Category: Types of Back Pain

Nearly 70% of all Americans will experience back pain at some point in their life. After the cold bug, it is the second most common reason people go to the doctor and call in sick to work. Much of the back pain experienced can be classified as acute pain. Acute pain is a short-term problem that is usually caused from activity or injury where the person experiences symptoms for less than a month. Many people who have acute pain will feel relief within two weeks or less. Chronic problems (pain experienced for usually longer than a month) are more often caused from degenerative conditions.

Most of the cases of back pain stem from stresses on the muscles or ligaments from, say, lifting improperly or too much weight. Many aches and pains will go away within a week without treatment, but some problems, like numbness, pins and needles, or a weakening in the legs or arms should be looked at immediately by a health care professional.

Here are some short descriptions of common back problems:

• Strains – Strain or “pulled back” occurs when muscle fibers on the back are torn or stretched, which can occur from both trauma and a more gradual overuse. Some strains happen while lifting something improperly; other strains can come from overuse or repetitive motion such as twisting and leaning while at a workstation. After the muscle is torn or over-stretched, inflammation occurs around the area to protect the strain from getting worse. Inflammation often causes stiffness and a reduction in the range in motion.
• Sprains – A back sprain is an injury to a ligament in the back. Ligaments are the fibrous tissues that connect the bones of the back, or more specifically the vertebrae. A sprain can occur when there is a quick or sudden movement, for example a car or bike accident, and the muscles of the back cannot react quickly enough to hold the spine in place, so the ligaments holding the spine together are torn or stretched. Symptoms can range from inflammation to bruising to almost complete immobility. Most commonly, sprains are short-term injuries.
• Spasms – Back spasms are unusual, involuntary and sometimes prolonged contractions of a muscle in the back. Back spasms can occur in any muscle in the back, but most often occur in the lower region. These muscle contractions can happen to protect another part of the back from further injury. For instance, if there is an injury in the region of the spine, such as a sprained ligament, the muscle can spasm and because of the pain, immobilize that area of the back. This keeps the person from moving and therefore keeps the injury from further tearing. However, there are many different internal reasons for a back spasm such as tetanus, arthritis or even a tumor.
• Osteoarthritis or Spondylosis – Spinal osteoarthritis is a disease in the joints of the spine. Each vertebra has joints that connect them. A lubricating connective tissue, called cartilage, helps the joints bend and move fluidly. As cartilage breaks down, the vertebrae are unable to smoothly glide, so the bones of the spine or the facet joints (the joints where the vertebrae are connected) begin to rub together. This degeneration of the cartilage is called osteoarthritis, spondylosis, or degenerative joint disease.
• Herniated disks – Herniated disks are disks that rupture or bulge out between the vertebrae and begin to pinch the nerves in the spine or the spinal cord. It is possible for disks in the upper part of the spine to herniate, but it is most common in the lower or lumbar region. As people get older the soft, cushiony disks between the spine can lose their elasticity. As elasticity dissipates, the disk can tear or rupture.
• Sciatica – The sciatic nerve runs from the base of the spinal cord down through the buttock and into the leg. Disk problems, including bulging, compression or other inflammation at the nerve’s root can cause aching and pain all the way down the leg. This pain is called Sciatica. With proper care, most sciatica will go away within two weeks to a month. On occasion other damaging factors may be in play, so proper diagnosis is important.
• Osteoporosis – Osteoporosis is a disease where the bones become brittle, porous, fragile and break easily. Any bone can break with osteoporosis, but breaks most often occur in the hips, wrists and spine (vertebrae). Osteoporosis comes from a lack of bone mass or a structural deterioration of the bone.
• Degenerative Disk Disease – Most people will experience degeneration of their invertebral disks as they age. There are disks located between the majority of the vertebrae that have gel-like centers that pad the bones of the spine. Over time the center can dehydrate and compress. This deterioration can lead to several different chronic conditions, such as arthritis, pinched nerves or osteophytes.
• Fibromyalgia – Fibromyalgia Syndrome is an incapacitating, painful and uncomfortable chronic condition that affects the soft tissues of the body, e.g. muscles, tendons, and ligaments. There is not one definitive cause or trigger, but several symptoms that can help determine if a patient has the condition. It is a musculoskeletal disorder that is still somewhat of a mystery, but is recognized by the combination of several symptoms, such as tenderness to the touch, muscle aches and general unexplainable tiredness.
• Scoliosis – Scoliosis is an unusual lateral curvature of the spine. Though it is relatively common in its mild form, doctors do not know the actual cause. Teenage girls are the most at risk, but the severe cases only happen to about 3% of the population.
• Spinal Stenosis – Spinal Stenosis is a narrowing of the spinal canal (the canal where the spinal cord sits). Disk dehydration that comes with aging, inflammation, or sometimes, other more serious causes narrow the canal. Often occurring in the lower back where most of the spine’s stress is centered, this narrowing pinches the spinal cord and other nerves, which radiates pain throughout the back and the down through the legs.

