Mechanical back pain as above can give pain that extends beyond the back. This is because the spine is very rich in nerves and all structures in the spine have nerves and these nerves can communicate with other nerves and pass the pain along in them to other regions of the body. Pain that is caused by the facet joints, discs and structures surrounding the spine can cause pain that extends into between the shoulder blades, down to the hips, groin and upper leg.

Pain that extends beyond the knee is usually because one of the major nerves that run down the leg is being compressed. This is a different situation to the pain above. The pain caused by mechanical back pain that extends to other parts of the body is called referred pain. Pain that extends beyond the knee is called sciatica and is an indication of impending nerve damage. These large nerves that run down the leg and give sciatica when they are compressed are usually compresses because of a narrowing of the canal in which these nerves run. This can be the main spinal canal or the smaller canals on the side of the vertebrae where the nerves leave the spinal canal. The compression can be caused by a slipped disc or by bony spurs that grow from the vertebrae (osteophytes).

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Back pain – or mechanical back pain, in medical terms is caused by a host of factors. It is mostly due to the joints in your spine, the facet joints. These joints are located on both sided between the vertebrae and carry the weight of the spine along with the discs between the vertebrae. With damage to the discs, the weight is carried mostly by the joints and this can lead to osteoarthritis. This is a wear-and-tear kind of arthritis. Many people are predisposed to this kind of arthritis on a genetic basis. There are other factors such as pain from the discs, ligaments and other structures surrounding the spine that contribute.

The nature of damage to these structures is that the damage and resulting pain is cyclical and fluctuant in nature. As the damage mounts over time, the pain becomes more intense and the periods of pain last longer. Eventually it becomes permanent.

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The symptoms are usually that of leg pain and/or weakness of the legs and unsteadiness when walking and standing. In severe cases bowel and bladder dysfunction might also occur and this is once again an emergency that requires immediate surgery.

Mechanical back pain is usually worse on resting. My patients will frequently tell me that they have pain on sitting and that the pain worsens when they get up, but gets better after walking for a bit. Their pain is frequently worse at night and turning in bed can be quite painful. Getting out of bed is also usually painful. Once again as soon as my patients are fully mobile the pain will settle. Certain movements will elicit the pain and bending forward and especially back wards can worsen the pain. Bending towards one side can also be painful. It is frequent to have hip, buttock, groin and upper leg pain. Some patients report that they can play sport without much discomfort but that they pay the price the following day or later the same day.

This is a condition where the whole spinal canal is narrowed and all the nerve roots that supply the legs and feet are being compressed. This is a slowly progressive condition and results from a combination of factors. It is usually a combination of slipped discs and enlargement of the joints of the back and thickening of the ligaments inside the spinal canal. This can be a hereditary condition but is usually a wear-and-tear age related condition affecting people in their sixth decade and beyond.

Sciatica is when a nerve root that supplies the leg is being compressed. This will lead to pain that extends to beyond the knee. Your healthcare provider will be able to get a good idea which nerve(s) is being compressed by the distribution of the pain. It is a frequent occurrence that the pain is accompanied by a tingling, pins-and-needles type of feeling. When the nerve is severely compressed you may experience weakness in your leg or ankle. At this stage the pain might disappear. This may appear to be a good sign, but rather is an ominous sign that the nerve roots function is so badly affected that the pain carrying function of the nerve no longer functions. A dramatic and extremely dangerous situation is when you start having problems to control your bowel and bladder. This is an emergency situation that requires immediate surgery as you may lose bowel and bladder control permanently if you do not undergo emergency surgery.