The Spine and Lower Back Pain
90The 4 Spinal Curves
The Spine
The spine is made up of 33 vertebrae separated by 23 intervertebral disks. Vertebrae are named based on the region where they are located. Cervical vertebrae are located in the neck, Thoracic vertebrae attach to the ribs, and Lumbar vertebrae are found in the lower back just above the sacrum. There are 7 cervical vertebrae, 12 thoracic, and 5 lumbar. A simple saying will help you remember how many are in each region. "Breakfast at 7, Lunch at 12, Dinner at 5." Those who have already done the math recognize 7 + 12 + 5 = 24. The sacrum, just below the lumbar vertebrae, and the coccyx, or tail bone, become fused as we age. Originally the sacrum is comprised of 5 bones and the coccyx 4, hence 24 + 9 = 33.
When we are born our spine has 1 curve. Learning to lift our heads and crawl we begin to develop the anterior curve of the cervical spine. As we begin to stand and walk the anterior lumbar curve develops. The curves of the spine are very important. A curved spine can support 10 times more weight than a straight spine.1
Spinal Mechanics
Vertebral Movement
The vertebral disks act as natural shock absorbers and provide space between the vertebrae. Looking at the image on the right you will see a few things. Notice that when the top vertebrae moves forward the disk below it moves to the back. The opposite is true when the top vertebrae moves back the disk material is pushed forward. Also notice the facet joints highlighted by the black arrows. These are smooth bony surfaces that glide over each other during spinal movement. If a disk is compressed the distance between the vertebrae is reduced and the facet joints will have limited mobility, especially on extension, or bending backwards.
Spinal Nerves
In the figure above notice the hole just in front of the facet joint. This is where the spinal nerves branch out from the spinal cord. If the vertebrae are not aligned properly the spinal nerve will be pinched on one side or both. Not only do these nerves control muscles they also ensure proper functioning of organs.
Back in the 1920s, Dr. Windsor, a doctor of medicine from the University of Pennsylvania, was interested to find out if there was a correlation between curvatures in the spinal column (meaning, bones in the spine out of place) and diseased organs. To investigate this theory, Dr. Windsor examined fifty cadavers from the pathology department to search for unhealthy organs. In the fifty cadavers, he uncovered 139 infected organs, such as hearts, livers and gall bladders, in different phases of sickness. Next, Dr. Windsor studied the nerves from the affected organs and traced them back to the spine.
The discovery by Dr. Windsor was amazing! In all of the cadavers, there existed a misalignment of the curvature in the spine, which was directly connected to the nerves leading to the unhealthy organs.2
From top to bottom different regions of the spine control different organs. These nerves are part of the autonomic nervous system, the "automatic" nervous system. The signals they send to the brain and spinal cord, the central nervous system (CNS), are interpreted. When the information has been processed the CNS sends a message back to the organs resulting in a metabolic change. So, if the spinal nerves are pinched the communication between the organs and CNS is diminished. Typically people associate pinched nerves with excruciating pain. In many cases that is true, but there are varying degrees of nerve compression. A nerve can be slightly compressed and not produce any pain symptoms. For a visual demonstration of spinal mechanics the video below demonstrates movement in the lumbar spine.
Mechanics of The Lumbar Spine
Lumbar Lordosis
Lower Back Pain
At any given time 2-5% of the world's population suffers from lower back pain. 3 In some cases the pain is only musculoskeletal. In these instances the bones and muscles are out of proper alignment so they have to work harder than normal. There is a phenomena in the body called the pain-spasm-pain cycle. It works as a protective mechanism, but if it is not addressed it leads to further problems. Whenever an area of the body is injured or in pain the body will tighten the muscles in that area to prevent further damage. Although this helps reduce the pain, the tight area begins to affect surrounding muscles and tissues not originally involved.
Herniated Disk and Sciatica
Bulging and Herniated Disks
More serious forms of back pain include bulging and herniated disks. Remember how the disk material moves posteriorly, towards the back of the body, when the spine bends forward? This is why lifting with your legs instead of your back is so important. A disk that is bulging or herniated posteriorly can press on the spinal nerves and or the spinal cord.
A disk that presses on a spinal nerve between the 4th and 5th lumbar vertebrae can cause sciatica. Symptoms of sciatica include pain in the lower back, weakness in the legs, and pain and tingling down the leg.
