Back Pain

Back painThis website does not provide specific medical advice and the information provided should not be used as a substitute for seeking medical advice from a registered health practitioner.

Back pain is defined as mild to severe pain or discomfort in the area of the lower back. The pain can be acute (sudden and severe) or chronic if it has lasted more than three months.

The symptoms of low back pain vary in some ways and are similar in others. Most people find that reclining or lying down will improve their pain and after their initial severe episode, many will be able to rest at night without severe pain. Most people are worse when they bend over to pick something up. Some get relief from arching backward (extending the back). Leg pain also can be part of the problem. The pain is most common in the back or outer side of the thigh, and can go all the way to the foot. Pain that goes to the foot is called sciatica because it is pain that follows the course of the sciatic nerve. Sciatica is often made worse by coughing or sneezing. With an acute episode, back pain can be very severe for a few days or a week, and then will often improve. By 2 weeks to 4 weeks, the large majority of people are much better. Individuals vary greatly in length of time between episodes, length of each episode and intensity of each episode, and how they cope with the pain.

My patient's FAQ about back pain:r.

 ( Answer from back pain or acupuncture website) WARNING: The views contained in the this section are those of the readers of this site, and those of the author. The author is NOT a registered (UK) medical doctor . His views are only based upon his personal experience. The author and this website accept NO RESPONSIBILITY for any usage of the information on this site or in any email. The author does not intend to use this section to diagnose or treat any medical condition. Any medical condition should be referred to a qualified medical professional.No responsibility for content incorrect)

 Do I need surgery for my back pain?

Most people with back pain can be treated conservatively. For most patients surgery is deferred until all non-surgical modalities are exhausted. All patients with severe or persistant back pain, or back pain associated with other symptoms, such as fever, burning on urination, or weight loss, should consult their physician to obtain an accurate diagnosis for the cause of their condition.

What are the risks of surgery?

Back surgery is less risky now because less invasive procedures are used for the majority of patients with disc disease. Nevertheless, surgery is invasive and requires anesthesia, which also poses a risk by itself.

Does bed rest help for back pain?

Bed rest for more than a few days is not recommended, as this can reduce your muscle strength. When the pain lessens, activity levels must be increased gradually and carefully.

When is back surgery necessary?

In fewer than 2% of cases of back pain is surgery necessary. There are many other effective treatments and surgery is only considered when a patient experiences unrelenting pain or progressive muscle weakness caused by nerve compression, or incontinence, which can point to spinal cord irritation.

How can I prevent osteoporosis?

Osteoporosis is bone loss.  The bones become brittle and break more easily.  This is especially true of the vertebral bones.  When they break, they can cause severe pain .Curing osteoporosis is not possible.  Once the bone is lost, it is not easily rebuilt.  Preventing osteoporosis is, fortunately, fairly easy.  If others in your family have osteoporosis, you need to be especially careful since your chance of having problems is increased.It is best to start in childhood but even the elderly can benefit from several simple tips.  First, get enough calcium and vitamin D.  Both are found in dairy and green leafy vegetables.  Supplements for both are inexpensive.  Second, exercise regularly.  Walking two miles a day is plenty to prevent bone loss and weight gain for most people.  Third, stop smoking.  Smoking kills bone cells.  Next, limit alcohol use.  Too much speeds bone loss.  Finally, avoid fad diets.  they do not contain enough nutrients.

What is whiplash?

Whiplash is a sudden movement of the head that can lead to injuries of intervertebral joints, discs, and ligaments, cervical muscles, and nerves. The injury can also extend to shoulders, arms and even low back.It is the most common injury resulting from car accidents.

Why should I be seen by a medical doctor?

Most cases of back pain can be effectively treated by a acupuncturist. However, there are some conditions, potentially serious problems, which must be considered before initiating any treatment. Most of these conditions can be screened with a thorough history and physical examination. Symptoms that raise concern include: Any problems controlling bowel or bladder function; Numbness around the genitals ;Pain with associated fevers, chills, sweats; Pain that awakens you at night .

