By Shirvinda Wijesekera, M.D.
Back pain can arise for a variety of reasons. People often describe their pain as an aching, tight spasm type pain that will not relent despite rest, massage, or medication. Others describe their pain as a sharp, tearing pain that can be worse with a simple cough. Yet others, experience burning, electrical pain down the legs or simply an aching in the buttocks. Why would your back pain differ from someone else's? To answer we must get the source of the back pain.
The muscles that control our spine are long strong muscles that begin at the base of the skull and travel toward our tailbone. They are remarkable in their ability to adapt and protect us from injury. When we injure a segment in our spine, the muscles of our back work hard to restrict motion to the injured segment while we heal the damage. Generally, the injury heals and the back pain dissipates over time. Unforunately, on occasion the injury does not heal quickly and the muscles begin to fatigue under constant pressure to restrict motion. The muscle can give rise to painful spasms, unrelenting aching pain, and a loss of mobility.
Often times, the injured area in the spine is the disc, or the cusion between the vertebrae or bones of the spine. This disc has a soft spongy center that absorbs the forces life delivers to our spine. Surrounding the spongy center are rings of tissue that reinforce the disc. When the disc becomes injured, these rings of tissue tear leading to a decrease in the effectiveness of the disc. During these times of injury, the spongy center often loses some of its shock absorbing properties. When the disc is injured, we may experience this as a tearing pain that can be worse with coughing, sneezing, or bearing down.
If the injury to the disc is severe, the disc can lose its round shape. As the reinforcing fibers tear, the central spongy center can expand through these tears like a bulge on a damaged tire. The reinforcing fibers can tear completely allowing the spongy center to escape from the disc and travel outside its designed location. as the displaced center or bulge moves it can pinch the nerves that travel directly behind the disc and vertebral body. This pinching can lead to an electrical or burning pain, often described as sciatica. Sciatica has a variety of presentations. Some experience the classic pain that shoots down the leg like a bolt of electricity. Others may have aching in the buttock or weakness in a leg with activity. In fact some simply have buttock or leg pain, with no back pain.
Bone spurs can also cause back pain and lead to both the ache of the muscles and the pinching of the nerves. Bone spurs are Mother Nature's answer to a painful area in the spine. As an irritated area of the spine moves, it can cause symptoms. Nature's answer to pain is the bone spur, which limits the motion in the spine. The bone spurs can lead to pinched nerves, if they develop near the nerves in the spine. They also lead to arthritic back pain.
After your doctor makes the correct diagnosis causing your back pain, you both can decide on what treatment is appropriate for your condition. Physical therapy, medications or cortisone shots, and braces are all options to combat the back pain. The goal with all of these modalities is to allow our body to function and heal itself. Spinal surgery is not always an answer or option. Surgery can be thought of as a tool that must be applied to the correct problem. When modern spinal surgical techniques are applied correctly the results can be dramatic and life-changing. The surgeries of the past have been replaced with new innovative techniques that bring the advances of minimally invasive approaches, modern technology, and faster recoveries.