Treatments for back pain range from stretching to herbs and medication to surgery or other medical procedures. Since most acute pain will go away by itself within a week, surgery is only needed for a small percentage of sufferers. Anyone who experiences severe back pain that doesn’t go away after a week, numbness and tingling, or bowel/bladder control problems should seek the advice of a health care professional.

Fibromyalgia Syndrome is an incapacitating, painful and uncomfortable chronic condition that affects the soft tissues of the body, e.g. muscles, tendons, and ligaments. There is not one definitive cause or trigger, but several symptoms that can help determine if a patient has the condition. It is a musculoskeletal disorder that is still somewhat of a mystery, but is recognized by the combination of several symptoms, such as muscle aches and general tiredness, so often doctors will perform many blood tests and x-rays first and then, by excluding other possibilities, finally determining that Fibromyalgia is the culprit.

Fibromyalgia is not a life-threatening condition and it does not tend to become progressively worse. Women are near six times more likely to experience Fibromyalgia than men. Most cases develop in early to middle adulthood, but rarely it can happen to children and older adults as well. People with a family history of the condition and people with rheumatic diseases can be more likely to develop the disorder. It is likely that there are several causes that work together to cause Fibromyalgia. Triggers may include one or more of the following: infection, disturbed sleep patterns including sleep apnea, severe injury, especially when the spinal cord is involved, or Irritable Bowel Syndrome (IBS).

Here are some of the symptoms of Fibromyalgia:

• Muscle aches.
• Pain when pressure is applied to the body at specified pressure points.
• Depression.
• Fitful or restless sleep. Sufferers often get a full night’s sleep and wake up feeling lethargic and fatigued.
• Sensitivity to light, sounds, odors and touch.
• Tingling or numbness in the extremities
• Headaches, migraines, facial pain and aching or stiffness in the neck and shoulders. TMJ (jaw joint and surrounding muscle dysfunction) is also a sign of Fibromyalgia.
• Bowel trouble, e.g. constipation, diarrhea and abdominal pain.
• Women can experience painful menstruation.
• Leg cramps.

Because of the nature (and mystery) of the condition, routine blood tests and x-rays will not reveal anything more than a simple established physical examination using pressure points. The pain that a person with Fibromyalgia experiences is made significantly worse when easy pressure is applied to 18 specified pressure points on the body. This test is performed after a person has been experiencing symptoms for several months and if 11 of the 18 points produce pain, even with relatively easy pressure, that is a sign of the syndrome.

Fibromyalgia can be very similar to other hard-to-diagnose conditions such as Chronic Fatigue Syndrome. Since a general unwellness is felt instead of a particular malady, say, a broken leg, it is often misunderstood by others.

Health care providers use different techniques to treat Fibromyalgia. Medications have been developed and doctors might prescribe analgesics or anti-inflammatories to reduce pain, muscle relaxants to reduce leg cramps and anti-depressants to relieve depression. However non-pharmaceutical treatments are also used, often with greater success, and can be done in conjunction with medication as well. Alternative medicine such as acupuncture, chiropractic adjustments and massage can be a great relief to symptoms.

Exercising and sleeping regularly, eating well, and reducing stress are all things that a person can do at home to reduce or ease the symptoms. Establishing routines and patterns seems to help relieve symptoms as well.

