Why does my back hurt?

Understanding why your back hurts is the most important thing you can do to help it. With very few exceptions, back pain does not happen because you did something to it. It is not because you are old either. Back and neck pain most often occur because you did not learn how to take care of your spine and keep it in good enough shape to handle what you do to it.

Our spines, just like every other body part, requires some attention to stay healthy. It is not that complicated once you understand some simple anatomy and physiology.

All of us start out in life with a spine, made up of lots of moveable bones (24) with lots of other moveable joints attached to it (72+). These joints are held together with thousands of small, medium and large muscles, tendons and ligaments. These joints (where 2 or more bones connect) provide the potential to move and stay healthy. Motion is essential for joint health. Motion keeps muscles strong and coordinated, stretches tendons and ligaments, pulls nutrition and fluid in and out of the tissues and the disks of the spine (imbibition). A healthy spine is one that has perfect mobility among all of these joints, muscles, tendons and ligaments with perfect balance, range of motion and coordination. In my 22 years of practice, I have never seen a perfect spine.

When any muscle, tendon or ligament gets overstretched either suddenly or slowly over time, a sprain/strain injury will occur. This is what an episode of neck or back pain is. The muscles surrounding this injury will tighten up or spasm to protect it from re-injury much like a splint or a cast. These injuries can be very mild (crick or catch), moderate or severe depending on how much tissue damage occurred. Inflammation (fluid) begins to accumulate in the tissues over 12-72 hours (never apply heat) and then the body begins to heal the tissues injured. This healing process will always involve some amount of fibrotic or scar tissue being laid down. Once the healing process begins, the muscle spasms, inflammation and pain will gradually go away most of the time no matter what you do. This is what at one time was called a "self-limiting" episode of back pain.

Today we know that calling this episode of pain a "self-limiting" condition is wrong. Today this is considered an episode of pain of a chronic degenerative process. The effect of the scar tissue and adhesion's that remain after the episode of pain sets off a cascade of functional problems that spread throughout the spine over time.

Scar tissue will never go away, and since it is dense and fibrous tissue, it will limit the normal motion of the tissues and associated joints. (leave a cast on your elbow for 10 years and see what happens) This abnormal or limited motion is what causes joint degenerative arthritis over time. It is not age-related arthritis. Lost motion over time causes muscles to weaken from lack of use (atrophy), tendons and ligaments tighten and get shorter because they are not stretched out. Fluid turnover in the joint decreases because motion pumps fluid in and out of those tissues. In the spine, the disks will begin to dehydrate and ultimately, the joint will begin to develop bone spurs in an attempt to fuse it together. Use it or lose it. Immobilize any joint in the body and over time, this process will happen. This is a slow, progressive, chronic degenerative process that we do not feel happening over time. See Joint complex dysfunction. This is also described by Chiropractors as Vertebral Subluxation Complex. Also see proprioception to better understand some of this.

The spine is made up of chain of 72+ joints and they all move and contribute to your daily life of walking, sitting, working, sleeping, driving, tying your shoes and brushing your teeth etc. Once one area of your spine goes through this episode, it will no longer participate in these activities normally. The tissues and joints above or below this healed injury will now try to move more to compensate for this lost motion which puts more stress on them. Eventually, these tissues will get a strain/sprain injury and go through the same process. And so goes the life of a spine. Over our lifetime, these "self-limiting" episodes will typically become more frequent and severe as we gradually lose flexibility and motion along this chain of joints. When we are younger, these tissues above and below the injury compensate somewhat successfully until they are damaged, thus we do not notice this gradual loss of flexibility as much. But over time, these repetitive strain/sprain injuries add up, and we wake up one morning when we are 60 and think, what happened to me, I used to be so flexible.

So what to do about this? Just remember move it or lose it. And just like seeing the Dentist or Optometrist, your spine needs to be checked for balance and mobility issues throughout your life. The only Doctor that is trained to identify and treat this pathology is a Chiropractor utilizing Spinal Manipulative Therapy. Chiropractors stretch, move and exercise tissues around joints that you cannot restore normal motion to yourself.

James D. McLelland D.C.
Chiropractor Henrico, VA. 23233
Chiropractic Centers of Short Pump

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