What is the Spinal Column?
You have successfully answered the question of what is hurting and now are probably wondering why it is hurting. But before we move on to the complex mechanisms of nerve pinching and radiculopathy, we should know some basics about the spinal column.
The Spinal Column is a group of 33 bones which are called vertebrae. These bones are irregular in shape and have elastic disks present between them to help them support weight. These disks are the reason you can freely bend your neck. Since we are interested in the lower back region, also called “lumbar” region, we will focus only on the 5 bones present as well as the sacral region which contains 5 bones fused into one. The spinal cord passes through these bones from behind the elastic disk we mentioned above. Now, the spinal cord gives out nerves from inside the vertebrae and these nerves exit the bone by passing between two successive vertebrae. The nerves that exit the spinal cord in the back are the ones that supply your leg, genital and anal area and if there is too much pressure on them, it can cause pain in the region that these nerves supply.
Wait! Why Do I Have Pain?
Hopefully, by now you have a basic understanding of the anatomy of the spine and we can start dwelling into what underlying pathology (medical term for unwanted condition) is causing your pain. Well, multiple factors including the type of pain, the area of pain and the involvement of arm pain can point you in the direction of what might be causing your pain. The doctor will even look at your X-Ray and your MRI to see what could be wrong with the basic anatomy of your spine.
The most common cause son your back pain include muscle pulls and ligament stretching. These injuries could be caused by improper lifting of an object, awkward movements, poor posture and even muscle spasms. However, if your back pain persists for more than a few weeks, these mechanical causes are not usually the culprits. These structural issues are given awkward medical names like disk herniation, sciatica, osteoarthritis, scoliosis, spondylosis, spondylolistehsis and so on. We will make sense them in the following section.
Did I do Anything To Cause This?
Some problems can be attributed to genetics. You could have inherited genes that could cause you to develop this disease. Another reason could simply be age. As you grow older, the strength and elasticity of your discs decreases, even the bone weakens. This is especially true in patients with osteoporosis. Therefore, when the disk is weak, it can easily tear and this can cause it to rupture and press on a nerve root.
The only known prevention of these problems is to exercise and maintain your weight, try to stand and sit properly (maintain good posture) and avoid any strains on your back. It is important to ensure that all your seating arrangements have adequate lumbar support to prevent excess pressure on your back. Multiple structural defects are associated with back pain and they are mentioned below. These defects could be age-related or could even be birth defects.
Back Strain
There are two common types of strain of the back which causes pain. These are muscle strain which occurs when the muscles of the back are over-stretched or torn which results in damage to the fibers and therefore causes pain. The other type of strain is lumbar strain which involves over-stretching and tearing which leads to pain. These are usually caused because of lifting a heavy object or lifting and turning or a sudden fall.
Herniated Disk
Spinal disks play an essential role in maintaining flexibility and shock absorbing capacity. However, if the disk ruptures or ‘herniates’ and leaks some of its inner material, then it can become a major source of pain. It can cause lower back pain and even pain radiating down to the leg. It is a widespread problem that begins for no apparent reason and is commonly seen in people between 35-50 years.
Degenerative Disk Disease
This refers to a condition which involves a compromised disk and leads to severe pain in the back. Literature suggests that the cause of this disease is most likely genetic, however most doctors believe that a myriad of factors lead the the development of this disease. It occurs because the vertebral disk itself does not have its own blood supply and therefore if there is any damage to it, it cannot repair itself and therefore the disk starts wearing out.
Fracture In Lumbar Spine
Fractures in the lumbar spine can vary widely in severity, from ones that require a emergency treatment to ones occurring due to osteoporotic changes. Causes of this fracture could include a motor vehicle accident, a sports accident or fall from a height. However, for people with osteoporosis, a fracture could occur even while reaching for something or or twisting.
Spinal Stenosis
Any sort of stenosis means narrowing of a particular canal. In this particular case, stenosis refers to narrowing of the channel through which the spinal nerves travel and leave the spinal column. Although some people are born with it, most people develop it due to age-related changes. The pain caused involves tingling, weakness or numbness that can extend from the buttocks down the whole leg.
Spondylolisthesis
Spondylolisthesis refers to a condition in the lumbar spine which involves ‘slipping’ of the one vertebrae in front of the vertebrae below. This condition is of two types. Isthmus Spondylolisthesis refers to slipping of a vertebral body in front of the one below it because of the presence of a fracture on a piece of bone called the pars articularis. This fracture usually occurs in young age. The degenerative condition however occurs due to the general aging process in which the bones, joints and ligaments become weak.
