Back pain can be a minor nuisance or an agonizing condition. The National Institute of Neurological Disorders and Stroke cites back pain as the second most common neurological ailment in the United States, with headaches taking the number one spot. Low back pain is listed as the most common cause of job-related disability and the leading contributor of missed work.
Most of us take for granted our ability to move freely and without discomfort. However, when dealing with back pain, even a minor problem can feel major. The health and condition of the spine is critical for maintaining flexibility, functionality, and correct posture.
Stretching from skull to pelvis, the spine consists of 33 bones, or vertebrae, connected by ligaments and muscles. The vertebrae protect the spinal cord, a nerve running through the vertebrae and responsible for communicating messages between the brain and the body. Between each vertebra is a disc that acts as a cushion and absorbs the shock from the body’s movements. The spine has three main sections: the cervical spine (neck), the thoracic spine (mid back) and the lumbar spine (low back).
Generally, back pain is categorized as acute or chronic. Acute back pain is usually short-term, lasting less than three to six months. Chronic pain persists for more than six months or even for years and can be associated with a current injury or a previous injury that has healed.
Dr. Zee Khan, a board certified and fellowship-trained spine surgeon with OU Physicians, explains that there can be numerous reasons why someone experiences back pain, including genetics, injury, a labor-intensive career or an unhealthy lifestyle.
“If a person is having back pain early in life, younger than 40 years old, it’s possible that it is genetic and the problem may run in their family,” says Khan. “You can also be predisposed to back pain from a past injury, or your job may play a part if it includes long periods of sitting, heavy lifting or bending.”
Another cause often overlooked can be smoking. One of the theories why smoking may harm the back is vasoconstriction, the narrowing of blood vessels.
“It’s something we don’t talk about a lot, but smoking constricts blood vessels and decreases the blood supply to the discs between the vertebrae. The discs serve as shock absorbers, and without adequate blood supply, [they] can be damaged,” says Khan.
Being overweight or obese can also contribute to back pain. To help understand how additional weight in the midsection can affect the back, Khan shares an example.
“If you hold a gallon of milk close to your body, you may be able to support and hold it there for hours,” he says. “However, if you hold a gallon of milk at arm’s length, you may only be able to hold it for a few minutes,” he says. “Carrying extra weight around your belly is equivalent to holding the milk at arm’s length. Your back muscles fatigue.”
Another cause of back pain, says Dr. Jayen Patel, a board certified anesthesiologist and founder of Oklahoma Pain and Wellness Center, is degenerative disc disease, the gradual degeneration of discs caused by the normal aging process. As we age, it’s important to strengthen the back. Unfortunately, people frequently overlook their back muscles and instead focus on arms or legs, muscles that are more visible.
“Back-directed and -focused exercises are often forgotten, including the ergonomics of seating and posture during exercise and sports,” says Patel.
Other commonly known spine disorders include a herniated disc, spinal stenosis, sciatica, spondylolysis and spondylolisthesis. A herniated disc occurs when a disc bulges or breaks open. It’s often referred to as a slipped or ruptured disc. Spinal stenosis is the narrowing of the spinal canal, which puts pressure on the spinal cord and nerves. Sciatica is a condition in which the inflammation or compression of the sciatic nerve can be very painful and cause numbness, tingling or weakness in one or both legs.
According to the American Academy of Orthopaedic Surgeons, the most common cause of lower back pain in adolescent athletes that can be seen on an X-ray is spondylolysis, a stress fracture in one of the vertebra. If the stress fracture is significant, spondylolisthesis will occur; the bone is weakened to the point where it’s unable to maintain its proper position and shifts out of place.
Additional conditions include scoliosis, an abnormal curvature of the spine, and osteoporosis, which causes bones to become less dense and more likely to fracture.
If you are experiencing back pain, you should first visit your doctor to receive an accurate diagnosis and a customized care plan. If possible, most physicians will take a conservative approach and begin with non-operative treatments such as anti-inflammatories, physical therapy, lifestyle changes or chiropractic treatment.
Khan’s philosophy is that surgery should be a last resort.
“What varies is how quickly you reach that point,” he says. “Surgery may be an option if there are structural problems, a neurological deficit or the patient has failed all non-operative treatments.”
While spine surgery may be a frightening thought, the good news is that it’s a field that is always evolving and benefiting from new research findings and technological advancements. A wide range of surgical procedures relieve back pain; some may involve the partial or complete removal of a vertebra and/or a disc, while others join or fuse vertebrae together.
If you are faced with surgery, Khan emphasizes the importance of having appropriate expectations and goals after recovery.
“Spine surgery is intended to improve one’s quality of life and reduce pain, but it may not take all of the pain away,” he says.
To assist with pain management, Patel uses multiple strategies.
“We have a comprehensive approach that includes physical therapy, responsible medication management, supplement and nutrition counseling, minimally invasive therapies and stem cell therapy,” he says.
While nearly everyone will experience back pain at some point in life, a healthy lifestyle can make a difference. Exercise, weight loss, proper posture and avoiding smoking are a few of the best places to start.