Anatomy of the Spine
To understand the causes and treatments of back pain, you must first understand the anatomy of the spine. The spine is a column of bony vertebrae with a hollow tube, or spinal canal, in the center. The spinal canal houses and protects the spinal cord, a bundle of nerves and tissue, which connects almost every part of the body to the brain, where it forms the central nervous system. The individual vertebrae are separated by vertebral discs, which act as shock-absorbers. The discs are round and somewhat soft, to allow for movement. They have a tough exterior, called the annulus, with a soft, jelly-like inside. When a back muscle or disc is pulled out of place and irritating one of these nerves, it can send pain, numbness or weakness anywhere on the body.
What is a spinal disc?
The anatomy of the spine consist of the bony vertebrae (with the hollow spinal canal inside), the spinal cord and nerves (housed and protected by the spinal canal) and the shock-absorbing spinal discs. The discs lie between each vertebrae to provide a cushioning and flexible barrier, to prevent two vertebrae from rubbing against each other. These spinal discs consist of a soft, jelly-like interior with a tough but flexible exterior, called the annulus.
A bulging disc is a spinal disc that is being pushed out of its place between two vertebrae. It is literally bulging out of the side of the spine.
A herniated disc is a spinal disc which ruptures, allowing the soft, jelly-like center to push out through a crack in the exterior of the disc.
Both of these conditions cause pain when the disc irritates nearby nerves. Because the spinal cord and nerves connect the brain to the rest of the body, irritating these nerves that run along the spine can cause pain, tingling, numbness or weakness anywhere else on the body.
What causes bulging or herniated discs?
Both bulging and herniated discs are most commonly caused by aging. Over time, the spinal discs lose some of their water content, making them more brittle, less flexible, flatter and more prone to damage. When this happens, it does not take much to rupture a disc or pull it out of place. A small trauma, tight muscles around the spine or improper lifting stance can be enough.
Other common causes of bulging and herniated discs include:
- Excessive body weight
- Genetics (a predisposition to a weakened or misshapen discs can be inherited)
- Repetitive movements, such as lifting, bending, standing, and driving
What are the symptoms of bulging or herniated discs?
The most common symptoms of bulging or herniated discs are weakness, numbness, tingling or shooting/stabbing pain in one or both arms and/or legs. Generally, if the problematic disc is in the lower back, the pain or numbness will be in the legs, buttocks or feet.
What is pyriformis syndrome?
Pyriformis syndrome is a condition in which the pyriformis muscles spasms, causing pain and possibly irritating the sciatic nerve, causing sciatica. The pyriformis muscle is located in the buttock, behind the gluteus maximus.
The pyriformis muscle, beginning at the base of the spine and connecting to each femur (thighbone), stabilizes the hip joint and helps to rotate the thigh outward, away from the body. It is vital to the majority of lower body movement, including walking, shifting our weight and keeping our balance.
What are the symptoms of pyriformis syndrome?
Symptoms may come and go depending on level and type of activity, but they commonly include:
- Pain, numbness or tingling in the buttocks
- Sciatica (shooting pain beginning in lower back and extending down one or, possibly both, legs)
- Pain that is triggered when sitting for long periods, climbing stairs, or putting direct pressure on the pyriformis muscle
What causes pyriformis syndrome?
Pyriformis syndrome is usually caused by repetitive stress motion on the muscle, such as running. It can also be caused by overuse of the muscles in the hip region, poor body mechanics and posture and an abnormal gait.
What is a leg discrepancy?
A leg length discrepancy is just what it sounds like—a discrepancy in the length of the two legs. The difference can be anywhere from one cm, which generally causes no problems, to more than six cm. The larger the discrepancy, the more the body has to compensate for it in gait, posture and motion. There are two kinds of discrepancies- structural and functional. A structural discrepancy refers to the actual tibia (shin bone) or femur (thigh bone) being longer in one leg. A functional discrepancy occurs when the legs are the same length but an issue somewhere else on the body gives the appearance of different lengths. For example, a condition called developmental dislocation of the hip causes the femur to be improperly positioned in the hip socket, causing it to hang lower than the other leg.
With either type of discrepancy, patients tend to compensate, often unknowingly, which can lead to other problems.
Those with a leg length discrepancy will often have a pelvic tilt, as well. A pelvic tilt is the orientation of the pelvis in respect to the femur.
