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Back Pain

Back pain is the second most common type of pain experienced in the United States, next to headache. It has a very wide range of causes, such as injuries to the spine, disc degeneration, nerve root irritation, poor posture, physical deconditioning, or muscle tension, to name a few. Spinal deformities, tumors, or infections can also cause back pain. When back pain becomes disabling or just interferes a little with your everyday life, Dr. Douglas Cancel is available to provide expert evaluation, diagnosis, and effective treatment as well as a spectrum of exercise protocols for fortification and strengthening to return you to action as soon as possible.

People often experience back pain in the lower (lumbar), region or, less frequently, in the middle (thoracic), region of the back. Symptoms may include:

  • shooting or stabbing pain
  • tingling or numbness
  • intense muscle ache or spasm
  • along with limited flexibility and difficulty walking or standing up straight.


General Overview Of The Back (Lumbar Spine)

The back and spine consist of many parts. Most people have five lumbar vertebrae. Vertebrae are the bones of the lower back. The spinal canal is the hollow center of the vertebrae that houses the spinal cord and nerve roots. The vertebrae are stacked on top of one another using an interconnected system of joints that allows spinal flexibility and movement.

A cartilaginous, semi-rigid "spacer" called a "disc" is positioned between each vertebra. The discs function as shock absorbers for the spinal column. The discs also enable the spine to be flexible. In degenerative disc disease, the discs gradually deteriorate, lose water content, and become narrow. Other changes in the appearance of the spine may also accompany this.

Spinal degeneration can occur over time as a result of aging and the accumulated stress of everyday movements. It can also be accelerated by smoking or exposure to trauma/injury. Each intervertebral disc is composed of a tough outer wall surrounding a soft inner core composed of a gel-like substance. With age, the discs may dry out, and the outer shell may develop cracks or bulges.

When the discs lose fluid, the disc spaces shrink and the space between the vertebrae become thinner. This may eventually lead to excessive wear on the interlocking joints between the vertebrae called "facet joints." It may also cause bony growths or spurs, called "osteophytes," to form. In some instances, these growths encroach on the spinal canal, narrowing the passageways through which the spinal cord and nerves travel. The narrowing of space in the spinal canal is called "spinal stenosis."

Age-related changes in the discs may also lead to small cracks or tears in their outer walls. If the wall integrity fails, the inner gel core may push through the cracks, causing the disc to bulge and intrude into the canals through which the spinal cord or spinal nerves pass. Depending on their size and extent, these bulges may be called "bulging discs," "disc protrusions," "herniated discs," or "prolapsed discs." Although the term is still heard from time to time, there is no such thing as a "slipped disc" in the scientific literature. Discs do not "slip."

Disc degeneration is often associated with osteoarthritis of the spine, the progressive erosion of cartilage that lines the ends of the bones in the spinal joints. In a healthy spine, interlocking facet joints move smoothly against each other, allowing the spine to bend and twist. If the protective layers of cartilage erode, movement between them can become painful and lead to permanent joint damage. A narrowed disc space may put increased pressure on the spine's joints, starting the degenerative process.

A large network of muscles aids in supporting the spine and allows you to bend, twist, lift objects, and walk. Back pain may involve the bones, nerves, muscles, or connective tissues like ligaments, tendons, and cartilage; very often it involves all of these structures.

Back pain that persists for more than six months is considered chronic and requires professional evaluation, if this has not already been undertaken. Back pain that persists despite six months of organized treatment efforts justifies a second opinion.


General Considerations

Dr. Cancel and Performance Sport Care are always mindful of the fact that there are many factors associated with the development of neck pain and back pain and are always on the lookout for the less common problems. Not all people's symptoms follow expected norms. A careful history and thoughtful examination is essential for accurate identification of each person's problem. An accurate diagnosis increases the probability that treatment efforts will be successful and that the total costs of treatment will be less.

Unfortunately, too many neck pain and back pain sufferers leave Doctors' offices with no diagnosis or explanation of what their problem actually is or why it persists. Some Doctors spend minimal time with patients and will rely heavily on imaging studies, like X-ray and MRI images. And that can sometimes be a problem itself. Some patients will be told their MRI scan reveals a herniated disc. However, the disc may have been abnormal for many years before the onset of pain.

Disc abnormalities can certainly cause pain. However, a disc protrusion or herniation may not cause any pain at all. In fact, tens of thousands of massive disc herniations have been identified on MRI scans in patients who have not displayed any of the common symptoms attributed to a disc herniation.

On the other hand, Dr. Cancel and Performance Sport Care have often received patients who have undergone spine surgery. The surgeon would, rightfully, state that the surgery was "successful" because the excision of disc material, for example, eliminated the patient's arm or leg symptoms. However, the patient's central neck pain or back pain persists despite the surgery. The surgery may have decompressed an inflamed nerve root, but the surrounding muscles or soft tissue structures may still be too tight, inflamed or scarred. In addition, there may still be muscles in the neck/upper back or hip/back that remain imbalanced and, therefore, remain unresolved factors in the persisting pain.

Neck pain and back pain can be a complex subject, but there is only one bottom line: getting people better. That is the only thing that matters. And that can only be accomplished by taking the time and care to accurately identify the actual cause(s) of the problem. Dr. Douglas Cancel and Performance Sport Care are committed to accurately identifying problems, successfully treating them, and putting people in the best position to take control of their health so they can succeed at any goal they choose. 

