FAQ Category: Lumbar Spine

Studies show there isn’t one single muscle that works the most or the best to hold the spine stable. That means it’s likely a single exercise isn’t going to give you what you
are looking for. If you really have to choose, it looks like the abdominal muscles work the most often throughout spinal movements and trunk stability.

A recent study at the University of Waterloo in Ontario, Canada, showed the importance of all the muscles. They found the muscles change how they function depending on the activity or movement. Some muscles have several different jobs to do and respond
according to the activity at hand.

This research supports the idea that many different muscles must be strengthened for good back strength and spine health. The key to successful exercise is find what works for you
and stick with it. Consistency is just as important as what you do when you exercise.

Research shows physical activity and exercise is the best medicine for many patients with chronic low back pain. Patients are usually advised to start slowly and gradually build up.

It’s likely that this type of program gives patients a greater sesne of control. It reduces pain levels and the fear of pain with movement. Your doctor wouldn’t advise this approach if it wasn’t safe.

You may have some set backs but give it some time to make a difference. Do what you can each day then add just a little more the next day. See your doctor for a follow-up visit if you don’t make any progress in four to six weeks.

It might make a difference for some people. For example the link between back pain and depression is well known. Long-term benefits of exercise have also been shown both physically and psychologically.

A group exercise class may help depressed patients feel a sense of belonging. This kind of social support may be what helps some people the most.

This is difficult to say without more information. It may be a good idea to discuss this with your husband. A follow-up visit with the doctor might be the next step.

Sometimes there are psychologic reasons for this kind of behavior. When people have a
back injury, it’s not uncommon to avoid moving in any way that may cause pain. This is called fear avoidance behavior. A physical therapist can work with the person to overcome this mental block.

Emotional stress and depression can add to the problem. Studies show physical activity and exercise can help. Ask the doctor for approval and consider becoming an exercise partner. This may help encourage your husband.

A recent study from Canada looked at the effect of employment on function after a bout of low back pain. They found no differences in pain level or function one month up to two years later. It’s possible that other factors are involved.

Researchers suggest we look more closely at social support, money earned, and self-esteem as factors in this area.

There may be no way to know the answer to this question. A recent study in Quebec, Canada, looked at the differences between employed women and homemakers. All the women had seen a doctor for low back pain.

Pain levels and function were measured four to six weeks after the doctor visit. All women were rechecked one year and two years later. Pain levels and number of disability days were the same for both groups.

It may be that unhealthy women tend to stay home. Those who have good health can get a job outside the home. This is called the healthy worker effect.

Diazepam is the generic name for Valium. It is used as a muscle relaxant and for anxiety. Motrin is an over-the-counter form of ibuprofen used as a pain reliever and antiinflammatory. It helps reduce pain and cramping associated with the menstrual cycle.
It does this by blocking the action of a substance called prostaglandin.

Prostaglandins have many functions. One of these is to make smooth muscles contract. During the menstrual cycle these contractions helps empty the uterus of any blood when there isn’t a fertilized egg. Blocking this action also keeps skeletal muscle from contracting and promotes relaxation.

It’s never a good idea to take more than one drug at a time without checking with your pharmacist or doctor first. Drug interactions can have serious side effects.

Flexeril is the brand name of a drug used as a muscle relaxant. It’s prescribed most often for the relief of muscle spasm and pain.

There are many types of muscle relaxants on the market. A review of studies shows different types of muscle relaxants are equally effective for acute low back pain.

According to the drug manufacturer, Flexeril is not a substitute for the physical therapy, rest, or exercise. Flexeril relieves the pain of strains and sprains, but it’s not useful for other types of pain.

It should be used only for short periods (no more than three weeks). There’s generally no reason to use it for a longer period since the type of injury that Flexeril treats should
get better in a few weeks.

Some studies don’t support the use of muscle relaxants for acute low back pain. Even so, they are commonly used for this purpose. Patients don’t regain function or recover any faster when using these drugs. In fact patients who use muscle relaxants have a somewhat
slower recovery.

Other studies show that taking a muscle relaxant is better than using nothing at all. Muscle relaxants can make you sleepy. This increases the risk of falls or problems while driving or while at work.

Anti-inflammatories such as aspirin or ibuprofen may be a better choice. Ask your doctor for more information before making a final decision about this.

A simple and common sense reason may be accessibility. Workers who are free during the day can get to the doctor’s without taking time off from work to go. It is possible that there are fewer workers available at night to help lift, carry, or haul heavy objects.

There aren’t any studies on this factor in looking at workers with low back pain. The answer to your question may remain a mystery until more research is done in this area.

Scientists aren’t sure the answer to this question. Perhaps there’s a little of both. Pain lasting more than six months is called chronic pain. Chronic low back pain is complex and poorly understood.

It’s clear that the changes take place in how chronic pain is transmitted. Surgery may not change the pain pathway. In fact it could make things worse instead of better. Since the cause of back pain is often unknown, the best treatment is also unclear.

