Spine 101: Types of Spinal Pain
By definition, this is pain that happens when your spine is stressed by physical or mechanical loads. It is pain that predictably changes its intensity and/or location depending on our movements, positions, and activities.
It may occur from abnormal stresses being placed on normal tissue (if you bend your finger back far enough it will hurt even though there is nothing wrong with it), or normal stresses being placed on abnormal tissues. Some of the more common types of spine pain are listed below. Understanding your type of pain can help both your clinician and yourself understand what tissues may be causing your pain and help direct treatment.
Most back injuries are called soft tissue injuries, sprains and strains. Most soft tissue injuries heal in a short time. However, their presence should serve as a warning sign that you may have a postural or body mechanics problem.
Sprains: Occur when a joint is forced past its normal range of motion (ROM). The ligament fibres stretch and tear creating inflammation. The symptoms include pain, swelling and decreased joint movement.
Strains: Occur when there is a tear or inflammation of the muscle fibres. The symptoms include local pain and swelling as well as a decreased ability to use the muscle.
Muscle spasm: This is a sudden, forceful and sustained muscle contraction. It may occur as a reaction to a joint sprain or disc bulge. In normal movement only some of the muscle fibres contract, in a spasm all the fibres contract at the same time. However the spasm is a reaction to an underlying problem, and long-term resolution of the problem involves an active approach aimed at the problem area. Remember, muscle spasm is not the main problem. It is simply the natural splinting mechanism the body utilizes to protect the underlying problem.
Pain is felt mainly in the neck or back but may spread to the arms or legs. The pain usually comes and goes, but may be constant and vary throughout the day. The pain is usually made worse by sitting, bending or lifting. Bending backwards, standing and walking usually eases it. This pattern of pain is often referred to as Discogenic back pain. This is occasionally referred to as a slipped disc, or degenerative disc disease (DDD). However discs are firmly attached to the bones of the spine and cannot slip. In addition the thinning and drying out of our discs is a normal age-related change that begins by our late teens. It is not a disease.
If you recall from the earlier review of anatomy, a good way to think about discs is that they are like jelly-filled doughnuts, with the outer ring (annulus fibrosis) containing the inner jelly (nucleus pulposis). As the discs wear, the outer ring of the disc can develop tears and/or fissures which will allow the disc to bulge or even herniate.
A bulging disc indicates that the outer wall of the doughnut is weakened and has developed a bulge in the sidewall. The jelly is still contained within the doughnut, however.
A herniated disc indicates that the outer wall of the doughnut has ruptured, allowing part of the jelly to squirt out. The jelly is no longer contained within the doughnut.
The outer part of the disc is pain-sensitive, so bulging discs can cause back pain. Herniated discs can cause back pain as well, but because the jelly has “squirted” out of the doughnut, it can press against one of the nerves as they travel to the arms or legs resulting in a “pinched nerve”. Pinched nerves only occur in 10% of people with back or neck pain.
Facet joint pain
As we age there is a natural decrease in the water content of the disc. Poor posture speeds this aging process. The drying and shrinking process can place an extra burden on the facet joints. They are not meant to be the primary weight bearing structures, so as they move closer together they may irritate one another. The loss of perfect alignment also makes it impossible for them to function normally. They rub together, which can cause local inflammation or “arthritis”. The degenerative changes may also result in the joints being stiffer. This is most noticeable when getting up in the morning, or after being sedentary for a period of time.
The pain is felt mainly in the back or neck but may spread to the legs or arms. The pain comes and goes (intermittent) and is made worse by standing or walking for long periods of time or bending backwards. Sitting or bending forwards eases it. This pattern of pain is often referred to as Facet joint pain (pain stemming from the posterior joints of the spine). People will often be told their pain is due to arthritis.
Arthritis is defined as “inflammation of the joint”. There are many different forms of arthritis. The most common type affecting the spine is osteoarthritis (OA). While there are many different things that can contribute to or predispose someone to having OA, it is essentially a wear and tear type of change affecting the spine. It results in the cartilage of the joints gradually wearing down. The ligaments that hold the vertebrae together tend to become thicker and less flexible and the body lays down more calcium, forming bone spurs (osteophytes). It is important to keep in mind that a certain amount of arthritis is actually a normal aging process and does not necessarily cause pain.
Sometimes, the degenerative changes in the spine can cause impingement or irritation of the nerves as they are travelling along the spine on their way to the various parts of the body. This can lead to pain or problems associated with lack of nerve function wherever the nerve might be travelling to. This is how problems in the spine can cause problems in areas of the body that are not directly connected to the spine (e.g. the arms or legs).
Radicular pain or pinched nerve
Pain is felt mainly in the leg or arm, although back or neck pain may be present. The pain is usually constant, and made worse by sitting and bending forward. This pattern of pain is commonly called a pinched nerve (“sciatica” or radicular pain). Pinched nerves are not a common cause of pain. Only 1 in 10 back pain sufferers have a pinched nerve. One of the most common causes of pinched nerve pain is from a herniated disc pressing on a nerve.
In lumbar spinal stenosis the pain is worse in the leg(s), and may be described as heaviness or aching. The leg pain comes and goes, and is usually made worse by activities such as walking. It is often eased by sitting or bending forward. This pain is sometimes referred to as Neurogenic Claudication.
Spinal stenosis is the term used to describe a shrinking of the central canal (the bony ring that the nerves travel through). Foraminal Stenosis is used to describe a shrinking of the lateral canals where the nerves exit the spine. As the canal becomes smaller in diameter, the blood supply to the nerves gets restricted. Just as your muscles need more blood and oxygen when we are more active (i.e. walking) so do our nerves. However, because the blood flow is restricted, you can feel pain, weakness, or numbness in any part of the leg supplied by the affected nerves.
Cervical and thoracic spinal stenosis gets a little more complicated because your spinal cord may be affected. Speak to your therapist or specialist for detailed information on your particular case.