Latest / Scoliosis with Dr. Chris Gubbels / 7 Types of Back Pain Ranked From Harmless to Serious

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7 Types of Back Pain Ranked From Harmless to Serious · Scoliosis with Dr. Chris Gubbels

• 0:00
  SPEAKER_00: You see, some back pain feels terrible, but it actually turns out to be relatively minor.
• 0:04
  SPEAKER_00: And other back pain may only be about a three or four on a scale of one to ten, but it's the kind of pain that's actually much more concerning.
• 0:12
  SPEAKER_00: Because how much your back hurts doesn't always tell you exactly what's going on, how worried you should be about it, or what you should potentially do about it.
• 0:20
  SPEAKER_00: So I'm gonna rank seven types of back pain from harmless to more serious.
• 0:25
  SPEAKER_00: And if you mistake one from the other, you could end up spending months, possibly even years, treating the wrong problem.
• 0:32
  SPEAKER_00: Now, when we get to number four, we're gonna be talking about the type of back pain that gets mistreated all the time.
• 0:37
  SPEAKER_00: Hi, I'm Dr.
• 0:37
  SPEAKER_00: Chris Gubel's leading specialist in the non-surgical treatment of scloss and hyperkyphosis and specializing in back pain related to scloss and hyperkyphosis.
• 0:47
  SPEAKER_00: So let's start with number one.
• 0:48
  SPEAKER_00: So the first type of back pain is the pain you get after overdoing it.
• 0:54
  SPEAKER_00: So let's say you spend the whole weekend working in the yard or you're moving a bunch of furniture, or possibly it's the first time you're going back into the gym after not exercising for several months.
• 1:03
  SPEAKER_00: The next morning you're obviously gonna be sore and you'll likely have some back pain.
• 1:07
  SPEAKER_00: Now, this type of back pain is usually the type that I worry about the least because an obvious reason why it started, and it should behave like something you simply overworked, or you were exerted muscles that were not used to that type of exertion.
• 1:20
  SPEAKER_00: But over the next several days, that type of pain tends to settle down and it doesn't generally come back with any specific movements, and eventually you return to normal.
• 1:29
  SPEAKER_00: The mistake here is getting worried too fast over this simple problem and taking excessive medications or rushing to the ER over a problem that may not really require any attention.
• 1:39
  SPEAKER_00: Your body is simply just recovering from having worked it more than it's used to be and worked.
• 1:44
  SPEAKER_00: You see, one episode of pain like this doesn't automatically mean you have a damaged disc or a pinched nerve or something more seriously wrong with your spine.
• 1:52
  SPEAKER_00: What changes my opinion is when this stops becoming a one-time thing.
• 1:56
  SPEAKER_00: So if every time you do something like guarding, traveling, walking a little further, exercising, anything slightly demanding, that same type of pain keeps coming back.
• 2:05
  SPEAKER_00: Now we're starting to see a repeatable pattern.
• 2:08
  SPEAKER_00: And that moves the seriousness up the list a little bit.
• 2:12
  SPEAKER_00: Now, the number two type of pain is pain that changes with positional changes.
• 2:17
  SPEAKER_00: Maybe sitting makes your back hurt, and when you stand, you feel better.
• 2:20
  SPEAKER_00: Or possibly standing aggravates it, but sitting gives you some relief.
• 2:24
  SPEAKER_00: Maybe bending forward helps while leaning back makes it worse.
• 2:27
  SPEAKER_00: This is all very useful information because you've already figured out there's something that you're doing or not doing that tends to irritate the problem and changes your pain pattern.
• 2:36
  SPEAKER_00: You may still not know exactly why it's happening yet, but if one position constantly makes it worse and another constantly makes it better, you have some information you can work with.
• 2:46
  SPEAKER_00: Sometimes that means how long you stay in that position that causes pain.
• 2:49
  SPEAKER_00: Sometimes it means changing how you move.
• 2:51
  SPEAKER_00: Sometimes it's buying the right stretch or the exercise for you instead of doing just general exercises or stretches that are thought to be good for back pain.
