Soft Tissue | Soft Tissues

The soft tissues of the back include the connective tissues that are responsible for the movement of the spine, and the cushioning of the vertebral bones and nerves against irritation, compression, and injury. The soft tissues that allow us to experience full mobility and comfort, when they are healthy, and pain and disability when they become injured or worn out - are the tendons spinal ligaments, intervertebral discs, facet joints, and myofascia. These tissues protect the bones of the spine from contacting one another, allow for movements within a healthy range of motion, and protect the nerves within and outside of the spine. Unlike the bones and muscles, which have a great capacity for regeneration, due to their high concentration of oxygen-carrying blood vessels, many of the soft tissues of the spine are more avascular. As a result, many soft tissue injuries, such as those to the ligaments, discs, and joints of the spine, are slow to regenerate or heal themselves. Some back pain sources refer to the soft tissues as all of the structures of the spine other than the vertebral bones, lymphatic tissues, and immune response blood cells. Other informational sources also don't include muscle as soft tissue.



How soft tissue injuries cause back pain. Back pain related to injury related or age relates soft tissue changes often involve the discs, ligaments, tendons, joints, and muscles of the middle back and lower back. Often, the soft tissues of the lower back are the most vulnerable to strain related or more long term injury because of the amount of weight they must absorb, due to their location near our center of gravity. Though the discs, vertebral bones, muscles, and other soft tissues in our lower back (lumbar spine) are thicker and denser to take on these added weights and pressures, they may be susceptible to injury over time. The structures of the back take on heavy loads, and these loads on the lower back increase when we use bad posture, lifting techniques, or even when we have accidents. Other lifestyle factors such as obesity, poor nutrition, work environment, and unhealthy health habits (e.g. smoking, drinking) may make us more vulnerable to injury and episodes of back pain.

Most people suffer from acute back pain that gets better on its own, with conservative or no treatments. Soft tissue injury is the most common cause of back pain. These injuries often involve the sprain of the back muscles, or the strain of ligaments and tendons. Sprains and strains, are minor injuries to the muscles and soft tissues, and often heal on their own, unlike tears and ruptures. Sprain and strain injuries may involve major traumas, such as whiplash from car accidents, but more often are caused by something seemingly minor such as a tweak while shoveling snow.

If your back pain or neck pain doesn't go away on its own, it may involve a soft tissue injury that requires treatment, or it may involve an unknown source of pain. After some combination of a medical history, physical examination, and imaging tests (e.g. X-Ray, MRI, CT Scan), your doctor should arrive at a back pain diagnosis and a plan for treating it. Unless you have an injury that requires emergency treatment or surgery, your doctor will first recommend all conservative treatment options, including:
  • Rest (bed rest or curtailing of normal daily or athletic activities
  • Pain medications (typically acetaminophen or NSAIDS)
  • Heat therapy or cold therapy (heat therapy to increase blood flow/circulation and cold therapy to reduce swelling and inflammation)
  • Deep tissue massage to break up areas of tightness or tension in the back muscles, or fascia (connective tissue coverings of the muscles)
  • Stretching or physical therapy to increase strength and flexibility to the back muscles