Dallas County Living Well Magazine Fall 2014 | Page 37

Why Does My Back Hurt?

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By Nathan S. Walters, M.D.
p to an astonishing 90% of people will
experience back pain at some time
in their lives. According to the National Center for Health Statistics,
over 14% of new visits to primary
care physicians are for low back pain. As we age, we
endure both macrotraumas, repetitive microtraumas
and undergo changes in body habitus that alter and
redistribute biomechanical forces unevenly on
the spine.
Much like your knee, the padding or
cartilage (i.e., the disc) is mostly
water-based and will progressively
degenerate the longer we spend
in gravity. This degeneration
of the spine has characteristic
anatomic, biomechanical, radiologic, and clinical findings
and is called degenerative disc
disease. Factors such as weight,
genetics, trauma, and environment
can contribute to an earlier presentation of
this disease, affecting people of all ages, with radiologic evidence of disc disease increasing with age
to nearly 100% by age 60.
Multiple pain syndromes can follow this degeneration. Weak discs can tear and cause back or neck pain. They
can also bulge or protrude into the spinal canal and impinge
on the nerves that are traveling through to control your
arms and legs. Also, when bones don’t have as much padding (disc) as they would like, they form new bone, or “bone
spurs,” which can obstruct the areas where the arm and leg
nerves are traveling. This can cause arm/leg pain or numbness and tingling.

Where is my pain coming from?
The patient’s history, as always, is extremel y important in
my effort to pin down the pain generator. Multiple key questions help me diagnose the source of pain. With pressures
within the disc increasing significantly with forward flexion
at the waist, patients will typically report exacerbation of pain
with prolonged sitting, driving, rising from a seated position,
first thing in the morning, bending over to pick something up,
tie their shoes, doing dishes, bending over to shave, etc. However, the discs bear some amount of pressure in all positions,
so there is some variability. Often there is a specific trauma:
I’ve heard coughing, sneezing, vomiting, picking up a table,
picking up something as light as a pen. However, just as often,
there is no inciting event and patients will “wake up with it.”
Relieving positions often include lying flat or on a side with
legs bent up, sort of in the fetal position. Staying active and
moving around is often reported to ease discomfort. Often patients will point to the lumbar spine and report pain in a band-

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like pattern around the waist line and radiating
into hips. Of course, if there is nerve root (sciatica)
involvement, there can be a history of pain radiating into buttocks and down the leg.

Do I need an MRI?
A patient’s history and physical exam are
crucial pieces to the puzzle. MRI is currently
the gold standard for detecting disc pathology. A magnetic field is used to obtain images
with superb soft tissue detail and excell