|
The causes of back pain are nearly as numerous as terms used to describe
the symptoms. Back pain is a primary reason people seek medical attention.
Considering that almost 80% of the adult population will encounter
some form of back pain, it could be said that back pain is a universal
epidemic. Back pain recognizes no age, economic, or ethnic barriers.
ACUTE - CHRONIC - EPISODIC
Typically back pain originates in the neck (cervical), mid back
(thoracic), low back (lumbar), or a combination such as 'thoracolumbar
pain'. Depending on the source of the pain, certain types of pain may
be indicative of disease or a particular disorder.
Pain may be described as sudden, sharp, persistent, or dull. Symptoms
may be localized to a specific area of the back (e.g. neck) or may
radiate into the shoulders, arms, low back, buttocks, legs, and even
the feet. Sometimes pain is accompanied by neurologic symptoms such
as numbness, tingling, or weakness.
Back pain is either acute or chronic. Acute pain may begin suddenly
with intense pain usually lasting a short period of time. Chronic pain
is persistent long-term pain, sometimes lasting throughout life. Even
chronic pain may present episodes of acute pain.
Certain neurologic symptoms may indicate the need for immediate medical
attention. These 'red flags' include bowel or bladder dysfunction,
extremity weakness or numbness, severe symptoms that do not subside
after a few days, or pain that prohibits everyday activities.
A MYRIAD OF CAUSES
A cause of back pain is muscle strain and spasm. Strain may result
from the 'weekend warrior syndrome', heavy physical work, awkward bending
or twisting, even poor posture.
Whiplash
is neck pain, which commonly occurs following an auto accident.
This is typically caused by hyperextension and/or hyperflexion because
the head is forced to move backward and/or forward rapidly beyond the
neck's normal range of motion. The unnatural and forceful movement
affects the muscles and ligaments in the neck. Muscles may react by
tightening and contracting, creating muscle fatigue, resulting in pain
and stiffness.
Osteoarthritis (Spondylosis)
Spinal osteoarthritis, or spondylosis, is a degenerative disorder
that may cause loss of normal spinal structure and function. Although
aging is the primary cause, the location and rate of degeneration is
individual. The degenerative process may impact the cervical, thoracic,
and/or lumbar regions of the spine affecting the discs and spinal joints.
Osteoporosis
Osteoporosis commonly affects the thoracic and thoracolumbar regions
of the spine and may cause debilitating pain. This disorder is caused
by a loss of bone mineral density resulting in fragile bones, which
may fracture. Osteoporosis may cause vertebral compression fractures,
loss of height, stooped posture, even a humped back. The patient can
control some of the risks for osteoporosis. These include poor diet,
smoking, excessive intake of alcohol, and inactivity.
Herniated Disc
A disc herniation is a disc rupture. This may occur if the nucleus
pulposus (gel-like center) erupts through the annulus fibrosus (protective
disc wall) or if the annulus fibrosus fragments. The progression to
an actual herniation varies from slow to sudden onset of symptoms.
There are four stages:
(1) disc protrusion,
(2) prolapsed disc,
(3) disc extrusion, and
(4) sequestered disc.
Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete
herniations.
Sciatica
The term 'sciatica' is commonly used to describe pain that travels
along the sciatic nerve, the largest nerve in the body. The pain may
be sharp, dull, burning, or accompanied by intermittent shocks of shooting
pain beginning in the buttock traveling downward into the back of the
thigh and leg. The most common cause of sciatica is a herniated disc
in the lumbar spine.
Compression Fracture
A compression fracture is a common fracture of the spine that may range
from mild to severe. Each vertebral body is separated from the other
with a disc. When an external force is applied to the spine, such as
from a fall or carrying a sudden heavy weight, the forces may exceed
the ability of the bone within the vertebral body to support the load.
This may cause the vertebral body to crush. This is known as a compression
fracture. If the entire vertebral body breaks, this is considered a
burst fracture.
Spinal Stenosis
Spinal stenosis results when the small neural passageways termed 'foramen'
narrow. The narrowing of the foramen may compress and entrap nerve
roots. Nerves react to pressure by swelling, which further reduces
foraminal space. Stenosis can cause excruciating pain, numbness, tingling,
or burning in the involved extremity (e.g. leg, arm). Stenosis can
also occur with compression from a disc, osteophytes (e.g. bone spurs),
and ligaments.
Scoliosis
Scoliosis causes the spine to curve laterally to the left or right
and affects children and adults. Scoliosis is a complex three-dimensional
disease. To understand this concept, consider that in some cases, as
the spine abnormally curves, the involved vertebrae are forced to rotate.
At the thoracic level, vertebral turning impacts the rib cage and may
result in rib prominence on the opposite side of the curve. Deformity
is the primary complaint. Back pain from scoliosis is uncommon.
