FAQ Category: General Spine

Acupuncture is an ancient Chinese practice. It has made its way to the west in the last 200 years. Many different types of acupuncture have developed through this process.

Traditional or classical acupuncture chooses the points based on the meridian theory. Meridians are a network of energy pathways through the body. It’s believed that each organ has its own network and meridians.

More modern acupuncture uses points on the ear, scalp, hand, or foot. This is called nonmeridian or extrameridian acupuncture.

According to a recent review of acupuncture studies, one type of acupuncture hasn’t been proven better than another. In fact, when it comes to using acupuncture for low back pain there are no long-term benefits. It may help with short-term pain relief but doesn’t do as well as massage, for example, in the long-run.

Acupuncture along with exercise, heat, back education, or pain relievers is more effective than acupuncture alone.

Technically, these terms refer to the same problem. “Slipped disc” is a bit misleading as the disc doesn’t really slip and slide around. Using either term in a search engine will bring up similar (if not the same) web links.

The disc is made up of two basic parts: the inner core called the nucleus and the outer covering called the annulus. A bulging disc refers to movement of the disc back and/or to the side toward the spinal cord or spinal nerves. The nucleus is still contained inside the annulus. Sometimes this is also called a prolapsed disc.

When there’s a tear in the annulus, the nucleus can move out past its own covering. This is referred to as a disc protrusion or herniation. The disc protrusion or herniation can come into contact and press on the nerve root. It can also send chemicals that come into contact with the nerve root causing painful back and leg symptoms.

Searching the web for medical information may be helpful. Be sure to check out any information you get for accuracy with your doctor. Sometimes wrong information is more harmful than no information at all.

There are no standards for medical information on the internet. Even so millions of Americans are using the internet for health information. In fact many sites are commercially-based. Banners and pop-ups with products or services to sell will help you recognize these sites.

Studies are starting to come out rating web sites that offer information on medical problems. Medical doctors have reviewed carpal tunnel, lumbar disc herniation, and other orthopedic problems. They report the majority of sites have poor quality information.

It may be best to do some web surfing and then talk to your doctor. Look for non-commercial based information from a university, medical society, or medical doctor. Ask your doctor to tell you which sites can be trusted. Ask him or her to review information you’ve found on the internet.

Studies show that over 100 million internet users in the United States are searching for health information on-line. More than half don’t discuss what they find with their doctors. Only about 4 percent of the physicians polled give their patients tips on which web sites to go to for good information.

With internet use becoming so popular, doctors may best serve patients by asking them which sites they are using for their medical information. Sites with good (or poor) quality information can be identified.

Consumers should ask their doctors for reliable and accurate web links. According to a study at Brown University Medical school, physicians should steer patients away from commercial sites. University or other academic sites and medical groups like the American
Medical Association give the most accurate information.

Spondylolysis refers to a crack in the vertebral bone. Unilateral means it’s only on one side. Benign suggests the condition won’t get worse or cause further problems. When spondylolysis occurs on both sides of the spine at the same time, the body of the vertebra can slip forward. The slippage can cause a worse problem called spondylolisthesis.

A recent study from the University of Toledo suggests this condition may not be so benign in young active athletes. They looked at 13 athletes younger than age 20. Each one had unilateral spondylolysis.

A computer analysis of the CT scans showed increased bone remodeling on the opposite side of the spondylolysis. There is an increased risk of stress fractures on the other side of the spine. Repeated spinal motions, especially rotation, seem to be the biggest risk factors. Medical follow-up is advised if your son starts having back pain that doesn’t go away.

A stress reaction sometimes called a stress fracture is an overuse injury to the bone. It occurs as a result of strain on the bone. Damage occurs from the strain of repeated load cycles. The amount of load to cause a stress reaction is much lower than the stress required to fracture the bone from a single traumatic event.

Stress reactions are linked most often with vigorous exercise. Exercise with repetitive, weight-bearing loads, like running or marching cause bone reactions in the pelvis, hip, or leg. Repeated rotation of the spine is linked with stress reactions of the spine.

Stress reaction is a better term than stress fracture because no fracture line is seen on X-ray. The bone reacts to the increased load by trying to remodel itself. The bone can handle a small amount of remodeling.

