What Causes Back Pain?
The back is a complicated structure of vertebrae separated by discs, held together by ligaments and muscles. It must be flexible enough to provide a wide range of movements and yet strong enough to protect the spinal cord and the delicate nerve fibers which exit between each vertebrae. The spine functions as a whole, so if we have mechanical disturbances in one part of the spine, even as far away from the low back as the neck, it can influence conditions in another area of the spine. Imbalances in the pelvis, problems in the sacroiliac joints, facet fixations, as well as joint restrictions in the mid-back and the neck, can contribute to the process of disc degeneration, weakening the joint and making it susceptible to injury. Back pain can be caused by any combination of sprained ligaments, strained muscles, ruptured disks, and irritated joints, any or all of which can lead to pain. A "slipped disc" most often occurs when a number of these and other factors act together resulting in injury.
Of course your spine could be normal in every way and become injured in a fall, accident, or sports injury. Just as often, however, weaknesses from lesser, earlier injuries accumulate and compound as the years go by so that eventually the simplest of movements-for example, bending over to pick up your shoes from the floor - can have painful results. In addition,
arthritis, poor posture, lack of exercise, weight gain, and even psychological stress can cause or complicate back pain. Most back pain is mechanical in nature. Less frequently back pain can also directly result from medical pathology such as kidney stones, infections, blood clots, bone loss (osteoporosis), and others. A complete history and a thorough examination can rule in or rule out a wide range of possibilities.
Spinal Stenosis / Foraminal Stenosis
Spinal Stenosis is a medical condition in which the spinal canal narrows and compresses the spinal cord and/or exiting nerve roots. Stenosis is from the Greek word meaning "a narrowing". Central canal stenosis is a narrowing of the channel through which passes the spinal cord in the center of each vertebra on its way down the spine. Foraminal stenosis is a narrowing of the channel on either side of the vertebra where the spinal nerve roots exit on their way to various parts of the body such as down the arms or legs. Spinal stenosis may affect the cervical, thoracic or lumbar spine. Lumbar spinal stenosis results in low back pain and can radiate down the nerves into the hips, legs, thighs, feet or buttocks. Cervical spinal stenosis results in neck pain and can radiate into the shoulders, arms, wrists, and hands.
Although it is true that some individuals congenitally have larger or smaller canals than do others, the cause of the narrowing is usually a combination of 3 different degenerative factors present in varying degrees in different patients. First, when a disc herniates the bulge takes up space narrowing the nerve channel. Second, as the involved disc dries out and loses height (a process known as desiccation) it causes the vertebra to become closer together further narrowing the nerve channel. Third, as the stress on the joint accumulates and osteoarthritis begins to result, bone spurs form and ligaments hypertrophy gradually narrowing the channel even further. These 3 factors in various combinations and degrees of severity compromise the space in the channel and conspire to compress (pinch) the nerve. These 3 factors may also be referred to as Degenerative Disc Disease, the most common cause of spinal stenosis.
Spondylolisthesis (see below) and scar tissue formation as a result of prior surgical fusion are other factors that can contribute to spinal stenosis.
How does Spinal Decompression Treatment help Spinal Stenosis?
Spondylolisthesis describes the anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. The term was coined from the Greek spondyl for vertebrae and olisthesis for slip. This finding often contributes to spinal stenosis, a narrowing of the spinal canal.
The most common grading system categorizes severity based upon measurements on lateral X-ray of the distance from the posterior edge of the superior vertebral body to the posterior edge of the adjacent inferior vertebral body. This distance is then reported as a percentage of the total superior vertebral body length:
- Grade I is 0-25%
- Grade II is 25-50%
- Grade III is 50-75%
- Grade IV is 75-100%
This is not an uncommon condition with a reported prevalence of 5%-7% in the U.S. population. Fredrickson, et al. demonstrated that the spondylolytic defect is usually acquired between the ages of 6 and 16 years, and that the slip often occurs shortly thereafter. Once the slip has occurred it rarely continues to progress. Although not necessarily symptomatic it can be argued that the biomechanical stresses incurred by the joint are greater than they might be otherwise and that there is a greater likelihood of disc degeneration and associated osteoarthritic changes at this level. Rarely is surgical intervention necessary.
