FAQ Category: Lumbar Spine

First of all, we should tell you that scientists aren’t even sure why a small leg length difference would cause low back pain…but it does! Maybe the angle of the pelvis gets tilted enough to change how the muscles of the spine work together. Given enough time the changes lead to low back pain.

Having said that, we can also tell you it’s not clear why a thin shoe lift gives people relief from their pain…but it does! A recent study compared two groups of back pain patients who all had one leg mildly shorter than the other.

One group had a shoe insert inside the shoe of the shorter leg. The other (control) group did not have an insert to correct the length difference. The group with the shoe insert all reported less back pain. There was no change in pain or symptoms for the control group.

Research shows back pain is the most frequent reason for days missed on the job by workers under the age of 45 years. Yet studies show over and over that low back pain occurs in more than 70 percent of all adults at some time in their lives.

A recent study from the Spanish National Health Care System looked at 195 low back pain patients. They collected data on the background of each patient. This included age, sex, education level, and type of work.

In this study group, the average age was 46 years with a fairly equal number of men as women. All professions were included from blue collar to retired and all points in between. Patients were most likely to be students, blue collar workers, or housewives. Retired workers and white collar workers were affected almost equally, but in fewer numbers.

A recent study from researchers in Spain report that improved pain in back pain patients doesn’t always lead to any changes in disability and quality of life. Many studies show that other factors besides pain affect quality of life, but more study is needed to find
these.

It may be that your aunt’s treatment must focus on improving pain, but also address the areas of mobility, activity, and quality of life. It’s likely that separate treatment programs are needed for each area. Improving one doesn’t always change the others.

You’re right about a new interest in quality of life (QOL) issues. Once again, we can thank the Baby Boom Generation for changing the way we think about life and health. In the past, the focus was on living longer (or as long as possible).

Today’s adults want more than that. They want to live longer and live well. This has brought about a change in how health problems are treated. Improving quantity and quality are equally important.

QOL is measured in different ways. One measure called the EuroQoL Questionnaire includes several categories: mobility, self-care, family or leisure activities, pain, and mood. This is a valid scale for measuring QOL used in health care studies.

Studies generally agree that exercise therapy is a valuable treatment for chronic low back pain. A behavioral component is also advised. This part of the program looks at any fears you may have and the tendency to avoid activities because it might cause back pain.

Even studies where patients do a small amount of exercise show positive results. Physical therapists around the world are researching the specifics of type, intensity, frequency, and duration. We don’t have a blue print yet. It may turn out that exercise is based on age, weight, gender, or the underlying problem. Maybe the answer lies in a combination of these. We just don’t know yet.

If your doctor isn’t directing you to one form of exercise over another, experts suggest starting with something you like and are likely to keep doing. For some people, that’s walking. For others, a swimming program suits them better. Still others prefer riding a
stationary bike.

Whatever you choose, start slowly, and build up gradually. Try to be consistent. Ten minutes a day is better than one hour, once a week. Get a partner to exercise with you. You’re more likely to stick with it if you’re doing it with someone else. Some people find it’s easier if they always exercise at the same time each day. This eliminates trying to find the best time and not going at all.

There hasn’t been a study comparing just these two groups under equal circumstances. A recent Canadian study did identify height as a risk factor in men. In the Canadian study,
weight was not linked to back pain or injury in either men or women. However, other studies have reported increased back pain in overweight adults.

Risk factors for back pain remain a mystery. Despite many studies, researchers really don’t know what puts one person at greater risk than another. Some say smoking is a risk factor while other say it’s not. Age (older) may put us at risk, but this isn’t proven.

Most agree that personal stress and other psychologic or social issues are connected with back pain. More studies are needed to help us understand risks for back pain. The next step is preventing it.

You may have heard about the new report taken from the Canadian National Population Health Survey. Men and women 18 and older were asked about back pain and assessed for risk factors. It is true that gardening or yard work was was linked with back pain for some men.

The report pointed out that this was true when the men had a negative association with yard work. This may not be true for men who enjoy this activity. Other risk factors may be equally important. These include height, general stress, and overall health.