A back sprain is an injury to a ligament in the back, as opposed to a strain, which is an injury to the muscle. Ligaments are the fibrous tissues that connect the bones of the back, or more specifically the vertebrae. A sprain can occur when there is a quick or sudden movement, for example a car or bike accident, and the muscles of the back cannot react quickly enough to hold the spine in place, and so the ligaments holding the spine together are torn or stretched.

Acute pain can happen as a result from a back sprain. The pain is described as intense or sharp and stabbing and sometimes a popping or tearing can be heard. Inflammation can occur around the sprain to keep the area from becoming injured further. That inflammation can causes stiffness or a reduction in motion and is often the source of the pain. Sprains can be minor, moderate, or severe. The more trauma that the ligament receives then the more severe the symptoms. Symptoms can range from inflammation to bruising to almost complete immobility.

A longer time period will be needed to heal a more traumatized ligament. With proper care a mildly sprained back can take six to eight weeks to heal. Since ligaments heal slower than muscles a severe sprain can take months to recover and must be rehabilitated properly so that there isn’t a recurrence.

The first step in caring for a sprain is to reduce the inflammation and pain. There are many techniques in reducing inflammation, including icing (never put the ice directly on the skin), anti-inflammatories, such as ibuprofen or aspirin, and topical analgesics, however there is disagreement among healthcare professionals as to whether these are necessary, as most acute pain will subside on it’s own with proper rest and care. Complete bed rest might be necessary for the first couple of days when the pain is the most acute, but after that normal or near-normal activity should be returned to as soon as possible. The quicker that someone can get up and moving (without pain, of course), the better.

The second step in caring for an acute back sprain is rehabilitation. Exercise and stretching to improve the overall condition of back but especially the injured area is key to a speedy full recovery. There are many gentle stretches and exercises that can aid in recovery, including walking, swimming and biking. If pain returns and increases with exercises or if there is ever any numbness, bladder control problems, weakening in the legs, or if the pain becomes unmanageable, a sufferer should immediately consult with a physician.

Almost every adult at one time or another will experience back pain. It is the second most common reason Americans see their PCP and/or call in sick and two thirds of us will experience it in our lifetime. Staying physically fit and keeping core muscles strong can decrease your chances of having acute pains.

Back strain or “pulled back” occurs when muscle fibers on the back are torn or stretched, which can occur from both trauma and a more gradual overuse. Strains often happen while lifting something improperly or lifting too heavy a weight, but occasionally strains occur for no apparent reason. Other strains can come from overuse or repetitive motion such as twisting and leaning while at a workstation. This overuse fatigues the muscles and makes them weaker so they are susceptible to a strain.

After the muscle is torn or over-stretched, inflammation occurs around the area to protect the strain from getting worse. The inflammation will cause stiffness and reduction in the range in motion and this inflammation causes pain, which is usually described as intense or sharp, but some people feel a dull ache or pressure in the affected area and down their legs. Sometimes the inflammation will also cause a muscle spasm; these spasms usually happen within the first few days after the injury occurs.

Some back strains will go away without treatment. But treatment for a strain begins with the reduction of inflammation and pain. Depending on the person, applying an ice pack to the affected area and/or taking anti-inflammatories can be helpful. Exercise and stretching is not recommended for people suffering from acute pain, though complete bed rest is also not recommended. Only one to two days of bed rest is suggested, after that normal or near-normal activity should be returned to as soon as possible. The second part of the treatment is rehabilitation through gradual exercise, which should begin about four to six weeks after a severe strain. There are many gentle stretches and exercises that can aid in recovery, including walking, swimming and biking.

Back pain, especially pain in the lower back, is one of the most common ailments in adults. Around 85% of adults will experience some sort of back pain in their lives. Though keeping the back healthy and strong might not keep back strains from occurring, it may reduce their severity. Maintaining a healthy back includes frequent low impact aerobic, core strengthening, and stretching exercises. Maintain an ideal body weight is also helpful.

By taking some basic steps, mild pain often goes away without a doctor’s visit in about two weeks and severe pain six to eight weeks. If there is ever any numbness, bladder control problems, weakening in the legs, or if the pain becomes unmanageable, a sufferer should immediately consult with a physician.

