Back Pain Guide 1

Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., M.S.

The spine is one of the most important parts of your body. Without it, you could not keep yourself upright or even stand up. It gives your body structure and support. It allows you to move about freely and to bend with flexibility. The spine is also designed to protect your spinal cord. The spinal cord is a column of nerves that connects your brain with the rest of your body, allowing you to control your movements. Without a spinal cord, you could not move any part of your body, and your organs could not function. This is why keeping your spine healthy is vital if you want to live an active life.

Pathological Concepts of the Spine

Back pain can be caused by a number of spinal conditions, and below are descriptions of various causes of discomfort:

Mechanical versus Compressive Pain

Sometimes it is useful for back specialists to understand back problems by dividing the problems into different categories. One way to look at back pain is to divide problems into two large categories -- mechanical back pain and compressive back pain.

Mechanical pain is often called back strain because is linked with the movement, or "the mechanics" of the spine. This type of pain occurs when injury to the spine's discs, facet joints, ligaments, or muscles results in inflammation. It is called mechanical pain because it relates to the mechanics of your spine. The more you use the back, the more it hurts.

This pain can be caused by many conditions in the spine. These conditions include: fractures of the vertebra, muscle strains in the paraspinal muscles, ligament injures in the spine, and wear and tear of the spine's joints and discs.

Compression pain is a result of pressure or irritation on the spinal cord, or nerves that leave the spine. For example, if an intervertebral disc herniates (usually called a ruptured disc) and pushes into the spinal canal, it can cause problems with the nerve. Usually this pressure or irritation causes pain, numbness, and muscle weakness where the nerve travels.

Each part of the spine can cause pain. It can be helpful to understand which part of the spine is causing your back pain and whether the pain is from a compressive or mechanical type problem.

Arthritis Pain

The term arthritis means inflammation of the joints. Arthritis of the spine usually refers to a condition where there is inflammation of the facet joints between the vertebrae. The pain that results from arthritis is usually the mechanical type of back pain. If bone spurs develop due to the arthritis and begin rubbing on the spinal nerves, there can also be compressive type pain produced as well.

There are two types of arthritis: systemic inflammatory arthritis, and wear-and-tear arthritis. A systemic type of arthritis is actually a disease process that affects all the joints of the body - such as rheumatoid arthritis.

Many arthritis type diseases affect the connective tissues of the body. All of these diseases cause inflammation of the joint tissues and destruction of the joints. The joints of the spine may be involved in systemic types of arthritis because the facet joints are made up of the same tissues as any other joint. Therefore, diseases that attack joint tissues also attack the facet joints.

Wear-and-tear arthritis, or osteoarthritis, can result from many things. It can come from a single injury that damages the joint. It can also result from a lifetime of overuse of different joints that damage the joint a little bit at a time. Doctors are now beginning to realize that osteoarthritis also runs in families. Something about the genetic makeup of different individuals makes them more prone to develop osteoarthritis of various joints.

Osteoarthritis is caused by a permanent breakdown of the articular cartilage inside the affected joint. Articular cartilage is the material inside the joint that cushions the bones of the joints from impact and allows smooth, gliding motions. Because damaged cartilage cannot repair itself, it begins to fray, making it less flexible and more prone to injury. Over time, the cartilage can wear away completely, causing the bony surfaces of the joint to rub directly against each other. Eventually the joint becomes worn away and bone spurs develop around the joint.

Facet Joint Syndrome

Sometimes the facet joints are the main cause of back pain. In many cases, the facet joints are at least part of what is causing your back pain. When your doctor thinks the facet joints are a major source of your pain, he may use the term "facet joint syndrome". Facet joint degeneration, or osteoarthritis, can be caused by a combination of aging, pressure overload of the facet joints, and injury.

Pressure overload on the facet joints is probably caused by degeneration of the intervertebral disc. As the discs degenerate, they wear down and begin to collapse. This narrows the space between each vertebra. This narrowing of the space between each vertebra affects the way the facet joints line up. When this occurs, it places too much pressure on the articular cartilage surface of the facet joint. The excessive pressure leads to damage of the articular surface and eventually the cartilage begins to wear away.

When facet joint arthritis gets bad enough, the cartilage and fluid that lubricate the facet joints are eventually destroyed as well, leaving bone rubbing on bone. Bone spurs begin to form around the facet joints. When bone spurs develop, they can take up space in the foramen (the opening between vertebrae where nerve roots exit the spine) and press into nerve roots. As the bone spurs begin to grow larger, they can eventually extend into the spinal canal itself. This leads to narrowing of the spinal canal (spinal stenosis).

