Back Pain
Back pain is a widespread issue and a leading cause of disability both in the US and globally. Almost everyone will experience significant back pain at some point in their lives. Fortunately, most cases are due to muscular strains that are transient and self-limited. However, over 50 million Americans suffer from more serious, persistent chronic back pain that limits their activities and affects their quality of life. This number increases when considering those with recurrent episodes of pain.
Addressing the root cause of back pain requires a clear diagnosis and understanding of the pain mechanism. Commonly diagnosed causes include degenerative disc disease, disc herniations, facet joint arthropathy (arthritis), spondylolysis (vertebral arthritis), and spondylolisthesis (vertebrae slipping forward on one another). These conditions are often identified through X-ray and MRI imaging. However, abnormalities on imaging do not always correlate with the major cause of pain. Imaging often misses vertebral instability and ligament and tendon enthesopathy, which can be significant pain generators when stretched or torn.
Supporting this viewpoint, a statement from the medical journal Spine highlights the lack of detailed literature on vertebral ligament anatomy and function. This suggests that ligamentous causes of pain are often neglected, likely due to an over reliance on MRI results for diagnosis. Studies have shown that many patients without symptomatic back pain display MRI abnormalities, which can lead to unnecessary surgeries if misinterpreted.
MRI is frequently used to assess low back pain in conventional orthopedics, but it is often over-ordered. While it provides valuable information, MRI findings should be correlated with a thorough physical exam to ensure an accurate diagnosis. MRI lacks specificity and may not detect micro tears in the deep ligaments and tendons stabilizing the vertebral joints, which can be the true source of pain.
Doctors often assume that back pain comes from discs unless proven otherwise. While disc abnormalities are common, they are not always the primary cause of pain. Spinal discs are shock absorbers that allow the spine to flex, bend, and twist. Pain from discs, known as discogenic pain, is commonly blamed for low back pain. However, disc degeneration seen on MRI does not necessarily cause pain, as many people with disc degeneration do not experience discomfort.
Indirectly, disc degeneration can cause major pain by leading to vertebral instability, stretched connective tissue, and possible disc rupture. When a disc herniates, the nucleus pulposus can put pressure on nerve roots and cause chemical irritation, resulting in serious pain radiating down the leg (sciatica).
Facet joint sprain is another frequent cause of low back pain. The facet joints stabilize the vertebral bodies and can be damaged or develop arthritis. Pain from facet dysfunction typically affects the lumbar spine, thoracic region, and neck but does not extend into the extremities like sciatica. This pain is usually worsened by back extension or rotation.
To interrupt the cascade of disc degeneration, vertebral instability, and possible disc rupture, a comprehensive regenerative approach is needed. Stabilizing and regenerating the connective tissue supporting the lower lumbar back can gradually realign the vertebrae, reducing pressure on the disc and allowing it to heal.
The regenerative approach focuses on joint stability and connective tissues. In cases of persistent back pain, the primary suspects should be connective tissue enthesopathy and vertebral instability. Comprehensive diagnostics and injections are necessary to ensure all supporting structures are targeted. Strengthening the ligamentous support of the spine can alleviate pain by stabilizing the vertebrae and allowing discs to heal.
While MRIs often reveal disc irregularities, injecting stem cells directly into the disc is not recommended. Instead, tightening and rebuilding the ligaments and tendons affecting the lumbar region should be the focus. This approach has an 80-85% success rate in resolving back pain.
For persistent pain despite regenerative treatments, options like the Discseel procedure or microdiscectomy surgery may be considered, with spinal fusion as a last resort. This sequence aligns with the principle of minimally disruptive treatments that preserve the natural connective tissue integrity of the region.
In summary, the holistic regenerative approach to low back pain, which considers all connective tissue structures and vertebral stability, often yields superior results compared to traditional methods that focus mainly on the discs. A thorough palpation exam by a skilled regenerative doctor can help identify the true causes of pain and guide appropriate treatment.
