Back Talk

Back Pain

The epidemic of back pain is enormous. It is a $44 billion industry, it is the leading workers' comp injury, it is the leading reason for disability for people under the age of 45, it will strike 90 percent of all American adults, it is the second-leading surgical procedure and it is only getting worse.

  • Up to 85 percent of the U.S. Population will have back pain at some time in their life
  • On any given day 6.5 million people are in bed because of back pain
  • 5.4 million Americans are disabled annually due to back pain
  • An estimated 93 million work days are lost each year due to back pain
  • 90 percent of all back pain resolves in six-12 weeks
  • Five-10 percent of low back pain becomes chronic
  • Only 20 percent of all back surgeries are successful after two years
  • The total number of spine surgeries in the U.S. approaches 500,000 per year
  • An estimated $45 – 54 billion is spent on the treatment of low back pain per year

Back Anatomy

The spinal column (or vertebral column) extends from the skull to the pelvis and is made up of 33 individual bones termed vertebrae. The vertebrae are stacked on top of each other grouped into four regions:

Chronic Back and Neck Pain

Term # of Vertebrae Body Area Abbreviation
Cervical 7 Neck C1 – C7
Thoracic 12 Chest T1 – T12
Lumbar 5 or 6 Low Back L1 – L5
Sacrum 5 (fused) Pelvis S1 – S5
Coccyx 3 Tailbone None

The cervical spine is further divided into two parts: the upper cervical region (C1 and C2) and the lower cervical region (C3 through C7). C1 is termed the atlas and C2 the axis. The Occiput (CO), also known as the Occipital Bone, is a flat bone that forms the back of the head.

Atlas (C1)

The atlas is the first cervical vertebra and therefore abbreviated C1. This vertebra supports the skull. Its appearance is different from the other spinal vertebrae. The atlas is a ring of bone made up of two lateral masses joined at the front and back by the anterior arch and the posterior arch.

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Axis (C2)

The axis is the second cervical vertebra or C2. It is a blunt, tooth–like process that projects upward. It is also referred to as the ‘dens’ (Latin for ‘tooth’) or odontoid process. The dens provides a type of pivot and collar allowing the head and atlas to rotate around the dens.

Thoracic Vertebrae (T1 – T12)

The thoracic vertebrae increase in size from T1 through T12. They are characterized by small pedicles, long spinous processes and relatively large intervertebral foramen (neural passageways), which result in less incidence of nerve compression.

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The rib cage is joined to the thoracic vertebrae. At T11 and T12, the ribs do not attach and are so are called "floating ribs." The thoracic spine's range of motion is limited due to the many rib/vertebrae connections and the long spinous processes.

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Lumbar Vertebrae (L1 – L5)

The lumbar vertebrae graduate in size from L1 through L5. These vertebrae bear much of the body's weight and related biomechanical stress. The pedicles are longer and wider than those in the thoracic spine. The spinous processes are horizontal and more square in shape. The intervertebral foramen (neural passageways) are relatively large, but nerve root compression is more common than in the thoracic spine.

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Purpose of the Vertebrae

Although vertebrae range in size, (cervical the smallest, lumbar the largest) vertebral bodies are the weight-bearing structures of the spinal column. Upper body weight is distributed through the spine to the sacrum and pelvis. The natural curves in the spine, kyphotic and lordotic provide resistance and elasticity in distributing body weight and axial loads sustained during movement.

The vertebrae are composed of many elements that are critical to the overall function of the spine, which include the intervertebral discs and facet joints.


Functions of the Vertebral or Spinal Column


  • Spinal Cord and nerve roots
  • Many internal organs

Base for Attachment

  • Ligaments
  • Tendons
  • Muscles

Structural Support

  • Head, shoulders, chest
  • Connects upper and lower body
  • Balance and weight distribution

Flexibility and Mobility

  • Flexion (forward bending)
  • Extension (backward bending)
  • Side bending (left and right)
  • Rotation (left and right)
  • Combination of above


  • Bones produce red blood cells
  • Mineral storage

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