Back Pain

Back pain is an extremely common complaint and it is estimated that approximately 80% of people in the United Kingdom are affected by it during some stage in their lives.

According to The Back Pain Charity, through a one year period, 3.5 million people experience back pain for the first time and for 3.1 million of these the pain persists for over a period of one year.

How the back works

The spine is made up of many small bones called vertebrae. These are separated by discs which allow the spine to bend and are often described as the ‘Shock Absorbers’ of the spine. The vertebrae and discs are supported by muscles and ligaments. The spinal cord threads through the centre of each vertebrae, carrying nerves from the brain to the rest of the body.

Cervical Spine

This relates to the neck area of the spine. The cervical spine consists of seven vertebrae, each one is separated by an intervertebral disc. Each disc has a pulpy substance in its centre and is surrounded and contained by a tough fibrous membrane, which is attached to the adjacent vertebral bodies. The cervical spinal column provides strong flexible support of the head and protection of the spinal cord.

It is in constant motion during the waking hours and often during the sleeping hours.

Thoracic Spine

This relates to the chest area and the thoracic spine contains twelve vertebrae. These vertebrae do not have as much motion as the cervical vertebrae. The ribs and breastbone (sternum) are attached to the thoracic spine and this protects many of the body’s vital organs.

Two struts of bone called ‘pedicles’ are on each side of every vertebral body and an arch of bone, called lamina, is attached to the back of each vertebral body. This bone encloses a hollow space (like a tube), this runs the length of the spine and contains the spinal cord and spinal nerves. At each vertebral level a pair of spinal nerves (right & left nerve roots) come out from the spinal column through openings called foraminae. These nerves supply sensation to the skin and power to the muscles of the arms and hands. The spinal cord carries the motor and sensory nerve pathways to the trunk and legs including nerves that control bowel, bladder and sexual function. The spinal cord and nerve roots are enclosed by a tough membrane called the dura. Inside the dura is a flimsy membrane which contains a colourless spinal fluid which bathes the spinal cord and nerves. The spinal column is supported by discs, muscles, ligaments and also ‘facet’ joints. These facet joints aid the movement of each vertebral body.

Lumbar Spine

This relates to the lower part of the back and contains five vertebrae which start from the lower thoracic spine to the sacrum. These vertebrae are the largest of the spine because they are responsible and bear the majority of the body’s weight. The sacrum is a triangular shaped bone beneath the last lumber vertebrae and is made up of five fused vertebrae. Underneath the sacrum is the tail end of the spine. This is called the coccyx and comprises of four fused vertebrae.

Common causes of back pain

It is important to mention that most causes of back pain will be resolved by gentle exercise and simple pain killers.

In cases of ‘simple back pain’, the cause is usually muscle strain or spasm. It is usual for these attacks of acute back pain to get better within 2 – 6 weeks.

Common triggers of back pain include:

• Poor posture
• Lack of exercise
• Standing or bending for long periods of time
• Sitting in chairs which do not provide adequate support
• Sleeping on a bed that does not provide adequate support
• Lifting, carrying, pushing or pulling loads that are too heavy
• Incorrect technique when lifting, carrying, pushing or pulling loads
• A trip or fall

When to consult your Doctor

If your back pain lasts longer than 6 weeks or is continuous, keeps you awake at night or becomes suddenly worse you should consult your Doctor.

If you develop pain, pins & needles, numbness in any of your limbs or buttocks or have difficulty passing water; you need to consult your Doctor.

Types of back pain

Most of the readers of this web site will probably already have chronic pain and will more than likely have had a diagnosis, operation or tried some sort of symptomatic pain relief.

The details given about the different types of back pain are for information only and not for the purpose of self diagnosis.

The information provided by The Pain Clinic is to provide hope to pain sufferers that Pain Management Programmes and an holistic approach can be successful in reducing pain; even when you may feel that there is nothing left to try – there is!

Common causes of Cervical, Thoracic and Lumbar pain:

Injury or Trauma, which causes fractures to the neck are beyond the scope of this site

Whiplash is an injury which is commonly due to a car crash and causes neck pain due to the soft tissue in the spine being stretched and strained suddenly and forcefully. This mainly affects the Cervical or Thoracic region.

Mechanical & Muscular neck pain is very common. The causes include minor injuries or sprains to the muscles or ligaments in the any part of the back. Poor posture is also a common cause. For example, neck and thoracic pain is more common in people who spend their working day at a desk with a ‘bent forward’ posture, whereas incorrect lifting techniques tend to affect the lumbar spine. Also sports injuries can often cause muscle sprain and spasm. Often the exact cause or origin of the pain is not known

Acute primary torticollis, is sometimes called ‘wry neck’. This is when the head is twisted to one side and it is very painful to move the head/neck into another position. Most cases happen while sleeping or, for example, reaching into the back seat from the front of the car. When this happens one or more muscles on one side of the neck go into spasm. Usually the spasm should ease over a few days.

Degeneration, also known as ‘wear & tear’ happens to the spinal bones and the discs and can affect any part of the spine.

Radiculopathy occurs when a nerve root is pressed on, or is injured as it comes out from the spinal cord. Common causes are disc problems such as disc bulge and prolapses commonly known as slipped disc. Symptoms depend on the area involved but will usually involve referred pain, pins & needles, numbness, and weakness in parts of the limb or limbs supplied by the nerve.

Facet Joint problems, can affect any part of the spine, although they more commonly occur in the cervical spine. These small spinal joints can become inflamed and cause pain in the affected area. This pain is often associated with cracking or clicking of the facet joints.

Slipped Disc, although this is a term which is commonly used, the disc does not actually slip but bulges out towards the spinal cord. This occurs when the soft part of the disc bulges through the circle of connective tissue. A slipped disc can occur in any area of the spine. This prolapse may press on the spinal cord or the nerve roots; however, many people have a disc bulge without spinal cord or nerve root involvement. If the disc bulge does push on the spinal cord or nerve roots you will experience pain or paralysis radiating to the arms or legs depending upon the site of the bulge. If you experience any of these symptoms, you must consult your Doctor, who will advise you of the best course of treatment.

Failed Back Surgery is a term normally used for people with chronic spinal and nerve root pain which remains after back surgery has been performed. This group of people often have not obtained adequate or any relief from the surgical intervention and many feel that the intervention has made their condition worse.