FAQ Category: Lumbar Spine

This would be a very good question to ask your husband’s doctor next time you go in for an appointment. Each patient is different. For the most part, areas are injected based on the patients pain pattern or tenderness.

The doctor may use a list of points identified in previous research studies. Some doctors combine known acupuncture points with points that are tender when pressed.

Prolotherapy is the injection of irritants into ligaments and tendons to increase the strength of these tissues. It’s used most often with patients who have chronic back pain from injury of the soft tissues.

Even though the treatment has been around for more than a decade, there aren’t a lot of studies to show if it works or what’s the best treatment protocol. Some doctors combine
prolotherapy with other treatment as well.

One group of researchers from Australia reviewed studies published on this treatment method. They only found four studies close enough to be able to compare the results. Most doctors treated patients once a week or once every other week for a total of three to
eight treatments.

In some cases patients get good relief from painful symptoms and stop treatment. They may return for further prolotherapy months to years later. More studies are needed to find the answer to your question.

We don’t know everything there is to know yet about disc disease. Why do some people start developing disc problems at a young age? How can severe symptoms occur with mild disease and no symptoms with severe disease? What is the role of family genetics in all this?

These and other questions are under investigation by researchers around the world. A recent study from Finland may offer a bit of insight. They found many adults between the ages of 35 and 70 who had back pain from blocked arteries in the low back and sacral areas.

The blockage was linked to high (LDL) cholesterol levels. LDL stands for low-density cholesterol. Some people call these the “lousy” cholesterol. A loss of blood supply
to the discs leads to lack of nutrition to the discs. Tissues without oxygen and
nutrients quickly shrink (atrophy) and degenerate.

Atherosclerosis, the formation of plaques in the blood vessels, does occur with increasing age. When LDL levels are elevated at an early age, it’s often a family trait. Changes of this type have been seen in teenagers and start to increase around age 30. Early diagnosis and treatment may help prevent worsening of this condition.

Sometimes patients with blocked arteries DO have significant pain in the low back area. When they don’t it may be because of the body’s natural ability to stay as normal as possible. This is called homeostasis.

Gradual blockage gives the tissues time to adapt to less blood flow. Smaller blood vessels branch out to send blood around the blockage. These are called collateral blood vessels. In the case of obstructed blood vessels, there may be no symptoms or only mild symptoms if the blockage occurs slowly and there’s enough time to form collaterals.

Over time you may develop symptoms if the collaterals can’t supply enough blood for normal function. The discs will start to break down if they don’t get needed nutrients through the blood supply. Your doctor will help guide you with treatment to avoid this problem.

Disc degeneration in the spine is common as we age. Doctors gauge how severe the damage is by giving the disc a number from 1 to 5 from best to worst. The grades are usually written in Roman numerals (I to V).

Early degeneration is noted by Grades I and II. Moderate destruction is a III. More severe damage is labeled IV and V. Grade V means the disc is no longer healthy. It has lost its ability to cushion the spine. In fact, the disc may be collapsed with very little space between the bones.

MRIs can show the condition of the two parts of the disc. These include the outer covering called the anulus and the inner core called the nucleus. Damage from aging or injury can result in disc degeneration. The nucleus and annulus are no longer visible on MRI as two separate structures. A very low signal intensity shows up on the MRI with a grade V disc.

This is a good question. Many studies show chronic back patients need a total program for rehab. This should include physical, social, psychologic, and emotional recovery. The injections you are receiving help strengthen the ligaments. Prolotherapy treats the physical part first.

Sometimes it’s good to try one thing at a time. That way you know if what you did made any difference. Your doctor may be treating you with this in mind. At other times, combining two or more treatments helps each treatment work better. Several studies show that prolotherapy does work better when used along with other treatment.

There are several other interventions that have been tried along with prolotherapy. The doctor may manipulate your spine or suggest some low back exercises to go with the prolotherapy. Getting back to everyday activities and regular walking are often advised. Some doctors tell their prolotherapy patients to use oral vitamin C, zinc, and manganese supplements. These products may help collagen tissue grow and heal.

Ask your doctor about your program and what would be best for you at this time. The prescribed program may change as treatment progresses and you start to get better.

It would be if your doctor didn’t use a local anesthetic first to the nerve before applying the heat. The doctor uses a special kind of X-ray called fluoroscopy to place the needle-shaped probe at a specific nerve.

