Spinal Problems: Neck and Back Pain

Neck and Back Pain are the most frequent reasons for people to make an appointment with their health provider.

A review of the anatomy will explain why:

The skeleton, the main support for the human body has approximately 206 bones.

It supports our internal organs (heart, lungs, liver) and is enveloped by the skin, which has the largest number of sensory receptors in our body (OUCH)

The spine (spinal column, back bone) starts at the based of the skull and ends at the level of the hips. It is made up of many drum shaped bones called vertebrae (1 vertebra)

Each vertebra is attached to the next one by small facet joints which allow movement to occur in different directions.

Each vertebra is also separated from the one above by a disk (disc) of slippery material called cartilage (and other tough fibrous tissue) which protects and cushions the vertebrae. Cartilage is also found between other joints of the body (knee, hip)

When viewed from the side, the spinal column (spine) is shaped like an S with 7 vertebrae in the cervical or neck region, 12 in the thoracic or dorsal region and 5 in the lumbar region.

The end of the spinal column is called the sacrum and is comprised of several vertebrae that have fused together, the last one called the coccyx or tailbone.

A hollow tube is formed when all the vertebrae are stacked one on top of  the other. The spinal cord projects into this hollow tube through the large foramina (hole) at the base of the skull.

The brain and the spinal cord are called the Central Nervous System.

The spinal nerve roots emerge from the spinal cord and exit through the facet joints at different levels of the spinal cord (from the upper cervical region to the low lumbo-sacral area)

 Each nerve will innervate a specific region or segment of the body. These nerves have both a sensory and motor division, allowing both movement and sensation (OUCH!)

Bones are wrapped in soft tissue called periosteum which has its own blood and nerve supply.

Pain is rarely caused by bony tissue alone, unless they are diseased (malignancy) or broken (fractured)

Ageing, trauma, and at times disease can cause a narrowing of the spaces between the vertebrae.

When the cushioning effect of the disc is lost, vertebrae can touch each other causing OSTEOARTHRITIS  (osteo- bone; arthro-joint- itis- irritation).

Bony spurs or osteophytes can also form when the ends of the vertebrae rub against each other.

DEGENERATIVE DISC DISEASE (DDD) is the term  used when these ‘degenerative’ changes occur in more than 1 area of the spine. It is NOT a true disease but a condition. DDD is not necessarily a problem unless PAIN is associated with it.

SPINAL STENOSIS: A narrowing of the foramina (opening, tube) in the spine can cause pressure/irritation on the spinal nerves as they exit. This narrowing can be causes by the formation of extra bone (osteo- arthritis, by one or more vertebrae no longer in alignment with the one above, and in some cases disease.

SCOLIOSIS: A side-tilting of the spine is called a scoliosis. Congenital (often called idiopathic) scoliosis is more common in adolescent girls and is treated with exercise, bracing and at times surgery.

Adults usually have an ‘acquired scoliosis’ caused by postural changes, pain and muscle imbalances or weakness.

DISC HERNIATION : (Slipped Disc):  When the disc moves out of its normal alignment in the spinal column, it impinges on the spinal nerve(s) exiting from the spine at that level. The most common herniation moves the disc backwards into the spinal canal, causing radiating pain into the arms or legs.

All the problems noted above can occur in any area of the spine- but are more common in the weight-bearing regions in the mid to low back.

A good education site on many diseases and conditions can be found at: