Spinal pain; from diagnosis to treatment
Incorrect body movements and postures are among the most common causes of spinal pain. Fortunately, such pains can often be relieved through corrective movements and exercise therapy. However, there are also many other factors that can cause acute or chronic pain and injury to the spinal column. In such cases, in addition to correcting incorrect postures, the patient also needs to follow the recommendations and treatment methods of a specialized physician. If you are also suffering from spinal pain, join us in this article to learn more about the causes of your pain.
A comprehensive look at spinal column pain and its causes
Familiarize yourself with the anatomy of the spinal column
To familiarize yourself with the causes of spinal pain, you must first become acquainted with the anatomy of the spinal column. The human skeletal system consists of two main parts: the axial skeleton and the appendicular skeleton. These two parts move independently of each other. The axial skeleton includes the skull, 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, the sacrum, coccyx, ribs, and sternum. There is a disc containing fluid between each of the vertebral bodies. In the center of each disc, there is a gelatinous lens called the “nucleus pulposus,” which is surrounded by fibrous rings. The discs essentially neutralize the vertical impact on the spinal column and protect it.
Another part of the spinal column is the ligamentous tissue that surrounds the vertebral bodies and protects the joints. Muscles are another component of this system, connecting the bones to each other and enabling movement.
What causes spinal column pain?
Every morning, as soon as the body transitions from a horizontal position to an upright position upon getting out of bed, pressure is exerted on the vertebral discs of the spinal column, leading to compression. The weight on the vertebrae, improper body postures, and repetitive bending and straightening over time can cause the expulsion of disc fluids, resulting in pain and symptoms of nerve compression. To better understand this, imagine standing in a pool of water and trying to jump and move sideways.
The presence of water in the pool restricts jumping and movement, making it slower and more limited. Conversely, jumping and moving in an empty pool is much easier. Similarly, when the intervertebral discs are compressed and their fluid content is expelled, the gelatinous nucleus pulposus in the center of the disc becomes more mobile than usual and can cause damage to the surrounding protective fibers. As a result, the disc can protrude from its position, potentially leading to tears and ultimately causing spinal column pain.
Osteoarthritis
Osteoarthritis of the spinal column develops over time due to instability, microscopically-induced damage, and deterioration in joint tissues. If the joints, muscles, and ligaments of the spinal column lack sufficient stability, the brain instructs the extraction of calcium from the blood to compensate for this instability and prevent the degenerative process of the joint. As a result, calcium deposits form around the vertebrae. This leads to the formation of bone spurs and symptoms such as pain and limited mobility.
Vertebral Fracture
In addition to causing spinal canal narrowing, vertebral fracture can damage the discs and lead to instability in the spinal column. Vertebral fractures are commonly seen in athletes involved in bodybuilding and powerlifting. These individuals may experience fractures in the pedicles of the vertebrae (vertebral arches) due to lifting weights and the stress placed on the vertebrae. In such cases, the vertebral body separates from its pedicles and the vertebra tilts forward or backward. Vertebral fractures typically occur in a forward direction and their severity is classified into 5 degrees. Radiological imaging can be used to assess the severity of the fracture, and appropriate treatment for this type of spinal pain can be chosen based on the severity of the injury and the degree of vertebral instability.
Fractures
Another cause of spinal pain is fractures. Vertebral fractures differ from fractures in the hands and feet, and they are not easily immobilized with casts. From hairline fractures to complete shattering of the vertebra, these fractures can have varying degrees. In cases of mild vertebral fractures, immobilizing the spinal column using a brace and maintaining immobility can aid in healing and reconstruction. However, if the vertebra is shattered, the patient should be referred to an orthopedic surgeon to restore the spinal column to its natural state.
Infectious Diseases
Bone infection, also known as osteomyelitis, occurs acutely due to factors such as bacteria, fungi, and viruses, and it usually spreads to the spinal column from other parts of the body through the bloodstream. Diagnosing this infection can often be challenging, especially if there is insufficient patient history available. Untreated spinal column infection can be highly damaging. It can even completely destroy the bone, leading to instability and exacerbation of spinal pain. Spinal column infection can also affect the nerves, causing symptoms such as severe pain, fever, weight loss, muscle spasms, tingling, numbness, and sciatica-like symptoms.
Spinal Stenosis
Continuing the examination of the causes of spinal pain, spinal stenosis can be mentioned. Spinal stenosis can occur as either congenital or acquired. In cases of congenital stenosis, the space within the spinal canal is smaller and more restricted than normal since birth. Acquired cases can include tumors or bony protrusions within the spinal canal and protrusion of intervertebral discs. Essentially, any factor that leads to the narrowing of the canal and puts pressure on the spinal cord can affect the nerves and disrupt their functioning.
