Sooner or later everybody has low back pain. Back pain is one of the most common reasons people go to the doctor or miss work. But most back pain resolves with rest and NSAID medications like Ibuprofen. Many scientists and doctors think our spinal vertebra, which are near identical to those of four legged mammals, is less than ideal for our upright posture and the hours on end that we sit before a computer terminal. Anthropologist and anatomist Bruce Latimer at Case Western Reserve University compared the spine to a tower of 24 cups and saucers, with each cup representing a vertebra in the spine and each saucer one of the disks between each vertebra. Dr. Latimer continues the anology:
“Then take a book like a dictionary and put it on top. This is the head. If you are really careful, you can balance it — otherwise there’s a lot of porcelain on the ground,” Latimer said. “Then imagine taking this and putting in all the curves that you naturally have in the spine. I could give you all the duct tape in the world, and you still couldn’t possibly balance it.”
Social security disability benefits require a condition that lasts or is expected to last at least 12 months, so our periodic struggles with and even temporary incapacities due to back pain will not result in the payment of social security disability benefits. Yet lumbar (low back) pain is a leading basis for social security disability if it is chronic.
Even if a social security disability decision maker like an Administrative Law Judge agrees with Dr. Latimer that our spines are not designed to go the distance in modern life, there must be specific objective medical findings to support the degree of pain and limitation alleged by the disability claimant.
There are certainly a number of spinal conditions that could be the source of chronic and debilitating back pain:
- Spondylolysis. This is a vertebral defect in the from of a crack in the bony ring on the back of the spinal column. The most common location for this to occur is in the lowest vertebra of the spine, which doctors call L5. Spondylolysis often leads to Spondylolesthesis.
- Spondylolesthesis. This is where, to use Dr. Latimer’s analogy, the tea cups do not sit evenly on top of one another. One vertabra has shifted out of place, and often means the vertabar begins to press on nerves.
- Spinal Stenosis/nerve impingement. A narrowing of the spine space around the spinal cord can put pressure on nerves. The narrowing is typically caused by bone spurs that have developed as a result of osteoarthritis.
- Scoliosis. An abnormal curvature of the spine can cause back pain.
- Osteoarthritis. Osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time. Client’s often report doctors telling them that their spine is “bone-on-bone”, or “eaten up with arthritis”, or that they “have the back of an 80 year old”. You can be sure these are cases of osteoarthritis.
- Ruptured Disc. This is where a disc, that jelly-like structure between spinal vertebra that functions as a shock absorber, has torn and the critical cushioning fluid has leaked out, which often comes in contact with the spinal cord or nerves and is thought to be a source of pain. Claimant’s often confuse a “bulging disc”, which reflects spinal instability but may not be a source of significant pain, with a “herniated/ruptured disc” which usually required surgical intervention.
Studies have been done in which adults over 40, with no allegations of chronic back pain, were given a lumbar MRI. These studies reflects a significant incidence of the above spinal abnormalities, yet these persons are fully functional. Therefore the correlation between the extent and severity of anatomic defects and the degree of pain and loss of function is not absolute. Studies have documented that people markedly differ in their perception of just how painful the same stimulis is. Psychological factors such as depression due to inability to work and functional limitations as well as anxiety about causing more pain through activity amplify the intensity of and disfunction caused by a spinal defect.
It takes an experienced local social security disability to marshall the evidence and present a winning case. If you live in the Dallas Fort Worth, Tyler, Sherman-Denison, Denton or Waco area, I am available to consult with you without charge about your chronic low back pain and social security disability ar 214-272-2103.