However, the symptoms of sciatica can also be caused by gluteal muscles. Specifically, the piriformis muscle. For some of the population the sciatic nerve runs under the muscle and in others the nerve runs through the belly of the muscle. Genetics determine where the nerve is located in relation to the muscle. This is one of the reasons why gluteal massage is so important for back health. The forces generated by every step we take are transferred through the pelvis to the back. If the pelvis and legs aren't happy it is virtually impossible for the back to be happy. Without a proper foundation muscle asymmetries will develop leading to back pain.
Lower Cross Syndrome
Muscle Asymmetries of Lordosis
When the muscles of the lower body create an anteriorly tilted pelvis it is referred to as the lower cross syndrome. Drawing an imaginary line from the weakened gluteals to the weakened abdominals creates half of the cross. Connecting the shortened iliopsoas with the shortened erector spinae makes the other half of the cross. This is a very common muscle imbalance that is the source of most back pain. Many people view their body as separate parts which are not related to anything else. In the case of lower back pain it does not occur to most of us that our stomach is the front of the lower back. Pregnant women are the perfect example of this muscle asymmetry and lower back pain. Not only does the weight of the baby pull the spine forward the abdominal muscles also become stretched and weakened. Since there aren't many people over 25 with abdominals toned to a six-pack it is easy to understand why so many suffer from lower back pain.
If we could travel back in time I'm sure we would notice that cavemen didn't sit behind desks 40 hours a week. Our brains continuously monitor muscle tension. While sitting for extended periods of time the brain detects too much slack in the quadriceps, front of the thigh, muscles. When the front of the thigh muscles are short and tight they pull the pelvis down in the front. This causes the back of the pelvis to move up towards the spine creating lordosis. One would think that if the pelvis is tilted forward then the upper body should be tilted forward as well. Looking around it is pretty rare to see people walking around bent forward at the waist. The brain also works to keep the eyes level with the horizon. So as the pelvis is tilted forward the brain shortens the muscles in the lower back to bring the torso upright.
Restoring Balance
If you have been diagnosed with lordosis there are a few steps you can take to help prevent further low back pain. Strengthening the weak abdominal, gluteal, and hamstring (back of the thigh) will help even out muscle asymmetries.
Massage can also be an excellent tool to aid in lengthening the shortened quadriceps and lower back muscles. As the shortened muscles are lengthened the pelvis can begin to rotate posteriorly. Look for a therapist who performs myofascial release. It's a gentle technique that addresses the connective tissue, fascia, of the muscles. Fascia can be thought of as pantyhose surrounding a muscle. If the pantyhose are pulled tight it is virtually impossible for the muscle to occupy its optimal form and function.
Chiropractic work can also aid in proper spinal alignment. In my professional experience chiropractic and massage therapy work very well together. Since the muscles hold the bones in place, chiropractic adjustments are usually more productive after the muscles and fascia have been released.
Related Hubs
- Preventing and Understanding Lower Back Pain
What do do about back pain? When to get medical help for back pain? What causes lower back pain? This hub on preventing lower back pain answers those questions and more. - Back Pain, 4 Unusual Causes of Backache
Find 4 reasons for your backaches, back-pain, or back discomfort. Learn how to appreciate and keep your spine healthy and long lived. - Common Causes of Neck Pain
Common causes of neck pain are all related to a forward head posture. Office work, hobbies, sleep, and the brain all have the potential to create muscle asymmetry leading to neck pain.
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Outstanding Jennifer!!! Back pain has got to be the worse pain. Correct posture is so important. Voted UP and pimped! Well done!!
What a great hub!! This was a really clear explanation of the spine and about misalignment--great job!
Excellent Jennifer - not only is the information interesting but it looks beautiful!! Very well written!
Thanks dear for such an informative article.
Well done and crafted! Very helpful information!
This hub is chock full of very important and useful information. I have a small, unhealed fracture on my L5S1. I'm told this is a very common area for all sorts of back problems for adults, and I have to concur on that: a friend has an injury there that will spasm and weaken the legs; my younger brother has a bulging disk in this area. You did great in pointing out that muscle weakness is closely related to back health and support. We often forget that our stomach muscles especially act as a "girdle" to support us. This is called our "core" and it's important to keep it strong. Thanks for all the information and pictures you put in this hub; excellent work!
Well written and illustrated hub, Jennifer! Thanks for sharing all this information. Voted up!
Many thanks to everyone for sharing your thoughts and time. I have all 3 of the exaggerated curves a person can have so I'm no stranger to back pain myself. In the future I hope the medical and insurance communities begin to give massage therapy more value than they currently do.