Too much repeated stress speeds up the remodeling too fast. In an attempt to make better bone, some bone cells are absorbed to be replaced by newer, stronger units. But the resorption process is faster than the building or remodeling. The bone gets weak and the affected person experiences pain. With enough stress or increased load, the weak bone can fracture.

Spinal height does change throughout the day. This is mainly due to disc height. The discs in between the vertebrae are fluid-filled and act as a cushion against compressive forces on the spine.

After rest and especially after sleeping for six to eight hours, the discs are fully restored. For this reason people are at their tallest after getting up from bed. Activity and the upright posture slowly push some of the fluid out of the discs. When this happens height may decrease slightly.

This spinal shrinkage may be counteracted by muscle activity of the paraspinal muscles along each side of the spine. The normal adult is not usually aware that any of this is happening. In the person with a bulging or herniated disc, the fully plumped up disc can put increased pressure on the nearby spinal nerves. The result is greater back pain in the morning.

You may be having paraspinal muscle spasm. The paraspinal or erector spinae muscles along either side of the spine run the full length of the back. These act to support the spine and also help the spine extend to a neutral, straight back.

Studies show increased paraspinal muscle activity even at rest for individuals with low back pain. Paraspinal muscle spasm put pressure on the discs. The compression then
irritates the joints of the spine.

Can you think of any repetitive motion that could be causing this problem? Perhaps turning or twisting to one side over and over?

If your symptoms don’t go away in three to five days, see a doctor or a physical
therapist. Early intervention can go a long way in preventing chronic back pain and disc problems.

Musculoskeletal problems, especially back pain are very common among workers. Most people get better on their own and don’t even need medical care.

According to a recent study of industrial workers from nine companies about 45 percent sought medical care. Most went to their family doctors. Others saw a physical therapist. A few went to a specialist.

Recurrence rate over a six-month period was fairly high (68 percent). The more severe the symptoms were the first time, the more likely someone was to have recurrence of symptoms.

The study did point out that older women were at greatest risk for these kinds of problems. Workers who had high job strain were also at increased risk for recurring problems. Job strain was defined as low control over the job and poor supervisory support.

Physical activity and exercise is directly linked with the health of your spine. If you aren’t on a regular program of activity or exercise, now would be a good time to get started.

Not likely. In fact saying painful symptoms are slightly, moderately, or severely bothersome is a useful way to classify low back pain.

Words that point to an emotional response to pain include “killing,” “miserable,” or “torturing.” “Cruel,” “punishing,” and “unbearable” are other words that might be used to
describe an emotional response to a disease, injury, or illness.

Doctors listen carefully when patients talk about painful symptoms. Words like “throbbing” or “pounding” often describe vascular pain. “Burning,” “shooting,” or “stabbing” pain may point to nerve pain.

“Bothersome” has been shown to be a good word to predict future results. In a recent study of back pain patients 80 percent of the adults who said they had “extremely bothersome” pain were disabled six months later. Early treatment might make a difference
when patients are identified at the first exam with “bothersome” pain.

The National Spine Network (NSN) collects data from patients with back pain and from doctors who treat back pain. They have seven main groups of back pain diagnoses.

These include herniated disc, spinal stenosis, spondylosis, sprain or strain, pain syndrome, deformity, and “other.” Some of these groups list a variety of conditions.

For example deformity includes scoliosis, Scheuermann’s disease, and congenital problems. “Other” includes infection, fracture, dislocation, rheumatoid arthritis, osteoporosis,
and tumor. “Other” even lists “other diagnosis” to cover anything that might not be listed.

This should give you a place to start. Once you look up some of these problems you’re sure to come across some others. These seven groups cover most common back problems seen on a day-to-day basis in the doctor’s office.

The National Spine Network (NSN) is a group of spine care centers around the United States. They try to work together to collect data from patients and doctors to help understand back pain and how to treat it more effectively.

No one’s name or contact information is given out. You can safely complete this information without fear of unwanted mail or phone calls.

Most of the time data is collected about symptoms, general health, use of medications, and satisfaction with care. The doctors also fill out a form on each patient with information about treatment, prognosis, and tests ordered.

Every week the surveys are sent to a central coordinating center. Data is entered into a main computerized database. This information can then be used in conducting research about spine problems. With over 60,000 patients entered the data can be very helpful just from the number involved.

