FAQ Category: Lumbar Spine

Steroid injections for sciatica are usually given at one or two areas in the spine at a time. This prevents the build up of the drug and avoids the overall effects on the body. Even better, today’s technology allows physicians to use a special kind of X-ray (fluoroscopy) to guide the needle directly to the problem area. The medication is injected directly in the area of the irritated nerve.

Without the benefit of guided injection, the medication may miss the mark entirely. In this case, further injections are required and complications such as bleeding, headache, or infection can occur.

Sciatica is the term used to describe low back pain that goes into the buttock and travels down the back of the leg. The cause is usually pressure on an irritated spinal nerve. This can come from arthritic changes in the spine, disc protrusion, tumors, or other changes in the bone structure.

Treatment usually ranges from medication to active exercise in physical therapy. You may want to ask your doctor about steroid injections. This treatment has been used for many years with some success. Recently, this technique has been improved using a new X-ray imaging method called fluoroscopy. Fluoroscopy allows the doctor to guide the needle right to the problem area and inject the medication directly at the nerve site.

With this method, you may only need one injection. There are fewer complications with fluoroscopy than with “blind injection” (injection without X-ray imaging). Treating with this type of injection before the symptoms have lasted a full year is advised. Combining injection with a rehabilitation program seems to have the best results.

Studies have shown that when a disc has been injured, there is an inflammatory process that follows. Chemicals that are part of this process irritate the nerve.

Steroids are known to alter or stop the effects of these irritating chemicals. Steroids can even block pain signals. A new method has been developed to inject medication directly into the site of inflammation. This method can reduce pain and increase motion, sometimes preventing more involved surgery.

Researchers in New Zealand studied a large group of adults who hurt their backs on the job. They hoped to find risk factors that could account for people who go from having acute, short-term injuries to long-term, chronic problems.

The researchers did indeed find two sets of risk factors–one that was worker-related and one associated with the job or work setting. Individual risks included increasing age, obesity, problems sleeping, depression, and severe pain down the leg or legs. On-the-job risks included lifting or moving heavy objects, long hours of driving, and not being able to return to light duty after injury.

Addressing any of these items that may apply to you could help you return to work sooner.

The first goal of surgery for low back pain is to reduce or eliminate the presenting condition, which is pain. But what’s the best way to tell if pain has been reduced?

There are many ways to gauge patients’ pain. Doctors often use a visual analog scale, or VAS, which has patients locate their pain on a scale from zero (no pain) to 100 (the worst pain).

A recent study found that pain scores on VAS were related to other measures of pain and to patients’ satisfaction with surgery. In this study, comparing before-and-after pain scores on VAS wasn’t felt to be as good as looking at VAS scores after surgery or simply asking patients about changes in pain. Finally, there may be no “best way” to measure changes in pain. Each method captures something slightly different.

According to a recent study, patients with different diagnoses have very different patterns of pain. Researchers asked 750 patients to rate their back and leg pain on a scale from zero (no pain) to 100 (the worst pain).

Patients with herniated discs had minor back pain but strong leg pain. Patients with narrowing around the spinal canal (“stenosis”) had moderate back pain and strong leg pain. Patients whose vertebrae had dislodged and were pressing forward (“spondylolisthesis”) had moderate back pain and minor leg pain. Patients who had degenerative disc disease had the most back pain of all the groups and minor leg pain.

Doctors were surprised just how distinct the patterns of pain were. Different patterns of pain may call for different kinds of treatment.

A recent study monitored 34 patients with chronic low back pain while they walked on a treadmill. These patients were compared to 22 healthy subjects who walked at the same speed. Patients with low back pain took shorter strides than the other group. This may be because patients with low back pain are trying to avoid discomfort as they walk.

Spinal movement during walking was recorded by ultrasound. In general, both groups showed similar patterns of movement. But patients with back problems showed a lot more variability between strides than the other group. This variability had to do with how much up-and-down motion was recorded. 

The authors think that low back pain reduces patients’ control over movement. This may result in less than optimal walking patterns for patients with low back pain. According to the authors, variability in movement should be addressed in the treatment of low back pain.

Not according to a recent study. Thirty-four patients with chronic low back pain were monitored while walking on a treadmill. Twenty-one patients were male; 13 were female. No differences in movement were detected between groups.

On the whole, however, these patients did vary from a group that didn’t have low back pain. Patients with back pain took shorter strides than the comparison group. They also showed an inconsistent stride.

From these results, it seems that gender doesn’t matter when it comes to walking. Low back pain does. The painful or cumbersome effects low back pain has on walking should be addressed in treatment.

We tend to think that the legs alone control walking. In fact, walking is the result of thousands of small spinal movements as well, especially in the low back. It makes sense, then, that patients whose low backs are impaired might have a harder time walking.

Patients often develop styles of movement to compensate for back problems. Research has shown that patients with chronic low back pain tend to take relatively shorter strides. These patients may walk more cautiously than the average person to prevent or reduce pain.

Patients with low back pain also show more variability in movement. For patients with low back pain, one stride may be different from the next. Spinal movement itself actually fluctuates quite a bit in these patients. Researchers think that low back pain reduces patients’ control over movement, possibly by interfering with the body’s information systems. This no doubt makes it hard for patients to maintain a consistent, effective gait.

Awkward postures held for long periods of time place high demands on the muscles that support the spine. Keeping the spine bent forward for long periods may deactivate key back muscles. Like a loose guitar string, the normal level of tension in the elastic tissues of the back is also reduced. This leaves the spine vulnerable to injury.

