FAQ Category: Lumbar Spine

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.

Doctors and therapists know that back pain lasting more than six to eight weeks involves more than just pathology or tissue disease. Something has gone wrong with the pain signals. Studies show the nervous system has a memory and may be keeping the memory of
the pain alive longer than needed.

Pain that lasts more than three months is called chronic pain. Patients with chronic back pain are advised to regain as much movement, strength, and function as possible despite the pain. The symptom intensity should not be what limits your exercise progression.

For patients with chronic pain reducing pain isn’t the goal of treatment. Being more active and increasing function is the primary goal.

Radiofrequency (RF) is a form of heat energy used to stop nerve messages from reaching the joint. It has a low rate of complications and can be used at more than one level.

Most patients have half dozen areas heated during the same treatment. Repeating RF treatment to the same area may be needed if the nerve is not completely disabled. A second procedure to heat new levels is possible.

The doctor will use low voltage electrical stimulation to the area first. This confirms that there’s a problem and the exact location.

Hands and knees balance exercises are among the core exercises for spinal stability. These exercises are considered core for two reasons. They are central to the program and
also work on the core muscles that provide a stable spine during all postures and movement.

Scientists think that different muscles have different jobs. Some are lcoal muscles. These hold or stabilize the spine in one place. Other muscles are global.
This means they function to produce movement. There’s ongoing debate among researchers about which muscles are the most important for each function. The best way to train the motor control system is also being studied.

For now, we know the standard quadruped (on hands and knees) exercises help strengthen the local muscles for control and stability. Doing them properly is probably more important than doing them every day. If possible, use a mirror to watch your posture. Keep your low back and pelvis level. One side shouldn’t be higher than the other.

Tighten your abdominal muscles and hold your stomach in without holding your breath. Don’t scrunch your shoulders up around your ears. Keep them down while stretching the arm
forward. Avoid tension on your neck by keeping your gaze either down at the floor or just a little ahead of your body.

These exercises are hard to do. The body gets tired easily in these stable core positions. That’s why they work well to help the spine hold and why they are important to keep in the program.

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.

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.