Understand Your Spine Pain

What is Spine Pain?

Spine pain refers to pain that comes from the structures associated with the spinal column and the contained nerves. The most common spine pain is felt as low back or buttock pain but pain can be felt in other areas of the spine such as the cervical (neck) or thoracic (middle section) areas. When the spinal nerves are the source of pain (neurogenic pain) then the pain can be experienced in the arms or legs and can have associated pins & needles, numbness or weakness of the muscles that are supplied by that nerve. Sometimes spine pain is felt in areas away from the pain source such as headaches or chest pains.

Types of Pain

  • Acute Spine Pain – this pain is the most common and has been present for less than 3 months. Most times acute spine pain is self limiting and does not reflect serious underlying disease even if the pain is severe. Most people in this category are suffering from an underlying mechanical problem in the spine. Most of the time the body can heal itself if it is given the right “instructions”.
  • Chronic Spine Pain – this pain has been present for months to years. It can be difficult to find a single pain generator in this type of pain and even repairing the problem that started the pain can sometimes not remove the pain. This makes this type of pain more difficult to treat but with appropriate interventions the pain can be improved and controlled and function can be improved. A multi-disciplinary team approach can improve care for patients with this type of difficult pain.
  • Intermittent Spine Pain – some people experience intermittent pain from various conditions of the spine and there may be an underlying structural problem in some of these people but often times there can be no clear pain generator and as long as the pain resolves or can be controlled there is no need to further investigate for an underlying cause. Your therapist or doctor will be the best to advise you the best treatment.
  • Specific Pathological Spinal Pain – due to underlying cancer or infection or fractures of the spine is uncommon (doctor asking a few specific questions and performing a physical examination. A few of the things to look out for will be discussed later.

ANATOMY of the SPINE

The spine’s main functions are to support the skeleton and allow the body to move providing an attachment for other bones, muscles and ligaments. it also provides an important protective function for the spinal cord and nerve roots. the spine has a rich blood supply and contains many of the blood forming cells within the vertebrae.
The spine is made up of 24 vertebral bones between the skull and the sacrum/coccyx at the lower end. The discs connect the adjacent vertebrae and allow movement at each segment.

Each motion segment consists of 2 vertebral bones connected by a fibrous disc at the front and 2 facet joints at the back. There are many ligaments also connecting the 2 vertebrae and these are important in restricting excessive movement and provide stability.

There are both short and long muscles connecting the vertebral bones at the back and sides These muscles are usually very strong and help to keep your upright position and allow you to move through the back. There are also very important muscles in the front and side of your abdomen that connect the pelvis to the rib cage and these muscles also help to support and move the spine. These muscles are now commonly referred to the ‘core muscles’ and may be strengthened to help support your spine.

The disc consists of an outer strong ring of fibrous tissue called the annulus and an inner cartilage gel called the nucleus. This design helps the disc to withstand the compressive forces of the upright posture.

Why does my back hurt and when is the pain going to go away?

Patterns of mechanical spine pain

In order to best treat spinal pain it helps to work out if it fits a recognised pattern of pain even if an underlying cause cannot be clearly defined. Once the serious pathological specific causes of spinal pain are ruled out by your doctor or treating team then
working out a pattern that best fits your symptoms allows treatment to begin even without blood tests, X-rays, CT scan or MRI scans. Below are a series of patterns that are commonly seen with mechanical spinal pain. In order to work out which pattern you fit into you need to ask yourself a few questions.

  • 1. Where is your pain worst?
    For low back is it low back/buttock or leg pain?
    For neck pain is it neck/shoulder or arm pain?
  • 2. Is your pain constant or intermittent?
  • 3. What makes the pain worse?
  • 4. What makes the pain better?
    (for neck patterns see handout “Neck pain patterns”)

Back or Buttock Dominant Pain

If your pain is mainly felt in the low back or buttocks then you have to decide which patten below fits you best for your pattern of pain.

How often are you in pain? What makes your pain worse? What makes your pain better
Pain is usually intermittent but can be constant and just vary in intensity with good days and bad days Pain is worse with bending forward activities or sitting Pain is usually eased by leaning backward
Prefer to stand or walk than sit
Pain is always intermittent Pain is worse with bending backward or prolonged standing or walking Pain is usually eased by bending forward
Prefer to sit than stand or walk

If your pain is mainly felt in the leg (s) then you have to decide which patten below fits you best for your pattern of pain

How often are you in pain? What makes your pain worse? What makes your pain better
Pain is usually intermittent but can be constant and just vary in intensity with good days and bad days Pain is worse with bending forward activities or sitting Pain is usually eased by leaning backward
Prefer to stand or walk than sit
Pain is always intermittent activities or sitting Pain is worse with bending backward or prolonged standing or walking Pain is usually eased by bending forward
Prefer to sit than stand or walk

I need help with the patterns

Don’t worry if you don’t exactly fit one of the patterns. Your therapist or doctor will help to decide which pattern your symptoms best fit into and then your treatment plan can be customised to you.