Radiofrequency energy is supplied through the tip of the probe for about 70 seconds. The temperature of the tissue gets up to about 175 to 180 degrees Fahrenheit. If it’s done properly, you shouldn’t feel a thing.

Pain relief from the treatment is immediate but often doesn’t last forever. For many patients, the pain comes back later, but the months of pain relief is generally worth it.

There are many gray areas in the treatment of chronic low back pain using nerve blocks. How much pain relief makes this treatment worth it? And for how long?

A recent study from the San Francisco Spine Institute used 50 percent pain relief as its deciding factor. Anyone who got relief from 50 percent (or more) of their pain was considered to have a “successful” treatment.

Fifty percent was used because other studies show a link between patient satisfaction and 50 percent pain reduction. Each patient must decide for him or herself how much pain relief is enough to make it worth a second (or third … or more) treatment(s).

At least 85 percent of all patients who have a repeat nerve block get pain relief that lasts an average of 10.5 months. Some even had up to seven repeated treatments.

You ask a question that the scientists look at too. In an ongoing series of studies from the University of Linköping in Sweden, patients are surveyed every five years. Questions are asked about pain, function, and general health. The patients are also asked how often they see a health care provider for their back pain.

They recognize that one factor affecting results could be age. General health may decline with age. The scores for general health will reflect the increasing age. It’s not clear if changes in pain and function can also be linked to age. The answer to this question may come as more studies are done with more people in each study.

Healing of pain from back problems should occur in the first six to eight weeks after injury. Pain that last beyond that time frame can become chronic pain. Often there’s no known cause of the pain.

Long-term studies of back pain patients show at least half of all patients with back pain after one year will still have pain five years later. Some have bouts off and on while others have continual pain.

Researchers are trying to sort out who gets better and why. They are also looking for methods of treatment that work better than others. The treatment focus for pain that continues past the expected time for healing is different than acute pain. Treatment for chronic pain tries to shift the focus from pain to function. Improving function, not reducing pain, becomes the goal.

There are health care professionals who work just with cases of chronic pain. You may want to ask your doctor about any services of this type in your area.

Studies show over and over that people who have an episode of back pain are likely to have back pain again. A recent study from Sweden reports about half of all patients will seek out health care up to five years later.

You’re asking if a second or third episode of back pain is a flare up of the same problem or a new attack. Your primary care provider (doctor, chiropractor, physical therapist) is the one who will make this decision. It’s usually based on what caused the symptoms and results of your physical examination.

So while it’s true that a previous history of back pain puts you at increased risk for more back pain in the future, each bout of back pain must be examined and classified according to its presentation. You’ll need to ask your doctor or therapist to submit proper documentation to the insurance company to prove this.

Exercise is usually always a good idea with chronic back pain. Strength training for the arms and legs sounds like it might help with your overall job tasks. As far as the back goes, whenever possible your exercise program should be based on what’s wrong.

For example, exercises for joint pain are different from exercises for a disc problem.
In many cases of low back pain (LBP), strengthening the abdominal muscles is a good idea. A recent study looked at how and when the abdominal muscles contract when a person with LBP moves the legs.

They found the deep abdominal muscle (transverse abdominis) doesn’t contract fully or soon enough with leg movement in adults with LBP. Other studies have shown similar problems with abdominal muscle control during arm and leg movements.

It’s not clear yet exactly what kind of exercise program will work the best to retrain the TrP yet. More studies are needed. We do know activity and exercise in general is the best treatment for chronic low back pain. If you are unsure what to do, check with your doctor or a physical therapist.

There are several ways to test this. First, stand sideways and look in the mirror at yourself. Do you have a large swayback? This is called lordosis and may be a sign of weak abdominal muscles.

Now lie down on the floor on your back with the legs extended and the arms behind the neck. Contract your abdominal muscles by trying to touch your belly button to the floor. Can you flatten your low back against the floor? If you can’t, you may have weak
abdominal muscles.

Now while keeping the abdominals tight and your back flat, lift your legs both up off the floor a few inches. Don’t stay in this position if your back hurts or you can’t keep your back flat on the floor.

If the abdominal muscles are strong, the back can be held flat on the floor. If the abdominal muscles are weak, the pelvis tilts forward as the legs are lifted. The back will hyperextend into lordosis.

Another way to check for abdominal strength is to clasp your hands behind your head. Don’t pull on your neck. Keep your chin tucked. Now bring your head, shoulders and arms off the table as if doing a sit-up. Just come up far enough to lift the bottom part of your shoulder blades off the floor. If you can do this and come up equally on both sides
at the same time, the muscles aren’t weak.