Inflammatory Diseases
Inflammatory diseases, such as rheumatism, are another cause of spinal column pain. Rheumatoid arthritis is an autoimmune disease that occurs when the immune system attacks the cartilage tissues of the joints. In this condition, the joint is deteriorated, leading to pain and inflammation for the patient. Inflammation and pain in the spinal joints can also be caused by repetitive movements. In such cases, the pain is usually relieved with rest, ice compression, and anti-inflammatory medications. Strengthening the muscles in the affected area can also help prevent the recurrence of inflammation.
Referred Pains
Spinal pains, especially in the lumbar region, can be associated with other organs in some cases. For example, benign prostatic hyperplasia, hernia, uterine and ovarian issues, kidney stones, gallbladder disorders, and more can all cause spinal column pain. Investigating and identifying the root causes of such pains require careful examination, detailed medical history, and understanding the patient’s condition. For instance, if an individual experiences urinary dysfunction along with lower back pain, a kidney stone examination should be conducted. Pain related to the gallbladder can also radiate to the left shoulder and arm in some cases, mimicking symptoms of a heart attack.
Muscular Disorders
Muscular disorders such as muscle knots, weakness, and muscle spasms are often indicative of incorrect habits and improper movement patterns. Muscle spasms are common in intervertebral disc disorders. When a disc protrudes, the muscle spasms occur to protect it and prevent further protrusion. In such cases, muscle relaxants should not be used as they can worsen the condition.
Furthermore, an imbalance and lack of symmetry among the muscles in the lumbar region can also cause pain and discomfort in the spinal column. For example, in excessive lumbar lordosis, the iliopsoas muscle is often more active than necessary, or in excessive lumbar kyphosis, the hamstring muscle is more active than required. These issues and the resulting pain are often alleviated through corrective movements and proper muscle activation.
Fibromyalgia
Fibromyalgia is another factor in the occurrence of spinal pain, and it is a type of psychosomatic or psychogenic illness that causes tender points and pain in 11 areas of the body, including the neck, shoulders, elbows, wrists, lower back, knees, and more. This condition lacks a physical diagnosis and is primarily caused by stress, anxiety, depression, and psychological factors. The symptoms of fibromyalgia often improve with exercise and nerve relaxation techniques. To achieve this, you can visit a chiropractor who can provide you with suitable exercises and treatments based on your condition.
Thoracic Outlet Syndrome
Another cause of spinal pain is thoracic outlet syndrome. Thoracic outlet syndrome usually occurs as a result of cervical rib (you can watch our instructional videos on cervical rib). In this condition, the cervical rib puts pressure on the brachial plexus of nerves in the neck, causing symptoms such as tingling, numbness, and weakness in the upper torso and hands. These symptoms may worsen with neck movements. Thoracic outlet syndrome can often be improved through non-invasive methods, such as stretching exercises for the neck ladder muscles and increasing their range of motion. However, if the pain and nerve involvement persist despite these methods, the individual may be referred to a surgeon for cervical rib surgery.
Tumors
Spinal tumors come in various types, including benign and malignant tumors. Depending on their location in the spinal column, these growths can compress nerves and cause spinal pain and symptoms of nerve involvement, such as tingling and numbness. Malignant tumors are typically treated through surgery. Benign tumors may also require surgery depending on their location.
Scoliosis (Lateral Deviation of the Spinal Column)
When observing the spinal column from the front or back, the vertebrae should be straight and aligned in a straight line on top of each other. In scoliosis, the spinal column appears curved from the back. The lateral curvature in the spinal column can be in the shape of an “S” or “C.” Scoliosis is divided into two categories: “structural” and “functional.” Structural scoliosis originates from a disorder in the bone structure of the spinal column, while functional scoliosis is caused by imbalances in muscles and muscle spasms. Genetic factors may also play a role in this condition. Secondary causes of scoliosis include leg length discrepancy, muscular dystrophy, muscle atrophy, and congenital diseases.
Scoliosis is more common in females and typically begins in childhood, manifesting its symptoms as growth progresses. It often stabilizes after the completion of skeletal growth. While scoliosis can occur in any region of the spinal column, it is more commonly seen in the thoracic and lumbar regions. Scoliosis can cause pain in the shoulders, shoulder blades, neck, and back, as well as muscular discomfort. It may also be accompanied by symptoms such as shortness of breath, constipation, and increased menstrual pain in females. From an aesthetic perspective, scoliosis often leads to the prominence of curves on one side of the body. In the long term, this condition can potentially result in cardiovascular and respiratory problems.