• 2:58
  SPEAKER_00: This also reminds me of something one of my instructors once told me when I was in chiropractic school.
• 3:03
  SPEAKER_00: Now, I don't remember exactly what was bothering me, but I remember telling one of my instructors, like, hey, I get pain when I do this.
• 3:09
  SPEAKER_00: And he looked at me and said, Well, then stop doing that.
• 3:13
  SPEAKER_00: So obviously, if you get pain with specific movement, that's something you don't want to repeatedly do.
• 3:19
  SPEAKER_00: And if you can change your pain simply by what you're doing or not doing, I would use that information as a starting point and not necessarily rush into more serious treatments because you've already found out what influences, and that should give you clues about what's going on based on what aggravates it or what potentially makes it better.
• 3:37
  SPEAKER_00: But this is also a type of pain you don't want to ignore.
• 3:39
  SPEAKER_00: You want to investigate exactly why certain movements are causing pain and why certain movements give you relief.
• 3:45
  SPEAKER_00: But these are clues that can be used to find out what is actually going on and what's driving the pain.
• 3:51
  SPEAKER_00: Now, a type of pain that either gets better or worse by what you do, and you can identify that and you control it, puts it a little bit lower on my list.
• 3:59
  SPEAKER_00: Compare the type of pain that continuously comes back no matter what you do.
• 4:03
  SPEAKER_00: You see, pain that keeps coming back no matter what you do, and there's nothing you can identify that makes it better or gets worse.
• 4:09
  SPEAKER_00: That's a completely different story.
• 4:11
  SPEAKER_00: Now, let's move on to pain number three.
• 4:14
  SPEAKER_00: Morning pain and stiffness that keeps lingering and keeps getting worse over time.
• 4:18
  SPEAKER_00: You know, you wake up stiff, it takes a few minutes to get moving, and then your back loosens up and it feels better.
• 4:24
  SPEAKER_00: Now, pain like that on its own doesn't generally move very high on my list of pain that's more severe.
• 4:29
  SPEAKER_00: But another thing that gets my attention is when I hear people constantly say, you know, that's just me getting older, that's just old age.
• 4:36
  SPEAKER_00: And they say that over and over while the pattern changes and it gets worse and worse over time.
• 4:40
  SPEAKER_00: I don't like to take that's just age as an explanation.
• 4:44
  SPEAKER_00: You see, once the stiffness starts to get longer and it starts to come back later in the day, or you start to change what you're physically doing because of the pain, now we have a problem.
• 4:54
  SPEAKER_00: See, maybe it used to take you just five minutes to loosen up, but now it takes you like 30.
• 4:58
  SPEAKER_00: Maybe it used to disappear completely once you got going, but now it comes back later in the day, or when you're doing things like standing or walking for an extended period of time.
• 5:07
  SPEAKER_00: Maybe you're waking up with a specific spot or the same side of your back pain hurting every single day.
• 5:13
  SPEAKER_00: This is when we stop treating it or addressing it just like early morning stiffness.
• 5:17
  SPEAKER_00: You see, you may still feel better once you get up and get moving, but that relief can get shorter and shorter and starts to come back throughout the day and it gets harder and harder to manage.
• 5:26
  SPEAKER_00: At that point, we know something is changing.
• 5:29
  SPEAKER_00: And when you start getting pain like that, I absolutely recommend not waiting until it gets bad enough where you're starting to lose the ability to do your normal daily activities.
• 5:38
  SPEAKER_00: This is the type of pain you need to start taking more seriously.
• 5:41
  SPEAKER_00: Like as I've been getting older myself, I also notice if I'm not on top of things and taking care of myself, I also will start to get some stiffness and aches and discomforts.
• 5:49
  SPEAKER_00: But I also know as long as I'm taking care of myself proactively and I'm doing regular mobility exercises and core stretches and strengthening things, then I don't have any problems.
• 5:59
  SPEAKER_00: But if I don't take care of myself, those aches and pains can slowly start to creep.
