If you have ever visited a doctor for your back pain, you would know the three essential questions doctor would ask:
- How long have you had this pain?
- Where is the pain located exactly?
- How bad does it hurt?
This is simply because there are different types of back pain and the answers to these questions will help the doctor diagnose your pain better. Here’s how.
Back Pain Overview
Depending on whether your relationship with your back pain is a casual, on-again, off-again affair or a steady one that has stood the test of time and medicines and exercises, you could call your back pain acute or chronic.
The pain, if acute, may last for anything between one month or three, leave on its own, and come back just as willfully. And yes, it’s called acute because even at its most casual form, back pain can make you miss work. WHO even has a term for this: YLD, an acronym for years lost due to disability.
If it lasts more than three months after an injury, or even after you’ve received treatment for acute back pain, you could safely label it chronic.
Your vertebral column can be divided into three parts—upper or cervical (with the bones c1 to c7), middle or thoracic (with the bones th1 to th12), and lower or lumbar (with the bones l1 to l5).
Along with the bones of your spine, together called the vertebrae, which are separated from each other by rubbery discs made of cartilage, there are a number of associated muscles, ligaments, tendons, and nerves.
A deformity, an injury, or a degeneration of any of these could be a cause of your back pain. But there are cases where a more serious condition may not at all cause any pain until there are further complications.
Upper Back Pain
Say your answer is upper back pain, or cervical pain, or to be more specific, pain between your shoulder blades.
Based on your structure, history of injury, and daily activities, if the doctor can rule out a chance of deformities like scoliosis, where the spine curves sideways, and kyphosis, where the spine curves excessively to give you a hunchback, and fractures, she’ll most likely zero in on muscle irritation and muscle strain.
If you are middle aged, the doctor might ask for a diagnostic test for spinal osteoarthritis and spinal stenosis. Albeit rare, you could also be asked to look out for herniated disc and cervical radiculopathy.
Don’t read this text hunching or slouching in front of your computer screen or craning your neck to peer into your mobile screen. A bad posture leads to muscle irritation.
If you’ve been feeling a tightness and tenderness for a few weeks now, and the pain worsens when you are in stationary positions like driving or sitting or when you press on the spine, the cause might be muscle irritation. The tendons that link your back muscles to the spine get inflamed because of overuse, bad posture, poor muscle or bone strength, or improper lifting, bending, or twisting. And this results in muscle irritation or inflammation.
Muscle Strain And Sprain
Don’t cradle your phone between your ear and the shoulder, nor your violin for hours at a stretch.
What if your reason for visiting the doctor is a sudden sharp stabbing pain, and you can trace its onset to a sudden violent movement?
Most likely, it’s a muscle strain, where the sudden movement put too much pressure on your muscles, making its fibers snap. It’s painful but not something that takes you to the emergency room, unless the strain is total and the entire muscle, not just a few fibers in it, has ruptured.
Sprain, on the other hand, is when the ligament joining two bones tears.
Though it’s mostly an age-related decline, younger people can get osteoarthritis after a traumatic injury.
If you are diagnosed with arthritis of the facet joints, also known as spinal osteoarthritis and degenerative joint disease, the doctor will tell you that it’s a more serious condition. Spinal osteoarthritis also makes you prone to herniated discs and spinal stenosis.
This condition is more likely when you are of an advanced age. With age, the discs between your vertebrae that help you twist, flex, and bend the back wear off and lose their ability to cushion friction between the spinal bones during movements. As a result, the facet joints that link the vertebrae wear off, causing inflammation and chronic pain. To make up for the wearing off of the joints, your body spurs a bone growth, forming bony projections on the spine, which are known as osteophytes and lead to further friction and pain.
You may curse the pain, but you are lucky if the symptoms are experienced in the early stages; some people don’t feel anything unless the arthritis has reached a very advanced stage.
Be especially careful if you are somewhere around 50. This is the age the spine starts narrowing.
Eventually, the osteophytes narrow the spinal canal, putting pressure on the nerves and causing pain. The narrowing mostly happens in the cervical and lumbar region, where the space is more restricted.
