Most people consider the “back” as a single unit, and, in many ways, it is. It is made up, however, of multiple interlocking joints. In the “normal” human back, there are eight cervical vertebrae, 12 thoracic vertebrae, five lumbar vertebrae, and a sacral bone. Each forms a joint with the next level.
Each of these individual parts provides ample opportunities for problems to arise as a person ages, leading to pain and, in some cases, a loss of mobility. However, there are common reasons to explain why this happens. Top chiropractors in Denver are experts at diagnosing and treating “bad” backs.
Normal Back Anatomy
Understanding the normal back anatomy is necessary to know how aging can cause pain. Nature did not design the human body to maintain functioning past a certain point without degenerate changes. As more people survive over the 100-year mark, the consequences of advanced age become more evident in body structures and organs. The back is a typical age-affected structure.
The spinal cord carries nerves back to the brain for processing. Under ideal conditions, the vertebral bodies remain separated, allowing a space between them for nerve roots to exit. Any process that compresses the area where the nerve root exits the spinal column, called the neural foramina, initially causes pain along the nerve tract. After a time, the continued pressure results in numbness, muscle weakness, and finally, muscle atrophy.
There are many types of arthritis. Osteoarthritis (degenerative arthritis) is a separate condition from inflammatory arthritis. Symptoms, distribution, pathophysiology, and treatments are completely different. A confusing facet is that you can have both inflammatory and degenerative arthritis simultaneously.
When a joint surface is repeatedly inflamed, osteogenesis (bone growth) develops. However, it is thin, brittle bone produced at the site, not a healthy, strong bone. It can, however, lead to painful deformities and a limited range of motion in a joint.
A radiculopathy is an inflamed nerve root from foraminal stenosis, the narrowing of the foramina. Osteoarthritis, a herniated disc, or both commonly cause the narrowing. In the lower back, this is called sciatica or lumbago.
Radiculopathy can present acutely with severe pain or develop with progressive and recurrent pain over time. Especially if age-related degenerative processes have started, a minor muscle spasm can be enough to produce symptoms.
Osteoarthritis of the Spine
Osteoarthritis of the spine is a leading cause of back pain in old people. 80% of “old people” report having had back pain at least once in their lives. The lower (lumbar) and upper (cervical) spine are most affected. The usual explanation is “wear and tear” from axial load weight bearing, that is, being upright and walking for a lifetime. Each step or jump compresses the spine, one vertebral body against another. Other proven factors contribute to arthritis of the spine and back pain in older adults.
Genetics plays a significant role in spinal arthritis. Science has identified multiple genes that code for proteins in discs and connective tissues that support the spinal column. Just as skin cell replenishment changes with age, so does the genetic coding for important spinal structures. As a result, some people are at higher risk of developing spinal osteoarthritis.
Bone spurs are formed from degenerative arthritis and can project into the foramina. Generalized growth can narrow the diameter of the foramina or form a pointed spur. The spicule can pierce the nerve root as it exits the cord, causing irritation and inflammation.
The work-related repetitive activity contributes to back pain. For example, drivers with daily bouncing, jackhammer drivers, farmers with shovels, and many job-related activities recurrently add to spinal compression.
A Slipped Disc
The intervertebral disc is an encapsulated cushion of gelatinous material between each vertebra. Over time and with repeated microtraumas, the disc material loses its elasticity and strength. As a result, the space between the vertebral bodies is shortened, which narrows the foramina.
An acute vertical compression injury can cause the disc to rupture. Or, over time, it can degrade enough that it just does. Gel-like material extrudes out of the intervertebral space. The path of least resistance is often posteriorly into the canal space or the foramina impinging a nerve root.
Concurrently, due to normal aging, the ligaments surrounding the spinal column also weaken with age. Consequently, they are unable to hold the disc in place as well. Remember that the spaces involved are very tiny; a few millimeters is all it takes for a nerve root or cord compression to produce symptoms.
Other Age-Related Contributing Factors:
There are other issues that can lead to back problems as people advance in years:
Male and Female Menopause
Healthy connective tissue and bone depend on hormonal influences for growth and repair. When the body stops producing estrogen and testosterone, there are direct effects that contribute to why older people have bad backs. Loss of muscle mass and tone are two results of hypogonadism. This includes the size and strength of the paravertebral muscles and ligaments.
Further destabilizing the back’s supportive structures increases the vertical compressive forces on the spine. It, in effect, “adds fuel to the fire” in a back developing back pain from degenerative changes.
- Osteopenia/Osteoporosis: Osteopenia is the bone loss that produces osteoporosis, a condition of brittle, weak bones. Incidental X-ray findings of vertebral compression fractures often diagnose osteoporosis. Reportedly more common in women, osteoporosis is also found in androgen-deficient men.
- Lifestyle Choices: Two other comorbidities with bad backs in old people are obesity and a sedentary lifestyle. Age-related weight gain increases the workload required of the spine.
All muscles require regular exercise to maintain strength and mass. As physical activity decreases with age, all muscles atrophy, including the back muscles. It is a negative feedback cycle when you don’t move because your back hurts, and your back hurts partly because you’re not moving.
The Bottom Line
Many aspects come together to create back pain as people age. The takeaway point is that the time to address back problems is as soon as possible — before you develop these issues. Maintaining a healthy weight, exercising regularly, considering hormone replacement therapy, and routine bone density screenings are excellent places to start. So why do old people have “bad” backs when they don’t have to?