After just 20 minutes of uninterrupted bending, researchers have observed spasms in the back muscles. These spasms suggest that some kind of damage can occur during periods of prolonged forward bending.

What’s the solution? Lots of rest. After 20 minutes of bending, even seven hours of rest might not be enough. Researchers think that 24 hours of rest may be needed to fully restore the strength of key back muscles. Without sufficient rest, the tired back is susceptible to injury. Using good body posture and frequent rest are two important ways to offset the potential injury and pain of staying in a forward-bent position.

More and more studies are being done with today’s improved technology to show which exercises help and how many to do. In fact, this is providing therapists with the information needed to actually prescribe exercises. One size doesn’t fit all! And one exercise doesn’t work for all.

Your physical therapist is the best one to re-examine you and revise your exercise program. The therapist will look at a variety of factors including your muscle strength, posture, goals, flexibility, and overall health. Based on these, a specific program will be designed for you.

Understanding the specific ways exercises work to strengthen the back is a major area of study right now. Physical therapists are using today’s technology to measure when and how muscles work during each exercise. First, they are studying healthy people who have not had any back injuries or back problems. These results will be compared with measurements of people who have had back problems. This information will help therapists more effectively train people with back pain or injuries.

Perhaps. A recent study showed that age may put patients with major pelvic injuries at a higher risk for blood clots. In this study, patients who developed blood clots were an average of 46 years old. In contrast, patients who didn’t form clots were about 35. Years seem to make a difference in patients with major pelvic injuries.

However, the rate of blood clots was only 14 percent overall when patients used mechanical devices that stimulate blood flow. Talk with your mother’s doctors about the best preventive care in her case.

It depends on the type of surgery your doctor performs on your spine. If you have a discectomy, you might expect pain to ease up in the first few weeks. You will probably be restricted from doing activities like sitting, riding in a car, lifting, bending, or twisting early on. This is to prevent you from re-injuring the sore discs. But you should be able to get back to most activities by six to eight weeks.

If your doctor performs a fusion surgery, it will take longer to heal, since it takes up to one year for the fusion to become solid. Be sure to check with your doctor about the type of surgery you’ll need and what activities you should limit or avoid afterward.

It may depend on how old they are. A recent study followed people of all ages who had work-related back injuries. Everyone in the study had the same treatment of physical exercise and counseling. One year later, all of the younger patients (under 25) had gone back to work whereas only 69 percent of the older patients (age 55 and up) had returned to work. Notably, the older workers were six times more likely to return to their original jobs. Younger workers more often switched jobs or employers or both.

These results suggest that older employees are less likely to return to work overall. But when they do, they often go back to their original job.

It may depend on how old they are. A recent study followed patients who had nonsurgical treatment for back injuries. One year after treatment, younger patients were more likely to return to work than older patients, and to stick with their jobs. In fact, 98 percent of patients under age 25 kept working, versus only 63 percent of patients 55 and older. The older the injured patients got, the less likely they were to keep working.

Researchers think that older people have a harder time healing, which makes it harder to work. There may also be fewer incentives to work as people get older and disability income becomes even more accessible.

Yes. A recent study showed that, even when patients had the same nonsurgical treatment, younger workers were much more likely to return to work after a back injury than older workers. One year after treatment, all of the patients under age 25 had gone back to work. Meanwhile, only 69 percent of patients 55 and older had returned to work.

Researchers believe that older workers are less likely to go back to work because older bodies have a harder time recovering from injuries. Older workers may have pain longer than younger workers. Also, it may be easier for older workers to get disability benefits. This might make them less inclined to go back to work.

A physical therapy program aimed at improving the strength of your back can do just that. A recent article reported on treatment similar to what you describe. Patients who had low back pain for an average of 11 years started doing physical therapy twice a week. After three months of treatment, patients had much better trunk strength moving their trunk in every direction. They were better able to use their back muscles and showed improved muscular endurance on certain tests. 

When you have low back pain, it’s natural to stop using your back muscles to some degree. Physical therapy can help get those muscles back in good condition, so you can do your daily activities with less pain and less chance of re-injury. Talk with your physical therapist about what kinds of changes you can expect from your program.

Research suggests that the form of exercise you choose is not as vital as simply being active. In a recent study, patients with low back pain did one of three types of exercise therapy. The first group had one-on-one physical therapy. The second group had treatment in pairs using special strengthening devices. The third group went to aerobics and stretching classes with an emphasis on trunk and leg muscles.

All of these treatment programs resulted in better physical performance. After three months of treatment, patients showed improved test results for back strength and endurance. Patients who did exercises using special devices tended to have more strength than the other groups, possibly because the testing equipment was similar to what they had used during treatment.

You’ll probably get the most benefit from an exercise program you enjoy. Ask your doctor for suggestions.

A certain amount of rest after low back pain is normal and in some cases recommended. But if you rest too long, your back muscles will begin to weaken. This, of course, makes it harder to recover fully from low back pain.

A recent study looked at patients with low back pain who did an aerobics and stretching class twice a week. The class included a half-hour of exercises targeting the trunk and legs, with patients using their own body weight as resistance. After three months, these patients showed better back strength and endurance. In fact, they did as well on strength tests as other patients who were doing specialized back strengthening or getting one-on-one physical therapy.

Based on this study, a low-impact aerobics class with a special focus on strengthening the trunk and legs could do your back good. Your doctor can give you more specific advice, based on your history and condition.