Understanding Back Pain: Your Spine and How it Works

The majority of patients present to my office with back pain, sometimes the direct result of an activity, but more often than not the onset of the pain is insidious; meaning that they don’t know what brought it on. In order to understand what causes back/neck pain, it is important to first understand your spine and how it works.

The spine consists of 24 freely moveable vertebrae which articulate at the bottom with the sacrum and at the top with the occiput, which is the base of the skull. Each vertebra is separated from the next by a disc, which is a shock absorbing cushion that provides the surface for each vertebra to move upon the next; hence they are “freely movable” upon one another. When we consider how two vertebrae move in relation to one another, we refer to movement of a joint. Thus, a spinal joint consists of two bones and the disc in between them. There are specific normal ranges of movement for these joints which often become compromised or dysfunctional long before the onset of pain. Insidious back pain is most commonly the result of long standing spinal joint dysfunction which goes undetected and unmanaged until the pain actually presents.

The spine is classified into three regions and the individual vertebrae are identified numerically within each region. The cervical region refers to the neck and consists of seven vertebrae positioned so that they form what is called a lordosis. Lordosis is the description of how the vertebrae align themselves into a c-shaped curvature when you look on a lateral (side-view) x-ray. For example, the third vertebra in the cervical region is identified as “C3”

Below the cervical region, the next twelve vertebrae comprise the thoracic region. Each thoracic vertebra articulates with a rib on both sides and the alignment in this region forms a kyphosis, or backwards c-shaped curvature. Similarly, the fifth vertebra here is referred to as “T5”, or thoracic vertebra number five.