FAQ Category: General Spine

You are at increased risk of back injury, whenever there is a muscle imbalance. Contracting the muscles on one side of the back while twisting or turning may put you at risk for damage to the ligaments or discs in the spine.

One way to counteract this problem is to rotate jobs. Either switch to a different task or work on an assembly process with the same motion to the other side. If this isn’t possible, take frequent stretch breaks.

As often as possible, stand up straight and tall. Make sure you twist and/or bend to the opposite side. A regular exercise program outside work is advised. Be sure and include stretching and strengthening exercises for both sides of the spinal muscles.

Many studies show that exercise and physical therapy have positive effects on patients with AS. With daily exercise, these patients have better motion, improved fitness, and better overall health.

There isn’t one best program for everyone. Some form of sports or recreational activity is advised. It’s best if this is done at least 30 minutes every day, five days a week. Exercises just for this disease are also important.

The physical therapist can help your son find a program that will interest him and still get good results.

Scoliosis is a curvature of the spine that occurs most commonly in older children and teenagers. It can be mild to severe with a range of treatment options. Patients with mild cases may not need any treatment, whereas severe scoliosis often requires surgery to fuse the spine.

In the past, the spine was fused using steel rods on one or both sides of the vertebrae. Since 1995, titanium mesh cages have been used for fusions in scoliosis. These cages are inserted between the bones in the disk space. The disk is an oval-shaped gel-pad between each bone of the spine. It gives support and cushions the spine.

The cages aren’t used alone in fusion for scoliosis. Either a single or dual rods are still placed alongside the spine. The cages give interbody support that increases the “stiffness” of the spine.

Chronic low back pain can be a serious problem. Sometimes, the spine must be fused to keep it from moving. In the past, bone chips were used to fuse the spine. There are quite a few problems with bone grafting. Doctors are looking for ways around bone grafts.

One of these alternative approaches is the use of titanium cages. These come in different sizes and shapes, but all fit into the disk space between vertebrae. They are screwed into the bone to hold them in place.

New ideas and new products like these are always tested on human cadavers or animals first. A cadaver is a body preserved after death for study. Doctors at Baylor College of Medicine in Houston, Texas inserted titanium cages into nine cadavers. The goal was to test the loads between and inside the cages.

Each spine went through 1500 cycles of movement. Researchers report the results and these make their way into news reports, journal articles, and television specials. Studies are often repeated by the same group or other groups for further proof that the idea works.

AS is a form of arthritis that causes the spine and sacroiliac joints to fuse in one place. This limits neck and back motion and affects posture. Later in life, a simple fall or minor trauma can cause serious injury.

Exercise has been proven to help all patients with this condition, including those with early stages of the disease. Special exercises are suggested to keep from ending up in a forward-stooped position.

More than half the adults with AS say the disease limits their ability to walk, sleep, perform their job, or enjoy sex. Exercise can improve flexibility and maintain movement. It has even been shown to help overall health for patients with AS.

Most doctors agree that early, regular exercise (5 days a week for 30 minutes) is the best medicine for AS.

The normal spine has a forward curve of about 40-degrees in the mid-upper back area. This curve can increase by 10-degrees or more with just a single fracture in the spine.

As we get older, bone loses strength and density. It becomes thinner and weaker. The force of gravity along with changes in posture can cause the front of the spine to collapse at one or more levels.

Spinal curves of more than 70-degrees are common in older adults with more than one fracture. As the bone collapses, it forms a wedge- or pie shape. The vertebral bones lose height causing a loss of overall body height.

Researchers around the world are trying to answer this question. They hope to find ways to see which treatment works the best by measuring changes in the damaged tissue. A recent study in Japan showed specific tissue changes at the cellular level. They found that nerve cell tissue was much worse when the disc put both mechanical pressure on nearby tissue and also caused chemical irritation. With pressure on the nerve tissue, swelling and loss of blood flow occur. The result is to reduce the speed of nerve cell messages.

