Where Does Back Pain Come From?
Back in elementary school, you learned the basics of the spine. Namely, your backbone—composed of bones called vertebrae—stretches from your head to your tailbone, and protects your spinal cord, which is the “telephone line” your brain uses to communicate with all the other parts of your body.
We here at Haycock Chiropractic understand there’s more to it than that. So let’s look at each part individually and let me help you to understand where back pain might come from.
The vertebrae bones are connected to one another by“discs”of cartilage that have a soft, pliable center. Think of each disc as a jelly donut, with the bread part as cartilage holding in the jelly-like nucleus. These discs add flexibility to the spine and cushion the vertebrae from grinding against one another. At each vertebra, bundles of nerves shoot off the spine to connect to the skin, bones, muscles, and internal organs in the immediate vicinity.
Your spine comes with four primary curves. The cervical vertebrae (neck) curve gently forward. The thoracic vertebrae (rib cage) curve back. Your lumbar vertebrae (lower back) curve forward again, and then the sacrum vertebrae (tailbone) curve back.
Most back pain issues start in the forward-curving neck and lower back. That’s because the sacrum vertebrae are fused (non-moving parts don’t wear out as quickly) and the thoracic vertebrae are held in place by the ribcage. So what moves? The neck and lower back.
Using a couple of terms from your high school physics class, your backbone and back muscles are built to absorb and distribute load and torque. When you carry weight (either as fat on your belly or in that heavy bag of groceries you’re carrying up stairs), you increase the load (downward pressure) on the discs. When you twist your spine, you increase the torque (sideways pressure) on the discs. The amazing structure that is your back works to help your body safely and painlessly handle the load and torque of walking, running, sitting, standing, stretching, sleeping, and everything else that happens in daily life—all while protecting the spinal cord.
To get an idea of how important this system is, let’s do a little math. When you’re standing, you might have 100 pounds of pressure on the L4-L5 motor unit (we can also call it the C5 disc) in the lumbar section of the spine. That section of your back does the most work. If you lean forward 30°, you double the pressure. Now you’ve got 200 pounds on the little section of cartilage and nerves that lets you bend, twist, reach, and walk. When you lean, your back does extra work—even if you’re not doing anything that you’d consider to be “work.”
Where Back Pain Comes From
Back pain occurs when this system is disrupted, either through a traumatic event like a car accident or through gradual degeneration. For example, when the disc—the “jelly donut”—between the vertebrae bones breaks down, the edges of the cartilaginous rings tend to break, allowing the “jelly” to push out from the center of the nucleus. Instead of firmly keeping the nucleus inside, the disintegrating rings allow the jelly to spread out and down. This is often referred to as a “bulging disc.” This bulging usually happens right near the nerves that branch out from the spine to the organs and muscles. Because there’s not a whole lot of extra room in there (there never is, in fine-tuned machines), this bulging puts pressure on the nerve, pinching it. That means pain.
The pinching of the nerve is called a subluxation. It comes from Latin root words: “sub” means “less,”“lux” means “light,” and “ation” means “a state or condition of.” So “subluxation” means being in a state of less light— or less energy, or lowered nerve impulse capacity (imagine the nerve impulses as light instead of electricity). If we weren’t using a fancy Latin-based word, we might instead say there’s decreased nerve capacity, which leads to lower organ functioning, which leads to impairment and pain.
You don’t always feel pain with a subluxation. Like heart disease or tooth decay, it can progress silently and without symptoms for years. The symptoms show up when there is massive cell damage. If the damage is still below the body’s threshold, it doesn’t send pain signals to your brain. The goal is to treat your back well enough that it never needs to get to the point of pain.
Nerves are also pinched when the curves in your back change. When a curve flattens out for any reason— such as the degradation of a series of discs, or decades of bad posture—your body tries to compensate for the uneven weight and pressure distribution by flattening an opposite curve. So if you lose one curve (called hypolordosis, in case you wanted to know), you may start to lose them all. This results in discs that aren’t spaced evenly, creating pressure where they’re squeezed together to compensate. Just like in an engine, pressure and friction cause wear and tear, and early failure.
Symptoms of Disc Problems
First off, you can have disc degeneration and hypolordosis without symptoms for years. The spine takes quite a bit of misuse before it begins to degrade enough to hurt. But once symptoms begin, these are the most common ones:
- Back pain is worse in the morning. During the night (and anytime you lie down, either in a prone or supine position), the disc is allowed time to rehydrate. When you get up in the morning, gravity causes downward pressure on your spine—and more importantly—on each disc. You lose 90% of the fluid in the disc during the first hour of the day. The extra fluids increase the pressure on the disc. Normally, that’s no problem, but when the nucleus is bulging out and pressing on the nerve, that means more pain than usual. It also means you’ve got a higher chance of injuring your back in the morning when the fluids are creating a little more pressure in the disc. Wait at least an hour after rising before doing any heavy lifting or manual labor to give your spinal fluids a chance to normalize for the day.
- Numbness or tingling in hands or feet. When nerves get pinched coming out of the spine, they lose function. The body parts farthest from the spine suffer the most, causing you to lose sensation in your fingers and toes.
- Discomfort upon coughing or sneezing. There’s a complicated multi-step process (involving muscles, veins, nerves, and more) happening when you cough or sneeze. Just know that if you have pain when coughing or sneezing, that’s a problem.
- Pain is worse when bearing down. Right along with coughing and sneezing, straining when using the bathroom can put extra pressure on pinched nerves.