• 6:04
  SPEAKER_00: That's completely different than the type of pain that keeps getting worse and worse and worse over time, regardless of what you're doing.
• 6:11
  SPEAKER_00: And that leads me to my fourth type of pain, and that is the pain that keeps coming back in the exact same place.
• 6:18
  SPEAKER_00: And this is where I think back pain gets treated all the time.
• 6:21
  SPEAKER_00: You know, you take someone who has back pain, they do some physical therapy, and then it feels better.
• 6:25
  SPEAKER_00: But then the pain comes back.
• 6:26
  SPEAKER_00: So then maybe they try chiropractic care.
• 6:28
  SPEAKER_00: They get some relief that works for a while, but the pain comes back.
• 6:31
  SPEAKER_00: Maybe they get an injection that works for a few months, but before you know it, they're right back where they're started.
• 6:36
  SPEAKER_00: Every time in this scenario, everyone's treating the exact same painful spot.
• 6:40
  SPEAKER_00: But if you're treating a painful spot three or four times and it keeps coming back, I think just trying to treat the source where you're feeling pain is a mistake.
• 6:49
  SPEAKER_00: You have to look at the overall picture and find out are there other things that could be contributing to that pain.
• 6:55
  SPEAKER_00: You see, a lot of providers only focus on where the symptom is.
• 6:58
  SPEAKER_00: But most of the time, in fact, there are many other things that could be going on outside of the exact spot where you feel symptoms that could be contributing to that pain or may even be the root cause of that pain that need to be addressed or corrected if you're going to relieve or permanently eliminate while the pain is there in the first place.
• 7:17
  SPEAKER_00: So at some point you need to ask yourself, why does that same spot keep coming back?
• 7:21
  SPEAKER_00: Why do I keep having pain in that exact same area?
• 7:23
  SPEAKER_00: You have to shift your focus from how do I relieve pain in that spot to what's actually driving or causing the pain.
• 7:30
  SPEAKER_00: You see, painful muscles or joint, disc or nerve may be completely real.
• 7:35
  SPEAKER_00: Those things can absolutely be irritated, but it doesn't necessarily explain why it's being irritated or why you're having a problem with the disc or why you're having a problem with the joint.
• 7:45
  SPEAKER_00: And this is especially important when you always seem to have pain on one side of your body.
• 7:50
  SPEAKER_00: You see, if your spine is leaning or rotating to one side, and that side ends up taking more load or pressure, the joints in the side become really irritated, the muscles have to work a lot harder, and your body starts to break down asymmetrically.
• 8:03
  SPEAKER_00: And you can spend years addressing the spot of the pain without ever addressing why that specific area keeps taking the repeated physical beating.
• 8:12
  SPEAKER_00: And this is one of the ways adult degenerative scoliosis gets missed.
• 8:16
  SPEAKER_00: Someone possibly gets an emorgability back, it shows arthritis, it shows there's a disc problem, maybe there's some stenosis creating narrowing around the nerve.
• 8:23
  SPEAKER_00: And almost nobody asks, how does the spine look from both the front and the side?
• 8:28
  SPEAKER_00: And is the spine overall out of balance when we look at the whole spine from the front side?
• 8:33
  SPEAKER_00: And is there something out of balance or out of major alignment that's repeatedly overloading certain areas of the spine?
• 8:40
  SPEAKER_00: So, as I mentioned earlier, if the exact same pain keeps returning after treatments you've already tried, and start asking, what do I do to address the underlying cause or source of the pain?
• 8:52
  SPEAKER_00: Meaning, why is this happening in the first place?
• 8:55
  SPEAKER_00: Because if nobody answers that question, there's a good chance you're gonna keep treating the same pain over and over while the problem continues to get worse.
• 9:02
  SPEAKER_00: And at some point, it's gonna get so bad the pain never goes away.
• 9:06
  SPEAKER_00: And it may get to the point where it's beyond conservative treatment.
• 9:09
  SPEAKER_00: All right, now we have three more types of back pain to go.