In the cervical region, there are higher chances of it pressing on the spinal cord, leading to severe spinal cord dysfunction, known as myelopathy. You might have shooting pain in the arms and legs and difficulty walking. Check if your handwriting is growing worse or if you are having trouble with your shirt buttons.
If it pinches the nerve roots, it causes cervical radiculopathy; even herniated discs can cause this. You will be able to feel the pain along the pinched nerve. You may even feel a tingling or numbness in the fingers and pain in the upper back.
Don’t lift a heavy weight alone. Get some help.
Herniated, or ruptured, or slipped discs are what you get when the jelly-like core of a disc spills onto a nearby nerve, pinching it and causing pain. In such a case, you will experience pain and even numbness mostly in the shoulders and arms.
If the rupture takes place in the thoracic region, however, your upper back will hurt, especially during coughing or sneezing.
Usually, herniated discs occur over years of bad posture, but even a sudden improper lifting or twisting result in a herniated disc. Since not all cases of herniated discs hurt, a regular check-up is always recommended.
Middle Back Pain
Though the causes are mostly mechanical and injury-related, diseases of the thoracic organs can also cause pain.
Now if your pain is in the middle or the thoracic part, the doctor is likely to rule out degenerative diseases because the vertebrae in this part do not move much and hence friction-related degeneration is uncommon. The function of the vertebrae is to protect the vital organs in the thoracic region, such as the heart, lungs, and liver.
Strain And Sprain
You might be able to hear a pop sound when the ligament tears.
If there’s swelling, bruising, tenderness, and pain that is worsened by movement, the more likely causes are muscle strain and sprain, which is actually ligament tear. Unless there is numbness, tingling, or radiating pain, you needn’t worry about herniated discs or any other disc problems.
Be careful. It might show no symptoms until it’s advanced too far.
A thoracic herniated disc is rare but can happen either because of an injury or osteoporosis. It can initiate chronic pain and affect nerve functions too. But in many cases, it might not present any symptoms, and the diagnosis may be a stroke of luck.
Low Back Pain
Bend your neck to touch your chin to the chest. Now bend to touch your toes. Aren’t the bends and twists sharper now? This hikes the risks of lower back strain, sprain, a stress fracture, or disc rupture.
Your doctor will probably take you more seriously if you trace the pain to your lower back, even if you label it as an acute pain. This is because apparently, 20 percent of the people with acute low back pain graduate to the chronic type.
Even WHO’s 2010 Global Burden of Disease showed that it trumps the other two kinds, the upper and middle back pains as the leading cause of disability worldwide. Americans alone spend a whopping $50 billion, at least, each year on back pain.
Because the majority of these can’t be attributed to serious conditions like inflammatory arthritis, infection, fracture, or even cancer, if your doctor says you have a non-specific back pain, understand that the cause of the pain are mostly mechanical factors. You will be questioned on your history of injuries, daily activities, or inactivity, and your lifestyle.
The mechanical factors are pretty much the same as in the upper and middle back, but the risks of those harming the lower back are higher because the angles of the bending or twisting movements in your lower back are much greater and bear more pressure.
Spondylolysis And Spondylolisthesis
If you practice weightlifting or gymnastics or play football, be careful to not overstretch the spine.
Did you say you participate in sports activities like weightlifting, football, or gymnastics, or in any activity where you overstretch the spine? Then, a possible cause of your lower back pain could be spondylolisthesis.
It usually happens when you have already had a stress fracture in the fifth lumbar bone because of the activities mentioned, leading to a condition known as spondylolysis. When the fracture makes the bone so weak that it cannot maintain its position, it slides over the bone below it, leading to spondylolisthesis.
Spondylolysis itself may not present any symptoms, but when it aggravates to spondylolisthesis, you would experience a pain radiating from your lower back to your buttocks and one or both legs, which might make walking or bending difficult.
This affects men more and can start as early as when they are 17.
If the doctor can link your low back pain and a stiff spine to ankylosing spondylitis, it means the condition is still in its initial stages. The pain and the restriction on movement proceed to the neck in its later stages. This inflammatory arthritis of the spine where it joins the pelvis, eventually making the vertebrae fuse with each other, affects men more and can start as early as 17.1
Once it reaches the cervical area, it can narrow the spinal column and affect the spinal cord.