Spinal Infections (Osteomyelitis)
Osteomyelitis is a bone infection usually caused by bacteria. In the
spine it is commonly found in the vertebrae, although the infection
can spread into the epidural and/or intervertebral disc spaces. Typically,
symptoms include persistent and severe back pain exacerbated by movement,
swelling, fever, sweating, weight loss, and malaise.
DETERMINING THE CAUSE
Back pain is not always indicative of a spinal problem. Rarely is back
pain an emergency or serious medical condition. A proper diagnosis
is paramount to determine the best course of treatment. A thorough
physical and neurologic assessment may reveal the cause of the pain.
The examination begins with the patient's current condition and
medical history. The oral segment of the examination often includes
many questions such as "when did the pain start?" - "what activities
preceded the pain?" - "previous treatment" - "does the pain radiate
or travel into another part of the body?" - "what makes the pain less
or greater?" - and so on.
This examination includes observation of the patient's posture, range
of motion, and physical condition. Any movement generating pain is
noted. The physician will palpate or feel the curvature of the spine,
vertebral alignment, detect muscle and tender points. Abdominal palpation
may be performed to determine if the cause of low back pain is possibly
internal organ related (e.g. pancreas).
The neurological examination tests the patient's reflexes, muscle
strength, detects sensory and/or motor changes, and determines pain
distribution. If nerve damage is suspected, the physician may order
special tests to measure the rate at which nerves conduct impulses.
These tests are termed Nerve Conduction Velocity (NCV) and Electromyography
(EMG). Typically these studies are not performed immediately because
it may take several weeks for nerve impairment to become apparent.
If infection, malignancy, fracture, or other risk factors are suspected,
routine lab tests may be ordered. These tests may include complete
blood count (CBC), erythrocyte sedimentation (ESR), and urinalysis.
Plain radiographs (x-rays), CT Scan, and/or MRI studies are performed
when fracture or disc disease is suspected, or to evaluate neurologic
dysfunction. An MRI represents the gold standard in imaging today.
An MRI renders high-resolution images of spinal tissues such as the
spinal cord and intervertebral discs. X-rays are still the imaging
method of choice to study the bony elements in the spine.
NONSURGICAL - CONSERVATIVE TREATMENT
Seldom does back pain require surgical intervention. A conservative
treatment plan may include bed rest for a day or two combined with
medication to reduce inflammation and pain. Medications recommended
by the physician are based on the patient's medical condition, age,
other drugs the patient currently takes, and safety.
The first choice for pain relief is often nonsteroidal anti-inflammatory
drugs (NSAIDs). These drugs should be taken with food to reduce the
risk of stomach upset and stomach bleeding. Muscle relaxants may provide
relief from muscle spasm but are actually benign sedatives, which often
cause drowsiness. Narcotic pain relievers may be prescribed for use
during the acute phase.
A cervical collar may be recommended to help a patient with neck
pain. Cervical collars limit movement and support the head taking the
load off the neck. Lying down has a similar affect. Limiting neck movement
and reducing pressure (weight) gives muscles needed rest while healing.
Cervical traction may be prescribed for home use. This form of traction
gently pulls the head, stretching neck muscles, while increasing the
size of the neural passageways (foramen).
Physical Therapy (PT) may be incorporated into the patient's treatment
plan once activity can be tolerated. PT may include ice therapy to
slow nerve conduction thereby decreasing inflammation and pain. Heat
treatments may be used to accelerate soft tissue repair. Heat increases
blood flow and speeds up the metabolic rate to assist healing. Heat
also helps decrease muscle spasm, pain, and promotes a relaxed feeling.
Ultrasound is a treatment used to deliver heat deep into soft tissues.
Sometimes a heat treatment is given prior to a session of therapeutic
exercise.
Therapeutic exercise can help build strength, increase range of motion,
coordination, stability, balance, and promotes relaxation. Therapists
educate their patients about their condition and teach posture correction
and relaxation techniques. Patients who participate in a structured
physical therapy program often progress to wellness more rapidly than
those who do not. This includes back maintenance through a home exercise
program developed for the patient by the physical therapist.
SURGERY - SELDOM REQUIRED
Seldom is surgery required to treat back pain. Indications for surgery
include, but are not limited to spinal cord dysfunction, bowel and/or
bladder dysfunction, excruciating pain (more often leg pain is greater
than back pain) unrelieved by non-operative measures, and prolonged
pain and/or weakness.
RECOVERY and PREVENTION
First and foremost, follow the treatment plan outlined by the physician
and physical therapist. Patients, who undergo a surgical procedure,
may find the road to recovery a bit longer. However, that is not reason
to become discouraged. It is normal to feel tired and emotionally down
following surgery. During stress such as surgery, the body cranks out
extra hormones - after surgery the level drops, which may result in
a 'down' period. To enhance recovery from surgery, an episode of back
pain, or to help minimize future exacerbation try to maintain good
posture, be consistent in a home exercise program, and eat sensibly
to maintain proper body weight.
 Video Presentations
|
