This Is What's Causing Your Back Pain

almost every single one of us will experience some form of back pain at some point in our lives now obviously that can vary in severity how bad it hurts how long it lasts and of course what the actual cause of that back pain is so in today's video we're going to take a look at the back the spinal bones nerves discs and surrounding muscles essentially looking at all these places where potential problems can occur so that you can better understand why you might be experiencing that back pain so let's jump right into it so as i mentioned there are multiple spots or places throughout the back or spine where we could have potential problems in there for pain so it probably makes sense for us to go over some of the basic features or anatomy of this spine also known as the vertebral column those can be used interchangeably and we can see that the spine is made up of multiple or individual bones that we call vertebrae and it's also broken down into five regions and just so you can see this a little bit more closely let's break this down on the tray as you can see we've got this wonderfully organized tray of vertebral bones or vertebrae and let's take a look at some of these structural features so that we can apply them to some of the origins of back pain now remember we said there's five individual regions that make up the spine this top row here is our first region referred to as the cervical region now the cervical region or cervical translates to neck and there are seven individual cervical bones or cervical vertebrae that make up this region here's cervical vertebra number one cervical vertebra number two you can see how annoying that would be so instead we choose to abbreviate c1 c2 all the way down to c7 here the next two rows represent the next region which is the thoracic region you can see the bones are also getting larger thoracic region just refers to chest as this is associated with rib and other chest anatomy and there are 12 individual thoracic vertebrae here's t1 all the way down to t12 here the next region is the lumbar region represented by this row lumbar translates to loin now we're not really referring to loin as in the context that you're probably thinking of we're not referring to like a stirring or a rustling in your loins or nether regions here in anatomy loin refers to this region between the lower rib and the pelvis here essentially this area where the lumbar vertebrae occupy but there are five individual lumbar vertebrae here's l1 all the way over to l5 here now i want to just pause for a second here because these top three regions the cervical thoracic and lumbar are known as the mobile or movable portion of the vertebral column meaning you can get movement between the individual bones like between l1 and l2 or c4 and c5 and that is great and all because we get mobility but whenever we get mobility there is an increased risk for injury damage pain and that's going to be a little bit different when we compare it to the next two regions or those bottom two regions the next one or the fourth one being here let me get this into focus in between my fingers called the sacral region the sacral region started as five individual sacral bones so you had an s1 2 3 4 and 5 but around age 14 to 16 these bones start to fuse together and by the time you're about 30 the final fusion takes place and it is one solid bone that we refer to as the sacrum the fifth region does something similar the coccygeal region that you can see here was individual little bones that you can see here that fuse together most of us had four individual coccygeal bones but some of us will have three some of us will have five but again the majority have four and one of those four fused together we call it the coccyx or many of us just refer to it as the tail bone so now that we've gone over some of these structural features we can really start to hone into some of these origins of back pain and one of the things i like people to think about is what are some of the functions or demands that we place upon the back or the spine one of those is to protect the spinal cord and if you look at these vertebrae again you can see they all have these holes and this hole is referred to as the vertebral foramen now if we stack those vertebrae on top of each other again it would create a canal called the vertebral canal and that's where the spinal cord will run through another demand we place upon the spine is to transmit forces or weight through the central skeleton this large region that you see on the majority of the vertebrae here is referred to as the vertebral body and that's going to transmit forces and weight now this little hole that's in these vertebral bodies is actually not supposed to be there it's more so if we just needed to string it up for an anatomical model but just wanted to mention that but the vertebral body is also associated with the intervertebral disc which we simply often refer to as the disc you can see body body disc in between has a nice little shock absorbing pad but we also know that the disc can cause some potential problems another thing we ask of the spine is to move in all three planes a space these cool lever arms that you see on the vertebrae here and these sideways ones are ones going off to the side are called transverse processes the ones coming off the back are called the spinous processes but these are attachment sites for some of these big spinal muscles so they can pull on these bones to move side to side front to back and even rotate so spine protect the spinal cord transmit all this weight and then move in all three planes of space and by the way try not to ever get hurt i have to joke around with my students and say that's no wonder people will have back pain because