• 9:12
  SPEAKER_00: But before we do that, if you're in Denver or in the Colorado area and you have pain that keeps getting harder and harder to manage, you don't have to keep guessing what's going on.
• 9:19
  SPEAKER_00: Here at Scholaricare Denver, we offer a free discovery call before you ever book your first appointment.
• 9:25
  SPEAKER_00: We can walk you through what you're experiencing, what treatments you've already tried, and whether a full scoliosis-specific evaluation may make sense for you.
• 9:34
  SPEAKER_00: We can just call our office or click on the link below in the description, request a free discovery call, and my staff will reach out and help you figure out what that next step is.
• 9:42
  SPEAKER_00: Now, the number five type of pain is pain that gets worse the longer you stand or walk.
• 9:48
  SPEAKER_00: Now, this is one of those patterns that I care about the most because now the problem is not just that your back hurts.
• 9:54
  SPEAKER_00: Now the pain is starting to take away what you can actually do.
• 9:57
  SPEAKER_00: Maybe you used to be able to stand for 30 minutes, then it gets down to 20 minutes, and now you're looking for a chair here or have to sit down after just 10.
• 10:04
  SPEAKER_00: Maybe you're even to the point where you're sitting on a stool while you cook.
• 10:07
  SPEAKER_00: You notice yourself leaning on the grocery cart to hold yourself up.
• 10:11
  SPEAKER_00: You stop taking walks because you know your back's gonna hurt, or you cannot walk as long as you used to.
• 10:16
  SPEAKER_00: You possibly get to the point where you're starting to avoid trips that you know you're gonna have to be traveling and be on your feet because you know that pain and discomforts is gonna keep you from being able to enjoy that trip.
• 10:26
  SPEAKER_00: Or maybe your back pain hurts when you're on your feet, and so you don't go because you know your partner's not gonna be able to enjoy that trip because you physically can't do the things you're gonna want to be able to do.
• 10:37
  SPEAKER_00: And before you know it, your whole day starts getting planned around how long your back can tolerate you being up on your feet.
• 10:44
  SPEAKER_00: This type of pain is absolutely not something that I would simply write off as normal aging.
• 10:49
  SPEAKER_00: And this is where that pain scale can be completely misleading.
• 10:53
  SPEAKER_00: First of all, severity of pain is subjective, it doesn't tell us objectively how serious the problem is.
• 10:59
  SPEAKER_00: And I care a lot more about whether or not someone's losing function than whether or not they rate their pain of four or an eight.
• 11:07
  SPEAKER_00: As a matter of fact, I get a lot more concern about someone who rates their pain of four out of ten who could only stand for a few minutes compared to someone who rates their pain an eight out of ten because they have a severe acute muscle spasm that's making it hard to temporarily move.
• 11:22
  SPEAKER_00: Because one of those will recover and the other one will not.
• 11:24
  SPEAKER_00: In adults with scoliosis, we see this every single day.
• 11:28
  SPEAKER_00: You see, if your spine is leaning or rotating in certain directions, the muscles on that side are gonna have to work a lot harder just to keep your body upright, while there are certain joints and discs that are getting excessive or asymmetrical pressure.
• 11:42
  SPEAKER_00: And the longer you stand or the longer you walk, the harder your body has to work to compensate and just to hold yourself in the upright position.
• 11:50
  SPEAKER_00: So this is where imaging really matters.
• 11:52
  SPEAKER_00: You see, a lumbar MRI can tell you a lot about the disc, the nerves, if you have a stenosis, which is just narrowing of a canal, or if you have arthritis.
• 12:00
  SPEAKER_00: But you're almost always lying down when those images are taken and they're usually just a section of your spine.
• 12:05
  SPEAKER_00: And if I'm trying to understand what your entire spine is doing while you're standing, I want to see your entire spine under the weight of gravity.
• 12:13
  SPEAKER_00: This is why standing full spine x-rays can sometimes show us things that other imaging, like suctional imaging or MRIs, cannot.
