain, numbness, tingling, burning, or muscle weakness of the involved extremity. (back to Top)
Spinal Stenosis
Spinal stenosis involves narrowing of the spinal canal which may cause compression of the spinal cord. Symptoms may include pain, numbness, tingling, and weakness. Severe cases may cause loss of function and disability. Spinal stenosis is more common in patients over fifty. Causes of spinal stenosis include injury and degenerative changes. (back to Top)
Facet Syndrome
This is a common spinal disorder which affects the posterior vertebral joints producing pain, stiffness, and inflammation. The increased stress at the facet joints results in stretching of the ligamentous capsule, deterioration of the smooth cartilaginous surfaces, and increased friction at the joint. With facet syndrome, pain is usually localized at the spine but occasionally pain is felt in the extremities or other areas. (back to Top)
Spondylolisthesis
This occurs when one vertebrae slips forward in relation to adjacent vertebrae. Stability depends on the degree of translation. Spondylolisthesis may be caused by several factors including facet or disc degeneration, trauma, or a defect in the vertebrae in the area called the pars interarticularis. Severe cases may cause spinal cord or nerve compression. If severe enough surgery may be required. (back to Top)
Sprain / Strain
Sprains and strains are the most common causes of back pain and may be caused by trauma, overuse, deconditioning, and poor body mechanics. Sprain describes any injury to a ligament. The term strain is used to describe a muscle or tendon injury. Usually patients complain of increased pain with movement and decreased pain at rest. Treatment usually includes a period of rest followed by a therapeutic exercise program to improve strength and flexibility. (back to Top)
Radiculopathy
Lumbar radiculopathy is pain in the lower extremities in a dermatomal pattern. A dermatome is a specific area in the lower extremity innervated by a specific lumbar nerve. The pain is caused by nerve root compression in the lumbar region of the spine. (back to Top)
Sciatica
Sciatica is a condition which causes pain down the back of one or both legs. Inflammation of the sciatica nerve may be constant or intermittent. Sciatica may be caused bony compression of a nerve as it exits the lumbar spine. It may also be caused by prostate cancer. The cause is usually a structural imbalance, however. Trigger points in the piriformis muscle may cause contraction and put pressure on the sciatic nerve also producing sciatic pain. (back to Top)
Ligamentous Hypertrophy
There are ligaments that run up and down the vertebral column. Hypertrophy of the ligaments in the vertebral canal can increase their mass causing narrowing of the spinal canal. The longitudinal ligament runs up and down along the back of the vertebral bodies. The ligament flavum runs up and down under the posterior bone ring made up of the spinous process and lamina. When hypertrophy occurs, the spinal cord and/or nerve roots may be compressed. Hypertrophy of the ligamentum flavum near the facet joint can also cause foramina stenosis and nerve compression. (back to Top)
Scoliosis
In scoliosis the spine is curved from side to side and may also be rotated. It is an abnormal curvature and on X-ray may look like a C or an S. It is usually classified as congenital or idiopathic which means arising spontaneously from an unknown cause. It may also be caused by neurologic or genetic conditions and other causes. (back to Top)
Osteoporosis
Osteoporosis is caused by loss of bone density. There is a deficiency of bone-building nutrients such as calcium, Vitamin D, and other vitamins and mineral. The most common complication of osteoporosis is compression fracture. These fractures can be caused by even simple daily activities such as bending and heavy lifting or can result from a fall. (back to Top)
Compression Fracture
These fractures can occur in any vertebrae and cause a collapse of the vertebral body. Symptoms may include sudden and severe back pain that is localized in one area. There may be numbness, tingling, or weakness in the arms or legs if the spinal cord or spinal nerves are compressed. Multiple fractures can cause a forward hump-like curvature of the spine. Causes of compression fracture may be accidents, falls, or weakening of the bone due to pathology such as osteoporosis or cancer. An X-ray or bone scan can show the fracture. (back to Top)
Fracture
Spinal fractures can be caused by pathology resulting in a compression fracture or can be caused by a traumatic event. (back to Top)
Dislocation
A dislocation occurs when a joint has been disrupted and has separated so that the two adjacent bones are no longer aligned or toughing. Joint dislocation causes spinal instability. The spinal column is unable to protect the spinal cord or nerves. (back to Top)
Fibromyalgia
Fibromyalgia is a chronic condition. There is widespread soft tissue pain, tenderness, and fatigue. A diagnosis is determined by pressing on up to 18 specific areas. Pressing these areas causes discomfort or pain. The pain from fibromyalgia can be severe enough to interfere with a persons work and activities of daily living. The cause of fibromyalgia is unknown. (back to Top)
Cancer
Tumors in the spinal column can cause pain by expanding or weakening the bone causing spinal fractures, nerve compression, or spinal instability. (back to Top)
Discitis
Discitis or disc space infection is an inflammatory lesion of the intervertebral disc. It occurs in adults, but more often in children. The exact cause is unknown but it is believed to be infectious. The infection probably starts in one of the contiguous end plates and the disc is infected secondarily. Back pain that begins insidiously is common with discitis. (back to Top)
Kyphosis
Kyphosis is the abnormal forward bending of the spine forming a hump. Symptoms are usually minimal unless the curve is severe. The back may ache. Nerve problems are rare. Kyphosis is usually caused by abnormal posture. Other causes can be vertebral fractures, spinal surgery, Scheuermann’s nodes which causes wedging of the vertebrae, tuberculosis of the spine, osteoporosis, spinal tumors, or nerve disorders. (back to Top)
Lordosis
Lordosis is an excessive inward curve of the spine. The cervical, thoracic, and lumbar areas have normal lordotic or kyphotic curves. The natural curves place the head over the pelvis and act as shock absorbers to distribute mechanical stress during movement. Lordosis can occur at any age and usually affects the lumbar spine. The patient appears to be swaybacked with prominent buttocks. Lumbar lordosis can affect movement and be painful. Certain diseases such as discitis, kyphosis, obesity, osteoporosis, and spondylolisthesis can cause lordosis. (back to Top)
Obesity
127 million or 64.5% of adults are considered to be obese. Being overweight can significantly contribute to symptoms associated with osteoarthritis, rheumatoid arthritis, degenerative disc disease, spinal stenosis, and spondylolisthesis. When excess weight is present, the spine must accommodate the extra burden, leading to structural compromise and damage. The low back is the area most affected by obesity. Lack of exercise and conditioning lead to decreased flexibility and muscle weakness of the back, pelvis, and thighs, increasing the lumbar curve. Posture is affected which can affect other areas of the spine such as the neck, causing pain in these areas as well. (back to Top)
Trauma
Injury can occur to the bony elements, soft tissue, and/or neurological structures. In a case of spinal trauma, instability of the vertebral column can cause actual or possible neurological injury. Stability can be affected when the bony elements are injured or the soft tissues such as the ligaments are disrupted. Instability affects the back’s ability to carry normal loads which can cause permanent deformity, severe pain, and potentially catastrophic neurological injuries. Instability usually comes from a fracture of one of the bony parts of the vertebrae such as the vertebral body, pedicle, or lamina. Dislocations and fractures can occur in any area of the spinal column. Surgery may be necessary to restore stability and prevent more neurological injury. (back to Top)
Pregnancy
Back pain can often occur during pregnancy and should be treated to prevent it from affecting activities of daily living and from making delivery more difficult. Pain can continue after delivery. Any back pain lasting longer than 6-8 weeks after delivery should be treated to avoid chronic or recurring problems. (back to Top)
