What’s the Cause and What You Can Do About It

Jennifer E. Engen

Back pain is very common, whether it’s a chronic condition as we age or it hits suddenly after improperly straining the spine to pick up something heavy. Whatever the cause – arthritis, spinal stenosis (narrowing around the nerve roots), blunt injury or something else — back pain is one of the most common reasons why Americans over the age of 45 seek medical care, next to the common cold, explains Ronald Tolchin, D.O., medical director of Miami Neuroscience Institute’s Spine Center.

Ronald Tolchin, D.O., medical director of Miami Neuroscience Institute’s Spine Center.

“Back pain can certainly be a warning that there is a problem,” explains Dr. Tolchin. “However, it could also be due to degenerative changes as one ages in the lumbar spine. We do know that the spine will degenerate with age.”

Why does the spine degenerate over time? This has to do with the cartilage between the vertebral bodies wearing out. This cartilage is called an intervertebral disc. It has a component of cartilage around the outside, and a soft gel like material on the inside called the nucleus.

“With time, cartilage dries out and this can cause tears in the outer part of the disk leading to pain,” says Dr. Tolchin. “In addition, it can put more stress on some of the small joints in the back of the spine called facet joints — and cause them to degenerate over time.”

Dr. Tolchin provides more insights into back pain and ways to alleviate or help prevent debilitating discomfort.

What is the best exercise to counteract degenerative changes in the spine as we age?

Dr. Tolchin:

“The best way to counteract some of these changes is to work on the core muscle strength. These are a group of 29 muscles in the front and in the back surrounding the entire spine. These include your abdominal muscles, your back extensor muscles, the pelvic muscles etc. — and these can all take over motion and offload some of the pressure of the spinal elements. You can strengthen these muscles your entire life as opposed to the degenerative changes in the spine which are not reversible.

“It is especially problematic in people that are overweight. They put more stress on the spine, and so the degenerative changes are enhanced in that situation. It is a growing problem as we are living longer in general and there are more arthritic changes as we age. So, we really need to take care of our spine and use appropriate exercise to offset some of the changes that occur with age.”

How debilitating can back pain become — even if the cause of the pain doesn’t require surgical intervention or something extreme?

Dr. Tolchin:

“Back pain can be quite debilitating. It depends on the exact cause of this. For example, herniated discs that cause pressure on the nerve can lead to extreme pain in the lower back, but also radiating pain into the lower extremities — such as burning, tingling, and numbness which can also be very debilitating. It can cause weakness in the lower extremity, and especially in the foot, and make someone prone to falls.

“A fall can lead to other problems such as a hip fracture, depending on the person’s age, or a compression fracture in the spine if someone has osteoporosis as well. Other examples of debilitating back pain occur with the small joints called facet joints. These are small joints that guide motion in the low back and if they are overloaded due to a lack of strong muscles around the spine. They can become quite arthritic and cause debilitating back pain.

“Other examples of debilitating pain can be a condition called spinal stenosis. This is where there is narrowing of the spine around the nerve roots causing pressure due to arthritic changes over time. This usually happens with older adults. Initially, it may start with back pain; however, as the condition worsens individuals have both weakness, fatigue, and sensory loss in the lower extremities which can be profoundly debilitating. “

What are some of the common causes of back pain that readers can try to avoid?

Dr. Tolchin:

“Some common causes of back pain are disc herniation. This is a tear in the outer band of the disc that allows the gel-like material to escape from the confines of the disk and press on the nerve. This can occur for example if someone is lifting more weight than they should, or if they are bending and twisting at the same time while lifting weight.  It can also just happen due to weakness in the outer band of the disc that can occur at any point in time.

“To try to avoid increased stress on the spine, an individual can lift using proper body mechanics and use the leg muscles when they are bending forward for example, such as doing a squat or lunge in order to get down to the ground to pick something up. Also, it is important to avoid bending forward with a round back to decrease the load on the spine. Instead, a flat back position, or the back arched backwards, would use more of the hip joint while bending and can be quite helpful preventing pain in the spine.”

Tags: back pain, Miami Neuroscience Institute, Spine Center


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