You put a lot of time and effort into this Hub. Lots of good info here. I've never had back pain, fortunately. I know it effects a lot of people though. My daughter recently bought a Back2Life and is getting relief from that machine. I even wrote a Hub about her experience. Thanks for sharing all this good info.
I haven't heard about Back2Life. I'll have to check out your Hub. Thank you for sharing your time and thoughts : )
Well written, indeed! I know all about back pain first hand, and second hand.
I have used chiropractic, and still do now and then, but I usually only go in for a fix if the pain gets too severe. It is just not in my budget; my so-called health care does not cover it, and my priorities are first a roof over my head and my utilities. After that, there is no money leftover for the chiropractor.
My husband was in a racing accident back in the mid 1970's, and has no discs at all between L-1 and L-5; it's bone-on-bone, so he is in constant pain, and there is nothing at all that can be done to fix missing discs.
I do believe in the concept of chiropractic, so I've voted this up, interesting, useful and awesome, because it is so well done.
Fantastic hub - I had no idea that the curvatures in the spine don't begin until we start to lift our heads and crawl. Myofascial release is one of few modalities that have helped my back pain and your pantyhose analogy was a perfect description. Voted up!
DzyMsLizzy - Thank you so very much for your kind words. I'm sorry your healthcare doesn't cover preventative care. Sadly not many insurers do. Your husband must be in excruciating pain since his vertebrae are rubbing against each other. I feel for the both of you. Thank you again for your kind words and sharing your time.
hush4444 - I've heard that some studies show that if a baby skips any of the stages or doesn't spend enough time in each of them it affects their spine into adulthood. Here is a link to a more in depth explanation: http://www.florencefamilychiro.com/child-developme
Myofascial release was the one technique I always told my students to master. A few slow fascial strokes are better than 100 fast and/or deep strokes.
Thank you for the vote!
Well written and quite resourceful. There is so much I learned about back pain from reading this article.
cr00059n - I hope reading this article has alleviated some of the back pain mystery. Thanks for stopping by and sharing your thoughts : )
An excellent hub!
This is so helpful and I learned so much.
Very helpful and especially timely article for me although my eyes have glazed over in understanding much of it. Currently have had excruciating almost non-stop pain for over two months and even though MRIs show bulging disc it finally took an ER doctor to diagnose what was going on even though Orthopedic, Oncologist, and Radiologist specialists had seen all the CTs and MRIs. Still trying to get into to see a doctor I was referred to at the spine and sports medicine clinic. Thanks again for sharing such important information. GClark
Now I understand why my back has problems sometimes. Voting this Up and Interesting.
GClark - I hope you get to feeling better soon. It amazes me sometimes how many medical professionals it takes sometimes to figure things out. I'm hoping this helps you understand whatever they're telling you.
alocsin and SanneL - I am very happy my writing helped you both to learn something new. After I completed my massage training I was amazed at how little the K-12 education system teaches us about our own body.
Many thanks to everyone for stopping by to share your thoughts and time : )
Hi, that was amazing and detailed, I never really thought about the fact that the spine would effect the nerves and therefore cause illness in the heart, liver etc, all of the insides, my brother has a bad back and is always complaining of different parts of his body hurting, I will definitely show him this, great stuff! cheers nell
Reading this Hub reminds me to remember to sit up straight and watch my posture. The problem is that modern society has us sitting too much (which I think is bad of the back and posture).
Thank you Nell, I hope this helps your brother find a way to feel better.
Wonderful hub with lots of good information. Voted up and useful. Thanks for sharing.
Great hub. I suffer from lower constant back pain. as a result of a car accident, I have two bulging discs in my neck and two torn discs, one being in the L5 that sits on the tailbone area. I broke my tailbone when I was thirteen, so I already had problems there. I cannot sit or stand for long periods of time. I also developed Fibromalgia, which means a massage is impossible for me.
I haven't been checked for it yet, but after reading an booklet that John Hopkins put out, I believe I have a bone spur in my lower back. I have them in my knees and one foot.
Great Hub, voted up and shared everywhere I could
My mom used to go see her chiropractor when her asthma was bad. He would fix her right up. She would quit suffering from it. Another time, her back was hurting, so she went in and he fixed her tonsillitis. Maybe that is why so many in my family don't have problems with tonsils. That would be a lot cheaper than having them taken out after suffering through many infections. Unfortunately, they are not considered "REAL" Dr. The insurance companies need to study this hub to find out how necessary they really are.
