The different origins of back pain

Back pain (commonly known as "back pain") is very common pain, which can be located at different heights of the spine. We talk about neck pain for pain in the neck, back pain in the lumbar region, etc. Whatever the location, this pain can have several origins: osteo-articular, muscular or nervous. Overview of the different types of back pain.

Almost 80% of us have suffered, are suffering or will suffer from the back at one time or another in our lives. Back pain is even called "evil of the century", as it is difficult to escape it, and unfortunately sometimes to get rid of it.

back anatomy

The vertebral column is made up of 24 vertebrae (7 cervical, 12 dorsal or thoracic, 5 lumbar) , to which are added "welded" vertebrae which are the sacrum and the coccyx . Between the mobile vertebrae, the intervertebral discs (made up of a ring of fibrous cartilage and a gelatinous nucleus) allow the movements of the column and act as a shock absorber.

The vertebrae have a "hole" in their center. Inside this canal (spinal canal) is the spinal cord. It divides into different nerve roots, which emerge from the back of each vertebra to innervate a specific part of our body.

All around our spine, ligaments and powerful muscles reinforce this framework.

Back pain of osteo-articular origin

Joint wear

In our daily movements, the vertebral joints are subjected to strong stresses. This is especially the case at the level of the lumbar vertebrae, located at the bottom of the column and at the crossroads of many forces (pressure, weight, shear, etc.). It is especially the posterior (rear) joints that are most likely to suffer from our bad positions, carrying loads, etc. The cervical vertebrae are subject to lesser forces, but they are extremely mobile. At this level of the column, it is therefore repeated and unsuitable movements that can damage the joints in the long term.

This chronic wear can lead to progressive destruction of the cartilage located between each joint and create osteoarthritis (degenerative rheumatic disease), causing pain. Osteoarthritis is a common cause of back pain, especially after age 40. The pains caused are rather dull and chronic , accentuated at night and during phases of prolonged immobility . They cause stiffness in the joints, particularly noticeable in the morning upon waking.

By promoting the formation of small bony growths (called " parrot's beaks "), osteoarthritis can also be responsible for nerve pinching . The pain is then acute, felt as "a discharge" . At an advanced stage, osteoarthritis can also be responsible for a  narrowing of the spinal canal , also called lumbar stenosis . Pain is not the main symptom of this narrowing, which will manifest itself more in gait disturbances and numb limbs. But if pain appears, it is often similar to pain from sciatica (back of the thigh)  or cruralgia (front of the thigh).

Diseases that affect the joints

Some rheumatic diseases can affect the spine. This is the case with ankylosing spondylitis , an autoimmune disease that manifests itself in flare-ups of arthritis and inflammation of tendons and ligaments. The lower spine and the sacroiliac joint are the preferred locations for this disease, which most frequently affects adolescents and young adults. It is characterized by chronic lower back pain and morning stiffness in the spine , which improves with movement.

Another bone disease that can cause pain in the spine is osteoporosis . This condition, characterized by a decrease in bone density, can affect the entire skeleton. Spinal involvement affects women more than men, particularly after menopause and the drop in estrogen levels. Osteoporosis can also be secondary to prolonged use of corticosteroids , phases of malnutrition ( anorexia nervosa, for example) or intense sports practice. At the level of the spine, osteoporosis often remains asymptomatic, the pain being caused more by possible fractures in the advanced stage of the disease .