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The Anatomy of Back Pain



Back Be Nimble Newsletter - March 2001

The anatomical make up of the spine is one of nature's most clever undertakings. The human spine is designed to be incredibly strong, yet highly flexible; so we can move in all directions.

However, the spine is also subject to the strong forces of daily living (e.g. poor posture, lifting a bag of groceries, recreational injuries, sudden jolts and lots of sedentary office work). Many different structures in the spine are capable of producing back pain.

Some of the most common causes of back pain include:

  • Irritation to the large nerve roots that exit the spine and go down the legs and arms
  • Irritation to the smaller nerves in the spine
  • Strain on the large muscles in the back
  • Injury to the bones, ligaments or joints in the spine

What makes up the spine?

There are three major regions of the spine:

  1. Cervical Spine (neck) - has seven vertebral bodies (segments), and most of the rotation in the neck occurs in the top two segments.

  2. Thoracic Spine (upper back) - has twelve vertebral bodies (segments) and has its motion limited by the support of the rib cage, making this region of the spine less susceptible to injuries. However, the ribs do connect with the spine by way of a synovial joint and these joints often become irritated by postural stress, tension or fast rotational movements of the spine (such as when starting a lawn mower). This can lead to a nagging, painful condition that often goes misdiagnosed.

  3. Lumbar Spine (lower back) - has five vertebral bodies (segments) that run from the lower thoracic spine to the sacrum. The sacrum is at the bottom of the spine and lies between the bottom lumbar segment and the coccyx (tailbone).

The sacrum is a triangular-shaped bone and consists of five segments that are fused together and connect to the pelvis and form joints called the sacroiliac joints.

The vertebral bodies are stacked on top of each other with a disc in between each one. All of the vertebral bodies act as a support column to hold up the spine. This column supports about half of the weight of the body, with the other half supported by the muscles.

Fifty percent of the motion of bending forward occurs at the hips, and fifty percent occurs at the lumbar spine. Most of the motion is concentrated in the bottom two segments of the spine, and these segments are the most likely to break down over time and be a source of pain.

What are common sources of pain?

  • Discs

    The disc is an interesting and unique structure. Its primary purpose is to act as a shock absorber. Discs are actually composed of two parts: a tough outer material and a soft (gel filled) inner core.

    The disc is originally composed of mostly water. Over time, however, the discs dehydrate and become stiffer and for some individuals this can be a source of pain. The theory is that the degeneration can produce a tiny amount of instability and the soft inner core of the disc probably leaks out of the disc space and inflames the nerve roots next to the disc.

    Sometimes a twisting injury damages the disc and can eventually lead to degeneration. In general, as we age there are less inflammatory proteins in the disc space and it is rarely a cause of pain after 6o years of age.

  • Soft Tissues

    The soft tissues around the spine can also be painful. An injury to the large back muscles (or tension and stress) can cause the muscles to become inflammed and spasmed, resulting in pain and limited motion.

    If the pain lasts for more than two weeks, the muscles can start to weaken, and muscle weakness can in turn lead to more pain because the muscles are less able to help hold up the spine.

    Another structure that plays a role in back pain is the hamstring muscles in the leg. Patients with tight hamstrings tend to develop low back pain, and those with low back pain tend to develop tight hamstrings. The theory is that tight hamstrings limit motion in the pelvis, so the motion gets transferred to the bottom lumbar motion segments and increases the stress in the spine.

    Finally, ligaments and tendons that attach from one structure to another in the spine can become injured and cause pain.


We hope that a better knowledge of the spinal anatomy and how everyday stresses can sometimes result in back pain will help you better manage your back health.

At Back Be Nimble, we bend over backwards to help your back be nimble again!

Best Wishes,

Dr. Brad Lustick
CEO and Ergonomic Supervisor


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