Can a disc herniation cause paralysis?

The spinal cord stops high up in the spine (lumbar 1) so there are only nerve roots in the lumbar spine. Nerve roots are very tough structures, so even a sizable disc herniation is very unlikely to cause paralysis. Rarely, a large disc herniation can cause loss of bowel or bladder control due to damage to the sacral nerves, or progressive weakness in the legs due to damage to the lumbar nerve roots. If you experience either of these conditions, medical attention should be sought immediately.

What is myofascial pain syndrome?  

Myofascial pain syndrome is a frequently unrecognized disorder. Pain originates at so-called trigger points that are extremely sensitive to pressure; it can cause numbness or tingling, dizziness, migraine and muscle cramps in an area of the body distant from the point of origin. Various factors can arouse the trigger points, including trauma, diet, hormonal change, generalized organic diseases and cold.

I've been told I have a slipped disc. Can you put it back?

The idea that manipulation 'puts discs back' is a popular misconception. A slipped disc has been likened to the effect of dropping a rotten tomato on a concrete floor! Even if the disc could be restored to its correct position it would be so weakened that it would have come out of position again before the patient reached the surgery door. Natural healing processes will usually gradually allow the problem to settle but recovery is likely to be quicker if the over-stressing of the damaged area is reduced by treatment with Power Assisted Micro-manipulation. Only a small proportion fail to settle and eventually require more invasive treatments such as surgery or other newer procedures only available in more specialized centres.

What are the differences between physiotherapists, osteopaths and chiropractors?

Physiotherapists work as a profession supplementary to medicine often under the overall control of medical doctors, who may lack a specialized knowledge of the functions of the spine and bones. Their training places emphasis on the use of therapeutic modalities, electrical equipment and exercises. Their focus is symptoms rather than function.

Osteopaths obtain their cures mainly via the improvement of blood circulation, whilst chiropractors emphasize the role of the nervous system.

Chiropractors adjust specific vertebrae in a specific direction, whereas osteopaths use long leverage often some distance from the joints been manipulated.

How can my neck be the problem when I feel the pain in my arm?

A. The pain you feel in your arm can be from a problem in your neck, much like leg pain can be from the low back. This type of pain is called referred pain. When there is injury or irritation in the tissues deep inside your body, your brain is not able to determine exactly where the pain is coming from. Instead, the pain is felt further away from the actual source of the problem.

My MRI Scan showed that I have a bulging disc in my lower back. Should I see a spine specialist?

A. Not necessarily. Studies show that many people have a "bulging disc" but have no pain or problems at all. The fact you have a bulging disc is not necessarily a problem, but if you have symptoms of pain, numbness, or weakness, you should see a doctor or a spine specialist.

 How can we tell the difference between a muscle strain in the back and the pain that is caused by a kidney infection?

Pain stemming from a kidney infection typically is in the area of the back where the kidneys lie, located to the sides of the spine, just above the hips. Kidney related pain often presents as tenderness in this area. Direct injury or trauma to the back, over the area where the kidneys are located, can cause direct injury to the kidneys themselves, and that is why getting struck in this area is commonly referred to as a "kidney punch."

Can smoking really contribute to back pain?

Yes. In addition to its many other threats to health, smoking reduces the amount of oxygen that reaches and nourishes spinal tissue. This impairment slows healing when there is an injury to the area

My doctor told me that I have degenerative changes in my spine.  I have no pain.  Should I be worried?

After the age of 20, most people start to show signs of aging in their spines.  This is just a fact of life.  Therefore, it is very common to find degenerative changes in the spine in many adults. The lumbar disc, as it ages, loses moisture and dries up.   This is another reason that we should be motivated to take good care of our backs.

Do massage help sciatica?

Is MRI for everyone?

Magnetic resonance imaging (MRI) is a diagnostic procedure that gives doctors a detailed view of the body's organs and other tissues.

