Where Back and Neck Pain Begin: Upper back and neck pain can stop you in your tracks, making it difficult to go about your typical day. The reasons behind this discomfort vary, but they all come down to how we hold ourselves while standing, moving, and — most important of all — sitting.
What is low back pain?
Low back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain in the lower back. Pain in the lower back can restrict mobility and interfere with normal functioning and quality of life.
What is neck pain?
Neck pain is pain that occurs in the area of the cervical vertebrae in the neck. Because of its location and range of motion, the neck is often left unprotected and subject to injury.
Pain in the back or neck area can be acute, which comes on suddenly and intensely, or chronic, which can last for weeks, months, or even years. The pain can be continuous or intermittent.
Common Causes of Back Pain and Neck Pain
Fortunately, most episodes of back pain will heal with time: approximately 50% of patients will feel relief from low back pain within two weeks, and approximately 90% within three months, regardless of the treatment.
The majority of episodes of acute back pain are due to a muscular strain and these will usually resolve with time because muscles have a good blood supply to bring the necessary nutrients and proteins for healing to take place.
Even with today’s technology, the exact cause of back and neck pain can be found in few cases. In most cases, back and neck pain may be a symptom of many different causes, including any of the following:
- Overuse, strenuous activity, or improper use such as repetitive or heavy lifting
- Trauma, injury, or fractures
- Degeneration of vertebrae, often caused by stresses on the muscles and ligaments that support the spine, or the effects of aging
- Abnormal growth such as a tumor or bone spur
- Obesity due to increased weight on the spine and pressure on the discs
- Poor muscle tone
- Muscle tension or spasm
- Sprain or strain
- Ligament or muscle tears
- Joint problems, such as arthritis
- Protruding or herniated (slipped) disk and pinched nerve
- Osteoporosis and compression fractures
- Congenital (present at birth) abnormalities of the vertebrae and bones
- Abdominal problems, such as an aortic aneurysm
Back Pain Caused by Lumbar Spine Problems
For patients with low back pain that lasts longer than three months, or patients with predominantly leg pain, a more specific and definable problem for the pain should be sought. There are several very common causes of low back pain and leg pain:
In younger adults (20-60 year olds) the disc is likely to be the pain generator and conditions may include:
In older adults (over 60 years old), the source of back pain or leg pain is more likely to be the facet joints or osteoarthritis, and back conditions may include:
In addition to the above, there are several miscellaneous causes of back pain.
Neck Pain from Cervical Spine Conditions
While neck pain is less prevalent than lower back pain, there are several cervical spine conditions that may cause neck pain, arm pain and other symptoms, including:
Additionally, there are several miscellaneous causes of upper extremity pain related to conditions of the cervical spine.
Understanding Back Pain
he back and spine are designed to provide a great deal of strength, protecting the highly sensitive spinal cord and nerve roots, yet flexible, providing for mobility in all directions.
However, there are many different parts of the spine that can produce back pain, such as irritation to the large nerve roots that run down the legs and arms, irritation to small nerves inside the spine, strains to the large back muscles, as well as any injury to the disc, bones, joints or ligaments in the spine.
Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Chronic back pain is typically described as lasting for more than three months.
Back pain can take on a wide variety of characteristics:
- The pain may be constant, intermittent, or only occur with certain positions or activities
- The pain may remain in one spot or refer or radiate to other areas
- It may be a dull ache, or a sharp or piercing or burning sensation
- The problem may be in the neck or low back but may radiate into the leg or foot (sciatica), arm or hand.
Other than pain, back pain symptoms may include weakness, numbness or tingling.
Fortunately, most forms of back pain get better on their own: approximately 50% of patients will experience back pain relief within two weeks and 90% within three months.
If the pain lasts for more than a few days, is getting worse, does not respond to back pain remedies such as a short period of rest, using ice or heat, lower back pain exercises and over-the-counter pain relievers, then it is usually advisable to see a back doctor. There are two instances in which emergency medical care is needed:
- Bowel and/or bladder dysfunction
- Progressive weakness in the legs
Fortunately, these conditions are rare.
Conditions That Can Create Back Pain
By far the most common cause of lower back pain is a muscle strain or other soft tissue damage. While this condition is not serious, it can be severely painful. Typically, lower back pain from a muscle strain will get better within one to three weeks.