Stories from patients and results from studies don’t agree. There’s a wide range of reports from “miracle cure” to “symptoms worse than ever.” No one has died from this treatment. The former Surgeon General C. Everett Koop is one of those patients who has been helped by prolotherapy–so much so that he began to use it on some of his patients.

A recent study from the University of Queensland in Australia report their findings. They put 110 subjects with chronic back pain into two groups. They either did or didn’t get an
injection with glucose and a local anesthetic and were given exercises or told to do their normal activities. Everyone got better with the injections. The exercise didn’t seem to matter.

No one has done a study on the effect of driving long distances after prolotherapy. It makes sense that long periods of sitting or inactivity may be harmful, but we don’t have any real data on that one. It may be best if your sister takes frequent breaks and gets
out of the car to walk at least every two hours.

Prolotherapy is a treatment for chronic low back pain of unknown cause. It involves a series of injections into the painful or tender spinal or pelvic ligaments. It
can also be used for neck, wrist, knee, foot, or any joint pain from an injury. Some patients with arthritis and fibromyalgia have also found relief from pain with prolotherapy.

The injection contains different solutions depending on the doctor. Sometimes it’s glucose or dextrose, two forms of sugar. Some doctors use a hormone called erythropoietin to make red blood cells. A recent study from Australia reports using
saline (a salt solution) works just as well. It may not be what’s injected that matters, but the injection or needling itself that makes a difference.

The COPM was developed to help patients find out what their problems are. Then it is used to measure their progress with treatment. It is focused on work performance and worker satisfaction with their performance.

Three areas are measured: self-care, productivity, and leisure. Self-care includes getting on and off the toilet, ability to walk or drive, and other activities such as stair climbing, standing, and lying down.

Productivity measures work tasks, the ability to shop or garden, and other jobs such as taking care of children, pets, and family. Leisure includes hobbies, sexual activity, going out for fun, and joining friends in various activities.

The COPM can be used to measure progress in treatment. Changes in scores of two or more are significant. The patient’s satisfaction with activities performed is also measured (separately).

By all means, make your interests and goals known to both your doctor and your physical therapist. This information will help them in making decisions with you about the best treatment for you.

It’s easy to get into the habit of rubber-stamping an exercise program that fits the average patient. The program may have to be changed when someone has specific goals and activities in mind.

Not everyone has the same problems either. A recent survey of chronic low back patients in England showed a wide variety of concerns and problems. About half the patients listed “limited walking” as their biggest problem. Others had trouble with sitting, sleeping, stretching, dressing, and gardening. A back pain management or rehab program must be geared to these differences.

Surveys are often used to gather information about patients. This helps programs meet the needs of their clients. It’s hard to find one survey that fits everyone. Next time this
happens to you, be sure to point it out to the clinic director.

Your feedback can be very helpful to them. Maybe they even have a better choice for you, but neglected to notice your employment and marital status. Of course, they might not know either of these things about you until you fill out the form.

The Biering-Sørensen Test is a test of trunk-muscle endurance. It measures how many seconds the subject is able to hold the upper body in a horizontal position without support. The subject is usually strapped into a special chair or to a table with support
from the pelvis down.

The person starts in a head-down position. The arms are crossed over the chest. The subject flexes at the waist to raise the trunk to a horizontal position. This position is held as long as possible. The test is stopped by fatigue or pain.

The advantages of this test are how easy it is to perform without expensive equipment or computers.

Scientists are still sorting this all out. A group of researchers in Norway offer some new insight. They measured muscle strength, size, and endurance in two groups of back pain patients. One group had a lumbar fusion; the other tried an exercise program. The
exercise program also had a lecture on anatomy and pain in the back.

The patients in the exercise group had the best result. They had greater muscle strength, density, and endurance. The results stayed the same even when measured a year later. The
scientists aren’t sure why the fusion group didn’t do better. Recovery of some muscle strength is possible just with daily activities.

The muscle atrophy and weakness in the fusion group was more than the researchers expected to see.

Managing this kind of problem depends on several things. First, does the X-ray show the cage is fractured, but still stable? In other words, has the cage shifted or moved in any way? Second are you having any bothersome pain or other symptoms? Third, is there any sign of spinal deformity developing?

