Hoag Spine Institute

Chronic pain in the neck and back is pain associated with the spine that lasts six months or longer. This pain in the neck and back can be constant or recurring, range from mild to debilitating and persist for months or even years. Depending on the severity and duration of the issue, chronic pain in the neck or back can have a significant impact on a person’s mental health, level of activity, ability to sleep, productivity at work and overall quality of life.

Degenerative disc disease (DDD) is a condition in which the spinal discs between each vertebra begin to deteriorate or break down over time.

The spinal discs serve several important functions, including acting as shock absorbers for the spinal column, allowing the spinal column to flex, bend and twist. In addition, the intervertebral discs cushion each of the vertebrae that make up the spine.

Over time, due to normal aging, injuries and wear-and-tear, the rubbery discs of the spine can experience disc degeneration, a process in which the spinal discs wear down and slowly lose their flexibility, elasticity and shock-absorbing abilities.

Because the spinal discs are very close to the spinal cord and nerve roots, disc degeneration can cause pain and lead to other problems, such as spinal instability and herniated discs.

A herniated disc (also called a bulging disc, disc herniation, a slipped disc or a ruptured disc) occurs when one of the spinal discs — the rubbery pads between each vertebrae that cushion the spinal column while allowing the back to be very flexible — becomes damaged to the point the soft, inner disc material begins to bulge through a tear in the disc’s strong outer shell.

A herniated disc can put pressure on the spinal cord or spinal nerve roots. Depending on how extensive the herniation is and where it occurs in the disc, that can result in numbness, loss of muscle strength and back or neck pain that may be severe.

Kyphosis is a condition in which the upper back develops an exaggerated forward curve. Those with the condition often look stooped or “hunched over,” with rounded shoulders, even when they’re standing up as straight as they can. In the past, kyphosis was sometimes called “roundback” or “hunchback.”

Many types of kyphosis go beyond poor posture, and create physical issues with the spine that make it hard, painful or impossible to fully stand up straight. While mild kyphosis may be barely noticeable, in those with severe kyphosis, the effect on the appearance can be substantial, including a visible hump.

In addition to pain, stiffness and inflexibility in the upper back, kyphosis can cause self-esteem issues due to the impact on a person’s posture and the way they look.

In severe cases, involving what’s called hyperkyphosis, the hunched posture and excessive outward curve of the spine can begin to compress the abdomen, causing issues like swallowing difficulties and acid reflux.

Lower back pain, also called lumbar spine pain, is a common condition characterized by pain in the lower part of the back, usually between the lower ribs and the top of the buttocks.

Lower back pain can range from a dull ache to a sharp, stabbing pain that can vary in intensity from mild to severe. In some cases, pain in the lower back can also radiate out to other areas of the body, including the buttocks, legs and feet.

Acute lower back pain only lasts a short time, usually improving with conservative treatments like using ice or heat, rest, and over-the-counter pain relievers. However, if lower back pain lasts more than three months without relief, it’s considered chronic lower back pain. Chronic back pain may indicate a more serious issue.

Those with chronic pain in the lower spine may need other treatment options to achieve back pain relief, including lifestyle changes, injections of nonsteroidal anti-inflammatory drugs, prescription pain relievers, muscle relaxants, transcutaneous electrical nerve stimulation, massage therapy or physical therapy.

In severe cases involving muscle weakness and muscle spasms, or if severe lower back pain persists despite treatment with more conservative measures, surgical procedures like spinal fusion or disc surgery may have to be considered to relieve pressure on nearby nerves and address the root cause of pain in the lower back.

Myelopathy refers to symptoms that can occur due to the severe compression of the spinal cord.

When the spinal cord is compressed (squeezed) due to an outside force putting pressure on the spinal nerves, it can cause various symptoms, including chronic pain, numbness or difficulty with moving certain parts of the body.

Compression of the spinal cord can stem from various chronic, or long-term, conditions, including spinal stenosis, disc degeneration or bone spurs.

However, people can also experience acute myelopathy, meaning that symptoms come on quickly, usually due to the effects of a spinal injury. Whether chronic or acute, myelopathy can severely impact a patient’s quality of life, especially if the condition is left untreated.

Neck pain, also called cervical pain or cervicalgia, is a common issue characterized by pain, stiffness or discomfort in the neck.

The neck consists of the upper seven vertebrae in the spinal column, along with the muscles, spinal discs and other soft tissues that help support and move the head. Issues like stress, disc degeneration or injury to these tissues can result in neck pain.

Neck pain can range from mild to severe. It can also be felt in different ways, with some people experiencing neck pain only when they perform certain movements, like turning their head or looking up or down. Others experience persistent pain all the time, even while holding their head still or when lying down.

Neck pain is also categorized by where it is felt. Radicular neck pain radiates from the neck to the upper body, sending severe, shooting pain into the arms and shoulders in serious cases. Axial neck pain, on the other hand, is felt solely in the neck, and doesn’t extend to other parts of the body.

