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Human Body - Central States Orthopedics

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Patient Info

Types of Back Problems

Types of Back Problems

Pain is the most common symptom of back problems and if you suffer from back problems the most important one. It is important to distinguish between acute and prolonged pain, because they reflect different types of problems and different medical treatment needs.

Acute back pain is a warning sign of injury such as a sprained ligament, bone fracture, or disc herniation. During the first days after an injury, the pain tells the body to avoid movement that would aggravate the injury and slow or prevent healing. This is why the neck becomes stiff a short time after a whiplash injury and why certain movements cause or increase pain at the site of a disc or muscle injury. Prolonged or chronic pain is different. It is usually the result of minor misuse, injury, or strain over a period of time and many factors may contribute to the type or severity of pain that is experienced.

For example, excess body weight may place too much strain on the muscles that support normal alignment of the vertebral column as well as on the cushioning discs between vertebrae. An old injury may “flare up” occasionally. Or repetitive misuse such as improper lifting technique that is used daily on the job or at home may cause a weakening of supporting ligaments and muscles and a “nagging” lower back pain.

Lower back pain, in fact, is the most common type of chronic back pain, and may be attributed to such seemingly benign causes as poor posture over many years, lack of exercise, improper lifting techniques, and excess body weight.

Select from the topics below to get more information on problems associated with the spine.

Inflammation

Inflammation occurs when the muscles and ligaments are stretched beyond their normal capacity or elasticity, causing pain and inflammation.

Low back pain usually results from an injury to the muscles and ligaments of the lumbar spine, often due to lifting or twisting injuries. Stress and bad posture can also be contributing factors. Often the pain does not occur immediately after the injury, so the specific cause of the pain may not be apparent. Although back pain can occur anywhere in the back, it is most common in the lower back.

Many back problems are relieved with time and rest. Heat or ice, gentle massage, and acetaminophen, ibuprofen, or aspirin can help ease pain. Therapeutic exercise under the guidance of a physical therapist may also be helpful. Stronger pain killers or muscle relaxants are sometimes prescribed for “flare ups.” Although these measures help relieve back pain, recurring back pain is quite common. Preventive measures, including good posture, proper lifting, exercises to strengthen the back, and losing excess weight, may reduce the likelihood of future back problems.

Symptoms of low back pain persisting beyond one month should be evaluated by a doctor. If you develop leg weakness or numbness, or loss of bowel or bladder control, you need to contact your doctor immediately.

Osteoarthritis

Degenerative arthritis or osteoarthritis, commonly occurring in the back and neck, is the normal aging or “wear and tear” that causes changes in joints over time. It may result occasionally in low back pain or irritation of a nerve. Osteoarthritis is characterized by deterioration of protective cartilage covering the joints and the development of bone formations that can affect joint function. Symptoms may range from a backache at the end of the day to numbness in the legs when walking. Symptoms typically appear and progress gradually.

If discomfort persists, seems to be worsening, or is accompanied by numbness and weakness, your doctor should be consulted.

Elements of treatment may include:

  • An exercise program, focusing on range-of-motion and muscle strengthening
  • Losing excess weight to minimize stress on the joints
  • Heat and ice therapy
  • Anti-inflammatory drugs
  • Surgery. Sometimes the arthritis can cause large bone spurs which put pressure on the nerves of the spine. These bone spurs may need to be surgically removed. Spinal fusion surgery is also sometimes used

It is important to see your doctor if:

  • Your symptoms are severe
  • The pain is keeping you from doing things that you do everyday
  • The problem does not go away within a few days

Call your doctor right away if you also have problems controlling your bowels or bladder, if you feel numb in the groin or rectal area, or if there is extreme leg weakness.

Whiplash

Whiplash is a common term for an injury that occurs to the cervical vertebrae and supporting soft tissues. The injury is caused by a sudden jerking, acceleration, or forward acceleration of the head with respect to the vertebral column. Most often cervical whiplash is associated with an automobile accident that produces a sudden and forceful forward or backward “whipping” of the head and neck.

Symptoms of cervical whiplash occur as a result of muscle and ligament sprains and strains to the cervical portion of the spine and supporting tissues in the neck. Common symptoms of cervical whiplash include:

  • Neck pain at the base of the neck that increases over time
  • Decreased ability to move the neck
  • Increased pain with movement
  • Muscle spasms in the neck

In some cases, there are no symptoms for hours to days after the accident. However, symptoms gradually appear and progressively worsen.

