Back Pain Tips

The facet joints are the connections between the vertebrae of the spine. Just like the knee or elbow or any other joint in the body, they allow the spine to bend and twist. They are also stabilizing joints that prevent excessive motion and help hold the body upright. The joints are on the back of each vertebrae and they link one vertebra to the vertebrae directly above and below to form a working unit that allows movement. The surfaces of the joints are covered with a tissue called the articular cartilage. The joint itself is lined with a membrane called the synovium and the joint is enclosed in a fibrous sac, the joint capsule. Synovial fluid, a thick liquid which acts like lubricating grease and surrounds the joint, allows the bones to move without friction.When these joints become inflamed secondary to injury or arthritis, pain and stiffness occur. If the joints in the neck or cervical spine are affected, these symptoms develop:• Headaches • Pain in the neck, shoulders, and upper back.• Difficulty rotating the head• Patients often complain that they have to turn their entire body to look to the right or left.When Facet Joint Syndrome affects the lower back, there is:• Pain in the lumbar area• There may be referred pain to the buttocks and thighs• Stiffness of back• Difficulty getting out of a chair• Difficulty standing up • Complaints that the patient must walk hunched overAn injury or changes associated with aging may cause the cartilage cushion that covers the bones to wear away, resulting in pain as the bones in the joint rub together. Also, small nerves that branch off the larger spinal nerves can become irritated or pinched, causing pain. Facet Joint Syndrome is more common in people over 50 and is usually associated with aging.Causes of Facet Joint Syndrome• Whiplash Injury can cause the syndrome in the cervical area.• Sports activities,such as gymnastics, where neck is extended• Arthritis• Poor posture which pushes the spine out of alignment• Inflammation• Infection• Degeneration of the jointDiagnosing Facet Joint Syndrome• History and Physical should be done• An X-ray, CT (computerized tomography) scan of the spine or an MRI (magnetic resonance imaging) will rule out fracture or herniated disc.• Facet joint block would determine if the joints are the source of pain.o A local anesthetic is injected into or near the nerves that supply the joint. If there is a significant decrease in pain, the diagnosis is confirmed.

Treatment

• NSAIDs (Non-steroidal Anti-inflammatory Drugs) such as ibuprophen, Naproxyn • Muscle relaxants and narcotic pain relievers might be prescribed for more severe pain.• Physical therapy • Exercise program to improve flexibility and increase pain free movement• Posture correction• Activity Modification to avoid excessive lifting, stretching, bendingApproximately 80% of the patients who follow an active rehabilitation program and take NSAIDs become pain free. This usually lasts several months.When conservative treatment fails, a surgical procedure called, Raiofrequency Rhizotomy, uses an electrical current to destroy the sensory nerves to the joint, resulting in pain relief.

