Back pain: what causes the pain?

The back is made up of 24 vertebrae, mobile, stacked on top of each other, and held together by discs, ligaments and muscles. But this set is fragile, subject to multiple constraints. The cervical vertebrae are among the most vulnerable in the spine. Having the function of supporting the head, while ensuring its mobility, they are therefore very stressed and often abused. That the pain is located in the lower back (low back pain), in the neck (neck pain) or more rarely in the middle of the back (back pain), the mechanism is identical.

The mechanisms of pain

At the origin, there is most often an anatomical lesion of the intervertebral disc, of the tear or degeneration type, caused or aggravated by the carrying of excessively heavy loads or the repetition of gestures.

The posterior part of intervertebral discl can be damaged and this lesion stimulates small nerves which propagate the painful impulses towards the muscles, the ligaments and the nerves. The neck pain can thus radiate as far as the shoulder, the elbow, the hand or even the shoulder blades, and a lumbar disorder cause calf pain.

When this pain persists for more than six weeks, it becomes chronic: it is often less intense, but leaves little respite to the sufferer.

A sudden movement or violent effort

Intense pain, “like a stab”, then a lower back blockage characterize the acute low back painWhere lumbago, the most common back pain. Located between the 12th rib and the fold of the buttocks, low back pain can be the consequence ofbrutal efforts (moving, gardening, earthmoving) or even too frequent forced gestures (bending over a patient, lifting bedridden people, working with arms stretched in the air) such as one finds in the professions of nursing assistant, painter building or beautician.

Acute low back pain affects a little more workers and craftsmen who make repetitive gestures and wear more heavy loads. On the other hand, the risk that this condition turns into chronic low back pain is the same in managers and workers. More often, a crack or collapse of the intervertebral discs is the cause of this low back pain.

Pinching of a nerve between two vertebrae

Back or neck pain can also be caused by pinching of a nerve between two vertebrae.

  • In the neckthe pain may be prolonged in the shoulder and in the arm.

  • In the lower back, the pain radiates to the buttock, or even to the leg. Caused by irritation of one of the roots of the sciatic nerve, it is characteristic… of the sciatica. There is a continuum between the three, over time. We start with low back pain, until the day when the herniated disc occurs, it occurs when a disc, crushed between two vertebrae, comes out of its original position and compresses the nerve root. Very painful, it causes an alteration of the sensitivity of the lower limbs, even difficulty in moving.

From the age of 40: osteoarthritis

Another major cause of pain: osteoarthritis. This progressive cartilage wear joint of the vertebrae causes stiffness and pain that become chronic.

  • In case of low back pain : the most affected are very arched people, from 40-50 years. Even more so if they are overweight, because this excess fat leads to a melting of the abdominals. Beyond the age of 60, low back pain is all the more frequent as disc problems and osteoarthritis are often combined. The main consequence is a narrowing of the lumbar canal (which contains in particular the nerves intended for the lower limbs, such as the sciatic nerves) and a lameness which cause sciatic nerve pain when walking, making prolonged walks impossible. Doctors speak of lumbar spinal stenosis syndrome.

  • In case of neck pain : osteoarthritis is the main cause of neck pain, or neck pain. This degeneration of the cartilage of the joints reduces the mobility of the neck and causes pain that radiates into the arm. When significant osteoarthritis is combined with bad working posturein front of the computer for example, it can, in the most serious cases, lead to a narrowing of the spinal canal (where the spinal cord passes) associated with compression of nerve roots from the spinal cord (cervicarthrotic myelopathy). The person suffers from pain in the neck and shoulders which is accompanied by stiffness and an urge to urinate, followed by slight paralysis of the lower limbs.

Neck pain: “whiplash”, torticollis or bad position

When the neck pain are not due to osteoarthritis, they can come from a disc problem, and are generally consecutive to a trauma such as “whiplash” (cervical disc herniation). Likewise, a persistent torticollis sometimes reflects an underlying mechanical pathology, in response to a flare-up of osteoarthritis or an abused disc.

It is also identified from bad postures adopted during sleep or at work as the origin of more or less severe neck pain. Back specialists strongly advise against sleeping flat on your stomach, leaning your head forward to work on a computer, or even phone stuck between ear and shoulder to take notes during the call.

More generally, any poor posture maintained for a long time, in sleep or in front of a computer (back curled forward) compresses the discs and pulls on the ligaments and muscles, leading to muscle contractures. Consulting a posturologist can help correct these bad habits.

Pain in the middle of the back: rarer

Dorsal pain concerns the middle of the back up to the root of the neck. Unlike lumbago and neck pain, they are very rarely due to osteoarthritis or disc problems.

You have to look for something other than a mechanical problem and make a complete and very precise assessment. It may be a sign of a spondyloarthritis (inflammatory disease of the spine) which wakes you up at night, or serious conditions of other organs (cancer of the pancreas, aneurysms of the aorta, etc.) which cause back pain. It’s rare, but it does exist.

When a child has back pain

It is not normal for a child to have back pain. If he complains, he should consult his doctor. His pain may be related to intensive sports practice such as gymnastics, horse riding, judo or rugby. The lower back is subjected to regular stresses which, over time, can crack the back of a vertebra. She can then slide forward (spondylolisthesis).

Consequence: very acute pain that lasts, requiring immobilization to consolidate the vertebra. In pre-teens, depending on the location of the pain and the way it manifests, the doctor will more likely suspect a spondyloarthritis or even a Scheuermann’s diseasea frequent growth anomaly of the vertebrae, which may require the wearing of a corset in adolescence.

In video: Against back pain, what physical activity?

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