Back Pain – My back has never hurt before – Why now?

Back Pain – My back has never hurt before – Why now?


– So one of the most
common reasons patients come to see me is for back pain. And the second most common
reason is neck pain. Often with arm and leg pain. So one of the most common
things we talk about is why are they having these symptoms? So I like to spend a little
bit of time with patients going over what we call
the pathophysiology or natural history of
degenerative disc disease. Because the primary cause
for back and neck pain and arm and leg pain
essentially is degeneration of the intervertebral disc. And the intervertebral
disc you should think of as the shock absorber in between
the bones of the spine. And as we age most likely, other reasons include trauma and accidents and things like that, and repetitive stresses. But the most common reason for that shock absorber
to degenerate is aging. And as we age the cartilage that fills up that shock absorber space
starts to change its structure. It becomes more dehydrated. The type of collagen
inside the disc changes from one type to another. The ligament that wraps around the bones that keeps that disc material inside where it’s supposed to be over time gets brittle and fractures and gets little tears in them. So this natural process of aging causes this disc or shock absorber to become less functional. Now if you can imagine two bones with a shock absorber in between them, if that shock absorber stops
doing its job very well those bones start to
rub a little bit more. So that level in the spine, for example, let’s say
the four and five bones, that four or five disc starts to wear out, the four or five bones start
to rub a little bit more. The facet joints which are where the bones meet like a shingle
on the roof of a house, in the back part of the spine starts to rub a little bit more. And that initiates a bunch
of changes in the human body. Because there’s excess movement now the bones will respond to
that by growing bone spurs. The bones are a living thing. So to make up for this extra stress and trying to decrease
the amount of movement, the bones will grow these little spurs to increase surface area. The other thing that the body will do to try and decrease movement is it will thicken the ligaments
that keep the bones together. So these structural changes in the spine, the bone spur growth,
the ligaments thickening, the disc material starting to bulge out of where it’s supposed to be, all these things in combination can start to crowd the
space where the nerves live. So as that bone spur grows
into the spinal canal area, the little nerve that lives near there has less and less room to be happy. And over time that nerve can get pinched. That’s when you start
to get the buttock pain, the leg pain, the numbness,
the tingling, the weakness. So the ultimate source
of all these changes and the symptoms that go along with that, is degeneration of the
intervertebral disc, back pain, neck pain, arm pain, leg pain, numbness, tingling, and weakness. And that is the primary cause for wearing out of the joints of the spine and the changes associated with it.

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