Bone on Bone Model
Many people, including medical doctors, continue to think pain that generates from the spine is due to a “nerve being compressed”. This is actually quite rare. It is only when your symptoms involve numbness, tingling and/or muscle weakness. These are the signs that an actual nerve is in the state of compression. And unfortunately, it only takes the pressure of a dime on the nerve to cause symptoms. (See Figure 1)

Fig. 1 Disc Herniation and Nerve Compression


Furthermore, each nerve is divided into sensory and a motor division. (See Fig 2) When patients complain of:

  1. sensory disturbance (like tingling and/or numbness) or
  2. motor disturbance (like muscle weakness)

it helps me determine which division of the nerve is being affected. This also helps direct a treatment strategy to relieve a patient’s symptoms.

Fig. 2 Sensory and Motor Divisions



Research is beginning to unravel the mysteries of back pain. MRI has helped us see this more and more clearly. What we know now (based on our more accurate anatomical understanding of the spine) is the effect of bone on bone. Little nerves exist right in the bone and at the perimetre of the bone which can cause so much trouble for people. Bone on bone pain, or I call “vertebral approximation“, is much more common than spinal nerve compression. In light of this, I developed a spine model that finally shows this inflammation and pain in preparation for the International Society of Advanced Spine Surgery Conference that I will be attending in Vancouver this April. (Click on Figure 3 if you want to have a look).


Fig 3 Bone on Bone Model

You can see in the video that flexion load (or bending forward too much) can cause the bones to get too close together and cause inflammation. My goal in treatment is to always create better spacing for each vertebrae. If you ever have any questions regarding your pain, ask me and I will do my best to answer.

In spinal health,

Jerome Fryer