Becky, Minds Eye53, and tarajeyaram,
Many thanks to all of you for voting and sharing your personal experiences. Our "healthcare" system truly needs an overhaul. I put healthcare in quotes because I think it is designed to keep us sick. If people were well the pharmaceutical and insurance companies couldn't profit off of our disease. Perhaps that should be a blog for another day : )
Great hub! Lots of information here! I am in constant pain concerning my back. When I was 14 I shattered L3 in a farm accident. L2-L4 are now fused together with a bone graph from my hip. The fusion sits at a slight angle so it slips sometimes and pinches the spine above and below the fusion. Also because of the accident, I developed traumatic arthritis in my back which was diagnosed at 18. Now that I am 52, many normal aches and pains are further aggravated because of these issues. Back pain I know intimately...
Thanks for this very graphic lesson. The pinched nerve seems to be very common among back pain sufferers. This information is very useful.
....I bet you Jennifer that every person here in the comment section has suffered at least one time from a back ailment - my latest I believe was not sitting on a proper computer chair in front of you know what (go ahead call me a silly man - I deserve it - lol) and then when my neighbor came to my rescue with an honest to goodness office swivel chair - my cat took over and made it his new home - (not the one in the picture but another cat I have - Mister Gabriel) .....so here I sit writing to you and quite happily I might add with lap top literally on my lap ..... lol lol
and my back pain has gone away thankfully but during that troubled time they literally had to send me home from work one night because I was so badly bent over and couldn't straighten up.
You write like an expert and I am so proud of you for doing so because you put this hub together in a very enlightening and educational way .......
lake erie time ontario canada 10:43pm
epigramman, thank you so much for your kind words. They are truly heart felt. Although my back is as crooked as a politician I have to admit that I don't always take my own advice. Somehow spending my days chasing a toddler leaves little time for yoga classes and massage.
MsDora - Pinched nerves are very common, especially in the lower back. Most of us have a forward tilted pelvis which encourages the problem.
homesteadbound - I am no medical professional, but one of the benefits to taking fish oil is a reduction in overall inflammation. I buy the burpless capsules and I definitely notice a difference in my back pain. Plus it's good for the skin, brain, heart...essentially everything. Hoping you find a source to reduce your pain.
Thanks for the information. Long hours huddled in front of computer is making us prone to this lifestyle disease. Though preventable, majority of us are ignoring it to suffer later. Educating people is an excellent preventive. And, you have done a very good job at it.
Thank you hoteltravel : ) I'm one of the guilty ones as I sit here on the couch with a laptop in my lap. Horrible Hubbing position but the blanket is warm .
I feel laptop is a major culprit in triggering back pain. The old-style PC on a proper table designed for it will help in reducing the occurrence. But convenience always wins. Or at least until pain is unbearable!
Thank you very much for sharing an information about spine and lower back pain.
This is a wonderful Hub. Both my husband and myself have had lower back surgery a month apart from each other. I had a bulging disk and he had a degenerated disk. I was very glad to see you letting people know the importance of building the supporting muscles to avoid and/or help control lower back pain. I can always tell when I have been slacking on my core workouts because my back gets really iffy and often feels like just one wrong move will send it in a tail spin...ha! get it? tail spin? Cracking myself up over here. At any rate this was a very informative hub one that I am looking forward to showing my Hubbs when he gets home. Thanks for writing this.
FrugalandFab - You crack me up with your tail spin. LOL! Preventing back pain is definitely the way to go if at all possible.
wmhseo - You are very welcome : ) I hope this Hub helps you keep your back in shape.
hoteltravel - yes a proper desk is the best position to work at if it is set up correctly
thanks for helping us understand low back pain. Interesting Hub.
This is very useful and informative article. I'm going to share this with my father. He is suffering from spine and back pain for long time. He does yoga to ease the pain and this really helps him.
cancer guru - It's my pleasure. This is what I taught for a long time so I figure I might as well share it.
Vinaya - Yoga helps my back tremendously. I especially like Bikram but I'll also pop in a DVD at home from time to time. I hope your father maintains his wellness. I'm beginning to learn about the aches and pains associated with age. Thanks for stopping by : )
Very informative and helpful Hub, The graphics are terrific. Nice work. Up , Useful, and Interesting. :)
Thanks for this great and informative hub. Well done;-)
Very informative hub on back pain. I'll bookmark this and come back to it in a couple years lol.
phdast7, Thelma, and roosterbob -
Thank you very much for voting and sharing your compliments : )
This was a useful read and very informative. I had back trouble for years until I found an osteopathy and a great practitioner. I have been pain free for years.
Great advice and illustrations.
