There are many causes of spine disorders; some common, some rare. The causes may be grouped into broad categories as outlined below.
The links in the text below connect to information about specific spine conditions provided by the American Academy of Orthopaedic Surgeons. This will give you useful background information and will help you to ask the right questions when you see us. To understand the basic way a spine is ‘built’ and to learn how it works, click here.
Back pain occurs when the spine is stressed by injury, disease, wear and tear, or poor body mechanics. Acute lower back pain is abrupt, intense pain that settles after a period of days or weeks. It usually resolves with rest and simple self-care measures or occasionally physiotherapy. You have the most important role in the prevention, treatment, and recovery of acute back pain. Rarely, acute lower back pain can persist. Whilst every case is unique, if pain persists for more than a few weeks your GP may arrange investigations to determine the cause or consider referral to a specialist surgeon. Pain that persists for more than 3 months is considered chronic and usually requires further evaluation. Unlike the lower back, thoracic spine pain is less common and usually requires more prompt investigation by your doctor.
Types of Back Pain:
Supporting the weight of your body whilst remaining flexible, the lumbar spine can be prone to injury and pain. Back pain ranges from mild to severe, acute to chronic.
Acute low back pain occurs suddenly and normally heals within several days to a few weeks. Pain is usually started in the muscles, ligaments, joints, or discs. Tight muscles, degenerative discs, and inflamed facet joints are usually the cause but occasionally a trapped nerve may also contribute to the pain.
Chronic back pain is diagnosed when pain lasts for more than 3 months. This may be felt all the time or only with certain activities. Its exact source may be initially hard to determine but may include nerve damage, arthritis, scar tissue or muscle loss. Chronic pain may have an impact on a person’s mental health. Similarly, mental health, stress and anxiety can all have an impact on chronic pain, increasing the intensity of the pain experienced.
Patients may experience a broad range of symptoms including stiffness, tightness, muscle spasm, aching, stabbing, burning pains. Some experience shooting pains, pressure, or tingling. Pain may radiate and be felt in the buttocks, thighs, or knees. Some may not have any pain felt directly in the back at all. Symptoms are usually more noticeable when bending or arching the back, lifting heavy objects, or if sitting or standing for a long time.
You should seek medical help immediately if extreme leg pain or weakness, loss of bladder or bowel function develops, the condition called cauda equina syndrome is a medical emergency.
Causes of Back Pain:
A sedentary lifestyle, excess weight, poor seating, and improper lifting techniques all place stress on the spine and can result in pain. A specific causes of acute lower back pain is only found 20% of the time. Although the specific cause may not be found, some conditions that cause back pain are:
• Muscle strain: A sports injury, fall, or strenuous activity can strain muscles. Often when performing out of the ordinary activity.
• Osteoarthritis or degenerative disc disease: Both the discs and facet joints involved in spinal motion degenerate with age. Facet joints can become arthritic and the discs may dehydrate, bulge or collapse.
• Bulging or herniated disc: The gel-like centre of a spinal disc can bulge or rupture through a weak area in the disc wall. This can cause both back pain and also sciatica
• Stenosis: Narrowing of the bony tunnel in the spine that the spinal cord and nerves run through can result in nerve compression.
• Rare causes: Very rarely more severe problems can cause back pain. These typically result in a progressive pain that does not self-resolve. These may include fractures, tumours and infections.
Your complete medical history will be reviewed by your treating doctor including the onset of your pain, aggravating factors and treatments already initiated. The impact on your function and wellbeing will also be considered.
A thorough medical examination will be conducted to help identify the cause and location of your pain along with testing the function of the nervous system that may be involved. Your doctor will also consider causes of pain that may not originate in the spine such as your shoulders, hips, chest or abdomen.
Medical imaging and investigations may be required. NeuroSpine Institute has developed a close working relationship with leading medical providers. You may be referred for x-rays, a CT scan, MRI, SPECT-CT or nerve conduction testing. Occasionally diagnostic injections may be required.
Most back pain can be treated without surgical interventions. The aim is to improve your pain, correct the problem, restore function, and prevent a recurrence.
Self-care: Back pain often resolves with rest, ice, massage, simple pain medication, and gentle stretches. Reducing muscle inflammation and pain using an ice pack during the first 48 hours. A warm shower or heating pack may be used after to relax the muscles. A short period of bed rest is okay, but more than a couple of days can do more harm than good. If your pain is ongoing or recurrent you’ll need to see your doctor.
Medications: Many people get pain relief with over-the-counter anti-inflammatory medications such as ibuprofen or naproxen. Commonly paracetamol may also be used. You should consult with your doctor or pharmacist as to which medication to take. Even common non-prescription medications can have serious side-effects if taken for more than a few days.
Injections: A steroid like Cortisone may be injected directly into the pain source, with the large number of possible pain sources in the spine though identifying which one to inject may be complex.
Physiotherapy: For most back pain, we recommend a nearly normal schedule where pain allows from the onset. Physiotherapy can help you return to full activity as soon as possible and prevent re-injury. You may be referred to a NeuroSpine Institute Physiotherapist who will assist in both education and training for proper lifting and walking techniques, and exercises to strengthen and stretch your back, legs, and abdominal muscles.
Alternative therapies: Some people may find benefit from alternative therapies such as yoga, pilates, and acupuncture. These treatments may require self-funding and need to be considered on an individual basis. These are not treatments currently offered at NeuroSpine Institute but their role in your treatment will be considered.
Surgery: Surgery is rarely needed to treat back pain alone, non-surgical measures are usually highly effective. In cases where back pain is present in conjunction with nerve compression or spinal instability, surgery may be required. Every patient is unique, however, in general a focus towards minimally invasive procedures with accelerated rehabilitation protocols is favoured. Surgical decompression or microdiscectomy, artificial disc replacement or fusion may be considered.
Recovery and prevention:
Most people with acute low back pain respond to treatment. 80% are symptom-free within 1 to 2 weeks and 90% have recovered within 12 weeks. Maintaining regular activity, a positive mindset and a prompt return to work are all vital. If regular work duties cannot be performed, a period of light duties or reduced hours may be recommended if available in your employment. Typically the longer a patient has off work the longer it will take for them to return to full function.
Preventing future back pain is as important as treating the current symptoms. This involves developing safe lifting techniques, correct sitting posture, regular exercise, healthy weight, stress management and mental health along with not smoking.