Low Back Pain: Causes, Symptoms, Diagnosis and Treatment

Dorsalgia is a generalized clinical term used by doctors to describe back pain, regardless of its location or cause. It comes from the Latin root words: “dorsum,” meaning back, and “algia,” meaning pain. Despite its widespread prevalence, back pain is often described as “non-specific” due to the frequent absence of any identifiable mechanical issues.

Learn about different types and locations of back pain, and potential dorsalgia causes.

Why is back pain so prevalent?

According to the World Health Organization (WHO), back pain is the leading cause of disability worldwide, with the highest number of cases occurring between the ages of 50-55. To understand the widespread prevalence of back pain, it is important to understand the relationship between the spinal column and the central nervous system.

Your spinal column provides a protective casing for the spinal cord, a key component of the central nervous system (CNS), made up of the brain and spinal cord. The spinal column is made up of bony vertebrae that provide a rigid structure for protecting and housing the spinal cord. Vertebrae are separated from one another by discs that absorb shock and provide a space where nerve roots exit the spinal cord and branch out into neurons, connecting the CNS to the peripheral nervous system that innervates the various parts of the body.

Thanks to the spinal cord, your nerves are able to seamlessly transmit millions of signals between your brain and the rest of your body. Peripheral sensory nerves send messages to your brain about the external environment, bodily functions, and the body’s position in space. At the same time, motor nerves send signals from the brain to the body, to govern metabolic and biological functions, and to produce movement.

Due to the spine’s unique architecture, nerve roots often become compressed, or “pinched” where they exit the spinal column, causing back pain. Nerves can also be compressed when the muscles and fascia that support the spine become weak, damaged or imbalanced.

What are the different types of dorsalgia?

Dorsalgia can be categorized by its location along the spinal column, or by its primary causes. Let’s begin with spinal architecture.

• Cervical dorsalgia occurs in the neck, defined by vertebrae C-1 to C-8. Nerves that exit the C-spine control the muscles of the neck, diaphragm, deltoids, triceps, wrists and fingers.
• Dorsalgia of the thoracic region occurs in the middle back. The thorax is defined by vertebrae T-1 to T-11, with nerves affecting muscles of the hand, rib cage and abdominals.
• Dorsalgia of the lumbar region encompasses vertebrae L-1 to L-5, and is associated with lower back pain – the most common type of dorsalgia. Lumbar nerves affect muscles of the hip and pelvis, and the muscles of the lower extremities.

Nerves of the sacral spine govern reproductive and eliminatory functions, and pain in the coccyx – aka tailbone – is called coccydynia, often arising from a backward fall.

What are the Primary Causes of Dorsalgia?

Another way to think about dorsalgia is in terms of its origins. Many factors can contribute to back pain, and more than one factor can be in play at the same time.

The main types of back pain include:

• Acute back pain, most often caused by trauma or overuse. Acute back pain has a sudden onset and pain is often short-term, lasting from a few days to several weeks, although it can progress to chronic pain.
• Chronic back pain generally lasts longer than 12 weeks. It usually has a gradual onset, worsening over time. Chronic back pain is often associated with arthritis or degenerative spinal stenosis, but it can also arise from factors like obesity and poor posture.
• Mechanical back pain is the most common type of dorsalgia and involves the muscles and fascia, comprising the myofascial system. Elastic tension provided by the myofascial system supports the spine, a property called tensegrity. Fascia can develop densifications and adhesions, entrapping nerves and interfering with muscle action. Mechanical back pain often manifests as a dull ache that diminishes over time.
• Radiculopathy is a condition where a nerve root in the spinal column becomes compressed or irritated, leading to pain, numbness, tingling, and weakness in the areas innervated by the affected nerve. It can be caused by a herniated disc, spinal stenosis – narrowing of the spinal canal – or myofascial dysfunction and trigger points.

What are the Most Common Dorsalgia Symptoms?

Dorsalgia symptoms can vary from one person to the next, depending on factors like physical activity level, posture, excessive sitting, and even metabolic health.

Common Symptoms of Dorsalgia include:

• Dull, achy, or sharp pain of varying intensity. anywhere along the spine.
• Pain that radiates from the spine to other areas of the body. For example, pain from sciatic nerve compression can radiate to the buttocks, hips and legs.
• Muscle stiffness and spasms near the spinal column.
• Reduced trunk or neck range of motion, and reduced mobility.
• Numbness and tingling in the extremities.
• Pain that worsens at night.
• Pain during certain specific movements.

How is Dorsalgia Diagnosed?

During your initial visit, your doctor will review your medical history and ask questions about the onset, duration, and intensity of pain. Your clinical exam may include assessments of posture, range of motion, and location of pain. Depending on the examination results, the doctor may use electromyography to test for nerve compression.

To gain further insight, your doctor may send you out for an x-ray or MRI, but those imaging methods only produce static images of a limited area. By contrast, high-resolution diagnostic ultrasound gives you dynamic images in real time. In comparing ultrasonography to other imaging methods, one study concluded that ultrasound optimizes the visualization of vertebral and soft tissue structures, can enhance detection of radiculopathy, reduce patient costs, and shorten examination times.

What are the Most Effective Dorsalgia Treatments?

Medical doctors typically recommend rest, NSAID pain medications, muscle relaxants, and topical creams or ointments to treat dorsalgia symptoms. However, that approach may only mask your symptoms without addressing their underlying cause. Physical therapy and chiropractic care can help to improve posture, enhance spinal alignment, and promote mobility and stability.

Integrative therapy is a holistic approach to dorsalgia treatment that considers the whole patient, not just their symptoms. An integrative dorsalgia specialist may use a variety of alternative therapies to not only treat pain symptoms, but eliminate their contributing factors. Advanced holistic therapies are often combined, and used to prepare damaged tissues prior to physical therapy.

Advanced integrative therapies for dorsalgia pain include:

• Extracorporeal shock wave therapy (ESWT), a non-invasive approach that uses high frequency sound waves to reduce pain and inflammation, and attract stem cells and growth factors to the treatment site.
• Trigger point dry needling, to eliminate painful nodules of tightly contracted muscle fibers. Dry needling accuracy is dramatically improved when guided by high resolution ultrasound.
• Myofascial release, a manual approach that targets densified fascia and fascial adhesions.

• Interfascial plane and nerve hydrodissection, a procedure where a saline solution is injected into densified fascia to separate fascial layers and free up entrapped nerves and blood vessels. The procedure is best performed with ultrasound guidance.
• Percutaneous neuromodulation, a procedure where filament-thin needles are inserted into muscle tissue adjacent to a targeted nerve. A low frequency electrical current is then delivered via the inserted needles to stimulate and normalize the dysfunctional nerve.

Where Can I Get Cutting-Edge Dorsalgia Treatment in NYC?

There are dozens of private clinics in Manhattan that offer back pain treatment, but most of them do not feature advanced technologies like ultrasonography and multimodal shockwave therapy. At NYDNRehab, our state-of-the-art clinic features the most advanced and evidence-based approaches available for dorsalgia diagnosis and treatment. Dr. Kalika’s experience and expertise make NYDNRehab the clinic of choice for dorsalgia treatment in NYC.

Get Cutting-Edge Dorsalgia Treatment in NYC

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