Other symptoms that may occur include:

  • Visual changes, such as blurred vision
  • Nausea
  • Increase in frequency, intensity and duration of migraine headaches

Your physician may include some of the following methods to treat whiplash:

  • Rest can enable the body to heal
  • A soft cervical collar may be worn to reduce strain on the muscles and ligaments of the cervical spine and decrease pain. If a cervical collar is prescribed, it should be worn as instructed
  • Aspirin, ibuprofen, or other anti-inflammatory medication may be prescribed to decrease inflammation, reduce muscle spasm, and decrease pain. Muscle relaxants are sometimes prescribed for a short time to promote rest, reduce muscle spasm, and decrease pain
  • Physical therapy, including heat in the initial stages, then cold therapy
  • Isometric and range of motion exercises may be prescribed and a physical therapy consultation may be recommended

Be sure to tell your doctor if:

  • Symptoms worsen or new symptoms develop
  • Symptoms become worrisome

Herniated Disc

Herniated Disc

A herniated disc is a rupture of the jelly-like substance from inside one of the fibrous discs that provide cushioning between the vertebrae of the spine. Herniation results in pressure on nearby nerves which can result in a variety of symptoms, depending on the location of the affected disc. These include:

  • Pain
  • Numbness or weakness in the neck, arm or hand, shoulder, buttock, legs or feet

Any disc can rupture, but it is most likely to occur in the lower back as the result of disc degeneration over a period of time or a sudden strenuous action.

Your physician may include some of the following methods to treat a herniated disk:

  • A period of greatly reduced activity, possibly even bed rest. Activity can usually be resumed gradually.
  • Heat and/or ice therapy
  • Massage
  • Gentle exercise
  • Pain medications may be used to reduce pain
  • Epidural steroids

Traction also may be helpful

In many cases, pain will be relieved by these conservative treatments. However, if the pain is recurrent, or the conservative treatment does not help, surgery may be necessary.

If symptoms persist beyond one month, or if leg numbness or weakness, or loss of bowel or bladder control is present, you should contact your doctor immediately.

Compression Fracture

A compression fracture is the structural collapse of a vertebrae, often due to loss of bony mass caused by osteoporosis. If the fracture is minor, it may cause little discomfort. However, a more extensive fracture may cause painful backaches. Over time, an accumulation of spinal compression fractures can allow the spine to bend forward, causing what is commonly referred to as “dowager’s” or “widow’s hump”. If a compression fracture is suspected, you should consult your doctor immediately.

Rest and heat can help relieve the pain caused by compression fractures. Symptoms most often subside gradually over a few months. Rarely do fractures resulting from osteoporosis require surgery. To reduce the risk of osteoporosis and the resulting bone loss certain preventative measures are recommended, including:

  • Exercise
  • Proper diet
  • Calcium supplements, especially in the elderly and for women after menopause. Calcium supplements may be started earlier with physician supervision
  • Other medications to help restore or maintain bone density, such as Fossamax or Mycalcin
  • A bone density test may be recommended if you are at risk of or have already experienced problems associated with loss of bone density
  • Vertabraeplasty with bone cement

Scoliosis

Scoliosis is a sideways curvature of the spine which may occur for a variety of reasons. The spine develops a primary curve to one side. To compensate for the first curve, a secondary curve often develops in the opposite direction, resulting in an “S” shaped spine. The condition, which most often begins in childhood or adolescence, may worsen until skeletal maturity, is not usually accompanied by pain. Progression of the condition is gradual, and may not be detected until adolescence. Adolescent girls are more likely to have scoliosis than boys are. School nurses often do screening for scoliosis among school children.

If a curvature of the spine is noted, it should be evaluated immediately with x-ray films. If the curvature of the spine is slight, no treatment may be necessary. If the curvature is pronounced, or the curvature is increasing, treatment may include the use of a brace. Severe curvature of the spine may require surgery to prevent pressure on the heart and lungs from the spine caused by the body twisting.

Kyphosis, a condition formerly called “hunchback,” is an increase in the normal forward bend in the thoracic region of the spine. It can be caused by poor posture, arthritis, and osteoporosis.

Lordosis, or “sway back,” is an increase in the curve in the lumbar area of the spine. This can be caused by obesity, muscular dystrophy, and hip problems.

Both kyphosis and lordosis may require exercises, bracing, or even surgery.