According to a recent study physical therapists are sought out most often by women, patients with a higher socioeconomic status, and people in severe pain over a long period of time.

Women tend to seek medical care more often than men in general. Patients in lower socioeconomic groups may not be able to leave work to see a PT. They may not have transportation or insurance to pay for the services.

It’s not clear who can benefit most from the services of a physical therapist. PTs are actively engaged in research to help find out who should (or shouldn’t) receive physical therapy care.

One group from the University of North Carolina recently reported on the use of PT for neck and back pain. Keep your eye out for future reports in this area.

Research shows there’s actually a large gap in beliefs about low back pain between medical doctors and chiropractors. There are also wide differences of opinion in what the
general public believes and health care providers.

No one is quite sure how this has come about or what to do about it. There may be a lack of communication between patients and health professionals. There may be a similar lack of cooperation between various health care workers.

Acute low back pain is still treated by many professionals despite research that shows it will get better for most people in one to two weeks. And treatment varies depending on who’s giving it from doctors to chiropractors to physical therapists.

The difference between acute, subacute, or chronic is a matter of time. Different sources name the time frame differently. The cut off point seems to be somewhat arbitrary.

According to a recent study of back pain progression, the first two weeks after injury or start of symptoms is the acute phase. Pain past 14 days is labeled subacute. It’s generally agreed that pain persisting past three months is becoming chronic.

With chronic pain comes loss of function, disability, and decreased quality of life. Treatment during the chronic phase is focused on preventing disability. A pain center can help address all of your needs, not just the back pain itself.

This type of treatment is a good idea for anyone with chronic pain. The earlier the intervention, the greater your chances for improved function and even recovery.

There is a slight difference in height from the morning to evening but it may not be measurable. While the body is resting at night the discs take in water to replenish and nourish them.

Once we stand up in the morning the compressive force of the body weight causes the excess fluid to seep back out. The combined effect of muscle tension, gravity, posture, and reduced water content in the discs can make a small difference in height on a daily basis.

There is a much greater difference in height from young adulthood to old age. Thinning of the discs, degeneration of the spine, and the forces of gravity work over time to decrease the adult’s height by as much as four to six inches. This difference may be more or less for some people.

There are several ways to follow-up after a car accident. A medical exam is always a good idea to rule out fracture or neck injury. The first 24-hours is often the best time to do this. Early treatment for soft tissue injury may help prevent future problems.

Call your doctor and ask his or her best advice as to your next step. Emergency room visits are often much more expensive than an appointment with your medical doctor.

Predicting a person’s outcome without a crystal ball is never easy. But a recent study of neck and shoulder pain offered the following insights.

Don’t feel like you’re alone. About one-fourth of all patients who have posterior spine surgery develop this problem. All affected have been placed on a special frame, table, or device to support the body during the operation.

The patient is placed face down with the hips bent slightly. The chest and pelvis are held up by padded supports. If the patient’s lateral femoral cutaneous nerve crosses at just the right spot, the pelvic support can put pressure on it causing numbness.

Patients who are overweight or obese are at greatest risk for this problem. The weight of the unsupported belly pulls on muscles of the abdomen. This puts more pressure on the involved nerve.

Surgery also takes longer on larger patients. The longer they are in this position, the more pressure is exerted on the nerve, and the greater the chances of developing nerve impairment.

So if any of these factors were present for you, you may have your answer as to “why me?” and “why now”? The good news is that the condition is almost always temporary. The symptoms should go away in the next two weeks to two months at the most.

Are you having any other symptoms anywhere else? Have you injured your back, thigh, or hip in the last six months? You didn’t mention your age, which could be a factor.

It sounds like you may have some kind of nerve impairment. The spinal nerves that give your upper leg sensation exit the spinal canal at the level of the upper lumbar spine. Something could be putting pressure on the nerve.

It could be a bulging disc or tumor. Other less serious causes could be abnormal posture, muscle tightness or spasm, or tight-fitting corset or brace.

It would be a good idea to see a doctor since you’ve had the problem for a while and it seems to be getting worse. It may be a simple matter of changing the way you sit at work or your posture during track practice.

Something more serious should be identified and treated as soon as possible for the best results.