Voted up.
molometer - Good for you for finding an osteopath who has helped you remain pain free. I love ostepath's and wish more of the medical community viewed the body the way they do. Thank you for voting and sharing your thoughts.
Well written article Jennifer! For the past few months, I have had numbness in my right hand that doesn't go away. I've been to a chiropractor a couple times but can't continue because of the cost. He did tell me that it is attributed to my upper spine and how I sit at the computer, using the mouse all day. I've tried to re-position myself adding pillows to my chair, etc. But it hasn't changed. Right now, I'm just living with the numbness because I'd be even worse if I had to go through computer withdrawal :) Thank you, I learned a lot from your informative hub!
Sharyn
Sharyn-The very first question I ask people with numbness in their hand is: "do you feel it in all of your fingers?". If you only feel the numbness in a few fingers it may be carpal tunnel syndrome which is caused by tight forearm muscles. A student of mine had numbness in her whole hand but when she bent her head to the same side the numbness went away. Typically if the problem is in the spine that would aggravate the sensation. In her case the nerve was trapped in her upper shoulder muscle and wasn't a spine issue. I hope you get to feeling better soon. At least it hasn't affected your ability to type : )
Hi Jennifer,
Thanks, the numbness is only in three fingers, constant, never goes away and sometimes seems worse. What you said here really makes sense. The chiropractor did some x-rays and he was surprised that my spine was in pretty good shape. I told him that I thought it originated in my shoulder. And yet he set up this plan for me with a series of many appointments that would have cost me over $400. I just couldn't do it. Although I think he would have "made me feel better" - I'm not sure he could have helped with this. It certainly did not help the few times I did go. It does affect my typing yet I am so used to it now. Thanks for the info. I need to get checked for carpal tunnel. Sucks when you don't have insurance.
Sharyn
Sharyn, I have carpal tunnel and it sounds like that.
Sharyn If it is your thumb, index, and middle finger it sounds like carpal tunnel. Sometimes the ring finger is numb too. Massage is your best bet. Look for someone who does myofascial release. You can request a 30 min session just on your arm. Make sure they don't work too deep for that long. Therapists like to trade services. Maybe you could write something in exchange for massage :) School clinics also offer discounted massage.
OMG, I'm telling the world my problems here on HP, ha.
Thank you Jennifer for your feedback. It is NOT the fingers you suggest. It is my right hand, middle, ring and pinky fingers. My thumb and index finger are just fine. Ugh, now what? I love your suggestions about bartering and also massage schools. I will have to check it out. Thank you so much for your help.
Sharyn
If it is the middle, ring, and pinky finger then it is probably because your ulnar nerve is trapped. Here is an image I found that shows the areas of the hand affected by the different nerves. http://images.emedicinehealth.com/images/healthwis
They make arm massagers for massage therapists. Basically it clamps to a table and you slide your arm between 2 rollers. I've never tried one but it's an idea. I usually massage my forearm with the opposite forearm. It's kind of awkward but it saves using your hand and tightening the muscles in the other arm. There is an awesome stretch for the forearm and connective tissue. It can be intense so follow the steps until you feel gentle tension. Put your hand on the wall shoulder level and spread your fingers. Turn your body so that your arm is stretched out to your side with your hand on the wall. Now, turn your head and look away from the wall. The longer you hold it the more the tissues will begin to soften. You'll get better results with a longer stretch time than you will if you try to force it. I'd say hold it 90 sec to 2 min. You can also try alternating 10 minutes of ice with 10 min of heat back and forth for an hour on both sides of your forearm. A zip-loc bag filled with water and a splash of alcohol won't freeze solid. Hope you're feeling better soon. My next Hub is going to be about Carpal Tunnel. Thanks for the idea : )
Jennifer,
I really, really, really appreciate all this advice and time you've put in to helping me. I really do need to do something about it and have just been living with it. I'll let you know how it all works out. Thank you SO much. Looking forward to your next hub . . .
Sharyn
Very helpful hub loaded with information on lower back pain. Sitting on the chair whole day as a freelance writer gives me lower back pain. Voted up
freelanceauthor, I'm sorry to hear about your back pain but it is very common for those of us who sit behind a computer all day. Thank you for sharing your story and voting : )
VeronicaFarkas Level 5 Commenter 4 months ago
Great hub! You crafted it well; in a way that is easy to understand and follow.
I manage a chiropractic office, and we have 10 LMT's just in my office (there are 3 offices total). I'd love to see more hubs on this subject!
I agree w/ you 100% that chiropractic care & massage go hand-in-hand, and -together- do wonders!
"You only get one spine!" =] hehe