How back pain occurs

Cases studies Activation of pain transmission nerves Muscle contraction Inflammation Nerve root compression

Back pain occurs and is perpetuated through a neurological process:

1. Specific nerve fibers know as Ad and C, or "capsaicin sensitive" or "pain nerves" are activated.
2. The activation of these nerves causes pain, inflammation, and muscle contracture.
3. A vicious circle is initiated because inflammation and muscle contracture maintain the activation of the pain nerves.
4. Research studies reveal that if activation of Ad-C fibers persists over a period of time, other biochemical processes are initiated that could perpetuate their activation indefinitely. In this occurs, pain will persist although its initial cause has disappeared.

This neurological process that causes pain, inflammation and muscle contracture:

May be initiated by any structural injury. For example, a herniated disc will activate the pain nerves in the external layers of the disc by being in contact with inner substances. In this case, magnetic resonance imaging (MRI) would show the ruptured fibrous ring and would permut the identification of the cause of pain.

May develop without a structural injury. For instance, a sustained faulty posture may overburden a muscle group and provoke contracture, thereby activating pain nerves. If a patient's musculature is weak or asymmetric, there may be on overload of effort maintained for a long period of time or repeated periodically. In cases like this, no radiological tests would show a injury causing pain.

The following are accepted causes for back pain:

• Disc fissures, protrusions or herniations, wich allow contact of the nucleus pulposus with pain nerves located in the fibrous ring.
• Relevant deterioration of the facet joint.
• Muscle contracture, caused by faulty posture, effort, or spinal curve alterations. This latter assumption includes scoliosis of over 60º.

Nerve root compression caused by a herniated disc, spinal stenosis or grade III or IV spondylolisthesis.

Next is a review of the most important processes by which the back hurts, regardless of the cause.