While acceptable for most people, MRI is not recommended for everyone.

Here is a list of people from whom MRI may not be recommended, courtesy of the Pennsylvania State University's Milton S. Hershey Medical Center:

• Anyone with metal in the body, including metal plates, pins or magnets.
• People with pacemakers.
• Women who are pregnant, as MRIs risk to a fetus is not completely understood.
• People who are claustrophobic.

 (Content from back pain and acupuncture website site,No responsibility for content correct .Thank you!)

 Abdominal

Referring to the body area including the stomach, intestines and other digestive organs.

Acupuncture

A therapy using fine needles to control the body's energy flows.

Analgesic

Pain-killing.

Annulus fibrosis:

 Cartilage-like material formed in a series of rings surrounding the nucleus pulposus (soft center) of a disc

Anti-inflammatory

Reducing the inflammation which causes pain.

Ankylosing Spondylitis

A painful, inflammatory disease of unknown origin that causes the sacro-iliac joints and spinal vertebrae to fuse (ankylose) together.

Annulus Fibrosus

The tough, fibrous outer casing of the intervertebral disc that holds the nucleus pulposus in place.

Anterior

Front.

Apophyseal joint

The facet joint

Arachnoiditis

A disease where dense scar tissue forms around the nerves of the spine causing symptoms such as burning pain, pins and needles, numbness and weakness.

Bilateral

On both sides of the body.

Blood Tests

Blood is taken via a hypodermic needle from a vein in the forearm.  It is then tested to check for signs of infection, anaemia, rheumatoid arthritis and other inflammatory conditions.  The procedure of taking blood is referred to as “venepuncture”.

Bone Scan

A radioactive isotope is injected into the vein and a set of images is obtained, which will help to exclude such problems as Osteoporosis and Oseo-arthritis.

Cauda equina: A region at the lower end of the spinal column in which nerve roots branch out in a fashion that resembles a horse's tail.

Cervical

Refers to the seven vertebrae that make up the neck.

Conservative management

The non-surgical treatment of back problems.

Counselling

The opportunity to talk things over with a trained counsellor, who can offer new ideas for coping.

Cauda equina

This literally means ‘horse’s tail’ and is used to describe the nerve fibres at the end of the spinal cord, below the level of the second lumbar vertebra (L2).

Cerebrospinal fluid

The clear fluid that bathes the brain and the spinal cord.  It is removed for testing through a lumbar puncture.  It is into this fluid that the radio-opaque fluid for a myelgram is injected.

Cervical

This term describes the neck which is made up of 7 vertebrae.

Chemonucleolysis

This is a procedure whereby an enzyme derived from the papaya fruit is injected into the intervertebral disc to shrink it and try and alleviate pain caused by a bulging disc.

Coccygodynia (Coccydynia)

Pain in the coccyx region.  It can occur following a fall or other trauma.  It can also be secondary to low back pain.  Muscle spasm can occur in the piriformis, levator ani and coccygeus muscles.

Coccyx

This is the last bone of the spine that is made up of four tiny fused vertebrae.

Computerised Tomography (CT) Scan

This is an investigation that is performed as an outpatient in the scanning unit.  It is a painless procedure and takes an average of 20 minutes.  Cross-sectional images are produced from information received through beams of x-rays going through the body.

Congenital

Being present at birth.

Conservative Management

This describes any non-surgical treatment of back pain, e.g. physical therapies, pain killers, traction, exercises, massage.

Degeneration

The process of change, usually with age, in bone or soft tissue.  Sometimes referred to as ‘wear and tear’.

Degenerative Disc Disease

The discs undergo a process of change from a supple, flexible structure that allows movement and acts as a cushion, to a stiff and rigid one that restricts the amount of movement and is a less effective cushion.

This process can start as early as 20 to 30 years of age and by the 60^th year it would be a universal finding on x-ray examination.

Dermatome

An area of skin that is known to be served by a specific spinal nerve.

