March 20, 2008

Today Show host Meredith Vieira talks to Dr. Marcus and a patient about the importance of muscles as a cause of back pain. Most people think that lower back pain comes from the spine. The discs that separate the bones of the spine (the vertebra) sometimes rupture through the tissue holding them in place, resulting in a herniated disc, which may squeeze the spinal nerves and cause pain radiating into the leg (sciatica). The joints in the spine (facet joints, interbody joints) degenerate from wear and tear (osteoarthritis) and sometimes the bones of the spine do not sit evenly one on stop of another (spondylolisthesis). Although these conditions can clearly be seen on an x-ray or MRI, they frequently are not the reason someone has lower back pain. Up to 40% of adults have herniated discs and 70% degenerated discs (degenerated disc disease) without complaints of pain. Therefore, the presence of these findings doesn’t easily explain your pain. Actually, the number one diagnosis, accounting for 70-80% of back pain patients, is non-specific low back pain, referring to sprains and strains of soft tissue (muscles, ligaments, and tendons).

When our patient discussed the possibility that muscles, rather than the findings of spine degeneration on her MRI, could be the cause of her pain, she was told that was not possible. She did not want to receive surgery to her painful back. She was an avid athlete and distance runner. She wanted a non-surgical approach. Her evaluation revealed a number of muscles that appeared to be contributing to her pain. When these muscles were treated, her pain disappeared, and she has remained pain free for more than 3 years. She runs regularly.