Talking about spine-related pain can seem confusing to patients because of the variety of symptoms involved and because of other, pre-existing conditions they might have. There are also a number of care options the patient may take: conservative (exercise or physical therapy), interventional (e.g., injections), and surgical–all of which have a place in treating spine-related pain.
Spine care professionals have long emphasized the need for an individual to develop strong “core” muscles around the spine and pelvis in order to improve spine health. Some popular exercise activities such as Pilates, yoga, and kettle bells focus on strengthening and stretching the muscles and ligaments around the core. Only 20 to 30 minutes a day is enough time for a full set of exercises and enough time to strengthen the spine. Developing an exercise program that can be adhered to and practiced 4 to 5 times per week is probably the most important thing a person can do to maintain a healthy back. Other areas of spine health include good nutrition, adequate fluid intake, and enough rest.
Many websites feature core-stabilizing exercises that are helpful, but getting expert advice and attention from a trained health care professional–a physical therapist, athletic trainer, or chiropractor, for example–is often very helpful when beginning a core-strengthening program.
Causes of spine injuries
We can injure our spines in many ways. Often the process of aging itself brings arthritis, which is caused by the disks in the spine (the cushions between the vertebrae) becoming dehydrated. This makes them become more susceptible to degenerative conditions that can cause pain. So it’s important to drink enough water each day. Pain can be localized to the back and neck but can also cause “referred” pain, pain that radiates into the arms or legs.
The most common cause of back and neck pain is muscle strain. This happens when a person lifts something improperly and does not have a core strong enough to handle the job. Pain caused by muscle strain is routinely treated with a brief period of rest and over-the-counter anti-inflammatory medicine. Occasionally, stronger pain medications are needed, such as muscle relaxants. Pain radiating into the arm or leg is more concerning. It is often due to nerve compression which is often associated with an area of numbness or muscle weakness. When this occurs, seeing your primary care physician or spine specialist is usually recommended. Many nonsurgical options still exist, but often an MRI or CT myelogram (an MRI or CT using contrast dye) is needed eventually to diagnose the source of the nerve compression and to focus nonsurgical treatment on that nerve or area.
Types of back pain
Some of the most common causes of back pain in children are scoliosis (curvature of the spine) and pars fractures, also known as spondylolysis, commonly due to sports-related injuries. (Spondylolysis means that stress on the fifth lumbar vertebra has fractured it, weakening the spine so that it cannot maintain its proper position and starts shifting out of place.) In adults, the most common cause of back pain is disk herniation in the lower back and neck. The disk is a flat round structure that separates the vertebrae in the spine. In disk herniation, the disk’s central portion “herniates,” or slips, into the spinal canal putting pressure on a nerve root, which then causes pain. As we age, additional problems such as spinal stenosis (arthritic bone spurs that narrow the spinal canal) can become more common. This can often prevent an older person from standing or walking for a long period of time.
Spine-related pain treatment options
While various minimally invasive surgical treatments are available, there are more conservative, nonsurgical measures that can be tried first, such as bracing, core-strengthening exercises, and/or injections. As mentioned before, the most important thing one can do to prevent back pain is to develop a weekly exercise routine. Another type of helpful intervention typically involves a diagnostic and/or therapeutic injection in the spine. Epidural steroid injections are commonly used to treat cervical and lumbar-mediated arm and leg pain. In either of these conditions, a nerve in the neck or lower back is compressed. Common causes of nerve compression are disk herniation, spinal stenosis (arthritic bone spurs), balance instability, and narrowing of the nerve foramen. The foramen is a natural opening or cavity in a human body, usually one through which blood vessels and nerves pass through bone. Some of these conditions cause compression of the nerve or conditions such as disk herniations which can cause both compression and an inflammatory reaction to occur around the nerve.
Many studies have been performed which show the therapeutic benefit of injections. Steroid drugs help because they stop inflammation, breaking the cycle of pain and contributing to the stabilization of the nerve membrane. There are several types of epidural steroid injections, including “caudal, interlaminar, and transforaminal.” Of these three types of injections, transforaminal, or selective nerve root injections, allows the steroid to be concentrated in the area of nerve compression. They are also performed to confirm or diagnose the source of painful symptoms. Confirmation of the source of pain leads to significantly better surgical results.
Other types of injections to treat back and neck pain include facet injections and “medial branch blocks.” The term “facet” refers to the facet joint, the small stabilizing joint between each vertebra. The nerves in the facet joint are called “medial branches;” “block” means to numb the pain. If the pain is at the facet or medial branch, a procedure called a medial branch rhizotomy (deadening the nerve in a facet) can be performed which will provide 2 to 18 months of pain relief.
When nonsurgical treatments fail, then surgery may be recommended. The physician will determine the scope of treatment options based on the patient’s diagnosis, and after ordering diagnostic imaging to determine the source of compression or degenerative changes. Technological advances are being made all the time, resulting in improved surgical outcomes. Examples include minimally invasive approaches and motion preservation technologies such as cervical and lumbar disk replacements. Sometimes a spinal fusion is recommended.
The combination of conservative care (adapting a healthy lifestyle), diagnostic/therapeutic interventional therapies, and surgery provide most patients with a successful outcome in managing their back, arm, and leg pain.
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