The spine is a highly complex mechanism of bones, joints, muscles, ligaments, and nerves that work together in a beautifully integrated way. It bears the weight of our body and supports our arm and leg movement. It protects the spinal cord and nerves that connect our brain to every other part of our body, and contributes significantly to balance and coordination. Like links in a chain, each vertebral segment of the spine moves in relation to the segments above and below. Yet, an imbalance in this complex mechanism of spine function results in back or neck pain.
According to the CDC, 80% of us will have back pain during our lifetime, and 20% of the population currently has back pain. In fact, back pain alone is the second most common reason for a visit to the doctor’s office. (Upper respiratory infection is the most common reason.) One’s first episode of back pain is equally likely to occur at any age from early teens to early 40’s, and 80-90% will have a recurrent episode. Like back pain, neck pain is also a significant health problem. Every year, 14% of working adults are limited by neck pain, and up to 85% will have chronic or recurrent symptoms. Obviously, spine pain in general is a serious problem. The good news is that new research is providing more effective treatment strategies and prevention opportunities.
What causes spine pain?
The vast majority of spine pain is not caused by fractures, tumors, or other deteriorating disease, but by mechanical spine problems. Sprained ligaments, strained muscles, ruptured discs, pinched nerves, and swollen joints are considered mechanical spine problems. These injuries cause further changes as the joints become stuck, the supporting muscles weaken, and the nerves become further sensitive to pain. This cascade of problems is a major contributor to the above detailed high pain episode recurrence rate.
An initial injury may occur during falls or car accidents, or the injury may result from something as small as a sneeze. Often an episode of pain begins with something small, as someone bends to pick up a pencil. Additionally, repeated microscopic traumas, such as repetitive movement, inactivity, or poor posture, will summate over time to cause a mechanical alteration.
Does spine pain resolve by itself?
In the past, doctors believed that mechanical neck and back pain heals with pain medication and bed rest. However, we now know that when untreated, back pain recurs in episodes. The pain continues to effect people long after it began, and there is a risk of more significant disability when the initial episodes last for more than 30 days. Additionally, sometimes the way the pain signals are sent through the body can become problematic. Even after the injured back has healed or is inactive, the pain signals are still sent to the brain. It is like a memory loop of pain that is constantly being replayed.
What are the best treatment options?
The cycle of dysfunction (see diagram) can be addressed in several different ways. Recent scientific investigations show that a single type of treatment is not nearly as effective as an integrated treatment plan. The benefit of an integrated treatment plan is the application of the correct therapy at the correct time. Over the past decade, researchers have investigated the effectiveness of spinal manipulation, rehabilitative exercises, anti-inflammatory medications, and advice to stay active. While some individuals can be successful with any single treatment, research indicates that spinal manipulation may be more effective than advice and medication alone. Also, spinal manipulation in conjunction with rehabilitative exercise is most beneficial for persistent mechanical neck pain with or without headache. Oral anti-inflammatory medication can be a useful treatment to minimize pain and inflammation. Additionally, research has shown that a pinched nerve resulting in difficult arm or leg pain may respond well to a course of manipulation and injection of medication into the area of mechanical dysfunction. There is certainly a shift in the management of spine pain toward using multiple therapies at specific times through the treatment plan. Following the best evidence will result in better patient satisfaction, improved outcomes, and less cost.
What is spine manipulation?
Spine manipulation restores mobility at specific joints in the spine by manually applying a controlled force into joints that have become restricted in their movement. As previously discussed, mechanical dysfunction of a spine joint results in an imbalance of motion. The muscles and nerves always are affected by joint motion restriction. A course of several manipulations acts to increase the motion of a previously restricted spine joint and balance the motion of the spine.
It is clear that neck and back pain are very prevalent in our society. Many do not seek treatment, thinking that pain is a fact of life or that pain is normal. Yet the pain limits activity and can result in significant disability. Given the successes of an integrated treatment approach for mechanical spine pain, many are adopting a proactive attitude toward their spine health.