Pinched Nerve (Radiculopathy)

Radiculopathy is the medical term used to describe a "pinched nerve" in the spine. A radiculopathy occurs when a nerve is irritated by something that is either rubbing on the nerve or pressing on the nerve. In some cases, such as a herniated (or ruptured) disc, there may also be a chemical reaction irritating the nerve. Chemicals released from the inside of the disc seem to irritate nerve tissue, causing pain and inflammation of the nerve.

Abnormal pressure or irritation on a particular nerve causes several problems. First, there is numbness in the area where the nerve usually provides sensation, or feeling. For example, if the nerve usually ends in the side of the foot and supplies sensation to that area, it will have decreased feeling, and often pain.

The key to understanding a radiculopathy is understanding that your brain cannot tell where the problem really is. While the irritation or pressure on the nerve may be in your back, your brain thinks the pain is coming from your foot. In addition, the muscles that the nerve usually controls will not work right. You will usually have weakness in the muscles, and the reflexes controlled by the muscles will not work. This is why doctors always check reflexes. The body has a pretty standard wiring diagram. By determining which reflexes are not working, the doctor can usually tell which nerve is involved with the problem.

Things that can cause a radiculopathy include: herniated discs, bone spurs, tumors that are growing into the nerves, and fractures that put pressure on the nerves.

Sciatica

The term sciatica refers to a certain type of radiculopathy that occurs in the leg. It is called sciatica because it describes the radiculopathy that occurs when one or more of the nerves that make up the large sciatic nerve are irritated or pinched. Therefore, sciatica is not any different than a pinched nerve anywhere else in the spine. It simply has its own name because it is fairly common. It also occurs in the lumbar spine, the most common site of spinal nerve irritation.

Sciatica is used to describe the travel the leg from the sciatic nerve in the lumbar region into your buttocks, back of the thighs, and sometimes calf and foot. The pain is typically caused by irritation of the nerve roots that join outside the spine to make up the sciatic nerve. Conditions that can cause sciatica are: herniated discs, bone spurs, cancerous tumors that are growing into the nerves, and fractures that put pressure on the nerves.

Spinal Cord Pressure

We have seen how individual nerve roots are affected by pressure and irritation -- but what about the spinal cord itself? Pressure on the spinal cord typically results from a condition called stenosis. Stenosis means narrowing of an opening or tube - in this case the spinal canal.

Spinal Stenosis

Spinal Stenosis is a term commonly used to describe a narrowing of a portion of the spinal canal. Stenosis can occur in all areas of the spine, but it is most common in the cervical and lumbar spine. There can often be narrowing of most of the lumbar spinal canal and of several segments of the cervical spine. Each behaves somewhat differently.

Although there is some space between the spinal cord and the edges of the spinal canal, this space can be reduced by many conditions. Bone and tough ligaments surround the spinal canal. This tube cannot expand if the spinal cord or nerves require more space. If anything begins to narrow the spinal canal, the risk of irritation and injury of the spinal cord or nerves increases. Some conditions that can lead to narrowing of the spinal canal include: infection, tumors, trauma, herniated disc, arthritis, thickening of ligaments, growth of bone spurs, and disc degeneration.

Spinal stenosis usually occurs in older people after years of wear and tear or degeneration of the spine. This wear and tear results in changes in the structures around the spinal canal, such as thickening of the large ligaments that connect the vertebra together, bone spurs around the facet joints and disc space, and bulging of the discs themselves.

All of these changes push into the spinal canal, making the tube of the spinal canal smaller. Eventually, there is not enough space in the spinal canal for the nerve to comfortably fit without causing too much pressure. Stenosis can also develop because of injuries, infections, or tumors. Some people even have a narrow spinal canal from birth, and this abnormality leads to symptoms of stenosis.

The narrowing of the spinal canal can lead to irritation of the nerves of the spine. This can cause pain and problems with the nerves not working right. The lack of space can also cause the supply of blood and oxygen to the spinal cord to be reduced. When the spine needs more blood flow during increased activity, the blood vessels may not be able to swell to get more blood to the spine. This can lead to numbness and pain in the affected nerves. The nerves also lose some of their mobility when the space available to them is reduced. This leads to irritation and inflammation of the nerves.

Other symptoms of spinal stenosis include: a sensation of heaviness, weakness, and pain when walking or standing for a long period. With rest, these symptoms often disappear. These symptoms occur because the nerve roots are being tampered with, upsetting the normal signals that travel from the brain to the body. Irritation of the nerves in the spinal canal is worse when with standing or walking because of the mechanical compression and stretching of the nerves.


Back Pain Guide Part 2 Continued

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Before starting any self treatment Dr. Grisanti recommends that you consider consulting with a doctor trained in functional medicine. Visit www.FunctionalMedicineUniversity.com to find doctors thoroughly trained in functional medicine

Functional medicine embraces the totality of the regulatory functions of the body. It encompasses all of the biophysical, biochemical, enzymatic, endocrine, immunological, and bioenergetic regulatory capacities.

Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., M.S.