Common Back Problems

Various types of back pain you may be experiencing are listed below. Please note that each individual experiences different forms of pain and the best way to treat your pain is to set up an appointment with one of our trained physicians who can treat you properly. Read about different symptoms that may be causing your back pain by clicking on the tabs below.

Ankylosing spondylitis is an inflammatory type of arthritis that occurs most frequently in younger men. It involves the inflammation and narrowing of the sacroiliac joints (the joints between the sacrum, or lower back, and the pelvis). Pain and stiffness are usually felt in this area, but they can spread up the spine and sometimes involve the joints in the arms and legs. This pain and stiffness is often worse after prolonged rest, such as in the morning, and improves with exercise.

The cauda equina is a collection of nerve roots at the base of the spine. Cauda equina syndrome is most often caused by a massive disc herniation that compresses these nerves.

Symptoms include:

  • Sciatica, often in both legs
  • Leg weakness and numbness, on both sides
  • Urinary retention
  • Incontinence
  • Saddle anesthesia (loss of feeling in the genital/rectal area)

Overview
Degenerative disc disease (also called spondylosis) is a general term used to describe changes that can occur along any area of the spine (cervical, thoracic, lumbar) as you age. It’s not actually a disease, but rather a condition in which your discs “degenerate,” or lose their flexibility and ability to cushion your spine. Your discs do not have a good blood supply, so once injured it tends to deteriorate in a cascade rather than heal. These age-related changes include:

  • Discs dry out and shrink – made of mostly water, as you get older the discs slowly lose water. This loss of shock absorption and flexibility puts more stress on the annulus because the mechanics of the disc are altered.
  • Small tears occur in the annulus – sometimes some of the gel-like material, or nucleus pulposus, comes out through a tear in the wall and touches the nerves. This material has many inflammatory proteins that can inflame the nerves and cause pain. These tears also affect the nerves in the annulus, and small movements, called micro-movements, can cause discogenic pain. Over the years the proteins eventually dry up, and the discs become stiffer; in some people this results in less pain by the time they are in their sixties.
  • Disc space gets smaller – due to the loss of water in the discs the distance between vertebrae begin to collapse, which is one reason we get shorter as we age.
  • Bone spurs grow – without the discs holding apart the vertebrae, they can rub on each other causing abnormal bone growths.
  • Spinal canal narrows – the stresses of all the above changes causes the ligaments and facet joints to enlarge (hypertrophy) as they try to compensate and spread the load over a larger area. This over-growth causes the spinal canal to narrow, which can compress the spinal cord and nerves causing pain.

Symptoms
The symptoms of degenerative disc disease vary from person to person. Many people with deterioration have no pain, while others may experience pain so intense that it interferes with daily activities. Interestingly, even though this condition affects people starting in their twenties or thirties, people in their sixties are less likely to have back pain caused by deteriorated discs.

Pain often starts in one of three ways: (1) a major injury followed by sudden and unexpected pain, (2) a trivial injury followed by sudden back pain, and (3) pain that starts gradually and gets progressively worse.

Usually, the pain begins in the lower back, and may be felt in one or both of your legs and buttocks (sciatica) if there is nerve compression. It’s often described as pressure or burning pain. You may also feel numbness or tingling in your leg and foot, or have weakness in your leg muscles.

You may have chronic underlying pain that is a nagging annoyance and occasional episodes of intense muscle pain from time to time. These episodes last from a few days to a few months.

Sitting and especially bending forward usually causes the most pain because in this position your discs have more weight on them. Activities such as bending or twisting usually make your pain worse, and lying down tends to relieve the pain.

Causes
Doctors don’t exactly know what causes degenerative disc disease or why some people experience pain and others do not. Most abnormalities relating to DDD can be seen on an MRI—an imaging scan that shows the parts of your back in clear detail. While a large portion of people with back pain have abnormalities confirmed by MRI, studies on healthy young adults have shown that as many as 80% of people without pain also have abnormalities that can be seen on an MRI scan.

It’s not known why some people have pain and others don’t, but various factors contribute to disc degeneration including: genetic, environmental, autoimmune, inflammatory, and traumatic factors in combinations and ways that aren’t yet understood.

Overview
This condition is a deterioration of the facet joints, which help stabilize the spine and limit excessive motion. The facet joints are lined with cartilage and surrounded by a lubricating capsule that enables the vertebrae to bend and twist. Over time, the cartilage begins to wear and lead to bone on bone contact. This can initiate spur formation which can generate pain in the facet joint itself. Additionally, if the spurs grow into the spinal canal or neural foramen, there can be nerve impingement and pain.