How recovery takes place remains a mystery. The patient’s symptoms aren’t always equal to the injury. Small amounts of damage can cause many symptoms while sometimes, a large lesion has no symptoms. More studies are needed to predict who will recover and how long it will take.

It is possible. A recent study from Japan showed cellular changes one week after injury. In this case, dogs were used as the study model. The dogs had disc herniation with or without pressure on the spinal nerves. There was fiber damage and swelling present inside nerve cells.

Those dogs with both disc herniation and spinal nerve pressure had much greater cell changes. The authors of the study think that a combination of mechanical pressure and chemical irritation causes more nerve root injury. Pressure from the disc by itself, or irritation of the nerve tissue alone had smaller changes.

Studies with humans will be the next step in understanding how these injuries affect the body.

Animal models present a unique research opportunity humans can’t provide. Researchers are able to remove the damaged tissue and look at it under a microscope. They can see and measure swelling, changes in blood flow, and even the speed of messages sent by nerves.

These measures can be made at the time of the injury and then again after treatment. This model makes it possible to compare the results of one treatment against another. Scientists may find faster ways to help tissues recover from injury using animals.

Proprioception refers to any joint’s ability to sense its own position. Each joint can tell how much it is turned, twisted, or bent forward or back. There are joints in the spine that also rely on this function.

When a joint is damaged or injured, its sense of proprioception can be changed. This may lead to reinjury. Physical therapists help patients avoid reinjury. They are studying proprioception in several joints. The ankle, hip, and back are the first three to be included.

Exercises to retrain proprioception will be the natural result of any findings from these studies. A recent study at McGill University in Canada suggests that proprioceptive training in the spine should take place in several positions. These include standing, sitting, and kneeling on hands and knees.

A recent study at McGill University in Canada confirmed your suspicions. Finding a neutral position for the spine is more difficult on hands and knees than in sitting or standing.

This is likely because of gravity and the position of the hips and knees. Lifting an arm and the opposite leg is a difficult exercise for everyone. It requires strength, balance, and coordination. The spine has a harder time returning to a neutral position when on hands and knees. The easiest position to return to neutral is in standing.

This exercise is an excellent one for many reasons. When done properly, it builds strength, helps prevent bone loss, and promotes good balance. These are important for anyone, but especially for aging adults.

You raise an interesting question that has been studied worldwide. Since doctors must decide when someone is disabled, they want to be as accurate as possible. However, when back pain is present, humans tend to have an emotional response to that pain.

Sorting out what is psychological and what is biological isn’t always easy. Doctors do have some tools to use. One is a series of five movements called Waddell’s Nonorganic Signs. Patients who test positive for this test show changes in their behavior that aren’t present when symptoms are caused by tissue injury.

Another test is the McGill Pain Survey. In this test, patients choose various words listed to describe their pain. Certain words, such as “torturing,” “killing,” or “dreadful” are linked with strong emotion. Other words such as “sore,” “aching,” or “heavy” are used to describe muscular pain.

Other similar tests can be used with patients depending on the location of their injury. Formal, psychologic testing is also possible.

Neurosis is the name that used to describe people who had a mental disorder with anxiety. Neurotic people avoided other people. It’s now used to refer to a larger group of mental disorders.

The American Psychiatric Association explains these in a book about mental disorders called The Diagnostic and Statistical Manual (DSM). This is often on the shelves at the public library or local hospital or clinic.

A recent study of back pain and success after surgery was reported by the Swedish Lumbar Spine group. Chronic low back pain patients from 19 different centers were included. The authors of this study found that patients with “neurotic” traits had a worse result after surgery to fuse the spine.

Some of the symptoms of neurosis for this study include being tense and stiff, uneasy, easily panicked, and restless. The non-neurotic patients were more relaxed, comfortable, and self-confident. They had a better result after surgery than the patients with neurotic traits.

Researchers think this is because non-neurotic patients cope with pain better. These patients turn the problem into a good one.

