Back & neck pain
What is back & neck pain?
Back and neck pain are among the most common conditions people suffer from. For some, back and neck pain is an annoyance or inconvenience; for others, it can be debilitating. Back and neck pain can also be a sign of serious underlying degenerative, neuromuscular, or musculoskeletal disorders.
The National Institutes of Health (NIH) reports that back pain affects eight out of 10 people at one time or another. You may have acute back pain that comes on suddenly and is gone in a few days or a few weeks, but chronic low back pain is the term for back pain that lasts more than three months. Acute neck pain can also come on suddenly and prevent you from managing your normal daily activities.
Anatomy of the spine
The spine is made up of small bones called vertebrae stacked on top of one another. Between them, inter-vertebral discs act as shock absorbers, cushioning the vertebrae and preventing them from rubbing against each other. The spinal column is made up of three areas that create three natural curves in your back:
- Neck area (cervical)
- Chest area (thoracic)
- Low back (lumbar)
The spinal column protects your spinal cord, a complex center of "electrical cables" that carry messages between your brain and muscles. Nerves branch out from your spinal cord through openings in the vertebrae and carry specific messages to different parts of your body.
Muscles and ligaments (tough, fibrous, rope-like bands of tissue) support and stabilize your spine and upper body. The ligaments connect your vertebrae to help keep your spinal column in position. Between the vertebrae, there are small joints (facet joints) that help your spine move.
Depending on the source of your back or neck pain, you may experience any of these symptoms:
- Muscle aches and/or spasms
- Shooting or stabbing pain
- Dull aches
- Limited range of motion and flexibility
- Inability to stand straight
- Radiating pain from a disorder or injury elsewhere in your body
- Pain that increases with movement
- Stiffness or tightness
If you have more severe symptoms such as fever, nausea, loss of bladder control and numbness, tingling or pain in your legs in addition to your pain, you may have a more serious condition. Always consult your physician if you are suffering from any of the above symptoms, but consider the more severe symptoms as a medical emergency.
There are numerous potential causes of back and neck pain, ranging from overuse, misuse, and injury to problems with the nerves, muscles, bones, joints, or specific areas of the spine. It can also be caused by problems with certain internal organs, such as the gallbladder and pancreas.
The leading causes of most acute low back pain are trauma to the lower back or a disorder such as arthritis. Pain may be caused by a sports injury, working around the house or in the garden, or a sudden jolt such as a car accident or fall.
In most cases, back and neck pain can be a result of many different causes, including one of more of the following:
- Overuse or strenuous activity
- Degeneration of vertebrae (often caused by the effects of aging or stress on the muscles and ligaments that support the spine)
- Obesity (resulting in increased weight on the spine and pressure on the discs)
- Weak back muscles
- Muscle tension or spasm
- Ligament sprains and muscle strains
- Ligament or muscle tears
- Poor spinal alignment
- Herniated or ruptured disc
- Pinched nerve
- Osteoarthritis and osteoporosis
- Spinal stenosis
- Spondylolysis and spondylolisthesis
- Vertebral compression fracture
How is it diagnosed?
When you see a doctor for back or neck pain, you will be asked to report your level of pain, usually on a scale of 1 to10 (with 1 representing mild or none and 10 representing excruciating or unbearable). You will also be asked to describe the pain—whether it is a dull ache, piercing, or burning sensation—and how long you’ve been feeling that pain for. Durations are characterized as either acute (less than 7 weeks), subacute (7-12 weeks), or chronic (persistent).
After your physician gathers your complete medical history and provides a physical exam, one or more of the following diagnostic tests for neck pain will be performed:
- Blood tests
- X-ray—A test that uses invisible electromagnetic energy beams to produce images of internal organs, tissues and bones
- MRI (magnetic resonance imaging)—A diagnostic imaging procedure that creates more detailed images of internal structures than an X-ray does
- Computed tomography scan (CT or CAT scan)—A diagnostic procedure that uses a combination of computer technology and X-rays to produce images of the body
- Myelogram—A diagnostic procedure in which dye is injected into the spinal cord to allow the images to be seen clearly on an X-ray
- Electromyogram (EMG)—A test that records the electrical activity of nerves and muscles
Treatments for neck and back depend upon the severity of the condition and can range from nonsurgical treatments and physical therapy to surgical procedures.
Most back and neck pain can be treated without surgery by using a combination of rest, exercise and pain relievers to reduce discomfort, as well as anti-inflammatory drugs to reduce inflammation. However, you should contact your doctor if you don't feel a noticeable reduction in pain and inflammation after 72 hours of self-care.
Consult a spine specialist to ensure that you receive an accurate diagnosis and the proper treatment plan. When nonsurgical treatment is unsuccessful, your doctor may recommend spine surgery. However, surgery is rarely recommended unless the source of the problem is a herniated disc, a spinal compression or another condition that results in more severe symptoms.
Nonsurgical treatments include:
- Immobilization—To take pressure off the affected structures, a soft collar or brace may be prescribed for a short amount of time.
- Physical therapy—A physical therapist can help you with strengthening exercises and apply ice, heat and electrical stimulation to help reduce pain and promote healing.
- Traction—This form of therapy uses weights and pulleys to gently stretch your neck and relieve pain.
- Transcutaneous electrical nerve stimulation (TENS)—Electrical impulses are delivered through electrodes near painful areas to relieve pain.
- Steroid injections—Corticosteroid injections near nerve roots, into small facet joints of the cervical spine or into muscles can help relieve swelling and pain in some patients.