The cage may be left in place if there’s no sign of shifting or nonunion of the bone graft. The cage should be in the center. A slight shift in one direction or another is okay. Another option is to remove the cage and reinsert another cage. Sometimes the surgeon reinforces the area with a metal plate or screws.

You’ll need to check with your doctor on this one. X-rays often tell the story. There could be another fracture causing more weakness of the spine. Just the weight of your mother’s body can be enough force to break another bone if she’s extremely osteoporotic.

Many patients who have post taumatic deformity (PTD) didn’t follow their doctor’s advise. The didn’t perform the exercises and stopped wearing the brace. Failure to take the medication is also a possible cause of the symptoms getting worse.

Each state has its own workers’ compensation (WC) system. This means the ways things are done may vary. Contact your case manager and bring this question up. Most WC systems
require two levels of medical tests to make a diagnosis. From there, the right treatment is prescribed. The conservative approach is usually followed.

Many times, surgery isn’t considered until rehab has been completed and all other treatment has failed. The doctor’s goal for the patient is to get the most medical
improvement possible before treatment ends. Since most injuries heal within four to six weeks, any symptoms beyond the three-month mark are considered chronic.

Treatment of chronic pain can be different than treatment for an acute problem. Surgery isn’t advised unless all tests show the patient is a good candidate. If you haven’t seen a doctor for a second opinion, ask your case manager about this option. You may have to be prepared to accept what you hear, even if it’s not what you want.

The cage is inserted between two bones. The force of the pressure of the bones against each other (and now against the cage) is enough to hold it in place. Sometimes the doctor
uses a metal plate or screws to help hold everything together until it heals. Bone graft material is also used to fill in where the bone once existed.

The best place for the cage is right in the middle of the vertebra above or below it. The cage can shift or slide. A small amount of slippage is okay. Too much slippage and the fusion may fail or the spine deforms. The doctor will keep an eye on this using periodic X-rays.

You may be given a rigid, plastic corset to wear for the first six (or more) weeks. Don’t throw it in a corner or closet. The corset will help stabilize the spine while it heals.
It can also help take some of the load off the nearby discs and healing area.

Studies show that up to 50 percent of all pregnant women have some kind of back and/or pelvic pain during pregnancy. Most of the time, the pain goes away in the first three
months after the child is born. A fair number of women end up with chronic pain that lasts months to years.

Pain after pregnancy is also common. The causes for both kinds of pain patterns are probably different for each woman. Pain during pregnancy that goes away afterwards may be linked to the position of the baby in utero. Pressure from the weight of the child can
cause nerve pain or hip, sacroiliac, or back pain. Once the baby is delivered to the outside world, the pressure is gone and so is the pain.

Researchers know that the hormone relaxin is present in greater amounts during pregnancy. It’s likely this hormone helps the muscles, ligaments, and other soft tissues
relax. This allows the pelvic bones to expand and make room for the baby during delivery. Pain that occurs after pregnancy may be related to the changes in the soft tissue structures. Weakness and instability of the muscles around the abdomen, hip, pelvis, and back often bring about this kind of problem.

Whether these conditions are a normal part of pregnancy or in fact, hereditary remains unknown.

Exercises should not bring on pain, even after having a baby. You didn’t describe your exercise program for us to evaluate, but here are some guidelines.

First of all, make sure your doctor gives you the go-ahead. There may be medical reasons to wait before beginning an exercise program.

It’s important to breathe while doing exercises. Holding your breath increases the pressure inside the abdomen. Exercises should be started slowly with only a few repetitions. Build gradually by adding a few more each day. Pain one or two days after starting a new exercise may be a signal that you are doing too many too soon.

After pregnancy the deep abdominal muscles and the low back muscles are often unbalanced. There are some specific exercises for this called stabilization exercises. A
physical therapist can prescribe these for you based on your body and the condition of your muscles, ligaments, and bones.

Smoking and obesity can add to painful back problems. Good nutrition and getting enough rest and liquids are also very important in regaining your health and strength after pregnancy.