Symptoms
Pain from facet joint syndrome differs depending on which region of the spine is damaged. If the upper (cervical) spine is affected, pain may be felt in the neck, shoulders, and upper or middle back even down into the shoulder blades. The person may also experience headaches. If the lower (lumbar) spine is affected, pain may be felt in the lower back, buttocks and back of the thigh. If nerve impingement occurs, then radicular type of pain out into the arms or legs can occur.

Causes
Facet joint syndrome occurs when the facet joints become stressed and damaged. This damage can occur from everyday wear and tear, injury to the back or neck or because of degeneration of an intervertebral disc. The cartilage that covers the stressed facet joints gradually wears away. The joints become swollen and stiff. The vertebral bones rub directly against each other, which can lead to the growth of bone spurs along the edges of the facet joints.

Overview
A herniated disc occurs when the gel-like center (nucleus pulposus) of your disc ruptures out through a tear in the tough disc wall, (annulus). The gel material is irritating to your spinal nerves, causing mechanical and chemical irritation. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc. Over time, the herniation can resorb and you may experience partial or complete pain relief. In most cases, if low back and/or leg pain is going to resolve it will do so in about 6-12 weeks.
Different terms may be used to describe a herniated disc. A bulging disc occurs when the disc annulus remains intact, but forms an outpouching that can press against the nerves. A true herniated disc (also called a ruptured disc) occurs when the disc annulus cracks or ruptures, allowing the gel-filled center to squeeze out. Sometimes the herniation is so severe that a free fragment occurs, meaning a piece has broken completely free from the disc and is in the spinal canal. Most herniated discs occur in the cervical or lumbar section of the spine, where nerves from the spinal cord exit between the vertebrae, and then travel to the arm or leg.

Symptoms
Symptoms of a herniated disc vary greatly depending on the location of the herniation and your own response to pain. If you have a herniated lumbar disc, you may feel pain that radiates from your low back area, down one or both legs, and sometimes into your feet (called sciatica). You may feel a pain like an electric shock that is severe whether you stand, walk, or sit. Activity such as bending, lifting, twisting, and sitting may increase the pain. Lying flat on your back with knees bent may be the most comfortable because it relieves the downward pressure on the disc and relieves some of the stretch on the nerve. Sometimes the pain is accompanied by numbness and tingling. You may experience cramping or muscle spasms. In addition to pain, you may have muscle weakness or reflex loss. In severe cases, you may experience foot drop (your foot flops when you walk) or loss of bowel or bladder control. If you experience extreme leg weakness or difficulty controlling bladder or bowel function, you should seek medical help immediately.

Causes
Discs can bulge or herniate because of injury and improper lifting or can occur spontaneously. Aging plays an important role. As you get older, your discs dry out and lose height. The tough fibrous outer wall of the disc may weaken, and it may no longer be able to contain the gel-like nucleus in the center. This material may bulge or rupture through a tear in the disc wall, causing pain when it touches or compresses a nerve. Genetics, smoking, and a number of occupational and recreational activities may lead to early disc degeneration.

Lumbar spondylosis occurs with aging because of wear and tear on the spine. Pain is generally experienced across the lower back, but may sometimes be felt into the buttocks or on one side of the back. Exercise and bending can increase pain, and rest can relieve it. Back stiffness may result from remaining in one position for a long time, such as in the morning after a night’s sleep.

A strain results when there is pulling or tearing of the muscles or ligaments of the back. Often, this occurs after a specific episode of bending, twisting, or lifting. A strain causes pain almost immediately and is most often felt in the lower back, or lumbar region. Frequently the pain radiates or branches out into the buttocks and the back of the upper thigh. Muscle spasm occurs and adds to tenderness and swelling in the strained area.

You may have heard this condition referred to as ruptured disc, slipped disc, bulging disc, prolapsed disc or a protruding disc. All of these terms are used to describe a tear or deterioration of the wall surrounding the disc that allows some of the fluid to bulge out or escape.

The term slipped disc is incorrect because the disc does not slip; it bulges out between two vertebrae. In some cases, the tough tissues that contain the disc are weakened by injuries that allow the soft, gel-like substance to protrude. If the protrusion presses on a nerve root, pinching it against the bone, the result is pain in the area of the body served by that nerve. Doctors can tell which disc in the lower back is causing the problem by the part of the body affected, usually the legs. The protruded part of the disc does not always slip back into place. Scar tissue develops around the protrusion and forms a capsule. If the outer tissues continue to be stressed, they will weaken further. In time, the slightest activity, a sneeze or cough, may cause the disk to burst through its capsule, or rupture.