Most neck pain isn’t dangerous, and improves on its own through at-home treatments like rest and over-the-counter pain medication. Neck pain that lasts only a few days or weeks is considered acute neck pain. Long-term neck pain that lasts more than three months is considered chronic neck pain.

Nerve Compression (also known as a “pinched nerve”) occurs when there is compression or pressure on a nerve related to the spinal column. Damage from a pinched nerve may be minor or severe and can cause temporary or chronic problems. In some cases, damage from a compressed nerve is irreversible. The good news is treatment usually relieves pain and other troubling symptoms.

Osteoarthritis, also called OA, is a type of progressive degenerative joint disease that can cause pain, stiffness, swelling and reduced range of motion in joints all over the body. It is most often diagnosed in the spine, knees, hands and hips. “Progressive” means the condition usually gets worse over time.

Osteoarthritis is the most common form of arthritis. In those with osteoarthritis, the cartilage that normally cushions and protects the joints begins to wear down and deteriorate. A tough, flexible connective tissue found throughout the body, cartilage plays a crucial role in healthy joint function, serving as a kind of natural shock absorber, helping protect the joints and keep bones from rubbing painfully together.

Once the cartilage in a person’s joints begins to deteriorate due to osteoarthritis, the joint can no longer operate as smoothly as it should. That can lead to a variety of often-painful OA symptoms. The most common symptom of osteoarthritis is chronic pain and joint stiffness in affected joints, especially after a period of inactivity like sitting still for a while.

Osteoporosis is a condition that involves having weak or brittle bones, which can increase a person’s risk of bone fractures.

Usually diagnosed in people over 50, osteoporosis may cause the bones to become so weak that a broken bone can occur from a minor fall, weight-bearing exercise or normal activities like bending down to lift a small child or laundry basket. In some cases of severe osteoporosis, even coughing or sneezing can cause a fracture.

While osteoporosis is a disease that is most widely known for its impact on older, postmenopausal women, both men and women can have the condition. According to the National Institutes of Health, osteoporosis affects 1 in 3 women versus 1 in 5 men.

Osteopenia vs. Osteoporosis

Osteopenia is the condition that often develops into osteoporosis. It’s defined as having bone mineral density (BMD) that’s below normal, but which doesn’t yet meet the official diagnostic criteria for osteoporosis.

Usually diagnosed through a bone density scan, osteopenia is, therefore, a sort of “pre-osteoporosis,” and should usually be taken as a signal to get serious about improving bone density and bone health, especially if you’re at higher risk for the condition.

Radiculopathy, commonly referred to as a “pinched nerve”, refers to a medical condition where there is irritation, compression, or inflammation of the spinal nerve roots, often resulting in pain, weakness, numbness or tingling that radiates along the path of the affected nerve.

Pain associated with radiculopathy can severely impact a patient’s quality of life and, in some cases, can lead to muscle atrophy.

About the Spine and Nerve Roots

The spine provides the body with structural support while also providing a remarkable amount of flexibility. The spine is made up of bones known as vertebrae, which are sandwiched between gel-like, cushioning pads known as intervertebral discs. Together with muscles and tendons, these structures form what’s called the spinal column — commonly referred to as “the back.”

While the spine promotes an upright posture, it also serves as a protective sheath for the spinal cord. The spinal cord is a network of nerves that run through a hollow space in the spine called the spinal canal. The spinal cord serves as an informational highway between the brain and the rest of the body, sending nerve impulses back and forth to help the body function. Nerve roots exit from the spine, transmitting nerve impulses from the spine to the body's muscles.

Sometimes, people can experience what’s known as nerve compression, in which one of the roots of the spinal nerves has too much pressure put on it by issues like herniated discs or bone spurs. That can result in severe pain, and the condition known as radiculopathy, or a pinched nerve root.

For your doctor to diagnose radiculopathy, he or she may perform a physical examination and order tests like an MRI, CT scan or nerve conduction study. Treatment for radiculopathy care typically begins with nonsurgical treatment, like physical therapy, or a series of epidural steroid injections to relieve nerve root inflammation. However, in severe cases, surgical procedures may be necessary in order to relieve pain and restore muscle strength.

Scoliosis is a type of spinal deformity involving an abnormal, sideways curvature of the spine.

Everyone has natural curves in their spine. But in those with scoliosis, these curves become abnormally severe, to the point they can begin to cause health problems or affect a person’s posture and appearance. In severe scoliosis cases, the spine can resemble a “S” or “C” shape in X-rays.

The abnormal curvature of the spine that’s characteristic of scoliosis can occur in different areas of the spine. In some cases, it can twist individual vertebrae as well. Scoliosis can vary in severity from person to person, with cases classified as mild, moderate or severe scoliosis.

