Lower Back Pain
The lower back is one of the most important parts of the body, as it holds most of our body weight when we stand and is involved in movement when we bend or twist at the waist. Because of its pivotal role and frequent use, it is susceptible to injury and chronic pain. Lower back pain is especially common in older adults, who may have decreased bone strength and muscle elasticity. The vertebral disc may be degenerated and worn away as well.
Lower back pain can be a result of a muscle sprain, strain or spasm, a ruptured or bulging disc or an irritated nerve. The pain may radiate down the legs as well. Obesity, smoking, poor physical condition and poor posture can create a higher risk for lower back pain. Trauma is also a common cause of pain.
While lower back pain is not usually a serious condition, it can be very painful and debilitating. Treatment for this pain is usually simple and can include medication, ice and heat, rest and exercise. In other cases, a more detailed evaluation may be necessary and can include x-rays, MRIs, diagnostic injections and even surgery.
A herniated disc, also referred to as a bulging, ruptured or slipped disc, is one that protrudes into the spinal canal and can apply pressure to a nerve root. A herniated lumbar disc can cause pain in the back and all the way down the legs and feet. About 90% of herniated discs occur in the lumbar spine. Treatment for a herniated disc includes anti-inflammatory medication, physical therapy and steroid injections. Surgery is not usually required but can provide significant relief in cases where needed.
Neck pain is a common condition that can result from degeneration of the cervical discs, cervical disc herniation, arthritis and trauma. Radiating pain into the shoulders, arms and hands can also accompany neck pain. In addition, numbness, tingling and even weakness in the arms can occur. Many patients complain of decreased grip strength.
These symptoms can be debilitating and pain from the neck can also radiate into the head, causing cervicogenic headaches (see Quick Links). Treatments can range from exercise, medication, injections, spinal cord simulators, and surgery in refractory cases.
Like other bones in your body, the bones of the spine, called vertebrae, can fracture. These fractures are usually a result of osteoporosis, pressure on the spine, metastatic disease, or a fall or other type of injury. A spinal fracture is called a vertebral compression fracture.
Compression fractures can cause mild to severe pain depending on how they occur. Treatment usually includes pain medication, rest and bracing. Medication simply relieves the pain but bracing will restrict movement, relieve pressure and allow the fracture to heal. For more severe fractures, surgery may be required but is not usually necessary. Vertebroplasty, a minimally invasive procedure to place a cement-like substance into the vertebral body, can provide immediate relief for most compression fractures. Taking measures to prevent compression fractures is the most effective treatment and involves exercise, vitamin supplements and medications.
Degenerative Disc Disease
Degenerative disc disease refers to the changes in the spine that take place over time, which may lead to severe pain and other symptoms, as well as conditions such as osteoarthritis, herniated disc or spinal stenosis. As we age, our inter vertebral discs lose fluid and become less flexible, and may bulge, herniate or thin. Sometimes trauma can be the initial precipitating factor that can lead to disc degeneration.
Patients with degenerative disc disease often experience back and/or neck pain that tends to worsen with activity. Pain may radiate through the arms or legs, and may be accompanied by numbness or tingling as well.
Treatment for this condition usually involves applying ice or heat to the affected area and taking anti-inflammatory medication to help relieve pain. Some patients may require more advanced treatment, especially when degenerative disc disease progresses to a more serious condition. Surgery may be performed to remove the damaged disc in severe cases.
Radiculopathy, or pinched nerve, involves irritation to the spinal nerves that can occur in the neck, middle or lower back. This can result in pain, tingling or numbness, usually radiating into the arms and legs but also into the ribs and abdomen. The most common conditions that cause a radiculopathy are bulging or herniated disc, bone spurs and narrowing of the spinal canal, or stenosis.
In most cases, this condition can be successfully treated with over-the-counter medication, rest and activity modifications. Physical therapy can also be beneficial. If treatment does not help, an MRI or CAT scan may be obtained to help diagnose the cause. Pain management injections usually provide relief where other treatment regimens have failed. Surgical options are reserved for patients that fail conservative treatment, but may be required on a more urgent basis for patients with progressive leg or arm weakness.