Spinal pain, or back pain is very common, with an estimated 8 out of 10 people being affected by it at some point in their lives, and of these one in five go on to develop chronic back pain, that is ongoing pain that lasts for longer than three months. Considering these statistics, it probably is not surprising that back pain is by far the commonest reason for people having to take time off work.
Although it can affect people at any age, it tends to first develop between the ages of 20 and 40 and becomes a bigger issue with advancing age.
The spine is divided into three zones – the cervical spine which is at the top and incorporates the neck ('cervix' is Latin for 'neck'), the thoracic spine, which is the mid- section and the lumbar spine, which is the lower back.
Spinal pain is most common in the lumbar section, followed by the cervical spine. The thoracic spine is the least affected by spinal pain.
The spine is an incredibly complex part of the body, comprising the spinal cord, protected within the bones of the spine ('vertebrae') and an array of muscles, tendons and ligaments, as well as the intervertebral discs located between the vertebrae.
Nerves exit the spinal cord via these intervertebral spaces. Pain can be associated with any one of (or a number of) these components.
Common causes of back pain include…
- Strains of muscles, tendons or ligaments.
- Muscle spasm (this is an autonomous process to protect the back from further injury).
- Facet joint inflammation.
- Myofascial pain.
- Degenerative disc disease.
- Spinal stenosis.
- Nerve related problems such as cervical radiculopathy, lumbar radiculopathy and myelopathy.
- Surgery to the back – particularly where the result is post laminectomy syndrome.
Some people are more prone to spinal pain than others. Risk factors for developing spinal pain include…
- Age – older people are more affected than younger people, partially due to natural deterioration in the components of the spine, especially the intervertebral discs.
- Low levels of physical activity – this in turn leads to poor physical condition which increases the risk of injury to the back.
- Weight – being overweight or obese places much greater strain on all components of the back.
- Repetitive heavy lifting, twisting, vibration – this may be caused by a very physical job or some sports.
- Not being careful when lifting heavy weights (the back should always remain straight with the legs taking most of the weight instead of the spine).
- Poor posture – this may be due to a primarily sedentary lifestyle e.g. desk job particularly where there is inadequate back support in the chair.
- Smoking – smokers are at increased risk of developing spinal pain; this may be due to smoking reducing blood flow to the spine.
- Anxiety and / or depression – people affected by these conditions are at more risk of developing spinal pain, although the reason for this is not fully understood.
Spinal pain is often a sharp pain in the back, however it may take a number of different forms, for example…
- Dull ache.
- Numbness or tingling / 'pins and needles'.
- Pain in adjacent parts of the body e.g. hip, buttocks.
- Muscle spasm / seizing up of back muscles.
These symptoms generally make common everyday activities, like getting in and out of a chair or bed, getting dressed and undressed and walking properly very difficult.
Spinal pain will often affect only one side of the body.
Most cases of back pain will resolve by themselves within a few weeks. Where spinal pain continues beyond this period it is a good idea to make a doctor's appointment.
Tests / Diagnosis
Generally speaking, imaging of the spine should not be a routine investigation, but should only be ordered if the doctor suspects there to be a fracture, infection, tumour or danger of damage to the nervous system.
The first step in diagnosing the cause of back pain is a review of symptoms and medical history. The doctor will examine the back to find areas of pain or tenderness, check range of motion and check for any nerve problems.
Blood tests may be recommended to find out if there may be other underlying conditions causing spinal pain, and if kidney stones are considered a possible cause of spinal pain, an ultrasound scan may be suggested.
In some cases, imaging tests such as X-rays, CT or MRI scans may be recommended. Of these, MRI is the most useful as it can show soft tissue and intervertebral discs clearly which X-rays and CT scans cannot (at least not as clearly).