Neck Pain

Neck pain is a common ailment among adults in the United States. For many, it is a short-term condition. In others, it can persist for longer than six months, often because it has been improperly treated or because the trauma that originally caused it was severe. Once it has become chronic, neck pain can interfere with your everyday routine. Dr. Douglas Cancel and Performance Sport Care in Walnut Creek, CA provides expert evaluation, diagnosis, and effective treatment of the neck, as well as a spectrum of exercise protocols for fortification and strengthening.

The general recommendation among the health professions has been that people should seek professional evaluation for neck pain that lasts longer than two to three weeks, particularly if the neck pain is accompanied by any weakness or numbness. Dr. Cancel is an expert in determining the cause of neck pain. This begins with a careful history and physical examination. Most people may not be aware that the physical examination is usually the most important factor in establishing a diagnosis. An accurate diagnosis usually leads to more effective treatment.

If indicated, the history and physical examination may be supplemented by the ordering of imaging studies such as x-ray, MRI, or CT or, possibly, the ordering of certain neurophysiological tests that evaluate the function of suspect nerves. Whenever indicated, Dr. Cancel will coordinate specialty medical or surgical consultations so that patients have all reasonable evaluation and treatment options available to them.


General Overview Of The Neck (Cervical Spine)

The spine is composed of a stack of bones called vertebrae. The neck, or cervical spine, consists of the top seven vertebrae; the joints that connect them; and the ligaments and muscles that support the head and permit movement.

In between each of the vertebrae is a semi-rigid cartilaginous spacer called a disc. The discs act as shock absorbers, dispersing the forces placed upon the spine and provide flexibility.

Of the many possible causes for neck pain, the most common are muscle strain, trauma, nerve irritation, disc problems, such as degenerative disc disease, herniated disc, and osteoarthritis.

In the neck, nerve roots and the spinal cord pass through certain "tunnels" in the vertebrae, namely, the neural foramina and spinal canal. When bones and other tissues, such as discs or thickened ligaments, rub or apply too much contact to a nearby nerve, that nerve may become irritated and its function disrupted, causing pain, tingling, or numbness. A herniated disc in the neck (a disc that has bulged beyond its normal confines) may put pressure on a cervical nerve root, causing pain that radiates down the arm.

As a person ages, the spine degenerates, causing diminished disc height. As noted with regard to the lumbar spine, the diminished disc height may increase the stress forces and wear upon the facet joints in the neck.

Over time, the loss of disc height and loss of shock absorbing properties causes increased bone friction forces that result in changes in the appearance of the bones and joints that are collectively known as osteoarthritis. The progressive wear and tear of osteoarthritis of the spine further reduces the protective lining between bones. When vertebrae rub together, small, hard growths called bone spurs, or osteophytes, may develop and push into the spinal canal, constricting nerve roots or the spinal cord. This friction may irritate nearby ligaments, causing them to swell and put pressure on the spinal cord or nerve roots. This can also cause pain in the neck and arms.

Neck pain and back pain can have many different causes, demonstrate different sets of symptoms, and display a wide spectrum of severity. It is the policy of Dr. Douglas Cancel and Performance Sport Care to make every effort to accurately identify the cause of the problems our patients present to us and to provide appropriate treatment of those problems. It is our policy to accept only those patients whom we have a reasonable expectation of helping, based upon our knowledge and experience. We serve the best interests of our patient. We have forged extensive professional relationships with teaching professors as well as field practitioners across all specialty areas and we will unhesitatingly guide our patients to the very best specialty medical providers in our community when our patients are better served elsewhere.

At Performance Sport Care, Dr. Douglas Cancel and team provide personalized care and extensive treatment to alleviate the pain and restore function and mobility in your neck and back. We serve the residents of Walnut Creek, CA, and the nearby communities of Concord, Pleasant Hill, Danville and Lafayette.

Experience comprehensive treatment for neck and back problems at Performance Sport Care. Feel free to contact us at (925) 945-1155 or use our Request an Appointment form to schedule your consultation. 

Our Services

Sports Injury

When engaging in any sports activity, it is important to stay healthy and pain-free so you can perform at your best. But with injuries, you may become limited in your flexibility, mobility and function. Maximize your participation in sports activities with Dr. Douglas Cancel’s help.

Shoulder Injury

Our shoulders consist of an interlocking network of soft tissues, tendons, muscles and bones, which allows us to perform a wide range of motion. From reaching our back to stretching out to throw a pitch, our shoulders are involved every step of the way in our day-to-day life.

Spine & Knee Injury

Our spine and knees are made of complex system of bones and muscles, which, unfortunately, are prone to problems. In the case of knee disorders, one of its most common causes is osteoarthritis. This degenerative disease affects the muscles, ligaments and tendons that surround the joints. On the other hand, spine problems usually involve herniated or slipped discs, which cause radiating pain

Leg & Hip Injury

Musculoskeletal problems in the hips and legs are triggered by inflammation of the joints. When this happens, walking, running or bearing weight on the affected hip/s can be very difficult to do. In many instances, this condition is characterized with pain, restricted mobility and limited function.