Festive Cake

Degenerative disc disease

Between the bones of the spine we have what are called spinal discs. These disc are made up of a soft jelly core and a tough outer casing that act like a shock absorber and reduce the forces going through the spine. Degenerative disc disease is the loss of cells and water within the disc that reduces the discs ability to act as a shock absorber. Degenerative disc disease can be a source of lower back pain as the loss of water pressure allows the nerves that are usually only on the outside of the disc to grow into the disc, the overall inflammation caused by disc degeneration can also activate nerves and cause pain. Because discs are a very deep structure that grow with the bones of the spine the bodies mapping of the area is not very good so the pain is usually dull and broad in the general area of the disc (unlike muscles that can have a very precise area of pain).

Sciatica / Lumbar radiculopathy

The spine accts as a housing for the spinal cord, in between the junction of each bone of the spine there is a gap called the intervertebral foramen where a nerve from the spinal cord can run through and out towards the body. The nerves are called spinal nerves and eventually branch into multiple smaller nerves that then innervate the arm, legs and trunk. Radiculopathy is when the spinal nerve is pinched and causes a loss of motor function (muscle weakness) and skin sensation in the area that the nerve serves. The spinal nerve can be pinched anywhere along it's root outwards towards the body. If the disc expands backwards towards the spinal cord (disc bulges and herniations) it can compress the spinal nerve and cause radiculopathy, if there is a degree of inflammation at the nerve there is possibly also a degree of pain. Sciatica is the sensation of pain running up or down the leg in a pulsating mannor, it usually runs down the back of the leg from the pelvis to the knee, although it often goes down to the feet and can even pulse from the feet up to the hip. Due to the large area that sciatica inhabits it does not involve a single nerve like the lumbar radiculopathy, rather it is a broad area that coveres multiple nerve area. This is due to sciatic mainly originating in the spinal cord where there is a "strumming" like activation of the fibres within the spinal cord that activates multiple nerve rapidly giving the sensation of the shooting pain associated with sciatica.

Facet pain

Facet joints are located in the back of the spine and reduce the amount that our spine can rotate side to side as well as how much we can bend backwards. The facet pain can occur when the synovial membrane that covers the surface of the facet joint becomes stressed and inflamed. The facet joints are stressed when we extend the spine backwards, this is common in the neck and lower back when we are in a slouched posture. The pain from facet joints is usually in the area around the facet joint but quite often can be in a large area around the facet joint. The facet joints are also covered in a capsule. The facet capsule is a tubular ligament that covers the facet joint and prevents the facet joint getting separated when we lean forward. In whiplash syndromes the facet joint capsule is overstretched and can cause the diffuse neck pain associated with whiplash. In the lower back the facet capsule can also be overstretched by forcefully leaning forward.

Muscular pain

Muscles are a common source of pain. They usually become painful once they are overworked and develop muscle knots (also called trigger points). Muscular lower back pain is where the muscle around the lower back are unable to cope with the posture of movement of the lower back and so become overworked and painful. During the ageing process where our spinal discs reduce in size we can develop lower back instability, this instability can compensated by lower back muscles becoming tight.