A medical doctor is the best one to answer this question. After asking the patient questions and looking at the medical history, tests can be ordered. These might include blood or urine samples and X-rays or other imaging studies such as MRI or CT scan.

There are some signs that pain is caused by a more serious problem. First, pain that is constant and never changes is a red flag. Usually, with pain caused by a muscular or other soft tissue problem, the pain can be made better or worse. Often, just changing position helps. Rest or sleeping makes it better. Certain movements or activities can bring it on or make it worse.

Anytime back pain is intense and constant, a doctor should be consulted. This is also true for pain that is present without change day and night.

Scientists have found dense bundles of nerve tissue inside the bones of the spine (vertebrae). A group of nerves together is called a nerve plexus. Researchers think that the number and size of these plexus suggests many different functions.

We know that nerves release a chemical called substance P. Substance P sends the brain pain signals. Other forms of sensation may be sent through this nerve plexus. It’s possible that the nerve plexus inside the vertebrae also controls bone growth and function. The blood supply to the bone may be under the control of these nerves as well.

Finally, it may turn out that these nerves inside the bones of the spine cause back pain. If this is true, treating back pain may begin by altering the messages sent by the nerve plexus.

Nerve tissue has been found in many, but not all places in the body. For example, the covering around organs such as the liver, heart, and spleen do not have any sensation. Likewise, the inner section of disc material between the bones has no nerve tissue.

Nerve tissue in the bones of animals was found in 1998. It was only recently that nerves inside the bones of the human spine were found. Within each piece of nerve tissue studied, the scientists found substance P. Substance P is a messenger in the nervous system. It signals pain.

Researchers don’t know how much back pain is caused by these nerves. Finding them and studying them are the first steps to gaining more information. It may turn out that blocking these nerve messages can help many back pain patients.

The high cost of work-related injuries is driving research to answer this question. There doesn’t seem to be a difference between standard medical care and early programs of intervention. In fact, many workers do just as well with words of encouragement and some simple exercises. Putting the prognosis in positive terms doesn’t hurt, either.

In the future, there may be some way to tell who needs early care and who doesn’t. Right now, these kind of prognostic factors are unknown. Researchers at the University of Saskatchewan in Canada are studying various groups of workers to look at these issues. Stay tuned!

You are probably thinking of a study done at the College of Medicine in Saskatchewan, Canada. The researchers were comparing standard care with early treatment for work-related injuries.

Part of the early care included work hardening and conditioning programs before returning to work. These programs delayed return to work by six to eight weeks. The results, according to the authors, showed that workers who went back to work without treatment did just as well, if not better, than workers in these programs.

The authors of this study were quick to point out that early care shouldn’t be abandoned. It may be that some workers will have a better result with early care. The next study will help find ways to tell who will need early and more complete care after a work-related injury.

Studies have shown that there’s no reason to restrict activities after lumbar disc surgery. However, a little common sense goes a long way. It will take your body six weeks or so to heal and recover at the surgical site.

Using good body mechanics and avoiding heavy lifting is good advice at all times. For example, feeding horses one or two hay bales is one thing, but moving two tons of hay alone is something else. Get help to do the big tasks.

Some researchers have studied whether or not horseback riding is helpful when added to a rehab program. The overall result isn’t any different, but the horseback riders returned to work sooner. As with all athletic activities, when resuming after a break, start slowly, and build up.

There are many debates going on about this. Much of the difficulty comes because of patient’s fears that he or she will reinjure the back. Many doctors suggest active treatment or rehab after lumbar disc surgery. Others adopt a more “minimal” approach, such as telling the patient to do what feels comfortable.

In fact, a group of researchers in the Netherlands did a review of many studies. These were done in centers around the world between 1966 and 2000. The results show that there’s no danger of reinjury when patients return to activity early after the operation. Staying quiet and inactive isn’t needed for a good result.

Exercise should start four to six weeks after the operation. Those patients who receive intense rehab at this time, return to activity and work sooner than those who do nothing.