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.

Sciatica pain is caused by irritation and inflammation of the sciatic nerve, a large nerve that branches off the spinal cord. The sciatic nerve is the largest nerve in the body, about the diameter of a finger. Its nerve fibers begin at the 4th and 5th lumbar vertebra (L4, L5) and the first few segments of the sacrum. It runs vertically down the back of the thigh, behind the knee, branching into the calf (hamstring muscle) and further down into the heel. The pain usually affects one side of the body, starting in the buttocks and gradually radiating down the back or side of the thigh. It may radiate down the leg below the knee and it may even reach the heel. It is described as:• Burning• Sharp• Dull ache• Tingling or Numbness• Continuous or intermittent painThese painful symptoms may progress to severe pain in the heel or foot along with numbness, tingling and progressive weakness in the affected limb. Additional symptoms are:• Pain increases with walking • Pain worsens with prolonged sitting• Pain may be worse when trying to stand from a low sitting position• Pain worsens when bending backward, coughing, sneezing, or strainingSeveral different types of spinal disorders can cause a compression of the spinal nerve, resulting in the pain and inflammation of sciatica. The most common causes are: • Herniated Disc• Bulging Disc• Degenerative Disc Disease• Lumbar Spinal Stenosis• Spondylolisthesis• Piriformis Syndrome• Spinal Tumor• Trauma caused by fall, car accident, or sports injury The most important step in treating sciatica is to determine what is causing the compression of the sciatic nerve roots. Because there are many causes, symptoms and treatment vary from patient to patient. Diagnostic tests and examinations must be complete and thorough. Imaging methods such as MR neurography has been effective in diagnosing 95% of severe sciatica patients. This is a modified MRI technique which provides improved pictures of the spinal nerves and the effects of compression on these nerves. Since some reports show that 15% of sciatica sufferers have disc related problems, this technique is a helpful diagnostic tool. The implementation of an effective treatment plan will be determined by a diagnosis of the cause of the sciatica pain.

During their lifetime, three out of four adults will experience back pain; and with an aging population and the prevalence of obesity, this number may rise even higher. Pain in the lower back, (lumbar area), from sprains and strains is the most common complaint. Often, the cause is due to lifting without using proper techniques or from a sudden twisting movement. Muscle strains and sprains will usually heal with time. Heat and massage, over-the-counter medications, and possibly physical therapy also help. Some causes of pain are due to severe spinal disorders such as spondylolisthesis (slippage of vertebrae) or a herniated disc. These conditions will require varying degrees of medical treatment and possibly life changes. Many lumbar strains and sprains can be avoided by changing some practices. Here are six bad habits which can cause a back injury:1. Using poor body mechanics when lifting2. Poor Posture3. Lack of Exercise 4. Overweight5. Ignoring an injury or persistent back pain 6. Smoking Poor Body MechanicsWhen Lifting:Stretch and loosen your muscles before lifting anything.Get close to what you will lift.Bend your knees and grasp it firmly.Lift straight up in one motion. DON”T TWIST!Hold lifted object close to your body.Move close to where you want to put the object you lifted.When lowering the object, bend your knees.Ask for help when needed.Poor PostureTo Have Good Posture:Stand with your feet slightly apart.Keep the knees straight.Tuck your chin slightly in.Keep your shoulders backSit in a chair that supports your back.Slouched shoulders, drooping head, locked knees place stress on the spine. Good posture is more comfortable and keeps the body in good alignment.Lack of ExerciseFind a way to include exercise in your daily life. Keep your back muscles strong and keep your spine healthy.Overweight A sedentary lifestyle has become all too common today. Research shows that people who do not exercise regularly and are overweight are more likely to suffer from back injuries and pain. Unwanted pounds, especially if the weight is in the abdomen, place stress on the spine. Follow a proper diet and maintain adequate nutrition.Ignoring An Injury Or Persistent Back Pain Most sprains and strains can be cleared up with time, medication, massage, and possibly physical therapy. If an injury goes untreated and there are no modifications in activity, it can progress to a more serious injury and, possibly, disability.Smoking According to experts, smoking increases the risk for back injury. Nicotine, in any form, blocks the flow of oxygen and nutrients to the intravertebral discs, the cartilage pads that are cushions between each vertebra, allowing smooth movement of the spine. When they are starved for oxygen, the discs are less able to repair themselves and often collapse at a much earlier age than in non-smokers. This can develop into degenerative disc disease with chronic back pain.A study by Duke University showed that in 1998, total health care expenditures incurred by people with back pain in the US reached $90.7 billion. Wouldn’t some of that money have been better spent on leisure activities or vacations, something more enjoyable than treating an episode of back pain? Many steps you can take to avoid back injury are simple and based on common sense.