Disc

One of the 23 shock-absorbing pads that act as spacers of the vertebrae.  Sometimes referred to as intervertebral discs.  See annulus fibrosis, nucleus pulposus and vertebral endplates.

Discectomy

The surgical removal of part of the disc that has prolapsed, bulged or ruptured causing pressure on spinal nerves.  This operation can be done by open method, by microsurgery and a minimally invasive technique through an endoscope.

Discography

An investigation that is done as an aid to a surgeon prior to surgery.  A contrast medium is injected into the disc nucleus and a series of x-rays taken that will show up the structure of a disc on the discogram.  The person’s pain reaction can also help determine which disc is causing the pain.

Discectomy:

Surgical removal of part or the entire herniated intervertebral disc

Epidural

Epidurals are given for the relief of lower abdominal and leg pain.  A cocktail of drugs containing a corticosteriod and a local anaesthetic is injected into the epidural space, between the bone and the membrane that encloses the spinal cord.

Facet joints

The point at which two vertebrae meet and move against each other.

Fracture

A break in the bone.

Foramen

This is the gap between the pedicles of the vertebrae that holds the nerve roots as they emerge from the spinal cord to the left and the right.

Herniation

The bulging through of a part of the body, e.g. the nucleus pulposus can herniated through the annulus fibrosus.

Inflammation

The pain and/or loss of function caused when the body's tissues are injured or diseased.

Intramuscular

Given by injection into a muscle.

Intravenous

Given by injection into a vein.

Instability

A term used to describe an abnormal increase in the movement of one vertebrae to another.

Kyphosis

The convex curve of the thoracic spine.  It can be over exaggerated in such diseases as Osteoporosis and Scheuermann’s disease.

Laminectomy

This is an operation to remove part of the bony arch at the back of a vertebra.  This is done to gain access to the nerves in the foramen and allow them more space.

Lordosis

The concave curve found in the cervical and lumbar regions of the spine.  Can be a deformity if it is excessive.

Ligaments

These are the bands of fibrous tissue that bind a joint and control its range of movement.

Lumbar

The area of the spine between the thoracic vertebrae and the sacrum.

Lumbago

An imprecise term for low back pain.

MRI Scan

Magnetic Resonance Imaging involves a highly technical scanner that uses magnetic fields and computer technology to generate images of the internal anatomy of the body, including the discs and nerve roots.

A contrast medium (Gladolinium) can be used intravenously to gain clarity of image, especially with those who have already undergone back surgery.

Myelography

A water-soluble, radio-opaque dye is injected into the cerebro-spinal fluid.  This allows nerve tissue to be viewed on x-ray and enables a doctor to trace any nerve entrapment.

Nerve Root

The start of the nerve as it leaves the spinal cord or cauda equina and passes through the left and right foremen to serve an area of the body.

Nucleus pulposus:

Soft center of an intervertebral disc, made up of gel-like substance.

Occupational therapists

Health professionals, also known as OTs, who find ways to help people live at home independently, despite their illness.

Orally

Given by mouth.

Osteophyte:

A small, abnormal bony outgrowth.

Osteoarthritis

The degenerative change of a joint, which makes it less able to withstand stresses and strains, causing pain and change to the shape of the joint.

Osteoporosis

A disease of bone characterised by the decrease of calcium content making the bone less dense.  This makes the bone more liable to fracture and collapse causing spinal pain.  It is more common in women after the menopause, but it can be found in people who have had eating disorders and after long-term steroid use.

Pathology

The branch of medicine concerned with the examination of diseased tissues.

Pelvis

The bony circle formed by the hip bones and the sacrum and coccyx of the lower back.

 Prolapsed disc:

A disc that bulges out from its position between two vertebrae.

Prognosis

An assessment of the expected future course and outcome of a person's disease.

Psychologist

A specialist in the processes of the mind and behaviour.

