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Back Pain

Being a doctor of chiropractic, I would say the number one reason patients seek care is  back pain. In fact, lower back pain is the second most common reason for visits to a doctor’s office, outnumbered only by upper-respiratory infections. It is estimated that Americans spend at least $50 billion each year on back pain, yes B-Billion. Experts estimate that 80% of the population will experience back pain at some point in our lives.

With so many back pain patients and so much money being spent every year, it would be easy to assume that diagnosis and treatment for back pain is uniform throughout and relatively an “easy” fix. Wrong.

The first problem when dealing with back pain is that most cases are non-organic, meaning they are not caused by serious conditions, such as inflammatory arthritis, cancer, infections, or fractures. Most cases are also insidious, meaning the patient can’t recall exactly when the pain started.

Secondly, the back isn’t exactly a simple structure. Technically you have 33 vertebrae that articulate with each other. There are discs that separate the vertebra and act like a cushion between the bones; somewhat similar to a meniscus in the knee, but far more complicated. You also have facet joints- these are the protective elements on the posterior (backside) of the vertebra. These joints are much smaller than the discs but just as important. Think of these like road barriers as they prevent individual vertebra to move too far in any one direction. In the thoracic spine (mid back), there are 12 pairs of ribs that all connect to corresponding vertebrae. Do the math, the number of articulations (joints) adds up quick. All of these structures mentioned above have specific ligaments and muscles. There are blood vessels, lymph nodes, and don’t forget about the spinal cord and nerves. Are we a little overwhelmed yet?

When I first meet a patient it is my job to find out the exact cause of their pain. Doctors of chiropractic are trained heavily in diagnosis. It is our due diligence to rule out anything that would require treatment that is outside of our scope of practice, in Texas we treat musculoskeletal problems. However, rarely I may find fractures, infections, or even cancer as the root-cause to the pain.

Once these conditions are ruled out, we look to common musculoskeletal conditions:

  • Disc displacement. Also called a bulging disc, slipped disc, or herniated disc, this is where the outer fibers of the disc becomes weak allowing the inner material to bulge out. Think of the disc as an orange, it is firm, but yet moveable. The rind protects the inner portion that is far more susceptible to damage. If you remove a portion of the rind, the inner portion is exposed and starts to deteriorate. A similar situation happens when there is an injury to a disc in your spine.  Patients complains of sharp, stabbing pain that increases with coughing or sneezing. Sometimes they notice a pop during heavy lifting or physical exertion.
  • This is a fancy word for degeneration, this is also the “bone-on-bone” analogy commonly used.  It is important to know that this condition is a slow process, often becoming after years of micro-traumas and abuse. Usually seen in adults over 50, this is where the vertebral joint becomes stiff and immoveable and starts to decrease in height. Often times you will see osteophytes (bone spurs) forming around the joint. Contrary to popular belief, these bone spurs are a normal physiologic process. The body is protecting this joint from further injury by laying down new bone because the existing structures aren’t functioning properly. Patients will complain of stiffness, especially in the morning, and a sensitivity to cooler weather.
  • Rib Pain: This is only seen in the thoracic spine (mid back) because this is where the ribs are located. Mostly this is condition is a relatively easy fix. Just like the vertebrae, the rib cage must move. If for any reason an individual rib isn’t moving properly, there will likely be increased pain- often with breathing, muscle spams and even swelling. The pain is often sharp or stabbing and will be noticed more on one side versus the other.
  • Sprain / Strain: This condition is similar to any other sprain / strain seen throughout the body. The ligaments and muscles of vertebral joints become torn from a certain traumatic episode. Most commonly seen in motor vehicle accidents (car wrecks) and youth in sporting events. There are 3 grades of sprains and strains, grade 3 is a complete tear and often times requires surgical intervention. Grades 1 and 2 are well within a chiropractor’s ability to treat conservatively. People will complain of stiffness in the morning, and a dull ache in the evening. Specific movements in specific directions often times will increase the pain.
  • Sciatica or “Pinched Nerve”: Not necessarily back pain, however many times this condition is related to a spinal condition. Think of hitting your funny bone, you will notice numbness, tingling, and even pain in the hand, but the cause is located around the elbow where the nerve was irritated. Same thing with sciatica, people will complain of leg pain or numbness, however the sciatic nerve is being irritated or ‘pinched’ in the spine, most likely due to a disc displacement or boney irritation from degeneration (see above).  This is also seen in the upper extremities, often times due to a cervical (neck) condition. Many times people are misdiagnosed with these conditions due to lack of a proper spinal examination.
  • Postural / Biomechanical Pain: This is the one of the most common conditions we come across. Think about being a caveman(women), our bodies are”designed” to be weight bearing (walk) for over 10-12 miles per day. Anything less than this is harming your body and setting you up for injury. Just evaluate how you are right now. Are you sitting at your computer slouching? Are you sitting on your couch with your head forward reading this on your phone or tablet? Prolonged sitting is extremely hard on your body and especially to your back and neck. Maybe you lift 50 pound boxes while twisting all day for work, maybe you’re a professional golfer hitting thousands of balls a week. My point is that any repetitive motion, no matter how minor, if done over the course of days, weeks, months, or years, can cause problems the spine. Vertebrae can easily become misaligned and causing pain. If left untreated this could form into more severe conditions.
  • Muscle Spasm: This is a very common condition, many have experience this in their lifetime. Most people just push through it or get a massage, but a lot of times I see patients who think they have a “simple” muscle spasm who really have a more severe underlying condition. Muscle spasms don’t just spasm because they want to, they are doing this to protect the body from further damage. It is always imperative to seek treatment for any condition that isn’t healing on it’s own, no matter how simple it may seem.

In no way is this an all inclusive list. Hopefully, it may give you some insight on how complicated back pain may be. Chiropractic care has great benefits when dealing with back pain, but no two patients are alike. Whomever you may see for your treatment of your back pain, it is important a detailed examination is done along with the necessary diagnostic imaging (X-ray, MRI, etc.).


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