Treatment usually involves a short period of rest, activity restriction, use of hot packs and/or cold packs for local discomfort, and pain medication. Over the counter pain medication used to treat muscle strain may include acetaminophen (e.g. Tylenol), ibuprofen (Advil), Motrin, or naproxen (e.g. Aleve). Prescription pain medications may be recommended for severe back pain.
Different Causes of Back Pain
Typically, younger individuals (30 to 60 year olds) are more likely to experience back pain from the disc space itself (e.g. lumbar disc herniation or degenerative disc disease). Older adults (e.g. over 60) are more likely to suffer from pain related to joint degeneration (e.g. osteoarthritis, spinal stenosis).
In some instances, a patient may experience more noticeable leg pain as opposed to back pain as a result of certain conditions in the lower back, including:
- Lumbar herniated disc. The inner core of the disc may lead out and irritate a nearby nerve root, causing sciatica (leg pain).
- Lumbar spinal stenosis. The spinal canal narrows due to degeneration, which can put pressure on the nerve root and cause sciatica.
- Degenerative disc disease. As the disc degenerates it can allow small amounts of motion in that segment of the spine and irritate a nerve root and cause sciatica.
- Isthmic spondylolisthesis. A small stress fracture allows one vertebra to slip forward on another, usually at the bottom of the spine. This can pinch the nerve, causing lower back pain and leg pain.
- Osteoarthritis. Degeneration of the small facet joints in the back of the spine can cause back pain and decreased flexibility. May also lead to spinal stenosis and nerve pinching.
It is important to know the underlying condition that is causing the low back pain, as treatments will often differ depending on the causes of back pain.
How can back and neck pain be prevented?
The following may help to prevent back and neck pain:
- Practice correct lifting techniques
- Use telephones and workplace computers and other equipment properly
- Maintain correct posture while sitting, standing, and sleeping
- Participate in regular exercise (with proper stretching before participation)
- Avoid smoking
- Maintain a healthy weight
- Reduce emotional stress that may cause muscle tension
Symptoms and Diagnosis
The cause of back pain can usually be diagnosed with a detailed description of one’s symptoms. The description of back pain symptoms, along with one’s medical history (and possibly diagnostic testing), will usually lead to a diagnosis of a general cause (such as back strain), or a specific condition (such as a herniated disc).
Back Pain Symptoms from a Sprain or Strain
Back sprain or strain symptoms generally include:
- Pain is usually localized in the low back (doesn’t radiate down the leg)
- Pain often starts after lifting something heavy, lifting while twisting, or a sudden movement or fall
- Pain may include muscle spasms, tenderness upon touch
- Pain is less when resting and worse during certain activities.
Lower back pain from a muscle strain usually will get better within one to three days.
Chronic Back Pain Symptoms
Symptoms that are part of a diagnosable chronic condition can include:
- Leg pain (sciatica) and possible numbness. Pain can radiate down the leg to the buttock and/or the foot, and can be worse with sitting or prolonged standing. This type of pain can be due to a lumbar herniated disc.
- Pain with certain movement and positions (such as bending forward, running). The pain tends to fluctuate, with low level or no pain at times, and then flare up at other times. This chronic back pain can be caused by degenerative disc disease.
- Lower back pain, often accompanied by leg pain, which worsens when standing or walking for long periods. This pain may be caused by a small stress fracture in the back of the spine called isthmic spondylolisthesis.
- Lower back pain that is worse in the morning and in the evening, and stiffness (usually in older adults). This back pain may be caused by facet joint osteoarthritis(degenerative arthritis).
- Pain that is felt down the legs when walking and standing upright and that feels worse with more walking and gets better after sitting down (usually in older adults). This pain may be caused by lumbar spinal stenosis and/or degenerative spondylolisthesis.
There are many more conditions can cause lower back pain, leg pain and other symptoms; the intention of this article is to highlight the most common ones.
There are a few symptoms that are possible indications of serious medical conditions, and patients with these symptoms should contact a doctor immediately:
- Difficulty passing urine or having a bowel movement
- Progressive weakness in the legs
- Severe, continuous abdominal and lower back pain.
What Can Increase The Potential for Back Problems?
There are many risk factors for back pain, including aging, genetics, occupational hazards, lifestyle, weight, posture, pregnancy and smoking. With that said, back pain is so prevalent that it can strike even if you have no risk factors at all.
