Causes of Back Pain and Sciatica
At BoulderBodyworks we have had great success in treating back pain related to the common diseases and conditions listed below using manual therapy, massage therapy, Rolfing®, Pilates, yoga and The Franklin Method.
Degenerative Disc Disease (DDD)
Degenerative Disc Disease is a natural condition of the body that causes deterioration of the intervertebral discs. This is a gradual process that may compromise the spine. Although DDD is relatively common, its effects are usually not severe enough to warrant significant medical intervention. The intervertebral disc is one structure prone to degenerative changes associated with aging.
Long before Degenerative Disc Disease can be seen radiographically, biochemical and histologic (structural) changes occur. Over time the collagen (protein) structure of the annulus fibrosis weakens and may become structurally unstable. Additionally, water and proteoglycan (PG) content decreases. PGs are molecules that attract water. These changes may lead to the disc’s inability to handle mechanical stress.
Herniation of the nucleus pulposus (HNP) occurs when the nucleus (gel-like substance) breaks through the annulus fibrosis (tire-like structure) of an intervertebral disc (spinal shock absorber). Injury to the disc may result in pain, numbness, tingling, or loss of muscle strength. Disc injuries in the neck region may affect the arms or hands, while disc injuries in the low back may affect the legs or feet. People between the ages of 30 and 50 appear to be vulnerable, because the elasticity of the disc and water content of the nucleus decreases with age.
Facet syndrome is a common spinal disorder affecting the posterior joints that results in pain, stiffness, and inflammation. Increased stress at the facets results in stretching of the ligamentous capsule, deterioration of the smooth cartilaginous surfaces, and increased friction at the joint. In facet syndrome, the symptoms of pain, discomfort, and weakness frequently localize to the spine, though a small percentage may be felt in the extremities or other body areas.
The spinal nerves pass through openings on the side of the spine called intervertebral foramen. Foraminal stenosis occurs when these openings are smaller than normal. This condition can be the result of injury, degenerative change, or congenital anomaly. The smaller opening may result in compression of the nerve. This irritation often causes symptoms of numbness, weakness, burning, or tingling in the involved extremity. Long standing or severe stenosis may result in a functional loss.
Spinal stenosis is a condition where the size of the spinal canal is reduced. This may lead to compression of the spinal cord. Symptoms often include pain, numbness, tingling and weakness. Severe cases may actually cause loss of function and may even lead to disability. Spinal stenosis is more common in patients over fifty years of age. Many factors can cause stenosis including injury and degenerative change.
Fibromyalgia is a chronic disorder associated with widespread soft tissue pain, tenderness and fatigue. A person with fibromyalgia will experience pain when up to 18 specific areas, called tender points, are pressed. The pain of fibromyalgia is more than the normal muscle aches common after physical exertion. Fibromyalgia often can be severe enough to disrupt a person’s daily work and activities. The cause of fibromyalgia is not known.
Osteoporosis is commonly called the “fragile bone disease.” It is due to loss of bone density caused by a deficiency in such bone-building nutrients as calcium, vitamin D, and other vitamins and minerals. The most common complication of osteoporosis is compression fracture. In people with advanced osteoporosis, compression fractures can occur as the result of simple daily activities such as bending, carrying heavy loads, or a minor fall.
Osteoarthritis, also called degenerative joint disease (DJD), is the most common type of arthritis. OA can occur in almost any joint of the body but most commonly occurs in the fingers, hips, knees and spine. Over time, changes occur within the smooth cartilaginous surfaces of the joint. These changes lead to a loss of elasticity and the cartilage becomes stiff or brittle, making it susceptible to injury. This will lead to stiffness, pain, and crepitation at the joint. Advanced cases may actually result in significant damage to the bone itself.
Spondylolisthesis occurs when one vertebrae slips forward (translation) in relation to the adjacent vertebrae. Stability is inversely proportional to the degree of translation. The ability of a vertebrae to “slip” in relation to its neighbor can be caused by many factors, including facet or disc degeneration, trauma, or a defect in a region of the vertebrae called the pars interarticularis. Severe cases may result in spinal cord or nerve compression and can require surgical intervention.
Sprains and strains are two of the most common causes of back pain. They can be caused by trauma, overuse, lack of conditioning, and improper body mechanics. The term sprain is used when this injury occurs in a ligament. Conversely, strain is used when the affected tissue is muscle or tendon. Typically, patients will complain of increased pain with activity and relief at rest. Treatment will often include a period of rest followed by a therapeutic exercise program to increase flexibility and strength.
If you have severe back pain, it is natural to wonder whether or not the pain might be a sign of cancer. Tumors in the spinal column may cause pain from expansion of the bone or from weakening the bone, which in turn can result in spinal fractures, compression (pinching) of the nerves, or spinal instability.
Kyphosis is a postural syndrome of the upper back and neck where the shoulders appear rounded and the upper back hunched. We examine the causes and treatment options.
Serious Kyphosis where the spine is significantly deformed will require medical treatment. We focus on Kyphosis as a result of poor posture and muscle imbalances. This type of Kyphosis may be corrected with postural awareness and exercises.
Lordosis is an exaggerated curve of the lumbar spine, where the pelvis tilts forward (as if to tip water out of the front of it) and the whole abdomen moves forward from plumb line of neutral posture.