Studies show back pain patients often have muscle wasting on the same side as the symptoms. It’s not clear yet which came first, the injury or the weakness. Some say since the muscle changes are seen right after back pain starts that the weakness led to the injury.

Others show an inactive lifestyle is what causes muscle weakness AND injury. If this theory is true then back injury isn’t caused by some problem inside the spine. This means back pain and injury can be prevented with exercise.

There are enough studies on both sides of the issue to suggest both cases are true. It’s possible that some back problems come about because of inactivity while others occur as a
result of some intrinsic problem.

Over the past few years physical therapists have been looking for ways to treat the muscles in the low back area. There is a theory that the local muscle system is key to the health of your back.

Muscles that help stabilize the spine and hold it steady are called core muscles. These include the transverse abdominal and low back multifidus muscles. The multifidus
muscle is a series of short muscle fibers close to the spine. They are part of the “deep” muscles of the spine.

Recently researchers think they found another “core muscle”: the psoas. This muscle goes between the lumbar spine and the femur (thigh bone). It works to flex the hip and sometimes the spine.

Contracting the core muscles controls how much the vertebra slide and twist. The effect is to increase the stiffness of the spine. The result is to protect the back from injury.

Your new exercise program will focus on contracting and holding the core muscles while moving the arms and legs. A variety of positions are used from standing to hands and knees and lying down.

There are several different schools of thought on this one. Some say it’s best to keep doing the exercises as “prevention” of any future back problems. Others say it’s probably safe to move on with your life. If you have any symptoms of back problems then you can get those exercises out and start them over again.

Researchers are trying to find out what exercise works best for each condition. It’s possible that each person is different enough that a specific program is needed when injury occurs. A general program of activity and exercise may be all that’s needed to prevent injury for most people.

Until more is known, stay active and seek help right away if your symptoms return.

Aging by itself is a key factor in changes that occur within the intervertebral discs. However there are studies that show the disc spaces getting higher as we age and others
showing smaller disc spaces. So we don’t have all the answers yet.

A recent study in Germany looked closely at the changes that occur in the spines of former elite track and field athletes. They found the smallest disc heights in marathon runners. The largest spaces occurred in jumping and throwing athletes.

At first the researchers thought this made sense. Exercises like jumping or throwing load the spine unexpectedly. This would cause positive effects on the nutrition to the disc and higher disc height. Long-distance running with its high compression loading could
reduce the nutrition.

However, higher loads like long-distance runners are found in discus throwers and shot putters but they have the largest disc height. Perhaps genetic or other unknown factors are at work here. Scientists say it may be the result of complex and unpredictable interactions of multiple factors.

The questions you ask are the very ones a group of researchers in Germany studied. They took X-rays of 159 former track and field athletes (all males). They compared the results with the event each subject participated in.

Here’s what they found: shot putters, discus throwers, and high jumpers had more bone spurs in the lower spine than any other field or track athlete. They also had low disc height in the lower spine.

Endurance athletes like the marathon runners seemed to have much less load on the low back. However, the marathon runners had lower disc height in the lumbar spine. Since there isn’t a great deal of twisting and arching in this event, yet they had the same
changes as the shot putters and jumpers, the researchers think there may be a strong genetic factor at play.

What is a “graded return to activity?” My doctor wrote this on my discharge instructions after back surgery. I’m sure someone explained it to me, but there’s a lot I don’t remember from that time in the hospital.

“Return to activity” seems clear enough–getting back to your daily activities at home, school, or work. Graded simply means you increase what you do a little at a time every
day. How much you do, depends on how strong you feel, how much energy you have, or how much pain free movement is present.

Sometimes you won’t know you did too much until the next day. Then a painful flare-up can put you back where you started. That’s why it’s best to start slowly and add gradually, testing new limits each day.

More is known today than ever before about low back pain. Studies show over and over that not all back pain is physical. There’s a strong psychologic, behavioral, and social side to back pain.

The most common type of acute low back pain is called mechanical back pain. This means the moving parts are inflamed or involved but there’s no known disease or visible change in the tissue. Movement and staying active are the best way to treat this type of back pain.

Back pain from a disc problem may increase with certain activities and exercise. A general guide is called centralization of pain. This means the pain increases in the low back area but doesn’t go into the buttocks or down the leg. The activity or movement may cause increased pain but no further damage is done to the disc area.