Specific Risk Factors for Back Pain
Patients with one or more of the following factors may be at risk for back pain:
Aging. Over time, wear and tear on the spine that may result in conditions (e.g., disc degeneration, spinal stenosis) that produce neck and back pain. This means that people over age 30 or 40 are more at risk for back pain than younger individuals. People age 30 to 60 are more likely to have disc-related disorders, while people over age 60 are more likely to have pain related to osteoarthritis.
Genetics. There is some evidence that certain types of spinal disorders have a genetic component. For example, degenerative disc disease seems to have an inherited component.
Occupational hazards. Any job that requires repetitive bending and lifting has a high incidence of back injury (e.g., construction worker, nurse). Jobs that require long hours of standing without a break (e.g., barber) or sitting in a chair (e.g., software developer) that does not support the back well also puts the person at greater risk.
Sedentary lifestyle. Lack of regular exercise increases risks for occurrence of lower back pain, and increases the likely severity of the pain.
Excess weight. Being overweight increases stress on the lower back, as well as other joints (e.g. knees) and is a risk factor for certain types of back pain symptoms.
Poor posture. Any type of prolonged poor posture will, over time, substantially increase the risk of developing back pain. Examples include slouching over a computer keyboard, driving hunched over the steering wheel, lifting improperly.
Pregnancy. Pregnant women are more likely to develop back pain due carrying excess body weight in the front, and the loosening of ligaments in the pelvic area as the body prepares for delivery.
Smoking. People who smoke are more likely to develop back pain than those who don’t smoke.
When To Call a Doctor
The bottom line that everyone should remember is that if one is in doubt, consult a doctor. If back pain is getting worse over time, does not feel better with rest and over the counter pain remedies, and/or involves neurological symptoms then it is advisable to be evaluated by a back pain doctor.
When to See a Back Pain Doctor
In general, if the pain has any of the following characteristics, it is a good idea to see a physician for an evaluation:
- Back pain that follows an accident, such as a car accident or falling off a ladder
- The back pain is ongoing and is getting worse
- The pain continues for more than four to six weeks
- The pain is severe and does not improve after a few days of typical remedies, such as rest, ice and common pain relievers (such as ibuprofen or Tylenol)
- Severe pain at night that wakes you up, even from a deep sleep
- There is back and abdominal pain
- Numbness or altered feelings in the upper inner thighs, groin area, buttock or genital area
- Neurological symptoms, such as weakness, numbness or tingling in the extremities – the leg, foot, arm or hand
- Unexplained fever with increasing back pain
- Sudden upper back pain, especially if you are at risk for osteoporosis.
Back Pain Symptoms That Require Urgent Medical Care
The following back pain symptoms may be indications of a serious medical condition and anyone with these should seek immediate medical care:
- Difficulty passing urine or having a bowel movement
- Progressive weakness in the legs
- Severe, continuous abdominal and low back pain.
People should also seek prompt medical attention if other unexplained symptoms accompany their back pain, such as fever, history of cancer, recent unexplained weight loss, pain that is so bad it awakens them from sleep, or pain after a trauma.
Diagnostic Tests for Indicators of Back Pain
Diagnostic tests can indicate if a patient’s back pain is due to an anatomic cause. However, because diagnostic tests in and of themselves are not a diagnosis, arriving at an accurate clinical diagnosis requires any test to be to be correlated with the patient’s back pain symptoms and physical exam.
The most common diagnostic tests include:
- X-ray. This test provides information on the bones in the spine. An x-ray is often used to check for spinal instability (such as spondylolisthesis), tumors and fractures.
- CT scan. This test is a very detailed x-ray that includes cross section images. CT scans provide details about the bones in the spine. They may also be used to check for specific conditions, such as a herniated disc or spinal stenosis. CT scans tend to be less accurate for spinal disorders than MRI scans.
- MRI scan. An MRI scan is particularly useful to assess certain conditions by providing detail of the intervertebral disc and nerve roots (which may be irritated or pinched). MRI scans are useful to rule out spinal infections or tumors.
Injections may also be used to help diagnose certain types of pain. If an injection of a pain relieving medication into a certain spot in the spine provides back pain relief, than it confirms that is the area causing pain.
If you are experiencing back or neck pain the team of physicians and staff members at TOCA (The Orthopedic Clinic Association) are here to help! For more information you can read more about our Neck & Spine Physicians and The Spine Center at TOCA for non-operative and operative procedures. For questions or to schedule an appointment with our orthopedic spinal surgery and general musculoskeletal physical medicine and rehabilitation specialists call: 602-277-6211!
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