Where is my back pain coming from?

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I can remember my first patient in clinic many years ago. I tried to explain everything I knew about the spine and their injury. The patient looked at me like a deer caught in the headlights. I could tell they were listening but I was unaware that I was just spewing out all these fancy medical terms that had been crammed down my throat in chiropractic school. It took me a few “headlights” to learn how to bring my education to the patient in a manner that they could understand. In someways this took more skill to master than learning all those fancy medical terms.

When discussing the spine I have found that it is important to break down the pain generator components. Most patients associate pain as their problem. It can be difficult to explain that pain is not the problem, but a symptom of the problem. Confused? Well, you would not be the only one. Understanding spinal injuries takes a complete view of the musculature and neurological systems.  It is possible to break the complexity of the these systems into three pain generators.

The first pain generator can relate to the facet joint. This pain generator is generally lower on the pain scale. There are orthopedic test to ascertain the presents of irritation of this joint. I say “generally” lower pain but I have seen these joints become very painful with some high impact football injuries and auto injuries.

The second pain generator may be due to an annular disc injury. These injuries can be deceptive with pain going down the back of the legs and arms. Many patients may not even present with lower back pain but they have significant leg pain. Now try to convince the patient they have a back problem when they are coming in with zero back pain. This is what exemplifies the meaning of pain is the symptom and not source of the problem.

The third pain generator may relate to the spinal nerve that exits at the disc level. This nerve may become irritated from the inflammation caused by a disc injury or may become impinged by the disc or a degenerative process. Orthopedic test can determine what type of impingement the patient is dealing with.

Although I still continued to use these dreaded medical terms….we can break in down into three simple terms

  • Facet
  • Disc
  • Nerve

If you are continuing to suffer from reoccurring lower back or neck pain, come in an see how to take control of your symptoms. My clinical treatments are based on rehabilitation and not just a “pop” and out the door you go. Come see what you are missing.

John Pellegrini, D.C.


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