Invertebral disks are the soft padlike cushioning between each vertebra that acts as a shock absorber for the spine and all of its different parts. Herniated disks are disks that rupture or bulge out between the vertebrae and begin to pinch the nerves in the spine and the spinal cord. It is possible for disks in the upper part of the spine to herniate, but it is most common in the lower, or lumbar, region. Sometimes called ruptured or slipped disk or pinched nerve, most doctors are referring to the same thing; the bulging disk between the vertebrae that is causing a person pain.

As people get older the soft, cushiony disks between the spine can lose their elasticity. As elasticity dissipates, the disk can tear or rupture. The disk can then bulge and put pressure on the nerves and cause tingling, numbness or other sensations. Sometimes, muscles spasms can occur because the affected area is trying to protect itself from further injury. Herniated disks can happen due to traumatic experience, like an accident or a fall, or from extreme overexertion, like lifting a very heavy weight. Herniations can also happen over time after normal wear and tear. There are also cases where a condition called Spinal Stenosis is narrowing the patient’s spinal canal and the herniated disk further aggravates and irritates the nerve.

Some symptoms of a herniated disk are tingling or numbness in the “saddle” region (any part of you that would touch while sitting in a saddle); electric shock type pains, which are unusual pains in the back and legs; weakening of the muscles; bowel or bladder problems. Bowel and bladder control issues can be very serious and the sign of an emergency, so a health care provider should be consulted immediately.

In diagnosing a herniate disk, the doctor will usually perform a physical exam and may possibly take an MRI or x-ray. (There is always normal wear and tear to a disk, so doctor has to determine what is normal and what might actually be causing the problem.)

To treat a herniated disk, doctors will often try non-surgical methods before considering surgery, depending, of course on the symptoms and the severity of the pain. The first step is always to try to reduce the pain and inflammation the patient is experiencing by having the patient rest (usually on a firm surface). Though complete rest might be necessary at the beginning until the pain is alleviated, it is necessary to get up and moving as soon as possible. Bed rest for more than a day or two can actually slow recovery, but avoiding excessive bending or lifting is advised. Other non-surgical methods are usually tried in addition to rest. Non-surgical methods can include:

• Alternating ice and heat and other compresses
• Anti-inflammatories or other medications such as muscle relaxants (if the muscles in the back are in spasm), corticosteroids, and a new class of medications called neuropathic pain medications
• Bracing the spine and hydrotherapy (to remove the pressure from the spine)
• Chiropractic care (or spinal manipulation) and/or traction
• Electrical stimulations (called TENS)
• Acupuncture
• Massage

The second step is to get the back moving again. Stretching exercises and mild activity is necessary. A doctor will probably recommend stretching along with some aerobic exercise along with core building exercises that will strengthen the stomach and back muscles.

Only one in 10 sufferers needs to have surgery. In most cases, if the person follows the healing regimen, the disk will shrink over time. Herniated disks tend to be very painful, and the pain usually eases up within one week, but it could take up to six months for the disk to fully shrink.

There are several surgical options if a person does decide on this route. Surgery is to reduce the pain, but also to get the protruding disk from causing nerve damage. Surgical methods include:

• Chemonucleolysis: An enzyme is injected directly into the disk to dissolve the portion of the disk that is protruding
• Diskectomy: Surgery under general anesthesia where a surgeon removes the protruding portions of the disk.
• Microdiskectomy: Similar to a Diskectomy, but it is less invasive, since the surgeon makes a smaller incision and the surgery is performed looking through a microscope, as opposed to the standard open surgery of a Diskectomy.

Recovery
Most herniated disks heal on their own with time and proper care. Of the people who need to opt for surgery, depending on the individual case and which surgical method, full relief from the pain and symptoms is possible. After the initial surgery, the doctor will prescribe an exercise regimen that will increase mobility and strengthen the muscle that will help to stabilize the back and spine.

Prevention
Back pain affects most American adults. There is no known, absolute prevention of back pain. However, the common belief is that staying physically fit to reduce the load on the spine and keeping the back and stomach muscles equally strong, so that the spine is able to keep in line, can reduce the chances of back pain and herniations.