of all the demands that we place upon the spine so let's start going into some of these specific causes like for example the inner vertebral disc that we already mentioned and if we fast forward into that conversation one of the things that can help decompress or take some of the pressure off your disc is sleep which is a nice little segue for me to say thank you to the sponsor of today's video helix sleep helix sleep provides premium mattresses and bedding that are customized to fit your needs and they are shipped to the comfort of your own home and helix sleep knows that everyone's sleep needs are a little bit different so they created the sleep quiz where you can get on there and customize the mattress based on body type as well as sleep preferences when i got on there i mentioned that i tend to be a back sleeper i don't like too soft of mattresses but also not too hard so i'm right in the middle and i wanted something that was a medium firmness if you sleep with another person they can also get involved in the sleep quiz so that you can customize a mattress that fits both of your needs and i ended up getting something called the helix midnight lux and let me tell you i've had this thing for about a week and a half and i love it for multiple reasons one it's super fun to just open this thing up and watch it expand two i'm sleeping more comfortably more soundly it just already feels better and three i'm not being a hypocrite creating a video on spinal health and then sleeping on a crappy mattress i'm sleeping on a good mattress no a great mattress and one other thing i think is important to mention is that getting a mattress can be a big purchase so you want to make sure you get the right one if you've ever been shopping for mattresses in person you've probably gone from one mattress to another and then you're lying on this thing thinking well this feels good but will it feel good for eight hours night after night after night well the great thing about helix sleep is they offer the 100 night sleep trial which means you can try one of their mattresses for a hundred nights and if you don't like it they'll come get it for you and give you a full refund they also offer a 10-year warranty and flexible payment options so if you're interested in getting one of these amazing mattresses go to helixsleep.com ioha for up to 200 off your purchase of a helix sleep mattress plus two free pillows we'll also put the link in the description below so back to these intervertebral discs now we're going to utilize cornelius the fake skeleton because he does have some examples of some disc anatomy here but keep in mind jeffrey's all up in arms about it because he's a real skeleton he's a fake skeleton but jeffrey doesn't have any examples of discs and cornelius doesn't have any real discs but this cadaver dissection that we have does so we're going to take a look at the sagittal cut through this cadaver and you can see the spine coming up like so and these amazing intervertebral discs you can see the difference between the bone here and the disc in between the bones disc bones on either side and those discs would continue up into the neck or in the cervical region and discs go from c2 all the way down to the sacrum with that last disc being between l5 and s1 here that i'm pointing at the probe there now what's really cool about this cadaver dissection is if you look closely you can look at these discs and see that they actually are narrowing on the back and the front or posteriorly and anteriorly starting to degenerate a little bit and if we move up that degeneration got even worse in the thoracic region you can barely make out the discs and even the vertebral bodies the bone started to actually narrow and degenerate and what that looks like if i show you kind of up close is the bones on that cadaver the body and the front started to narrow and create more of a wedge shape rather than this nice boxy vertebral body that we should have and so when you're thinking about this degenerative process yes you get pain from the bones degenerating as well as the disc and that's one of the ways that you can have disc problems is just aging and degeneration but many of you have met someone or maybe you've experienced just damaging or injuring your disc maybe from lifting something really heavy or just really bad luck and twisting funny and in that case we tend to refer to it as a herniated or bulging disc and luckily cornelius has taken one for the team to show us kind of this example of what a bulging disc would look like and again that bulge or that damage to the disc in and of itself would cause pain now you might be thinking well why is he keep saying that in and of itself could cause pain why can obviously herniating a disc would cause pain bones degenerating would cause pain well that's one category of pain and the other category of pain is essentially potential irritation or damage to structures that are close by and some of these close by structures are your spinal nerves represented in yellow here and you can see those spinal nerves are coming out of this hole called the intervertebral foramen or foramina for pleural and this is the pathway which in which the nerves communicate with the spinal cord inside but you can see if anything were to cause this hole to get narrowed that intervertebral foramen maybe the actual vertebral bodies degenerated and got thinner or the disc got degenerated and got thinner you could see that that would narrow that hole and potentially compress irritate or damage the nerve if i show you from this perspective of putting two vertebrae together without a disc you can see how narrow let me get my finger out of the way there but how narrow that hole or that foramen would be and cause a problem for that nerve