Overview
Sciatica is a term used to describe leg pain that radiates from your back into your buttock, and down the back of your leg. It is a general term used to describe symptoms rather than an actual physical condition. Typically the pain is caused by pressure on the nerve roots in your lower back. Doctors often call it lumbar radiculopathy, meaning that the pain begins in the spinal nerve roots and “radiates” to your leg.

Symptoms
Classic sciatic pain affects one leg, starts in the low back and buttocks, and travels down the back of the thigh, past the knee to the foot. The leg pain is worse than the back pain. Your pain may range in intensity from mildly annoying to severe. It’s often described as pressure or burning pain, and some people even experience shooting pain. You may also feel numbness or tingling in your leg and foot. More advanced cases can present with weakness in your leg muscles.

Sitting usually causes the most pain because in this position your discs have more weight on them, and this places more stretch of a nerve over a disc bulge or herniation. If the pain is from stenosis, standing may be a less tolerated position. Lying down tends to relieve the pain. You may actually feel better if you walk or run rather than sit or stand for too long because it allows you to alter your position.

Causes
There are several possible causes of sciatic pain and they all stem from compression or irritation of the sciatic nerve roots:

  • Injury or trauma: A significant force can stress the structures of the spine, for example, sports injury, or fall. A disc can herniate or the nerve can be bruised as in a “stinger” type of injury.
  • Bulging and Herniated Disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve.
  • Stenosis: Narrowing of the central spinal canal and nerve root exiting areas (foraminal stenosis) occurs as discs bulge or protrude, facet joints enlarge, and ligaments stiffen over time. As the spinal canal narrows, it can compress the cord and nerves, causing them to swell and inflame.
  • Degenerative Disc Disease: As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to stenosis or disc herniation.
  • Spondylolysis: A weakness or stress fracture develops in one of the bony bridges that connect the upper and lower facet joints. Resulting inflammation irritates the nerve root.
  • Spondylolisthesis: One vertebra is shifted anterior or posterior to an adjacent vertebra. When the vertebra shifts, the cylinder shape of the spinal canal is disrupted and the resulting “zig-zag” effect can entrap or pinch nerves.

Overview
Scoliosis is a curvature in the normal spine having 3 components. There is excess flexion or extension curvature, lateral or side curvature and rotation present. There are many causes for scoliosis, but the most common causes are degenerative in older adults or idiopathic in teenagers. The idiopathic scoliosis is typically painless but may create cosmetic issues for the individual. It may be treated by brace wear and sometimes requires surgery if the curve is large enough. In degenerative scoliosis, there can be some degree of spinal instability and there is also some stenosis present. This may or may not cause pain in the back, and if nerves are pinched, there can be leg pain. Again, depending upon the severity, there may be a need for surgery.

Symptoms
Should you notice any one or more of these signs as a preteen or teen, you may have idiopathic scoliosis and should schedule a screening exam with a doctor.

  • Shoulders are different heights—one shoulder blade is more prominent than the other
  • Head is not centered directly above the pelvis
  • Appearance of a raised, prominent hip
  • Rib cages are at different heights
  • Uneven waist
  • Changes in look or texture of skin overlying the spine (dimples, hairy patches, color changes)
  • Leaning of entire body to one side

A standard exam that is often used by pediatricians and in initial school screenings is called the Adam’s Forward Bend Test. Most schools test children in the fifth or sixth grade, using the Adam’s Forward Bend Test and often using a scoliometer. During the test, the patient is asked to lean forward with his or her feet together and bend 90 degrees at the waist. The examiner can then easily view from this angle any asymmetry of the trunk or any abnormal spinal curvatures. It should be noted that this is a simple screening test that can detect potential problems, but cannot determine accurately the exact severity of the deformity.

Causes
There are many types and causes of scoliosis, including:

  • Congenital scoliosis. Due to a bone abnormality present at birth. Typically there is a failure of formation of a structure or part of a structure causing asymmetric growth.
  • Neuromuscular scoliosis. A result of abnormal muscles or nerves. Frequently seen in people with spina bifida or cerebral palsy or in those with various conditions that are accompanied by, or result in, paralysis. Traumatic paralysis in a skeletally immature individual can also lead to scoliosis.
  • Degenerative scoliosis. This may result from traumatic (from an injury or illness) bone collapse, previous major back surgery, or disc collapse.
  • Idiopathic scoliosis. The most common type of scoliosis, idiopathic scoliosis, has no specific identifiable cause. There are many theories, but none have been found to be conclusive. There is, however, strong evidence that idiopathic scoliosis is inherited.