Spinal osteoarthritis is a disease in the joints of the spine. Each vertebra has joints that connect them. A lubricating connective tissue, called cartilage, helps the joints bend and move fluidly. As cartilage breaks down, the vertebrae are unable to smoothly glide, so the bones of the spine or the facet joints (the joints where the vertebrae are connected) begin to rub together. This degeneration of the cartilage is called osteoarthritis, spondylosis, or degenerative joint disease.

Osteoarthritis can occur in the neck and upper back from, say, slouching and poor posture, but is most common in the lower back (lumbar region) that carries the weight load of the body and all of the stresses that come with it. Osteoarthritis can be painful and cause inflammation in the area and eventually a loss of mobility in the spine. However, with proper care, most people who have osteoarthritis can lead normal, functioning lives.

Osteoarthritis is mostly an age-related disease that affects people over 45 and a higher percentage of women over men. People who are overweight have a higher chance of having osteoarthritis. Heredity can also play a part if the person already has joint irregularities or defective cartilage. Pain and inflammation is a common symptom, but the damage doesn’t always cause pain, or the pain may be intermittent. This intermittent pain sometimes makes it difficult for doctors to determine if the osteoarthritis is causing the symptoms. Other symptoms are bone spurs (osteophytes), which form in the areas where the bones are rubbing together, and/or a crunching sound when the joints are moved. Getting out of bed may be a longer process as the joints become stiff after a night of inactivity. In advanced cases, numbness or tingling might occur. Numbness, muscle weakness or a loss in bladder or bowel control can be a serious problem and a health care provider should be consulted immediately.

Osteoarthritis is a degenerative disease, but if taken care of, a person can still function normally, though they might have to alter their lifestyle somewhat, e.g. reduction of heavy lifting, weight loss. The disease most often can be treated without surgery. Non-invasive methods health care professionals use to treat the pain and stiffness is highly effective.

To determine what the cause of the pain or loss in mobility is, a physician will ask for medical and family history, conduct a physical exam and possibly take x-rays or in some cases an MRI.

Reducing pain and inflammation is the first step that is taken. Doctors will usually prescribe rest until the pain goes away, icing the area (never put ice directly on the skin, which can cause frost bite), anti-inflammatories and possibly muscle relaxants if there is a muscle spasm. Some people experience relief by using topical analgesics. Other common treatments are acupuncture; chiropractic care; massage; TENS (electrical impulses send through the skin); supplements (glucosamine and chondroitin, omega-3 fatty acids and MSM are three of the most commonly recommended); and herbal remedies. Your health care professional can help you decide what is best for you.

Occasionally invasive treatments are required. Some possible treatments in severe cases are:

• Spinal or facet joint injections where a hormone steroid is injected into the spine or facet joints
• Epidural Steroid Injection (ESI) where a steroid injection travels through the epidural area and coats the facet joints and nerves to reduce inflammation and pressure on the soft tissues in the area
• Surgery – to remove floating cartilage, bone spurs, or other things that are causing irritation or putting pressure on the nerves in the spine

Relief from invasive treatments is often temporary. As people find it more difficult to move and experience pain, they think that they need to stop moving, however strengthening the muscles of the back and stomach is a necessary step in keeping the spine protected and in line. Once pain and inflammation is under control, regular movement and a routine of stretching and low impact aerobics is often prescribed. Staying at an ideal weight, exercising regularly (and smartly) and stretching can help the person lead an active and normal lifestyle.

Osteoporosis is a disease where the bones become brittle, porous, and fragile and break easily. Any bone can break with osteoporosis, but breaks most often occur in the hips, wrists and spine (vertebrae).

Osteoporosis comes from a lack of bone mass or a structural deterioration of the bone. Most of a person’s total bone mass is acquired by the time they reach their late teens (around 85%). Acquiring bone mass early in life is important in reducing the risk of osteoporosis. To prevent or manage the disease a person should start early by getting the recommended amounts of vitamin D and calcium and bone strengthening exercise. Muscle strengthening exercises also strengthen the bones. Smoking and excessive drinking and a poor diet (early on and later in life) can increase the risk of osteoporosis.