At the Magaziner Center, Dr. Greenberg will evaluate each patient for a pelvic tilt / functional leg length discrepancy. This tilt, which is acquired, not congenital, can cause joint dysfunction in the spine, sacroiliac joint, hips, pyriformis, knees, and ankles, and can contribute to limping. Dr. Greenberg pioneered a highly successful treatment for pelvic tilt in 1999 that has stood the test of time and leads to remarkable results.
What causes functional leg length discrepancy?
Functional discrepancies are generally caused by one of two conditions: an upslip (one half of the pelvic bone moving upward, in relation to the other side) or an anterior rotation (one half of the pelvic bone rotating forward in relation to the other side). Both of these conditions are very common among athletes. This can happen from something simple such as improper lifting, bad posture, etc. It can also come from weakness in the ligament structures lower back, hip and foot.
What are the symptoms?
The symptoms of discrepancies can vary greatly, depending on the type and cause of the condition. There are, however, some signs or symptoms that are common to all types and causes, and result from living with one longer leg and compensating for the shorter leg and misaligned center of gravity. These include:
What is the sciatica?
Sciatica is a condition in which the sciatic nerve in the lower back is being compressed, causing pain which originates just above the buttocks and shoots down the back of the leg. The sciatic nerve is the largest nerve in the body and sciatica can be extremely painful.
What causes sciatica?
Sciatica can be caused by a number of conditions. Often, something as simple as muscle tension can result in compression of the sciatic nerve. When the muscles in the back become tense, due to mental stress, physical activity or any number of causes, they can be pulled out of place. This will often result in the compression of nerves that the muscle would not normally be in contact with.
Other common causes include:
- Herniated discs
- Degenerative disc disease
- Lumbar spinal stenosis
- Pyriformis syndrome
- Sacroiliac Joint (SI joint) Dysfunction
What are the symptoms of sciatica?
• Shooting pain that originates in the buttocks or low back and runs down the back of the leg (may even continue into the calf and foot)
• Pain in the lower back (not always experienced, and generally not as severe as the leg pain)
• Pain worsens when standing or sitting
• Tingling, numbness or weakness in the leg
What is sacroiliac joint dysfunction?
Sacroiliac joint (SI joint) dysfunction is a condition which refers to abnormal movement by the SI joint, causing inflammation and pain. The SI joint generally moves very little, and SI joint dysfunction can refer to either too much or too little movement.
The SI joint connects the sacrum with the pelvis, at the iliac crest, hence the name. It acts as a shock absorbing structure, preventing the impact forces of the lower body from reaching the spine. It also transfers the weight and movement forces from the upper body to the pelvis and legs.
What causes SI joint dysfunction?
The most common cause of SI joint dysfunction is osteoarthritis or degenerative arthritis. The SI joint is covered by a thin layer of cartilage which acts as a shock absorber and allows for limited motion. Dysfunction occurs when this cartilage gets damaged or worn away. The bones of the joint begin to rub against each other, causing osteoarthritis.
Other common causes include:
- Leg length discrepancy
- Altered gait due to pain or weakness in leg, foot, hip, back
- Ankylosing spondylitis
- Any form of arthritis or other condition affecting the joints
- Obesity, due to excess weight on the SI joint
What are the symptoms of sacroiliac joint dysfunction?
- Pain in the lower back (below the L5 vertebrae), buttock, hip or groin area
- Pain, numbness, weakness or tingling sensation in the lower extremities
- Pain upon standing
- Instability of the legs
- Inability to sit for long periods without pain
What is degenerative disc disease?
Degenerative disc disease refers to the pain, weakness, numbness and other symptoms associated with the degeneration of spinal discs. All of us experience some degree of disc degeneration as we age, but not all of have the symptoms. For most of us, gradual degeneration poses no problem and is just an accepted part of the aging process. For others, however, this can result in pain, sometimes sever and debilitating.
What causes degenerative disc disease?
As we age, our spinal discs begin to deteriorate. They begin to accumulate tiny cracks in the annulus (outside layer) and become drier, causing them to become less flexible, thinner and less able to absorb shock. As the discs become thinner, the space between the vertebrae shrink, causing bone spurs on the spine. These bony growths can put pressure on the nerves or the spinal cord and cause pain.
This is more likely to occur in the obese and those who do repetitive, heavy, manual labor. An injury may also begin or worsen the degeneration process.
What are the symptoms of degenerative disc disease?
- Pain that spikes during physical activity
- Periods of severe pain that can last from days to months
- Pain when bending, lifting and twisting
- Walking or running may provide relief
What is spinal stenosis?
