Neck and Back

Back pain is the most common reason for visiting the doctor and also is the leading cause of disability. 

Here are some reasons why your back may hurt

1. Muscle pull

2. Disc degeneration

3. Arthritis/facet syndrome

4. Sciatica aka "pinched nerve"

5. Back and/or leg pain despite surgery

Muscle pull

A simple muscle pull can feel very painful. This is due to over stressing the mucle beyond its ability. This pain is usually sudden and after completing a task. The pain usually does not radiate beyond the back and the muscle is sore to touch. Within a few days, this type of pain resolves. Gentle stretching, heat, and an anti-inflammatory can improve your symptoms. 

Disc Degeneration

Disc degeneration can cause back pain located in the back without any radiation into the legs. Usually, the pain is better in the morning after laying down and worse as the day goes on. Lifting can increase the pain. Most people described this pain as a dull, deep ache which cannot be made better with massage. 

Treatment for this pain involves, physical therapy, chiropractor, and anti-inflammatory medication. If these treatments are not helpful for you, you may try an epidural steroid injection or stem cell therapy.

Disc

Arthritis or Facet Syndrome

This is the most common reason for back pain. It is described as an dull or sharp ache located in the low back. The pain can radiate into certain patterns described to the right. The pain is usually worse in the morning and can make it difficult to stand straight. 

If you have not responded to conventional therapy, you may benefit from facet steroid injections or radiofrequency ablation of the nerves. These injections can result in 3 months to 12 months of pain relief.

Common Radiation Patterns

Sciatica or Pinched Nerve

Most people with this type of pain will have both back and leg pain. There also may be tingling/numbness in the leg. This is caused by a local inflammatory reaction occurring inside the spinal canal after a disc herniation/bulge which resulted in an inflamed nerve. The nerve will send signals to your brain as a specific pattern. The L5 nerve, for example, will send signals to the buttock, lateral hip, lateral thigh, shin, and to the top of the foot. Each nerve has it's own pattern. 

Luckilly, most pinched nerves get better even before you get to the doctor. If the pain doesn't respond to physical therapy, chiropractic therapy, and medications, you may consider an epidural steroid injection or a stem cell injection. These injections reduce the inflammation around the nerve and then allow the body to heal the nerve. The general rule is to keep steroid injections to 3 sessions in 6 months or 4 sessions in 12 months. 

Pain Despite Surgery

In the unfortunate event that your back surgery did not help your pain even after the normal healing process is over, you may consider that you have persistent nerve damage from your injury. If this is the case, you may respond to steroid injections into the spine or areas surrounding the spine such as the sacroiliac joints. If injections do not result in adequate pain relief, then you may consider a procedure such as a spinal cord stimulator.