Osteoporosis is thought of to be a disease for the elderly, but it can happen to anyone. It occurs more often in people over 50 and women are much more at risk than men. After menopause, risk of osteoporosis increases, as bone mass is decreased by up to 20%. Of all of the Americans with the disease, 80% are women. It affects Americans of all ethnicities, though more often the Caucasian, Asian, and Hispanic/Latino population. Other risk factors include people with a poor diet low in vitamins and minerals, people with a history of osteoporosis (family history), broken bones, anorexia, and people with low estrogen or testosterone. Smoking and excessive drinking also increase a person’s risk.

As the bones get weaker and more brittle, they fracture more easily. As there is no external way to see if you have osteoporosis, most people don’t know they have it unless they start experiencing pain or break a bone. Fractures in the spine can occur without pain, but sometimes people start stooping or even start losing height. Weak bones will easily break from a fall or other trauma, but brittle bones can also break from something as seemingly innocuous as a sneeze.

A patient’s health care provider might not know of the person’s osteoporosis until a break or other symptom occurs. However, special tests can be run at any time to gauge a person’s bone mass. Bone Mineral Density tests or BMD, measures bone density. If the tests are taken over time, a person can see if their bone mass is decreasing.

For prevention, many health care professionals suggest getting the daily recommended amounts of vitamin D and calcium and getting the following kinds of exercise:

• Weight-bearing, high-impact – climbing stairs, hiking, running, or jumping rope
• Muscle strengthening – weight lifting, tai chi or other gravity resistance training
• Stretching – yoga, Pilates and other posture aligning/balance exercises

There is no known cure for osteoporosis, but there are several approved medications to treat the disease. Keeping bones strong and maintaining bone density is key in keeping risk low.

Back spasms are unusual, involuntary and sometimes prolonged contractions of a muscle in the back. Back spasms can occur in any muscle in the back, but most often occur in the lower back. There is a high concentration of nerve endings in that region, so spasms occurring there are especially painful and can sometimes be debilitating for weeks. Two thirds of Americans experience back pain in their lives, but not all of those patients have muscle spasms.

It is believed that these muscle contractions can happen to protect another part of the back from further injury. For instance, if there is an injury in the region of the spine, such as a sprained ligament, the muscle can spasm and, because of the pain, immobilize that area of the back. This keeps the person from moving and therefore keeps the injury from further tearing. However, there are many different internal reasons for a back spasm such as tetanus, arthritis or even a tumor.

Some of the examples of when the muscle spasms are packing, lifting and moving boxes or poor desk ergonomics where bending and twisting occurs regularly. This repetitive motion and overuse of the spine can weaken or strain muscles that then spasm. Spasms are the most common athletic injury. Slouching while sitting or standing can also weaken the back muscles or put undue strain on the spine. Chronic ailments in patients with arthritis in the spine, or skeletal irregularities such as Lordosis (or swayback) often experience back spasms for the same reason – the muscles are working extra hard keep the spine safe and stable.

Reducing pressure on the back can ease the pain of a spasm. Most people find lying on their side with their knees pulled closer to the chest feels more comfortable than sitting and some believe that deep breathing can bring oxygen to the area to help relax the muscle.

In trying to find the cause of a spasm, a doctor will make a physical examination and ask for the patient’s health history. This exam can illuminate the reason for the spasm and if it is a regular reason for the spasm, or if there is something else causing the pain.

For spasms occurring from acute pain, such as back strain or sprain, treatment of spasms starts with reducing any inflammation and getting rid of pain. Icing the back at the area of discomfort, compression using an elastic bandage and resting the area is one of the first steps. Anti-inflammatories, such as ibuprofen or acetaminophen can help reduce the inflammation and muscle relaxants can help to reduce the pain. Some believe muscle relaxants and anti-inflammatories can slow recovery, so a patient should speak with their health care provider before proceeding with any medication. Chiropractic care or spinal manipulation is also often prescribed.

While the injury is causing pain, movement should be avoided. After inflammation has been reduced then normal activity can be resumed. Recurrence of back pain is high, so a patient should be fully recovered before resuming any intensive exercise routine. Keeping weight down and strengthening both the stomach and back muscles are important things to keep in mind. Overloading the spine with extra weight of the lack of muscle tone in the stomach, back and legs is thought to increase the possibility of the injuries that can lead to muscle spasms.