Underlying Medical Conditions
If your bones are really weak from osteoporosis, a powerful sneeze could cause your disc to rupture.
Certain underlying medical conditions, too can lead to back pain. Osteoporosis, more common among women, is known to lead to spinal compression fractures and can cause sharp, stabbing middle and lower back pain.2 But its ill effects can be felt across the spine.
A sudden severe back pain along with chest discomfort, arm pain, nausea, or a cold sweat, can indicate a heart attack.
Sometimes, the pain you feel on your back might not even originate there. In that case, it is a referred pain.
- For an upper back pain, try twisting your spine to see if the pain increases. If it does, it’s most likely to have been caused by a mechanical factor. If it doesn’t, and if it hurts especially when you breathe deeply or cough, it might indicate a lung infection or something more severe.
- If you get a sudden severe back pain with other symptoms like chest discomfort, arm pain, nausea, or a cold sweat, it can indicate a heart attack, especially if you are a woman.3
- Both liver and the gall bladder problems can cause pain on the right side of the body, on the right shoulder, upper back, and middle back.
- Kidney stones cause a consistent pain in the lower back.
Infections And Other Factors
Black women are two to three times more at risk of spondylolisthesis than their white counterparts.
Though not common, infections of the vertebrae, a condition called osteomyelitis, or of the discs, called discitis, can cause back pain. Tumors aren’t common either. In most cases, if a tumor in the back is causing the pain, it is because it has spread from a cancer in some other part of the body.
Other factors like age, genetic tendency, and race—yes, believe it or not, black women are two to three times more at risk of spondylolisthesis than their white counterparts—are difficult to counter. But irrespective of the location, duration, and the intensity of your back pain, your doctor will most certainly ask you to:
- Get rid of a high-calorie, high-fat diet that leads to obesity. Obese people, especially women, are at a high risk of back pain as the excess weight around the stomach puts pressure on the lower back.4
- Eat omega-3 fatty acid-rich foods such as salmon, Atlantic mackerel, sardines, or trout, cherries, coffee and red grapes to reduce back pain. And load your food with turmeric, which halts the inflammation of joints caused by arthritis by inhibiting the inflammation-inducing protein called NF-kB.5
- Quit smoking as it reduces the blood flow to the lower spine, which contributes to spinal disc degeneration and slow healing from back injuries.
- Swap your sedentary lifestyle with one that involves moderate but regular stretching exercises and specific yoga poses for the back, which will keep your spine and back muscles healthy and flexible.
- Avoid lifting heavy weights and running on hard surfaces.
- Manage your stress and anxiety issues.
The pain intensity is not always a reliable metric because different people have different pain thresholds and some of the more severe spine conditions, such as disc herniation, may not even cause pain. But your doctor needs to know it before prescribing any medication. So you will be asked about the nature, frequency, and the intensity of the pain.
When To See A Doc?
If you tend to visit the doctor for every little complaint, it’s actually not a bad thing when it comes to back pain. Because if you believe that time will heal the pain, you may be entirely off the mark as degenerative conditions only get worse with time. Since many of the symptoms of these conditions do not manifest until at an advanced stage, you should consider regular check-ups.
In any case, if your back pain comes with fever, numbness, loss of reflex, loss of bowel control, or weight loss, it is imperative that you visit a doctor.
References [ + ]
|1.||↑||Sieper, Jochen, J. Braun, M. Rudwaleit, A. Boonen, and A. Zink. “Ankylosing spondylitis: an overview.” Annals of the rheumatic diseases 61, no. suppl 3 (2002): iii8-iii18.|
|2.||↑||Osteoporosis. University of Maryland Medical Center|
|3.||↑||Chest pain: A heart attack or something else? Harvard Health Publications, Harvard Medical School|
|4.||↑||DEYO, RICHARD A., and J. Edward Bass. “Lifestyle and low-back pain: the influence of smoking and obesity.” Spine 14, no. 5 (1989): 501-506.|
|5.||↑||Beth Howard, Pain-fighting Foods. AARP|