How does Spinal Decompression Treatment help Spondylothesis?
The possible causes of nerve disorders in the human body number literally hundreds but may be divided roughly into 7 categories as follows:
- Direct Physical Pressure such as from herniated discs, osteoarthritic changes, spinal stenosis. Often referred to as a "pinched nerve".
- The toxins of acute Infective Diseases such as diphtheria, shingles, typhoid fever, malaria, scarlet fever, septicaemia.
- Acute or chronic Poisoning most commonly by lead, arsenic, mercury, copper and phosphorus.
- Autoimmune Disorders such as Rheumatoid Arthritis, Celiac Disease, Myasthenia Gravis.
- Central Nervous System Disorders such as Cerebral Palsy (CP), Parkinson's Disease, Multiple Sclerosis (MS).
- Metabolic Disease such as diabetes or alcoholism.
- Nutritional deficiency.
By far the most common of these that result in neck pain radiating into the shoulder, arm, wrist, and hand or lower back pain radiating into the buttock, hip, leg, or foot is (1) direct physical pressure. When a patient suffering from a ''bad back'' receives a diagnosis of ''pinched nerve'' the doctor is referring to direct physical pressure as the cause of the nerve pain.
Pinched Nerve in the spine
A pinched nerve occurs when too much pressure is applied for too long to a nerve by surrounding tissues—such as by bones, cartilage, muscles, tendons, ligaments, spinal discs or (rarely) tumor. Everyone has at one time or another applied too much pressure to the "funny bone" in their elbow which is actually the ulnar nerve.This physical pressure disrupts the nerve's function causing pain, tingling, numbness or weakness. Too much pressure applied for too long to a nerve along the spine results in much the same sensations.
Of the 7 broad categories resulting in nerve dysfunction listed above only (1) Direct Physical Pressure is properly referred to as a pinched nerve. The most common reasons for the direct physical pressure are as a result of the changes occurring with degenerative disc disease (DDD) and/or degenerative joint disease (DJD). Nerve pain resulting from direct physical pressure is called an entrapment neuropathy because the nerve is trapped or pinched by some structure. This term helps to distinguish them from neuropathies resulting from infection or disease.
How does Spinal Decompression Treatment help a Pinched Nerve?
Neuritis / Neuralgia
Neuritis is from itis for inflammation and neuro for nerve. Neuralgia is from the Greek algos for pain and neuro for nerve. The difference between neuritis and neuralgia is a technical issue regarding inflammation, which involves specific changes found on a cellular level, of interest only to a scientist, but of no interest to a patient. The most common cause of neuritis or neuralgia for those suffering from arm pain or leg pain is direct physical pressure as a result of the changes occurring with degenerative disc disease (DDD) and/or degenerative joint disease (DJD).
The pain may radiate anywhere along the course of the nerve and is most often described as a burning, stabbing, or shooting pain from the neck into the shoulder, arm, elbow, wrist, or hand. If the nerve originates in the lower back the pain radiates into the buttock, hip, thigh, leg, or foot.
How does Spinal Decompression Treatment help Neuritis / Neuralgia?
Paresthesia is from the Greek para for along side or near and aisthesis for sensation. Paresthesia is correctly used when there is involvement of the sensory nerves resulting in perhaps numbness or tingling, but not really pain and with no motor or muscle weakness. In the medical community Neuritis / Neuralgia / Paresthesia are often used interchangeably without clear distinction and simply mean that the nerve is irritated and causing symptoms. The symptoms often include actual pain, but may be limited to numbness, tingling, burning, stinging, prickling, pins and needles, skin crawling, itching, and many other descriptive terms of a similar nature.
How does Spinal Decompression Treatment help Paresthesia?
Radiculitis / Radiculopathy
Picture of Cervical Radiculopathy
These are not specific conditions, but rather describe a nerve that is being pinched at or very near the spinal cord at the beginning or ''root'' of the nerve. Radiculitis is from Latin radiculo for root plus itis for inflammation. Radiculopathy comes from the same Latin radiculo for root plus Greek pathos for suffering. The difference between radiculitis and radiculopathy is a technical issue regarding inflammation, which involves specific changes found on a cellular level, of interest only to a scientist, but of little interest to a patient.
