UNDERSTANDING NECK AND BACK PAIN
- Written by: Trevor Robertson
- Published on: Feb, 08 2012
Introduction More than 50 million people in America suffer from neck and back pain every year. Collectively we spend almost $50 billion on treatment with the majority offering only partial temporary relief. As physicians we owe our patients more than “partial temporary relief. Pain Pain in the neck or back results from injury or damage to one or more of the structures of the spine. These include the muscles, ligaments, joints, discs, nerves or bones. In most cases it is a combination of several of these with each effected structure presenting with different degrees of pain and limitation. To understand neck and back pain one needs to review the structure of the spine. Anatomy The spine is made up of 24 bones, called vertebrae. These vertebra have bony projections called facets that act as hinges to facilitate bending and twisting. Between each bony vertebra is a small oval cushion called a disc. The function of the discs is to absorb stress while keeping the bony vertebra from rubbing together. This stack of alternating vertebra and disc’s are wrapped in ligaments to form the spinal column. Muscles attach to the spine at different points and pull on the spine to produce motion. Ligaments can therefore be compared to cables, stabilizing and give support while muscles are more like rubber bands that stretch and pull on the spine to produce motion. Down the back of the spine from top to bottom is a large opening called the spinal canal that house a bundle of nerves called the spinal cord. This cord extends from the base of the brain down to the low back. Nerves branch off from the spinal cord passing through small holes between each vertebra and allowing information to pass from the control center of the brain to every muscle organ and system of the body. The spine has three main segments. The neck, which is called the cervical spine, the mid back called the thoracic spine, and the low back called the lumbar spine. From the side the spine appears like an S. This allows the spine to withstand stresses while keeping the body balanced. You’re Pain The majority of neck and back injuries are mechanical in nature with most involving more than one structure. Each effected structure presents with different degrees of pain and limitation which can lead to a complicated overlay of symptoms that are often misdiagnosed. The key to successful treatment therefore depends on a thorough understanding, an accurate diagnosis and appropriate timely treatment. What to Do A common misconception with neck pain is that it will go away on its own without treatment. In reality neck and back pain is usually recurring with subsequent episodes tending to increase in both duration and severity Who to See? Most neck and back pain falls under the classification of musculoskeletal injuries with the majority responding most favorably to conservative chiropractic care. Today chiropractic as a profession has evolved from its early roots to that of musculoskeletal specialists with chiropractors treating more neck and back pain than any other physician. A good Chiropractor will incorporate a variety of methods including physical therapy modalities, spine, joint and soft tissue mobilization, in addition to postural, structural and function management. This should be your starting point for all neck and back pain and a good chiropractor will maintain referral links with all other specialists if or when a referral is required. Before we treat we listen Before we can diagnose your problem or recommend a treatment plan, a history and physical exam must be performed. This allows your doctor of chiropractic to get a better idea of the potential causes of your pain. History A focused dialog with your doctor of chiropractic is considered a physical history. This will cover how and when the pain and injury began, the intensity, duration and location of the pain, if it radiates or is localized and any aggravating factors. Additional red flag questions including if you have had any fever, loss of appetite, unexplained weight loss or bladder or bowel changes will be covered. Exam A comprehensive examination allows your doctor of chiropractic to limit possible causes of your pain while focusing in on the exact underlying problem. Palpation helps determine muscle spasm, splinting or swelling while passive active and resisted motion helps note any loss of motion or restrictions. Your doctor of chiropractor will also be observing if a particular movement causes aggravation or reproduces your symptoms. Sensory and motor examination including sharp and dull along with reflexes are also performed. During these and other tests your doctor of chiropractor will evaluate findings that could indicate underlying non spine, joint, muscle, ligament or disc problems. Imaging Diagnostic imaging may be recommended to evaluate your condition. X Rays are used to rule out fracture of pathology of the bone and should not be used as a routine screening procedure for musculoskeletal complaints. If you see a chiropractor who wants to do routine X Rays this is a sure sign you are in the wrong office. An MRI may be recommended in cases where there is concern about injury or damage to of the nerves, ligaments or disc’s. Treatment Based on the history, examination and any additional imaging, your doctor of chiropractic will design a custom treatment plan tailored to your specific diagnosis The good news is that the majority of neck and back pain responds well to timely appropriate chiropractic care with most patients being pain free in as little as one to four visits. Although more severe injuries involving ligament, disc or nerves may take a little longer, there is no ethical or clinical justification for long open ended treatment plans. Chiropractors who advocate these are unfortunately designing plans tailored more their economic needs than your diagnosis. Dr. Robertson is a San Diego Chiropractor who spent more than 12 years specializing in the treatment of neck and back pain. He is recognized as a leading expert in the non surgical treatment protocols for musculoskeletal complaints and was voted Best Chiropractor in San Diego by the Union Tribune and Sign on San Diego. Dr. Robertson practices in La Jolla, California. He can be reached at trevorrobertson.com or by phone at 858 454-3612.