Several studies have been completed and reported on the success rates of the treatment of Chronic Low Back Pain using the mechanized Spinal Decompression machine. One study recently appeared in May 2007 in Chiropractic and Osteopathy. It compared success rates from the use of a non-surgical intermittent mechanized traction machine with the use of TENS in relieving low back pain due to a herniated or bulging disc. First, to understand any study, you need a picture of the disorder and the chronic misery it causes. Back pain due to an injury or accident is the leading Workmen’s Comp injury and the main reason for disability in people under 45. The spinal column is made up vertebrae stacked one on top of another. Between each vertebra is a tough, fibrous cushion, called an intervertebral disc, which contains a jelly-like substance. These discs act as cushions absorbing shock and allowing the spine to bend, twist and turn. Healthy discs are thick, flexible and compress when pressure is put upon them, like a sponge. When there is an injury, the vertebra may shift out of alignment or compress the disc causing the disc to bulge or rupture, out the jelly like substance. This herniated disc or bulging disc causes pressure on the spinal nerves, resulting in pain, numbness, and may progress to decreased function in the affected arm or leg.It is also known as:• a pinched nerve• sciatica• a blown out disc• a slipped discThe protrusion of the disc or its core material not only causes pressure on the spinal nerves, it compresses blood vessels and interferes with circulation to the area. Deprived of nutrients and oxygen, the disc cannot heal, and, over time, flattens, becoming stiff and hard, just like a dry sponge. This condition develops into degenerative disc disease.Standard treatment has included:• Physical/chiropractic therapy• epidural injections (an injection into the epidural space of the spinal cord)• NSAIDs (Nonsteroidal Anti-inflammatory Drugs)• Hot or cold packs with massage • Electrical stimulation (TENS)• Non-Surgical Spinal Decompression• Acupuncture • Surgery – as a final resort A treatment method that is gaining support is Non-Surgical Spinal Decompression, in which some studies show a success rate of 71% to 90%. An FDA approved machine, using a computerized program gently stretches the patient’s spine, slowly drawing the vertebrae apart, relieving pressure on the disc, allowing it to heal. Testing of the machine continues and a recent study compares treatment results of Decompression Therapy with that of the TENS ( Transcutaneous Electrical Nerve Stimulation) unit. TENS is a small unit which can be worn during therapy. This FDA approved treatment for back pain delivers low-volt electrical current to the affected area through electrodes. Its electrodes pierce the skin just deep enough to reach nerve fibers, usually 1 to 2 inches. It activates the body’s pain fighting mechanisms and may be used several hours a day. The StudyThe object of the study was to compare the effectiveness of the two treatment methods in relieving pain and improving mobility in patients with a bulging or herniated disc. Subjects were recruited through newspaper advertisements and had to meet several criteria for inclusion in the testing:• Disc protrusion or herniation confirmed by MRI (Magnetic Resonate Imaging) or CT scan (Computerized Tomography)• Low Back Pain for 3 months or more; could be associated with pain radiating to one or both legs. • Average duration of pain was 7.3 yearsThe study enrolled 44 patients; the average age was 42 years. The group was initially divided into 2 groups of 22 people each.• Spinal Decompression treatments consisted of 30 minute sessions, 5 times a week for 4 weeks. This was followed by once a week treatment for 4 additional weeks.• The TENS Group received treatment with a TENS unit for 30 minutes daily for 20 days. This was followed by a weekly treatment for 4 additional weeks.• Both groups were able to take anti-inflammatory and non-narcotic pain relievers. The ResultsThe outcome was measured by the 10 centimeter Visual Analog Pain Scale (VAS) and a disability scale. The disability scale rated the subject’s ability to perform their most affected activity on a 0 to 4 scale, with 4 being “could do an activity without limitation”. Success was defined as a 50% improvement in the VAS, showing the degree of pain relief. Any decrease in disability was given a positive rating. During the study, 4 subjects dropped out, leaving 19 in the Decompression Group and 21 in the TENS Group, a total of 40 participants.Conclusions:Spinal Decompression:• 13 out of 19 people (68.4%) showed improvement. • The 6 months follow-up showed 7 out of 19 people maintained their level of improvementTENS Treatment:• 0 out of 21 subjects showed any improvement. . Additional scientific studies are being planned or are underway now to demonstrate conclusively the treatment effectiveness of Spinal Decompression Therapy.