• 12:22
  SPEAKER_00: So if you're used to standing for 30, 40 minutes or as long as you want, and now you're done standing after only 10 because of the pain, that's not something you simply work around.
• 12:31
  SPEAKER_00: That's your functioning disappearing right before your very eyes.
• 12:34
  SPEAKER_00: And the longer you adapt to that by sitting more or walking less or avoiding trips and skipping the things you used to do, the easier it is to miss how much your world is actively shrinking because you cannot do the things that you normally would be able to do and you want to be able to do.
• 12:51
  SPEAKER_00: So in a case like this, you do not need another explanation of why your back hurts.
• 12:55
  SPEAKER_00: You need to know why your ability to stand or walk is getting worse and worse over time.
• 12:59
  SPEAKER_00: And if nobody's looked at your entire spine while you're standing, I can almost guarantee the providers you've seen don't have the full picture of what's actually going on.
• 13:07
  SPEAKER_00: And that leads us to pain number six, pain that travels down onto your butt, your hip, or your leg.
• 13:13
  SPEAKER_00: And now this gets more concerning because the pain is not staying focused or localized in your back.
• 13:18
  SPEAKER_00: It's traveling to different areas.
• 13:20
  SPEAKER_00: It may travel in your butt, your hip, your thigh, your calf, your groin, or even your foot.
• 13:26
  SPEAKER_00: You may have noticed some burning, tingling, numbness, or possibly even weakness in your legs.
• 13:30
  SPEAKER_00: And if it's got bad enough, you may even notice the size of your overall muscles on one side of your leg are smaller than the other side.
• 13:38
  SPEAKER_00: Most people call this sciatica.
• 13:40
  SPEAKER_00: The reality, it is the nerves being irritated in your spine that are starting to cause symptoms elsewhere.
• 13:46
  SPEAKER_00: That could be in your sciatic nerve, but a lot of times with scoliosis, it's in your femoral nerve.
• 13:51
  SPEAKER_00: When you hear the word sciatica, that's just a description of what nerves are being irritated.
• 13:56
  SPEAKER_00: It doesn't tell you why or what's irritating those nerves.
• 13:59
  SPEAKER_00: So sciatica gets treated like a diagnosis all the time, when it's really just describes where the symptoms are coming from or what nerves are being irritated.
• 14:08
  SPEAKER_00: You still have to figure out what is actually irritating those nerves.
• 14:12
  SPEAKER_00: You see, sometimes it's the disc, maybe it's a disc herniation or disc bulge or severe degeneration narrowing on the nerve.
• 14:19
  SPEAKER_00: Sometimes it's stenosis, where the actual opening where the nerve comes out is being compressed.
• 14:24
  SPEAKER_00: And if you have degenerated scoliosis, the curve can actually narrow the space around the nerves on one side and keep irritating that nerve in the same area.
• 14:33
  SPEAKER_00: What generally triggers the pain is inflammation.
• 14:36
  SPEAKER_00: And this is why someone can get an injection, they feel better for a while, and then that same pain over time comes back.
• 14:42
  SPEAKER_00: You see, the injection may cause down the inflammation and temporarily reduce the irritation, but if the spine is still putting pressure on that nerve, the reason it keeps happening is still there.
• 14:53
  SPEAKER_00: So if your sciatica keeps coming back after treatments, don't just let someone tell you you have sciatica.
• 14:58
  SPEAKER_00: They have to tell you why and how the treatments they are doing are going to address the underlying cause or how they're going to address the why.
• 15:05
  SPEAKER_00: Now, if you get to the point where you're starting to notice weakness, a leg is giving out, your foot is dragging, or you get foot drop where you can't actually lift or move your foot properly, or you get numbness that is clearly getting worse and worse over time, I would not keep treating this like ordinary back pain.
• 15:23
  SPEAKER_00: At that point, you need to know exactly what is happening to the nerves and why.
• 15:27
  SPEAKER_00: Now, one thing I should mention, people with scoliosis in the lumbar spine typically don't get sciatic nerve being irritated.
