The Facts

The spine is made up of bone segments called vertebrae. Vertebrae have two parts: 1) the cylinder-shaped vertebral bodies to the front; and 2) the boney bridges making up the facet joints at the back. Most of the spine is flexible enough to let people bend, stretch, and lift. Between the bones of the spine are small discs that are hard on the outside and soft and jelly-like on the inside. The spinal bones are connected by the facet joints at the back and by the discs at the front.

The nerves of the spinal cord run through the spinal canal, which is just behind the vertebral bodies, and separate into roots along the length of the spinal cord and at the tail end of the spine. Some of them pass through the pelvis to become the sciatic nerves, which pass down each leg. Problems with the vertebrae, joints, or discs can all cause back disorders. Back disorders can cause mild to very severe backache.

Many Canadians between the ages of 20 to 65 will develop back pain. Lower back pain affects approximately 50% of adults over the age of 60. Though it hurts, back pain is rarely caused by a serious disease and usually disappears on its own. It often comes back, however, making it one of the most common reason people see doctors.

Causes

Most cases of back disorders aren't caused by underlying disease. They're usually caused by aging, wear and tear, decreased muscle strength, and poor posture. Obesity and smoking are risk factors for back problems. There are a number of back disorders, each having a different cause.

Muscle spasms in the back can occur when any part of the back is irritated. Muscle spasms are often an attempt by the body to protect a sore back. Muscle spasms also occur when the spinal nerves are irritated or damaged. Joint pain occurs when the joints become worn by activity or by being twisted.

Disc trouble, also called discogenic back pain, can occur in two ways. The jelly-like material inside the disc either bulges out or bursts through the hard outer cartilage of the disc. When this material bulges out and presses on a nerve, it causes pain and is called a herniated or prolapsed disc. Disc pain usually gets worse over the course of a few days. It usually goes away after 4 to 6 weeks, but it may continue as a dull, nagging ache.

Anything that causes pressure on the sciatic nerve root causes sciatica. The most common cause of sciatica, which is characterized by buttock and leg pain, is a disc or bone spur pressing on spinal nerve. It usually gets worse over a period of days, and may last up to several weeks.

As people get older, they may develop a condition called spinal stenosis. Spinal stenosis is a narrowing of the canal holding the spinal cord. This can be due to bone spurs (osteophytes) sticking out into the canal or to hardening of the bands of tissue that support the spine. Spinal stenosis can cause back and neck pain or numbness and weakness in the arms or legs.

Symptoms and Complications

The pain from a muscle spasm in the back can travel down the buttocks and leg. Joint pain in the lower back may spread down the backs of the thighs. It's a stabbing pain at the time of an injury or a few days after. Someone who has trouble getting out of a car or bed or rolling over often has back joint pain. The pain usually gets worse when the person bends backward. Also, there's usually more pain in one leg than in the other.

Pain when bending forward is usually, but not always, a sign of a disc trouble, as are short severe attacks of back pain alternating with longer bouts. If someone has pain when bending both forward and backward, thinning discs have probably thrown the back joints out of line, making them easy to strain. Thinning discs can also make the back less flexible and may pinch a nerve, causing sciatic leg pain, which is pain that travels down the leg and possibly to the feet. Sciatica gets worse when bending forward. If there's enough pressure on the nerve, muscles can weaken and bowel and bladder problems may occur.

A herniated disc causes a constant back and leg pain. Intense persistent sciatic pain going down the leg to the foot may indicate a herniated disc.

Bone spurs jut out into the spinal cord and press on nerves, causing pain. Spinal stenosis is usually not a major problem. However, if someone feels worsening numbness or has trouble moving, they may need surgery to correct spinal stenosis.

Making the Diagnosis

Your doctor may do one of the following tests for underlying medical problems:

• a back X-ray
• bone scans
• computed tomography (CT) scan, in which computers combine many pictures to show a very detailed view of the back
• magnetic resonance imaging (MRI), a type of scan that uses electromagnetic waves to visualize soft tissue

Your doctor will likely examine your back for any deformity, redness, or rash. If you have nerve pain, they will likely examine the function of the spinal cord by testing your reflexes, strength, and ability to feel sensation. X-rays can show problems with the vertebrae, but not with the soft tissues such as discs, ligaments, or muscles. Bone scans can help your doctor screen for abnormal areas, which are further investigated with other tests.

CT scans can diagnose arthritis and spinal stenosis and other bone changes, but not always a herniated disc. MRI can show soft tissue, including discs, nerves, the spinal cord, and tumours.

Treatment and Prevention

Anti-inflammatory medications, painkillers, stabilization exercises, and rest are common treatments for mild to moderate back pain. Using heat and cold may help relieve acute muscle spasms. Surgery, bed rest, and medications have been used to treat severe back disorders without much success. Doctors now know that long periods without exercise can make back disorders worse: it weakens the muscles, increases the risk of blood clots, and makes it harder to get back to doing normal activities.

As soon as the most severe pain goes away, back disorders should be treated with daily exercises to improve general fitness, as well as with exercise routines geared to the specific back problem. Your doctor or physiotherapist should provide a personalized exercise routine for back problems. Brisk walking, cycling, and swimming are excellent exercises for people with bad backs. Also helpful are exercises that strengthen abdominal and core muscles, such as sit-ups and planks. A health care professional can also provide instruction about proper lifting techniques to minimize stress on the back.

Your doctor may advise you to lose weight, which may also ease some back problems. Alternative therapies such as massage and acupuncture may help some people with back pain.