Overview
Spinal stenosis occurs in young people born with a narrowed spinal canal and in older people with arthritis or chronic disc degeneration. Normally, nerves emerge from the spinal cord through openings in the vertebral column, like a network of wires from a main cable. If these small openings are narrowed either by birth defect or by age, the nerves become compressed, which causes pain. Pain may occur in the lower back, buttocks, and one or both legs. The pain is aggravated by standing and walking and relieved by resting, sitting, and lying down. These symptoms can imitate a problem with circulation. In addition to painful symptoms, numbness and tingling in one or both legs may occur. Even with all of these symptoms, the spine can maintain a good range of motion.

Overview
Spondylolisthesis is a condition that affects the moveable joints of the spine that help keep the vertebrae aligned one on top of the other. Spondylolysis is actually a weakness or stress fracture in one of the bony bridges that connects the upper and lower facet joints. This fracture can happen at any level of the spine but usually occurs at the fourth (L4) or fifth (L5) lumbar vertebra. This weakness can cause the vertebrae to slip forward out of their normal position, a condition called spondylolisthesis. Treatment options include physical therapy to strengthen the muscles surrounding the area. Sometimes the patient is placed in a brace. In severe cases, surgery is also an option.

Symptoms
Mild cases of spondylolisthesis usually cause minimal or no pain. In fact, the condition is often found by accident when a person has a pre-employment exam or an X-ray of the back for an unrelated reason. When spondylolisthesis does cause pain, you may experience low back pain, stiffness, and muscle spasms. You may also have sciatica (pain radiating down one or both legs), or numbness, if the slippage of the vertebra is enough to pinch nerves. Leg pain will usually be worse when you stand or walk because it increases any nerve pinch that is present. If the slip is minor, you have very subtle symptoms, such as tightness in your hamstrings or find that you can no longer touch your toes, but not feel any nerve pain.

Causes
Spondylolisthesis has several causes, but is most often associated with Spondylolysis or disc degeneration. The cause of spondylolysis is not as clearly defined. Most believe it is due to a genetic weakness of the pars interarticularis. About 5% of the population has this defect. Both spondylolysis and spondylolisthesis can be present at birth or occur through injury. Repeated stress fractures caused by hyperextension of the back (as in gymnastics and wrestling) and traumatic fractures are also causes. The most common cause in adults is degenerative arthritis.

A vertebral compression fracture occurs when one vertebra is crushed and broken. In normal bone, this fracture requires the force of some kind of trauma. In weakened bone, the fracture can occur spontaneously. Several conditions place a person at risk for weakened bones and subsequent spontaneous compression fractures.
These include:

  • Osteoporosis
  • Prolonged use of glucocorticosteroids, or steroids
  • Cancer that has spread to the bone from elsewhere in the body

Typically, a person with a vertebral compression fracture will report sudden onset of back pain at the level of the fracture. Most often, this occurs in the middle or lower levels of the spine with pain radiating across the back and around the trunk but rarely into the legs.

Common Neck Problems

When you have an unhealthy neck, it is often hard to determine how the problem developed. Regardless of how your neck became unhealthy, you may experience symptoms and neck problems that may limit your ability to move. Neck problems range from minor muscle strain to major soft tissue damage, such as tears in muscles and ligaments. Other problems are associated with changes in the disks and vertebrae in your upper spine.

Dull aches in your head or neck, sharp pains, and swelling of the soft tissue of the neck and shoulders are common symptoms. If there is pressure on the nerves in your neck, your arms or hands may be painful. These symptoms can be either temporary or long lasting.

Aging and neck injuries may cause your neck to degenerate or wear out, causing arthritis. Joints in your neck may stiffen and disks in your neck may thin. Bony outgrowths or bone spurs may grow on nearby vertebrae.

Neck strains can be related to misuse or overuse of the neck in such situations as cradling the handset of a telephone. The soft tissue of your neck may be slightly inflamed or swollen, and you may have tiny tears in your neck muscles and ligaments.

If you have muscle tension or stiffness in your neck, you may not be able to move your neck, arms, or shoulders comfortably. If your symptoms are not relieved, you may experience muscle spasms, or knots of contracted tissue (trigger points) in areas of your neck and shoulders.

Your neck structures can be damaged by a motor vehicle accident, a sports injury, or a fall. The muscles and ligaments in your neck may have been overstretched, causing tears and bleeding in the muscles.

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