trying to come out there now another way to narrow that pathway or to compress the nerve is to have a herniated or bulging disc especially if it goes posterior laterally towards the nerve and again that's just another way of narrowing that pathway and compressing irritated or den irritating or damaging that nerve so this could potentially happen throughout the spine where we have discs and associated nerves again we said from c2 down to the actual sacrum and when we talk about this nerve pain that's another type of pain on top of that mechanical pain that i kept harping over earlier in the video but that nerve pain can be this sharp shooting pain in the pathway of the nerve you can also get things like numbness and tingling in the skin and even potential weakness as some of these nerves will control skeletal muscle tissue and one last thing i want to mention about discs and nerves before we talk about other potential causes of back pain and that is commonplace where you often hear about herniated discs and that is the lower lumbar region and when you talk about herniating lumbar discs that often comes with a discussion around the sciatic nerve and sciatica so let me show you the sciatic nerve here is the right gluteus maximus reflected so right back side of the body right side of the hip and then the hamstrings coming down this direction and you can see this large nerve largest nerve in the human body called the sciatic nerve it would continue on the back side of the thigh down the back of the lower leg and into the foot but what does the sciatic nerve have to do with herniating lower lumbar discs well the sciatic nerve gets contributions from five different spinal nerves or five different spinal levels if you look at cornelius here we've got l4 l5 there then s1 s2 and even this s3 nerve if i can rotate it for you would contribute to the sciatic nerve so those five different spinal levels and you're thinking well that would make sense then if i herniated disc at l4 l5 that would affect those l4 l5 contributions to the sciatic nerve but don't think s s1 and s2 and s3 are off the hook because even though you're looking at cornelius's herniated disc here it's more of a lateral kind of just going straight out protrusion you can have herniations that are more directly backwards posterior and more medial which would go into the spinal canal and these nerves before they exit down here are running through that spinal canal and could get pushed on by a herniated disc that's going posteriorly so you could have those symptoms of sciatica like shooting pain on the back of the leg and into the foot numbness tingling and even potentially muscle weakness another potential cause of back pain is a form of arthritis called osteoarthritis and often when we think of osteoarthritis we point to things like knee arthritis hip arthritis maybe even arthritis in the joints of the fingers and this type of arthritis is when the cartilage covering the ends of the bones that are forming the joints starts to break down or degenerate that cartilage breaks down degenerates and eventually can cause pain within the joint and on the back side of the posterior aspect of the spine of the vertebral column there's a whole bunch of these tiny small little joints going the entire length that have cartilage within and if we use jeffrey here we can see one of those joints here here here here and all the way up on both sides you'll see these joints at every spinal level essentially between c1 c2 c3 from cervical down to lumbar and they're referred to as facet joints i think a lot of people will sometimes even pronounce them as facet joints but most like to say facet because it sounds more sophisticated but let's show you this in a little bit more detail here's two lumbar vertebrae let's zoom into one of them so i can really drive this point home but here would be an area covered with cartilage on this lumbar vertebra here would be another area and these would form facet joints then we'd have cartilage covering here as well as cartilage covering here again forming some facet joints with the vertebra below and if i bring the other vertebra together you can see how they would come together and where my probe is if that cartilage were to break down between those two bones in that facet joint that's a form of arthritis and can eventually lead to another type of back pain and again that could be anywhere within the length of the spine and it does tend to localize close to the area where the arthritis is and you might be thinking well what causes this well one thing is injury puts somebody at higher risk people for example who get whiplash are more likely to develop that type of arthritis in the neck wear and tear can cause it you can even talk about improper mechanics maybe an abnormal curve in the spine might put more pressure or more wear and tear on some facets other or facet joints more than others and of course aging is a risk factor and finally the last type of back pain we're going to talk about is good old-fashioned muscular back pain now this is the type of back pain that people will often say things like i threw out my back now some people will say they threw out their back when they re-injured like an old disc injury but most are referring to this muscular type of back pain now to be clear about this muscular type of back pain if you look at this cadaver dissection you might not recognize a lot of these muscles here some of the most recognizable muscles that we're used to seeing like at the gym or in pictures or like the trapezius or traps here the latissimus dorsi or lats would be down here even the rhomboids between the two scapulae that you can see right there and the reason that we remove those is because those muscles even though they are on the back