In a radiculitis or radiculopathy the problem is at or near the root of the nerve along the spinal cord. The most common cause of this is a herniated or protruding spinal intervertebral disc resulting in pain at that level of the spine in the neck or back. However, the most severe symptoms may manifest along the course of the adjacent nerve root resulting in arm pain or leg pain through a process called referred pain or radicular pain. For example, a nerve root impingement in the neck, or cervical spine, can produce pain, motor weakness, or sensory paresthesia in the shoulder, arm or hand which is called brachial radiculitis from Latin brachio for arm or more simply a cervical radiculitis or cervical radiculopathy. Likewise, a nerve root impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the lower extremity, a lumbar radiculitis or lumbar radiculopathy. This can result in pain, weakness, numbness, or paresthesia in the butt, hip, leg or foot. This is often called sciatica or sciatic neuritis. Sciatica due to compression of a lumbar nerve root is one of the most common forms of radiculopathy.
How does Spinal Decompression Treatment help Radiculitis / Radiculopathy?
Sciatica / Sciatic Neuritis / Sciatic Nerve Pain / Leg Pain
Sciatica (or Sciatic Neuritis) is a set of symptoms always including pain that is caused by general compression and/or irritation of one of five nerve roots that exit the lumbar spine and converge and give rise to the sciatic nerve that runs through the buttock muscles past the hip joint and into the thigh, past the knee, and on down into the calf, ankle, and foot to the toes. Sciatica is usually caused by the compression of lumbar nerve roots L4 or L5 or S1, but sometimes sacral nerve roots S2 or S3. The symptoms are felt in the lower back, buttock, hip and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, pins and needles or tingling, and difficulty in supporting weight on the involved leg. These symptoms are primarily felt on one side of the body although not infrequently some lesser symptoms are also felt on the other side.
Although sciatica is a common form of low back and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve causing the pain. The most common diagnosis is degenerative disc disease (DDD) or degenerative joint disease (DJD). Sciatica may also be caused by pregnancy, primarily resulting from the direct physical pressure of the uterus pressing on the sciatic nerve, and, secondarily, from the muscular tension and/or vertebral compression consequent to carrying the extra weight of the fetus, and the postural changes inherent to pregnancy.
When sciatica is caused by compression of a nerve root it is considered a lumbar radiculopathy, if the compression is accompanied by an inflammatory response, a lumbar radiculitis.
How does Spinal Decompression Treatment help Sciatic Leg Pain?
Neck, Shoulder, & Arm Pain
Neck, shoulder, and arm pain is just as common as is lower back, hip, and leg pain. The cervical vertebra of the neck bear far less body weight than do the lumbar vertebra of the lower back, and are therefore less subject to abnormal or excessive mechanical stress or injury due to gravitational compressive forces. They are, however, much more subject to abnormal or excessive shear forces or injury such as the hyper-extension / hyper-flexion whiplash injuries resulting from motor vehicle accidents that can be just as damaging. Who does not have a motor vehicle accident or two in their past?
The most common cause of neck, shoulder, and arm pain is a herniated or protruding spinal intervertebral disc resulting in at least some pain at that level of the spine, and this may or may not be accompanied by osteoarthritis. However, the most severe symptoms may manifest along the course of the adjacent nerve resulting in arm pain through a process called referred pain or radicular pain. This pain, motor weakness, or sensory paresthesia in the shoulder, arm, wrist or hand/fingers is called brachial radiculitis from Latin brachio for arm or more simply a cervical radiculitis or cervical radiculopathy. One or several of brachial nerve roots C5, C6, C7, C8, and T1 are most commonly involved when upper extremity symptoms are present.
When wrist pain or finger numbness or tingling is the major symptom, disc degeneration and/or degenerative arthritis can easily be mistaken for carpal tunnel syndrome when the actual cause of the symptoms are closer to the root of the nerve in the cervical spine. Muscles of the neck and upper back that reflexively spasm in an attempt to limit the motion of the offending spinal vertebra are a frequent cause of muscle tension headaches, a common accompanying finding.