Sacroiliitis is one of those ‘itises’ that once you have it you won’t want to repeat it –ever!This inflammation of one or both of the sacroiliac joints that connect the lower spine (sacrum) to the pelvis can be extremely painful. There is severe pain and stiffness in your low back and hips and walking is difficult. Pain may radiate from the lower back and pelvis into the buttocks or back of the thigh. The sacroiliac joints are surrounded by a large amount of ligaments and fibrous tissue for stability. Because these joints are deep in the muscle of your buttocks, they are difficult to examine. The pain when you move may be so severe that you become unwilling to move at all and this makes the condition difficult to diagnose. Sacroiliitis can be mistaken for other causes of low back pain such as:• Sciatica• Herniated disc• Muscle strain• Septic Hip• Abscess of the psosas muscle –this is a part of the hip flexor group of muscles• Malignancy• Kidney Infection• Ankylosing spondylitis• AppendicitisCauses • Trauma, such as a car accident or fall which affects your lower back, spine, pelvis or buttocks. Torn ligaments can create inflammation or lead to infection of the sacroiliac joints.• Heavy lifting, if done incorrectly, can injure muscles and joints.• Spondyloarthropathies, which are inflammatory arthritis conditions including: ankylosing spondylitis, arthritis associated with psoriasis.• Degenerative arthritis of spine, which can cause inflammation of sacroiliac joints• Osteoarthritis leads to degeneration of the sacroiliac joints.• Pregnancy, in which the ligaments in pelvis become softer and stretch to accommodate childbirth.• Infection of the sacroiliac joint. This may be due to a bacterial infection in food such as brucellosis. This disease occurs in slaughterhouse workers, farmers, veterinarians, ranchers. It was spread through contaminated milk prior to pasteurization requirements. • Reiter’s Syndrome, which causes sacroiliac joint pain along with other symptoms.Risk FactorsBecause of the difficulty diagnosing this disorder, predisposing risk factors must be considered, including:• History of bone, joint, skin infection.• Injury to spine, pelvis or buttocks• Urinary Tract Infection may spread infection from urinary tract to sacroiliac joints.• Pregnancy, when the area around sacroiliac joints may become inflammmed.• Endocarditis, which is an infection of the lining of the heart, can spread to joints and other body organs. • Illicit IV drug use increases the risk Symptoms• Pain and stiffness in lower back, thighs, buttocks• Pain becomes worse with walking due to the motion of the hips.• Psoriasis, an inflammatory skin condition, may occur with a type of arthritis.• Pain radiating down leg, often mimics sciatica• Limp• Decreased range of motion• Elevated temperature• Bloody Diarrhea occurs with Reiter’s Syndrome which causes painful urination, joint pain, sacroiliac joint pain, and eye inflammation• Eye inflammation in one or both eyes, a symptom of Reiter’s Syndrome and often evident with sacroiliitis.It is important to seek medical evaluation promptly with sacroiliitis and to not delay treatment. This illness is no ordinary episode of back pain, and it can lead to joint destruction and the possible development of a disabling ailment or a severe systemic infection.

Sciatica is a painful symptom of a disorder in the lumbar spine. There are a variety of conditions which cause sciatica and the first step in developing a treatment plan is arriving at an accurate diagnosis.Since trauma, such as one caused by a sports injury, a fall, or involvement in a car accident, can lead to sciatica, obtaining an accurate history is the first step toward diagnosis. The physician may ask you such questions as:1. When did the pain start?2. Was there an injury or accident that you recall?3. How did your pain develop?4. Describe the pain. Does it radiate down your leg? Is there numbness or tingling?5. On a scale of 1 to 10, with 10 as the most severe pain, how do you rate yours?6. What activities make this pain worse? For instance, sitting for long periods of time?7. Does walking up or down hill make the pain worse?8. Does coughing, sneezing, or straining increase your pain?9. Have you tried any form of treatment?10. What helped relieve your pain? The physician will complete a thorough physical examination, evaluate your posture, test your range of motion and note any specific movements that cause pain. He will examine your spine, note its curvature and alignment and check for muscle spasms. The physician will test your reflexes, your muscle strength, neurological changes, and pain distribution. In addition, the following tests may be done:1. Lab tests for symptoms of infection 2. Spinal X-rays3. MRI –Magnetic resonance imaging which produces cross-section images of your back to detect tumors, or damage to discs and ligaments.4. CT scan-Computerized tomography which can identify spinal damage. The MRI and CT scan are more effective than x-rays at showing the soft tissues in your spine and are helpful in identifying conditions such as a bulging or herniated disc. In addition, your physician may decide additional tests are needed to help in a diagnosis:1. Bone scan will help identify osteoporosis, vertebral fractures, or infection2. Discogram in which dye is injected and x-rays are taken to confirm the diagnosis that a disc is causing your pain.3. Myelogram which shows a spinal canal or spinal cord disorder after an injection of dye and an x-ray or CT scan.Obtaining an accurate diagnosis of the cause of sciatica pain is not always a simple process. Once the cause of your pain is determined, your physician will be able to develop a treatment plan that is appropriate for your condition.