The back is a complex arrangement of 23 bones (called “vertebrae”) stacked on top of one another separated by discs, all held together by ligaments.  The spinal cord runs from the base of the head to the low back protected by the bones.  The nerves exit the spinal cord between the vertebrae at each of the 23 levels from the neck to the low back, and travel like electrical wiring to their outlets, such as the muscles or internal organs.

Back pain and sciatica is a multi-million dollar industry, and answers are as varied as the number of professional practicing in the industry. Talking to a surgeon, the answer lies in the “disc”, whether it is “bulging” or “herniated”, causing irritation of a local nerve (like an old electrical wire without any casing left on it exposes the copper wiring underneath, leading to a “short-circuit”), or “arthritis” of the joints of the back, or even more severe problems which lead to one of the bones slipping forward, out of position (called("spondylosisthesis”), irritates the spinal cord and its surrounding nerves.  Talking to a chiropractor, the cause is misalignment of the vertebra (called “subluxations”) that irritate local nerves.   Talking to an acupuncturist, it may be lack of “chi” to an area.  Talking to a yoga or Pilates instructor, or personal trainer, or physical therapist, it may be “weak muscles”, or a “mind-body” connection that is not functioning properly.  

Typically, X-rays are taken, which may show “degeneration”, or “DJD” (degenerative joint disease) or “DDD” (degenerative disc disease).  Then an MRI (magnetic resonance image) is usually taken, which show the discs and any irritation due to “bulges” or “herniations". Recommendations are then made on these findings, including treatments such as anti-inflammatory or pain medications, cortisone or “steroid” injections such as “facet” injections or “epidurals”, physical therapy, chiropractic (or other “alternative”, “conservative” treatments). When these fail, surgery is typically recommended such as a “discectomy”, or “microdiscectomy” where all or part of the disc is removed, and possibly a “fusion”, where the unstable joint is screwed to the one above or the one below to prevent any movement that may be leading to pain.

The reason all these treatments may fail, or provide only temporary relief, is that the cause of the problem has not been accurately diagnosed, consequently, goes untreated, or worse, makes this problem even worse by further destabilizing the area.  The X-rays and the MRI’s do not show the cause of the problem.  Most often, the cause of the problem is the ligaments that hold the back together.  These ligaments act like door hinges, and when weak or stretched out, they allow the door to swing off its hinge with movement, leading to pain symptoms, including “sciatica” (pain starting in the low back and going down the legs).  95% of the pain sensors are located in these ligaments, and when they are stretched, cause pain.  The disc and bones have a very small number of pain fibers, and are therefore, not the cause of the pain.

Treatments are aimed at stopping the chronic swelling due to the irritation around the nerves, or muscle strengthening exercises, even psychological counseling, as the pain can be severe as to totally disrupt a person’s life and relationships.  Surgery treats the discs, and attempts to “stabilize” the joints with a “fusion”, however, in the long term, this may lead to further destabilizing the area, often resulting in another surgery.