are actually muscles that move the limbs like the shoulder joint and even the the scapula here and our true back muscles that actually move our spine are underneath and that's what you're looking at here so we had to remove all those more superficial back muscles so for example here's a group of muscles called the erector spiny muscles they're made of three like the iliocostalis here the longissimus here and the spineless fyi people have a nice little mnemonic to remember those muscles it's called i love school other people like no no i remember it better this way i'm just the messenger here just fyi they say something like i love sex they are the erectors after all but then there's also some other muscles that are deep to the erectors on this side like the multifidus and even the semi spinalis now i know we kind of just did some name dropping there but those are some of the names or some of the major muscles that could be involved in some muscular back pain not all of them but some potential major contributors and so what's happening with this type of pain is that the muscles can be strained your deep back muscles can be strained or pulled just like you can strain or pull a hamstring and when you strain a muscle the muscles can get tears in those muscle fibers and that can obviously vary in severity another thing that can happen is that the muscles can have a spasm or tension within them and people will often describe that as they feel tight and they don't want to move because that will aggravate the pain now an interesting question might be can you have more than one thing going on at the same time and the answer is yes i've had patients come in where they've re-aggravated a disc injury or had a bulging disc and the muscles surrounding that area also spasmed and created tension and pain on top of the disc injury i haven't had one patient recently who had a bulging disc pushing on the nerve arthritis in the same area and the muscles were spasming so as we're wrapping all this up i think it is important to note that we obviously didn't cover every single type of back pain we mostly focused on these mechanical forms of back pain that are actually coming from the spine or some of those closely related structures like the nerves and the surrounding musculature that affects the spine yes we could talk about traumatic fractures of the spine even pathological fractures from certain disease states cancer can even sometimes spread into the spine and create a problem there's also viscerogenic back pain viscera just means internal organs we know the kidneys refer to the back the pancreas is another example when it's inflamed can refer to the back and cause that back pain but when we're talking about the type of back pain that we referenced in this video or focused on in this video you might think well how do we deal with this well luckily for a lot of people these types of back pain can get better or improve with time and support of therapies and when we're talking about supportive therapies we're talking about things like possibly applying heat massage exercise and even physical therapy you can even use things like topical lidocaine patches nsaids which are things like ibuprofen to help manage the pain you can even step up to muscle relaxers if necessary if we've got some muscles that are spasming like crazy and if those more conservative approaches fail and people are still having issues you can step up even further to things like injections anti-inflammatory injections can be placed around the area where there's an inflamed nerve or even an inflamed facet joint there's this really cool procedure called a radio frequency ablation that can also be used for those inflamed facet joints where they inject this needle with radio frequency and what it does is essentially heats the nerve or creates this heat lesion not the nerves that we saw on cornelius those big nerves but a tiny tiny little nerve around the facet joint that's sending pain and that heat lesion can stop that little tiny nerve from sending pain and give somebody relief in that case there's obviously also surgical procedures that we could step up to creating more room around a compressed or inflamed nerve and obviously going in and doing some things with a ruptured or bulging disc to help with those cases that aren't improving again with some of those conservative therapies so protect that spine of yours obviously there's so much more information that we could go into but the intent of this video was to get us started on understanding the main forms of this mechanical type of back pain but we would love to hear from you guys so if you want us to go into any more detail of any of these different forms of back pain throw those in the comments below so that we can make some future videos if you're interested in getting a new mattress go ahead and check out the link below with helix sleep and if you like what you saw or you feel the need like subscribe turn on your notifications and while you're waiting for the next video go ahead lift with proper mechanics mobilize the spine properly and strengthen those surrounding muscles and we'll see you next time you

Channel: Institute of Human Anatomy

Views: 3,834,073

Keywords: low back pain, back pain, anatomy, back muscles, sciatica, sciatica pain, sciatica pain relief, arthritis, back arthritis, osteoarthritis, herniated disc, herniated disc symptoms, nerve pain, sciatic nerve, sciatic nerve pain, sciatic nerve pain relief, bulging disc, bulging disk treatment, muscle pain, back muscle pain relief, back muscle pain, spine, spine pain, spinal cord, cervical, cervical pain exercises, neck pain, neck pain relief, nerve injection, back injections

Id: rZv7S_Rxibw

Length: 20min 57sec (1257 seconds)

Published: Fri May 20 2022