How does Spinal Decompression Treatment help Neck, Shoulder, and Arm Pain?
Neuropathy from neuro for nerve and the Greek pathos for suffering is the term for damage to nerves (which may include cellular death) which may be caused either directly such as in the event of a stroke, or by diseases of the nerve itself such as Parkinson's Disease, or from the "adverse effect (medicine)" side-effects of systemic illness such as Diabetes. Central Neuropathy would be damage to a nerve in the brain or spinal cord (the Central Nervous System). Peripheral Neuropathy is damage of a nerve outside of the brain or spinal cord (the Peripheral Nervous System). There are many causes of both central and peripheral neuropathy including many drugs, diabetes, shingles, kidney failure, and vitamin deficiency. (See 7 broad categories of nerve pain.)
Neuropathies resulting from direct physical pressure (a "pinched nerve") are more correctly called entrapment neuropathies to distinguish them from neuropathies resulting from infection or disease.
How does Spinal Decompression Treatment help Neuropathy?
In approximately 15% of the population, the sciatic nerve runs through the piriformis muscle rather than beneath it. When the muscle shortens or spasms due to trauma or overuse, it can compress or pinch the sciatic nerve beneath the muscle. Conditions of this type are generally referred to as entrapment neuropathies; in the particular case of sciatica and the piriformis muscle, this condition is known as Piriformis Syndrome. It has colloquially been referred to as "wallet sciatica" since a fat wallet carried in a rear hip pocket will compress the muscles of the buttocks and sciatic nerve when the bearer sits down. Piriformis Syndrome is often the major cause of sciatica when the nerve root is normal.
Inflammation is characterized by redness and heat due to increased blood flow to the inflamed site; swelling caused by accumulation of fluid; and pain due to release of chemicals involved in the repair process that irritate nerve endings.
This is a complex biological response by the organism in an effort to remove injurious stimuli as well as initiate the healing process for damaged tissue. Inflammation can be classified as either acute or chronic. Acute inflammation is the initial response of the body to harmful stimuli and is achieved by the increased movement of plasma and leukocytes from the blood into the injured tissues. A cascade of biochemical events propagates and matures the inflammatory response, involving the local vascular system, the immune system, and various cells within the injured tissue. This process is initiated by cells already present in all tissues, mainly resident macrophages, dendritic cells, histiocytes, Kuppfer cells and mastocytes.
Prolonged inflammation, known as chronic inflammation, leads to a progressive shift in the type of cells which are present at the site of inflammation and is characterized by simultaneous destruction and healing of the tissue from the inflammatory process.
In the absence of inflammation, damaged cells would never heal and progressive destruction of the tissue would compromise the survival of the organism.
How does Spinal Decompression Treatment help Inflammation?
Spinal Decompression Treatment
How does Spinal Decompression Treatment help Nerve Pain?
There are 7 broad categories of conditions that result in nerve pain (see above.) Of the 7 categories, direct physical pressure (usually referred to as a pinched nerve) is the most common—this is the category that can be helped by spinal decompression therapy.
A nerve that is being pinched is being pinched by an identifiable something. That something is usually a combination of 3 specific identifiable factors listed below:
1.) A bulging or herniated disc that places direct pressure on the nerve.
Spinal Decompression Therapy helps by creating negative pressure (or a vacuum)
within the disc to pull the bulge back inside the disc.
2.) A degenerating disc that is drying out and losing its shock-absorbing properties as well as its actual height resulting in the vertebra becoming closer together, placing direct physical pressure on the nerve.
Spinal Decompression Therapy helps by creating negative pressure (or a vacuum) inside the disc to pull water, oxygen, and nutrients into the disc,
thereby re-hydrating it.
3.) The tissue around a stressed spinal joint is inflamed or swollen putting direct physical pressure against the nerve.
Spinal Decompression Therapy helps by relieving the stress on the joint allowing
the swelling and inflammation to subside.
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