It gives the lower back a hollowed appearance and can sometimes make the buttock muscles more prominent. Some causes include genetics, sporting activities where lordotic postures are encouraged and when people carry too much weight around the abdomen for example when pregnant or if they carry excessive amounts of weight.
A number of muscles are affected by this posture creating many muscle imbalances;
- The muscles of the lower back become shortened.
- The muscles of the back of the hips the buttocks become lengthened and under active.
- The muscles down the back of the legs the hamstrings become tight because they are overactive to compensate for under active buttocks.
- The muscles at the front of the hips become shortened.
- The muscles of your abdomen become weak and long..
According to the American Obesity Association (AOA) 64.5 percent of adult Americans (about 127 million) are categorized as being overweight or obese (1). The unfortunate truth is that obesity is becoming a global epidemic which affects adults and children.
Connection to Back Pain
Most people know that obesity contributes to the development of coronary heart disease, diabetes, high blood pressure, and colon cancer. However, did you know that obesity is a contributing factor to back pain? It is true. Being overweight or obese can significantly contribute to symptoms associated with osteoporosis, osteoarthritis (OA), rheumatoid arthritis (RA), degenerative disc disease (DDD), spinal stenosis, and spondylolisthesis.
The spine is designed to carry the body’s weight and distribute the loads encountered during rest and activity. When excess weight is carried, the spine is forced to assimilate the burden, which may lead to structural compromise and damage (e.g. injury, sciatica).
One region of the spine that is most vulnerable to the effects of obesity is the low back; the lumbar spine. Lack of exercise and bodily conditioning leads to poor flexibility and weak muscles in the back, pelvis, and thighs. This can increase the curve of the lower back, causing the pelvis to tilt too far forward. Further, this is detrimental to proper posture, and as posture weakens, other regions of the spine, such as the neck, may become painful.
You may try to dismiss the cause of some of these spinal disorders to the process of normal aging. It is true that with age, body tissues can cause changes to spinal anatomy. However, if you are overweight or obese, chances are you have, or will have, back pain.
Back Pain In Pregnancy
For pregnant women, back pain during pregnancy is not a trivial matter. If not addressed, it can have a negative impact on your daily lifestyle, cause missed time from work, and make your delivery more difficult. Back pain in the course of your pregnancy can also create problems that will continue for an extended period after delivery.
Addressing Back Pain During Pregnancy
While it is fairly common, back pain during pregnancy should definitely not be accepted as just part of the process. To help make your pregnancy as pleasant as possible and facilitate an easier delivery, back pain should be always be addressed as quickly as possible and managed throughout your pregnancy.
Low back pain of long duration (several weeks or months) during pregnancy is a predictor for post partum back pain (pain after birth). For this reason, pregnant women are encouraged to seek appropriate treatment for back pain during pregnancy.
Likewise, any postpartum pain that lasts longer than six to eight weeks should be treated in order to avoid chronic or recurring back problems.
Lumbar radiculopathy, which refers to pain in the lower extremities, is a dermatomal pattern. A dermatome is a specific area in the lower extremity innervated by a specific lumbar nerve. This pain is caused by compression of the roots of the spinal nerves in the lumbar region of the spine. Diagnosing leg and back pain begins with a detailed patient history and examination.
Everyone's spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. But some people have spines that also curve from side to side. Unlike poor posture, these curves can't be corrected simply by learning to stand up straight.
This condition of side-to-side spinal curves is called scoliosis. On an x-ray, the spine of a person with scoliosis looks more like an "S" or a "C" than a straight line. Some of the bones in a scoliotic spine also may have rotated slightly, making the person's waist or shoulders appear uneven.
Scoliosis is a descriptive term and not a diagnosis. In more than 80% of the cases, a specific cause is not found and such cases are termed idiopathic meaning "of undetermined cause." This is particularly true among the type of scoliosis seen in adolescent girls. Conditions known to cause spinal deformity are congenital spinal column abnormalities, neurological disorders, genetic conditions and a multitude of other causes.
Sciatica is a condition which causes pain down the back of one or both thighs. Inflammation of the sciatic nerve (which is the largest nerve in the body- about the diameter of your little finger) can be either constant or intermittent. Success in solving this problem is directly correlated to the diagnosis. Sciatica can be caused by a pinched nerve as it exits the low back spine, or it can be caused by prostatic cancer. Odds are usually that the cause is some structural imbalance, but there are so many potential causes, some serious and some benign, that it is better to at least know that there may be a grave cause to the symptoms.
This doesn’t mean that you shouldn’t immediately incorporate a strategy to eliminate any structural imbalances. Trigger points can accumulate in the piriformis muscle, forcing a contraction and strangulation of the sciatic nerve. The tennis ball exercise should be incorporated to help to relax the piriformis muscle. Stretching may be beneficial, but that is more of a “try and see” exercise. If the problem doesn’t respond to these basic efforts, then professional assistance may be needed.
We're here to help you uncover and treat your back pain and sciatica at BoulderBodyworks. Call us today.
BoulderBodyworks has been selected Best of Boulder for Pilates six years running: 2010, 2011, 2012, 2013, 2014, & 2015.
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