Pain

Pain is an emotion experienced in the brain, it is not like touch, taste, sight smell or hearing.  It is categorised into Acute pain – less than 12 weeks duration and Chronic pain – of more than 12 weeks.  Pain can be a warning of potential damage, but can also be present when no actual harm is being done to the body.

You can't rely on pain to tell you if you are damaging your back, because the spinous discs don't have nerves.

Peridural Fibrosis

Scar tissue formation around the dura.  This can be as a result of natural degenerative processes or of invasive treatments, such as surgery.

Radiologist

A doctor who understands and interprets a scan or an X-ray.

Radiology

The use of X-rays in the diagnosis and treatment of disease.

Ruptured disc: A disc with a torn annulus (the tough outer covering of a disc).

Sciatica

Pain along the length of the sciatic nerve running down the back of the leg. Often used to describe leg symptoms.

Scoliosis

A sideways curvature of the spine.

Shiatsu

A form of massage which works on the energy flow around the body, and which can be helpful for stress-related conditions.

Spasm

Sudden and/or continued convulsion/contraction of the back muscles which can cause immobilising pain.

Spinal canal

The hole running down the length of the spine, containing the spinal cord.

Spinal stenosis

Narrowing of the width of spinal canals, causing pressure on the nerves.

Spondylolisthesis

A condition where one vertebra slips out of alignment with the other.

Spondylosis

A condition of the spine where the discs have narrowed and extra bone grows between disc and vertebrae.

Sacrum

The area of the spine between the lumbar vertebrae and the coccyx, which consists of 5 fused vertebrae.

Scheuermann’s

Sometimes referred to as Spinal Osteochondritis.  This is a development abnormality in the intervertebral discs and vertebrtal bodies causing them to become wedge-shaped.  This can cause an increase in the kyphotic curve and predispose the person to premature wear and tear.  Exercise and attention to posture and lifestyle are important to prevent pain and deformity.

Spondylitis

Inflammation of any of the spinal vertebrae.  This can be because of injury, infection or rheumatoid disease (see Ankylosing Spondylitis).

Spondylolisthesis

A condition where one vertebra slips out of alignment with another.  Most common is the 4^th over the 5^th lumbar vertebra or the 5^th over the sacrum.  The causes can be congenital or due to structural defects, degenerative changes and injury.  Some people have it without symptoms, but others have major pain and nerve-related symptoms.  Called retrolisthesis if the slippage is backwards.

Spondylolysis

A crack in the neural arch of the vertebra that can predispose to a Spondylolisthesis.  This can be congenital, caused by over-use or found in people with a history of falls.

Spondylosis

A condition of the spine where the discs have narrowed and osteophytes have formed at the junction of the disc and vertebra.  This can lead to stiffness and eventually fixation of the joint.

Tendons: White glistening fiber bands of tissue that attach muscle to bone.

Thoracic

The region of the spine between the neck and the lumbar vertebrae.  The ribs connect with the 12 thoracic vertebrae.

Traction

An old form of conservative treatment that attempts to relieve pain by stretching the spine, in part or as a whole.  It can be done by hand or with a variety of machines, some of which turn you upside down.

Transcutaneous Electrical Nerve Stimulation

A battery powered machine that delivers small electric shocks via adhesively attached electrodes, placed either side of the spine, with the aim of blocking the pain messages to the brain and producing the body's natural pain killers, endorphins.

Vertebrae (Plural) Vertebra (Single)

The 33 bones of the spine, 24 of which are single and jointed, the others being fused.

Vertebral column:

 Flexible structure that forms the "backbone" of the skeleton, arranged a straight line from the base of the skull to the tailbone; also called spine.

Vertebral End Plates

The top and bottom of the vertebral body that comes into contact with the disc.

Visualisation

A way of becoming relaxed, involving putting an image into your mind and altering it as you wish.

Yoga

A combination of relaxation, breathing techniques and exercise which combats stress, and helps circulation and movement of the joints

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hThis website does not provide specific medical advice and the information provided should not be used as a substitute for seeking medical advice from a registered health practitioner.

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