This condition can be diagnosed through examination, orthopedic tests, and radiological evaluation. To determine the type of scoliosis, whether structural or functional, the “Adams forward bending test” can be used. In this test, the patient stands in front of the physician and bends forward as instructed while the physician stabilizes the patient’s pelvis. This movement allows the observation of the spinal curves. If the curves become more prominent and noticeable during this maneuver, it indicates functional scoliosis. In this type of scoliosis, the spinal curvature usually disappears or reduces when the patient bends forward.
However, in structural scoliosis, the curvature of the spine remains visible even during forward bending. After diagnosing the type of scoliosis, radiological imaging can be requested to determine the degree and location of the curvature. If the spinal curvature is greater than 10 to 12 percent, the diagnosis of scoliosis is confirmed. Timely diagnosis of scoliosis is of particular importance because early treatment can be highly effective. Mild cases of scoliosis can be improved with the prescription of braces (orthotics), manual therapies such as chiropractic care, and physiotherapy. However, severe cases may require surgical intervention.
Kyphosis
Kyphosis refers to excessive hunching of the spine in the thoracic region of the back. This condition can be caused by issues related to bones or muscles, congenital disorders, malnutrition and vitamin D deficiency, trauma, and more. However, in most cases, it is created and exacerbated due to weak muscles and incorrect habits such as sitting, standing, and walking in improper positions. In older age, factors contributing to kyphosis can include cartilage degeneration, intervertebral disc degeneration, osteoporosis, stress fractures (microfractures in the bones) resulting from bone porosity, or long-term use of cortisone and multiple myeloma (a type of bone cancer).
Kyphosis can occur at any age, but it is more common in middle-aged women. In infants to adolescents, this condition is usually caused by structural abnormalities of the spinal column and congenital or genetic disorders. Mild kyphosis may be asymptomatic, but in severe cases, it can cause pain, deformity, and complications such as nerve compression, cardiovascular dysfunction, respiratory problems, and gastrointestinal disorders. Additionally, it can reduce appetite and lead to weight loss by exerting pressure on the stomach.
To diagnose kyphosis and determine its severity, various examinations, tests, and radiological evaluations are available. During the examination, the patient is asked to bend forward from the waist so that the physician can observe the spinal column from the side. Kyphosis and hunchback resulting from it are more evident in this position. In addition, neurological or neurologic tests may be necessary to assess reflexes and muscle strength.
In radiology, if the kyphosis is greater than 20 to 45 degrees, the individual is diagnosed with kyphosis. The treatment of kyphosis is based on the patient’s age, underlying cause of the disease, and associated symptoms. Mild cases of this condition can be improved with the use of specialized braces, back muscle strengthening exercises, and corrective movements. However, if the kyphosis is severe, surgical intervention may be necessary. In fact, approximately 5% of individuals with hunchback are candidates for spinal fusion surgery.
Lordosis (excessive curvature of the lower back)
An increase in the curvature in the lower back, known as lordosis, is recognized. However, this curvature can also occur in the neck region. Lordosis is usually caused by muscle imbalance, reduced mobility of the pelvis, and incorrect habits such as sitting, standing, lying down, and walking in improper positions. Repetitive movements in the lower back area can also contribute to spinal wear and tear, pain, and lordotic curvature. Other factors that can contribute to lordosis include leg length discrepancy, obesity, osteoporosis, hunchback, and intervertebral disc inflammation.
This condition often manifests from a young age, but in very rare cases, it can also occur congenitally. Symptoms of lordosis may include lower back pain and similar signs to sciatic nerve involvement, such as tingling and numbness in the legs and toes. Typically, before the onset of back pain, a noticeable inward curve and lordotic curvature can be observed in these individuals. The severity of lordosis and the curvature can be diagnosed through physical examination, assessment of body movement, orthopedic and neurological tests, and radiological imaging.
This disorder can often be improved with corrective exercises, therapeutic interventions, and physiotherapy approaches. The use of anti-inflammatory medications can also help alleviate patient’s pain. To prevent lordotic curvature, it is important to maintain a healthy weight range and follow a proper exercise program. Individuals with lordosis should correct this condition before starting any exercise regimen. Movements that arch the body backward and exercises targeting the lower torso are generally not suitable for these individuals. In most cases, lordosis does not require surgical intervention.
When should we see a doctor?
If the spinal pain is severe and intense, or if it persists for more than 3 days since its onset, it is necessary to consult a doctor. In such cases, self-treatment should be avoided, and it is important to seek medical attention as soon as possible by contacting your own physician or using the available communication methods on Dr. Shahed Sadr’s website.