When Devaraj, 74, began experiencing back pain, everyone in his family, including himself, blamed it on his age. “Anyone this old will obviously have back pain due to bone degeneration or spondylosis. He should probably ease up and change his lifestyle to be less active from now on,” they said.

Dr. Sreeramalingam, a spine surgeon at Ortho-One Orthopaedic Speciality Centre in Coimbatore, disagrees. There are numerous myths about back pain in the elderly. Many people believe that back pain is caused by old age. Back pain is also thought to be caused by spondylosis, or degenerative changes in the spine. “If degenerative changes caused by aging were the only cause of back pain, then every 70 or 80-year-old person would have back or neck pain. However, only a small percentage of the elderly suffer from severe back pain or spine-related pain,” says Dr. Sreeramalingam. Although some disability is to be expected with advancing age,
Dr. Sreeramalingam believes that not all pain experienced by the elderly is due to age-related degenerative changes.

The spine is made up of motion segments, which are the basic units that control movement. It is composed of two vertebral bodies separated by a disc and has two moving facet joints in the back. The disc degenerates as we age, causing the vertebral bodies to point outward, a condition known as Osteophyte formation. The vertebral bodies eventually settle into these new positions with very little disc in between. These changes in the motion segment are usually not painful. As a result, while all elderly people will experience these normal degenerative changes, not all will experience back pain.

There are four major underlying causes of back pain in the elderly. These include:
1. Disc problems in which the disc material protrude and press on the nerves.
2. Degenerative spondylolisthesis caused by micro-instabilities in the vertebrae, resulting in the vertebral bone slipping on top of the next vertebral bone during movement.
3. Lumbar canal stenosis, a condition in which the spinal canal through which the spinal cord travels becomes narrow and presses on the nerves.
4. Cancer metastasis or other diseases manifesting in the spine from elsewhere in the body.

“These underlying causes of back pain or neck pain are not similar across the age groups and therefore such back pains should not be ignored in the elderly,” says Dr.Sreeramalingam. The elderly face additional challenges as a result of degenerative changes in the body caused by aging, which must also be addressed. Back or neck pain in the elderly, according to Dr. Sreeramalingam, deserves the same attention as back pain in much younger people.
People like Devaraj require medical attention and an accurate diagnosis to determine the source of their back pain. “Treating the underlying condition often helps the elderly live a pain-free and fulfilling life,” says
Dr. Sreeramalingam. Rather than restricting or ignoring the elderly’s symptoms, or simply chalking it up to old age, families must ensure that the elderly with back pain see a doctor and receive a timely treatment.