Stenosis

Stenosis is a term that means that an area normally open is narrowed. In the spine, the term refers to a narrowing of the spinal canal, the opening that houses the spinal cord. The opening may be narrowed as a result of a congenital condition or from degenerative changes associated with arthritis. The result often produces symptoms related to compression of the spinal cord and nerve roots. Most often, the stenosis affects the lumbar region, causing irritation and sometimes dysfunction of the nerve roots in the lower back. Symptoms may include pain in the lower back, buttocks, thigh and calf, usually precipitated by activity and relieved to varying degrees by rest. More severe symptoms may include pain in the hips and abdomen and a sensation of heaviness in the legs during walking and other activities. In some cases, the symptoms may mimic problems with the circulation of the legs and a diagnostic evaluation will be required to rule out vascular problems. Usually a CT scan/myelogram or MRI will reveal the stenosis.

Your physician may recommend some of the following treatments:

  • Medications to reduce inflammation during “flare ups” of the condition
  • Exercise or physical therapy to strengthen the muscular support of the area and reduce symptoms
  • Surgery is recommended in some cases, to stabilize the vertebral column in the affected area

Work-Related Injuries — Lower Back

Work-Related Injuries -- Lower Back

Back pain is one of the most common and significant musculoskeletal problems in the work place today. The Occupational Safety and Health Administration reports over 1 million workers each year are affected by back pain. It is second only to the common cold in causing lost days from work. Economically, low back disorders in the United States cost between $50 and $100 billion each year. An estimated $11 billion of those costs are covered by Workers’ Compensation, with an average claim costing $8,300 — more than twice the average cost all of other types of compensable claims combined.

Although the causes of low back pain are complex, much scientific research points to the fact that work-related activities are a significant factor in developing back disorders. The National Safety Council states that as many as 25 percent of workplace injuries are caused by overexertion, which is listed as the cause for 60 percent of all low-back injuries reported.

Back strain results from damage to muscles, ligaments, and/or tendons in the back, and is caused by over-stretching of the ligaments or tendons, or overuse of the muscles in the back. The most common problem is a strained or pulled muscle. Once the muscles, ligaments or tendons in the back are damaged, they are more susceptible to reinjury.

The National Institute of Occupational Safety and Health (NIOSH), a division of the Center for Disease Control, looked at over 40 recent studies addressing low-back musculoskeletal injuries, in an effort to correlate work activities as risk factors for low-back injuries. According to the NIOSH report, the most significant risk factors associated with lower-back injuries were job activities that required lifting and forceful movements, and jobs that exposed workers to whole body vibration. Awkward posture and heavy physical work were also identified as risk factors.

Most often cited as the cause of low-back pain were:

  • Improper methods of lifting, pulling, pushing, carrying, lowering, bending, or twisting
  • Unexpected exertion
  • Sudden slip or fall
  • Cumulative trauma

Back problems often result not only in lost time from work, but reduced quality of life, as those who suffer from the problem struggle to adjust their lives to avoid further injury.

Although no approach has been found to completely eliminate back injuries, there are some things that have been helpful in decreasing the amount of back injuries on the job.

  • Training in proper lifting techniques
  • Physical conditioning and stretching
  • Reduction in size of objects or material being moved
  • Adjusting the height at which the objects or material are retrieved or deposited
  • Implementing mechanical aids

Types of injuries that may typically occur in work situations include:

  • Strains and sprains
  • Herniated Discs

Work-Related Injury — Upper Back

Work-Related Injury -- Upper Back

Work-related musculoskeletal disorders of the upper extremities are quite common and occur in nearly all types of work situations. Each year direct Workers’ Compensation costs due to these types of injuries are over $2 billion, plus an additional $90 million in indirect costs.

The highest rate of disorder was found in industry workers whose jobs required them to repeat the same type of forceful motion throughout their work shift, such as food processors, automobile and electronics assemblers, carpenters, office data entry workers, cashiers, and garment workers.

Most often, disorders affect the soft tissues of the neck, shoulder, elbow, hand, wrist, and fingers. The disorders can develop gradually, resulting from repeated actions and the twisting and bending of the hand, wrist and arms combined with force.

To better understand the activities which significantly contribute to work-related injuries, the National Institute of Occupational Safety and Health (NIOSH), a division of the Center for Disease Control, reviewed over 40 epidemiological studies, and formulated a correlation between posture, repetition, force, and vibration, and work-related injuries in the upper extremities and lower back.

The NIOSH study determined posture, repetition and force were each significant risk factors in developing a work-related musculoskeletal disorder. Vibration was also a significant risk factor in developing conditions in the hand and wrist. However, in most instances, it was a combination of risk factors that proved to have the most impact.

Common injuries associated with the neck and shoulder area include:

  • Tension-Neck Syndrome
  • Rotator Cuff Tendinitis
  • Shoulder Impingement Syndrome
  • Thoracic Outlet Syndrome

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