Depending on the degree of spinal curvature, people with scoliosis can experience a range of issues with their appearance, including visible position differences in the height of their hips, shoulders or shoulder blades, or having a rib cage that’s more prominent on one side of the body than the other.

Sciatica is an issue in which pain occurs due to damage or pressure on the sciatic nerve. Beginning in the lower back, the two sciatic nerves branch away from the lower spine (the lumbar spine) before running through the hips and buttocks and down each leg.

Sciatica usually only affects only one side of the body. It can feel like stabbing, crushing or shooting pain that radiates from the lower back and upper buttocks and down one leg. In severe cases, the pain can reach as far as the feet and toes.

Sciatica pain usually occurs due to something pressing on or irritating the spinal cord or nerves, like a herniated disk. That can cause inflammation of the sciatic nerve that is interpreted by the brain as severe leg and back pain, with the pain radiating along the affected nerve pathway.

Spinal deformities refer to unnatural curvatures of the spine resulting from damage to the spinal column, such as damage caused by fractures or ankylosing spondylitis (Bechterew’s disease), or various defects and congenital conditions that cause the spine to grow unevenly. Common spinal deformity types include Scoliosis, Kyphosis, and Spondylolisthesis.

A spinal fracture is a break or crack in one of the vertebrae that make up the spinal column.

In younger people, spinal fractures occur most often as a result of high-energy trauma caused by a fall, automobile accident, sports injury or even issues like physical assaults or gunshot wounds.

Extreme trauma can cause especially severe fractures of the vertebrae, known as burst fractures. In extreme cases, these fractures can cause a broken spinal vertebra to shatter in multiple directions. Usually occurring due to violent impacts from car accidents or high falls onto hard surfaces, a burst fracture can scatter shrapnel-like bone fragments into surrounding tissues, including the spinal cord and nerve roots. That’s why experiencing a burst fracture increases the risk of the spinal cord being completely severed, potentially resulting in paralysis.

Spinal fractures can also happen as a result of having weakened bones due to osteoporosis, a disease involving bone-density loss that usually occurs in older people. Osteoporosis can reduce the density of bones, which can make them weaker and more likely to break.

When osteoporosis affects the spine, the result can be what are called vertebral compression fractures. In severe cases of osteoporosis, spinal fractures can occur even during minor falls or ordinary movements, like bending down to pick up a moderately heavy object.

Spinal fractures are more than just injuries to the bone; they can have a profound impact on a person’s overall health and mobility. The potential for paralysis or other neurological or mobility issues makes these injuries particularly serious.

Recovery may involve a minimally invasive procedure or more significant surgical interventions in the case of unstable fractures, often followed by physical therapy and rehabilitation to restore function and mobility as much as possible.

That said, minor spinal fractures, appropriately treated, may not adversely impact a patient’s quality of life or lead to debilitating consequences, as effective treatment options are readily available.

Spinal stenosis is a narrowing of the spaces within the spine, which can put pressure on the nerves that travel through the spine. This causes a “pinching” of the spinal cord and/or nerve roots, which leads to pain, cramping, weakness or numbness in the body.

Spinal tumors are abnormal growths of tissue inside the spinal column. If they originate in the column, they are called primary tumors, which can be either benign or malignant. If they originate in another part of the body, they are likely malignant and called secondary or metastatic tumors.

Spondylolisthesis occurs when a vertebra slips out of alignment with the bone below it. In many cases, this can occur gradually over time with age and wear-and-tear. Many patients can manage their symptoms conservatively. Surgery may be required in some cases if there is severe instability or if the slip is causing severe back and/or sciatic nerve pain and weakness.

Tailbone pain, also called coccydynia, is pain in and around the small triangular bone at the very bottom of your spinal column, above the cleft of your buttocks. The tailbone (coccyx) is made up of three to five small bones that can be injured by trauma during a fall. Tailbone pain can also be caused without trauma by prolonged sitting on a hard surface. Less commonly, patients may have degenerative joint changes or experience postpartum tailbone pain.

Whiplash is a neck injury that can result from the neck bending forcibly forward and backward, usually due to a sudden movement, jolt or impact from behind. It’s called whiplash because the violent movement of the head and neck that can cause a whiplash injury is much like the cracking of a whip.

Whiplash is most commonly caused by a rear-impact car accident, but the condition can also be caused by a variety of other factors, including a full-contact sports injury, a fall or physical abuse and assault.

Depending on the severity of the injury, whiplash can cause limitation in the neck’s range of motion, induce muscle spasms in the neck and arms, and cause neck stiffness and chronic pain. It is a fairly common injury, affecting millions of Americans every year.

While most people with a whiplash injury recover within a few weeks through conservative treatments such as physical therapy and pain relief medications, some patients may continue to suffer from the symptoms of whiplash for several months or longer.