A recent study in New Zealand reported that improvement–but not cure–is a common response to surgery to fuse the spine. Patients didn’t have great functional improvement, but their pain levels and drug use were less. Many were able to return to work. Most were
glad they had the operation.

It may depend on who’s looking for help. Costs may go up if patients wait too long and end up with expensive complications.

A recent study from the Netherlands suggests many workers with back pain wait it out and treat it themselves. Only workers with severe, intense pain sought help.

Researchers want to find out more about who does and who doesn’t seek help. This may help us find ways to reduce costs early and maybe even prevent back pain in the first place. Doctors want to know who seeks help so they can gear their exam and treatment toward those patients.

Gordon Waddell is a British doctor who has written a book called The Back Pain Revolution. This is a useful reference work for all clinicians treating patients with back pain. It gives the latest British and American guidelines for the management of non-
specific low back pain.

Early on in his work, Dr. Waddell came up with some simple tests to look for emotional or psychologic basis for back pain. Doctors and physical therapists use these tests to help
identify what kind of pain the patient is having.

The signs are meaningful only when found in groups of three or more. In other words, one positive Waddell sign doesn’t mean much. The presence of these signs doesn’t mean there isn’t something wrong with the patient. They don’t suggest the patient is faking. They are only signs that a psychologic component may be present.

Ask about the physical workload of the job. Will you be required to handle materials? Lift or carry heavy loads? Assume awkward working postures with your back twisted or bent? Work with the arms overhead?

If the answer to any of these questions is “Yes” then find out how often this will happen. Try to get the possible employer to answer on a scale from “seldom” or “never” to “always” with “now and then” and “often” in between.

A job with “often” or “always” during a regular working day may be too much. Find out if you are allowed to ask for help from coworkers. Job strain can be reduced quite a bit with coworker support.

You can also be tested formally by a physical or occupational therapist. The therapist can tell you how much weight can be lifted and carried. The type of physical demands will be taken into consideration when making this assessment. Your weight, body type,
strength, motion, and flexibility are also part of the picture.

Fear-avoidance beliefs and behavior occur when the patient avoids certain movements or activities because he or she is afraid these will cause pain. Studies show FAB is the single most important factor in predicting who will have chronic back pain.

A special questionnaire can be used to find out if a patient has FABs. It’s called the Fear Avoidance Beliefs Questionnaire (FABQ). This tool has two sections: a physical activity scale and a work scale. The higher the score in either section, the more likely the patient will avoid physical or work activities.

Treatment for this problem is geared toward patient education. Patients are told to view their pain as a common problem that will get better. They are reminded that their back pain is not from a serious disease. They don’t need to protect the back. Exercises are increased in frequency, intensity, and duration with this in mind.

Radiofrequency is used to heat nerve tissue to high temperatures. This causes enough damage or injury to the nerve to cut off its signals to the joint. Patients can end up with pain if the thermal injury is incomplete. The nerve continues to send pain
messages to the joint.

Injuries to other nerves can occur if the electrode slips. Rarely, infection occurs causing scarring and pressure on healing nerves. There have been some isolated cases of burns. This can happen when the insulation in electrodes breaks.

Confronting symptoms isn’t an approach used for all patients. Studies show that fear of pain or injury is the most likely factor to predict who will move from acute LBP to chronic LBP and increased disability. For this reason patients with acute low back pain
(LBP) are checked for the presence of fear avoidance beliefs (FABs).

The patient with fear-avoidance beliefs avoids movements and activities that might hurt. The result is decreased movement and decreased function. Pain intensity remains unchanged
or increases. For some patients, avoiding certain positions or movement makes sense. This happens in patients who have a fracture, infection, or pressure on spinal nerves. Confrontation of symptoms won’t work for this group.

More research is needed to prove no harm is done by asking patients to confront their symptoms. For now it has been given the thumbs up by researchers for use with some patients.

Radiofrequency (RF) has a low rate (1%) of post-operative complications. A local anesthesia is used so there are fewer overall risks. Most patients have a good result
with immediate relief from their chronic low back pain.

When problems do occur, it may be only temporary. The patient may have pain, numbness, or a burning sensation. These symptoms can affect the back, buttocks, and leg on one side. More rarely, muscle weakness can occur.

Many factors could be causing the differences here. Age and physical condition are the first to consider along with how many levels were fused at one time. Results seem better
when two levels are fused compared to one. The results of three levels versus one level are unknown.

Type of fusion can make a difference, too. Was the operation done from the back of the spine, from the side, or from the front? Were plates and screws used? What was the source of the bone graft? Each of these has a little different healing time.

Sometimes early dependence on a brace or support actually makes rehab last longer. Exercise to regain motion and strength are important early on.

Back pain is linked with asthma in both teens and adults. Whether coughing brings it on is uncertain. Although this makes sense as a possible factor, there are other conditions with coughing that don’t bring on back pain. It may not be the coughing itself that triggers the back pain but rather something linked to the asthma.

Scientists think it’s possible that some humans are just frailer than others. This puts them at increased risk for many problems. Among them are back pain, asthma, and headaches. It may also explain why some people have recurring bouts of the same problems over and over throughout their lifetime.