• 15:35
  SPEAKER_00: They more commonly get their femoral nerve irritated, which is a little bit higher in the lumbar spine.
• 15:40
  SPEAKER_00: And instead of getting pain on the back of the leg, which can happen more often with degenerated scoliosis, they own those symptoms in the side of their thigh, anterior thigh, or into the groin.
• 15:51
  SPEAKER_00: And that is because the nerves that are a little bit higher or in your mid-low back and the middle of the lumbar spine, they control different areas.
• 15:58
  SPEAKER_00: Basciatic nerve is the very bottom of your lumbar spine.
• 16:02
  SPEAKER_00: But with degenerated scoliosis, it's the nerves that are slightly higher that are more commonly irritated.
• 16:08
  SPEAKER_00: But you can get either of those with degenerated scoliosis.
• 16:11
  SPEAKER_00: And now in number seven, back pain with a major warning sign.
• 16:16
  SPEAKER_00: Now, this is the category where I absolutely do not want you waiting around to see what happens.
• 16:20
  SPEAKER_00: You have to take action.
• 16:22
  SPEAKER_00: You see, if your back pain comes with a sudden change in bower, bladder control, numbness around the groin in your saddle area, the spot between your legs, or rapidly progressing weakness, you need a prompt and immediate medical evaluation.
• 16:34
  SPEAKER_00: The same thing goes for severe pain that's followed by a significant trauma.
• 16:38
  SPEAKER_00: And if you have pain that is accompanied by things like a fever or unexplained weight loss, that points something that's way beyond typical mechanical back point that we've been talking to up to this point.
• 16:48
  SPEAKER_00: Those are not something that I would treat myself with stretching, exercise, or just another adjustment.
• 16:53
  SPEAKER_00: And it's definitely not the time to just try something else at home.
• 16:56
  SPEAKER_00: You need to get a detailed evaluation to find out exactly what is going on.
• 17:00
  SPEAKER_00: Because at that point there's likely some underlying pathologies that's the underlying cause of the pain that need immediate attention.
• 17:07
  SPEAKER_00: Now, if your pain sounds more like numbers four, five, or six, I would absolutely stop chasing the pain and start looking at the whole spine.
• 17:14
  SPEAKER_00: You see, adult scoliosis is easy to miss when every test is done at one specific spot that hurts.
• 17:20
  SPEAKER_00: That's why our office uses standing full spine x-rays.
• 17:23
  SPEAKER_00: We look at the entire spine from both the front and the side.
• 17:26
  SPEAKER_00: I want to see what the spine looks like in three dimensions.
• 17:29
  SPEAKER_00: I want to see the curve, the rotation, and how well balances.
• 17:33
  SPEAKER_00: I want to see alignment from the front, and I want to see all those normal curves look like from the side.
• 17:38
  SPEAKER_00: And maybe most importantly, I want to see how your spine looks when it's loaded with gravity pushing down.
• 17:44
  SPEAKER_00: You see, if one side is being overloaded every day, you can treat the joint, the muscles, and the nerves that keep hurting without ever addressing why it's happening.
• 17:52
  SPEAKER_00: So if you've been through treatment after treatment and the same pain keeps coming back, I would ask one simple question.
• 17:57
  SPEAKER_00: Has anyone ever evaluated you for adult scoliosis or hyperkyphosis?
• 18:03
  SPEAKER_00: Has anyone ever looked to see if your body is out of bounds?
• 18:06
  SPEAKER_00: Are you shifted over from the front or are you starting to lean forward from the side?
• 18:11
  SPEAKER_00: And if the answer to that is no, book a call with us at Scholar Care Denver.
• 18:14
  SPEAKER_00: We'll talk you through what you tried, what your symptoms are doing, and whether scoliospecific evaluation makes sense for you.
• 18:20
  SPEAKER_00: You can click on the link in the description and request a free discovery call.
• 18:24
  SPEAKER_00: And be sure to check out our next video where I answer the eight scolio specific questions that patients ask me all the time, including the ones that can completely change what you do next.
• 18:36
  SPEAKER_00: I'll see you there.