Spinal stenosis is a narrowing of the spinal vertebrae. The spine contains a hollow column, the spinal canal, which houses the spinal cord and nerves. Spinal stenosis causes this hollow area to shrink, putting pressure on the spinal cord and nerves within.
What causes spinal stenosis?
Spinal stenosis can have several different causes, including:
- Tumors of the spine
- Genetics—if the spine is too small or if there is a structural deformity present at birth, spinal stenosis can appear at a young age.)
- Spondylolisthesis—One vertebrae sliding forward over the one below it can narrow the spinal
What are the symptoms of spinal stenosis?
- Pain in the neck or back
- Problems with the feet
- Pain radiating down the legs
- Numbness, weakness, cramping or pain in the extremities
What is spondylolisthesis?
Spondylolisthesis is a condition, generally occurring in the lower spine, in which one vertebrae slides forward, ending up out of place in relation to the vertebrae below it.
There are small joints that connect the vertebrae to one another, keeping them aligned while still allowing movement. When there is a problem or deformation with one or more of these small joints, the vertebrae are not held in place properly. This allows the vertebrae to slide forward. If it moves too far, it can hit a nerve and cause pain.
What causes spondylolisthesis?
There are many possible causes of spondylolisthesis. Some of these include:
- A damaged vertebral joint (caused by infection, injury or arthritis)
- A congenital defect of the vertebral joints
- Accident or trauma to the spine
- Stress fractures of the spine
- Rapid growth during adolescence
What are the symptoms of spondylolisthesis?
- Pain that originates in the lower back and runs down one or both legs
- Back pain/ lower back pain/ buttock pain
- Trouble walking or standing
- Pain upon bending over or twisting at the waist
- Weakness and/or numbness in the legs
- Rarely, incontinence
Traditional Western medicine will generally treat back pain with medication — typically nonsteroidal anti-inflammatory drugs (NSAIDs)– physical therapy and possibly surgery. NSAIDs have powerful side effects and can cause secondary issues, such as stomach problems, including bleeding and ulcer, abdominal pain, fluid retention, kidney problems, heart problems, rashes and more. In fact, NSAIDs have recently been found to be more dangerous than previously thought. The FDA is now strengthening their warning that even the over-the-counter strengths can cause heart attacks or strokes. This course of treatment puts patients on a fast track to ever increasing doses of an ever increasing potency anti-inflammatories and pain-killers.
Spinal surgery is extremely risky, has a long recovery time and there is no guarantee that it will fix the problem. We see many patients who have had surgery and still experience severe pain regularly.
For the most part, medication is prescribed simply to suppress the symptoms, not to cure the injury or condition. Oftentimes, it can actually prevent the body from healing properly, by suppressing its natural responses, such as inflammation, which triggers the healing process. The symptoms associated with an injury or condition are the body’s way of letting us know that something is wrong. By suppressing these signals, but not working to fix the problem, we can actually do more harm than good. Medication also has plenty of risks, including side effects, addiction and the need for increasing doses, as it inevitably loses effectiveness as your body grown accustomed to it and builds a ‘tolerance’.
When back pain (or any joint pain) is treated with a pain killer or anti-inflammatory drug, the patient may feel some relief, because the symptoms are being suppressed. This is not a solution, however, because it is not fixing the cause of the pain. Inflammation is not the cause of the pain, it is the body’s natural response to injury and the trigger for it to begin the healing process. By suppressing the inflammation, these drugs are preventing the body from to healing itself. Painkillers are simply numbing the pain that results from the injury. If the injury is not treated, it may never properly heal and can even get worse as time goes on. Many of our patients have been on ascending does of pain medication for years, with no end in sight.
At the Magaziner Center for Wellness, we treat back pain holistically–by learning where the problem originated and working to heal it.
Using prolotherapy, Prolozone®, platelet rich plasma (PRP) and stem cell therapy, we accelerate and enhance the body’s natural healing process. We see many patients who have already been through the gamut of traditional medicine and have not found relief. Many people who have had no success with treatments such as surgery, nerve block, epidurals and steroid injections, trigger point injections, chiropractic therapy, acupuncture and more, find relief for the first time after receiving treatment at the Magaziner Center. With no side effects, downtime or surgery, we have gotten patients off of medication, helped them to avoid surgery and gotten them back to their lives.
*The treatment that we will recommend depends on the type and severity of the injury or condition. Call 856-424-8222 or email to schedule a consultation and learn about the options that are right for you.