Back Pain Causes, Symptoms & Treatments

In the healthy back, there is a disc filled with fluid between each bone (vertebra).  Disc problems can start from over-use, an accident, or just the wear and tear of everyday life and aging.  

Degenerative Disc Disease

When a disc breaks down (degenerates), the disc:

• Loses water. With less water, the disc becomes thinner and has less padding to absorb movement. The disc may become less flexible.
• Shrinks, which can narrow the space available for the nerve roots and spinal cord.
• May have tiny tears or cracks in its outer layer (annulus fibrosus).

As the disc deteriorates, the vertebrae may also begin to break down or touch.  Degenerative disc disease may worsen due to injury, obesity and smoking.

Disc Herniation

When a disc degenerates, the disc’s outer ring (annulus fibrosus) may form tiny tears or cracks. If the outer ring of the disc fully tears or splits, the gel-like center (annulus fibrosus) can squeeze out. Disc herniation, also called a disc bulge or a ruptured disc, shrinks the space between the vertebrae. 

Once the outer ring of the disc has degenerated and cracked, everyday activities can cause the disc’s center to leak out.

Symptoms of Back Pain

Loss of disc height or a disc that bulges beyond its natural location can put pressure on nerve roots and the spinal cord.  Depending on the amount of damage, patients with diseased discs experience varied levels of pain, less motion, numbness, and weakness in the neck, shoulders, arms, hands or legs.

More specifically, the:

• Spinal canal can narrow and pinch the cord and nerves (spinal canal stenosis).
• Spinal cord can be irritated causing a loss of feeling or movement (myelopathy).
• Nerve roots can be irritated or pinched causing pain, weakness, or tingling down the arm or legs and  possibly into the hands and feet (radiculopathy).

Not all disc degeneration or disc herniation results in pain or lack of mobility.

Back Pain Diagnosis

Using the type and location of pain as a reference, your doctor will perform a physical examination. The exam checks for the range of motion and strength in your neck, arms, and/or legs. Your doctor may also order images of your back: x-ray, MRI, or CT scan.  In the images, your doctor will look for thinning discs, unhealthy bone growth, and pinching of nerve roots and spinal cord.

Back Pain Treatment

Unless a nerve or the spinal cord is severely pinched, conservative treatment is usually the first choice in the care of degenerative disc disease. Your doctor may suggest physical therapy, rest, anti-inflammatory medications, exercise, heat, and lifestyle changes.

If conservative care does not help, if a nerve is pinched (compressed), or if the pain is severe, your doctor may recommend surgery.  Some patients have worsening weakness in the arms and or legs, where having surgery sooner can be beneficial. In some cases, if there is no surgical intervention, permanent nerve damage can occur.