Back pain is a very common complaint amongst people of all age groups. It is however more commonplace amongst people in their thirties and onwards. Back pain can be disabling and places a huge burden on the world economy through work-days missed and health care costs.

Back pain is due to degenerative (wear and tear) changes in the spine and is always part of a progressive disease. It means that the underlying problem responsible for back pain will slowly but surely get worse in time.  It is therefore of paramount importance that treatment focuses on supporting the structures of the back and to prevent excessive stress on the spine.

Back pain can be acute or chronic. Chronic back pain is pain that lasts for more than three months.

There are three types of spinal pain:

Mechanical back pain

This is pain that is caused, as the name suggests, by the mechanics of movement. There are muscles, tendons, bones, the discs between the vertebrae, nerves and many other structures that can cause pain. This is all based on inflammation of these structures and the aggravation of this inflammation by movement.

However the main source of mechanical back pain is the joints between the vertebrae called the facet joints. This pain is typically increased by certain movements. Turning in bed and getting out of bed in the morning can be difficult. The pain usually improves with movement, but certain movements like arching your back typically makes it worse. It is frequently associated with referred pain, which is pain that is distant to the site of the inflammation. 

Referred back pain

This is pain that spreads from the inflamed tissues in the lower back along nerves to other parts of the body. This would frequently be the hips, thighs and even between the shoulder blades. This is directly associated with mechanical back pain. It should not be confused with sciatica.

Sciatica (Radicular pain)

This is pain that is caused by a pinched nerve and the pain will travel down the length of the nerve and be severe where the nerve ends up. For instance if the nerve between the fourth vertebrae and the fifth vertebrae is being pinched, the pain will be felt at the ankle and on the top of the foot as this is where the nerve ends up. It is typical that referred pain would spread to the upper leg but that sciatica would spread to beyond the knee. Except for the compression of the nerve root there is usually also inflammatory changes in the nerve root that leads to pain.

A pinched nerve may require surgery. Although surgery is very effective in loosening nerves that are being pinched and fixing unstable areas of the spine, it almost always leads to increased stress on the spine and is thought to speed up the wear and tear of the spine.

The main aim of treating spinal pain should always be to support the normal biological recovery process of the body. Surgery is always the last option and the aim of surgery would be not to offend the normal biomechanical stability of the spine.