Bulging and herniated discs are well documented in directly and indirectly causing back pain. Patients may feel pain as a result of a drying and cracking annulus fibrosus, due to the progressive effects of degenerative disc disease. The annulus fibrosus is the outer layer of the disc, and the nucleus pulposus is the inner layer. Patients may also feel pain when the bulging wall of bulging discs come in contact with the nearby nerve roots. Patient may also feel pain as a result of herniated discs when hole in the wall of the annulus fibrosus open up that are big enough to expel some if their material into the nerve roots.

Arthritis of the facet joints are also a leading cause of back pain. The facet joints include the facet projections, smooth cartilage between the facets, and fibrous capsule that holds the structure together. Along the vertebral arch of each vertebra, two processes project upwards, and two processes project downwards to connect and link the vertebral bone above and below it. These facet joints serve to connect the vertebrae at the back of the spine. these facet joints allow for some movement, but resist excessive movements that would cause damage to the joint or associated structures of the spine.

Just like the joints of the knees, hips, and shoulder, the facet joints could become worn out, as the smooth cartilage between the facet faces becomes degenerated. Arthritis of the facet is also called Spondylosis, facet arthropathy, or degenerative joint disease of the spine. Though back spasms and degenerated discs get a lot of attention in medical diagnostics and treatment, Spondylosis is though to be the cause of back pain in up to 40 of cases in people over the age of 40. Facet joint arthritis may be found in any level of the spine, though the soft tissues of the lumbar vertebrae are the most often affected. Spondylosis may be the cause of chronic headaches in up to 30% of cases when the cervical facet joints are involved.

We may feel back pain as a result of Spondylosis. The facet joints themselves are supplied with pain sensitive nerve fibers, which may respond to degenerative wearing and tearing of the cartilage that protects the facets from rubbing together. When the cartilage is worn to the point of causing friction on the cartilage, Spondylosis may develop on the facets of the vertebral bones, which may cause pain and stiffness in these joints.

When spondylosis and other degenerative changes in the spine do occur, it may cause instability in that level of the spine. This instability may cause vertebral subluxations of the spine (minor displacement), ligament incompetence, hypermobility, and loosening of the joints. This instability of between the supportive structures of the spine may also cause the nerve roots to be compressed, resulting in many symptoms commonly associated with disc bulges and herniated discs.

There is no cure for these degenerative changes to the spine. To minimize symptoms, and to slow the progression of the disease, doctors and chiropractors often recommend mainstream back pain therapies, such as swimming, exercise, massage, rest, and anti-inflammatory medications. Decompressive therapies such as mechanical traction and manual mobilization may help to reduce the instability of the spine and produce some back pain relief.