FAQ Category: Lumbar Spine

Back pain less than eight weeks after injury or damaging episode is called acute. When painful symptoms last beyond the expected time for healing (usually six to eight weeks), then it’s called chronic back pain.

Many methods of treating the spine have been studied around the world. The results have been varied. Programs for acute versus chronic pain have been included. At this point, it’s agreed that enough proof exists to support some form of exercise for the treatment of all back pain. It’s still not clear what kind of exercise is best, when to do it, or how often.

A new study from Norway compared manual therapy with exercise therapy. Manual therapy is a form of treatment that manipulates or moves the spinal joints. Patients in the manual therapy group got twice the benefit of those in the exercise group. However, other researchers challenged this study. Clearly, more research is needed before a final answer to this question can be given.

Most people have an episode of back pain that goes away within a month to six week’s time. Back pain that lasts more than three months is called chronic.

Improvement in back pain can be measured in several different ways. Spinal range of motion and pain level are the two most common methods used. Number of days on sick leave or number of days before returning to work is another measure. Sometimes, general health and quality of life are used to gauge treatment success.

When pain levels remain the same day after day, then function can be used to measure improvement. Instead of asking you to rate your pain, the therapist asks what you can do today that you couldn’t do yesterday. For example, you have the same pain level on Monday and Tuesday, but on Tuesday, you can vacuum two rooms instead of just one. This is an improvement in function.

Tests given for return to work aren’t standard. The items given vary from region to region and clinic to clinic. There may be a survey to fill out asking questions about how you feel and what you can or can’t do.

Usually, your vital signs are taken. This includes pulse, temperature, blood pressure, and breaths per minute. These measurements may be taken again during work tasks. You may be asked to lift and carry objects of various sizes, shapes, and weights.

Grip strength is often measured three times on each hand. Range of motion (ROM) for the injured body part is measured and compared to normal values. ROM is also compared from when you first injured yourself to now.

Call the clinic where the test is going to take place. Ask for a list of tasks in the test. This will help you decide what clothes and shoes to wear, and may ease your mind about what to expect.

Your concerns are very common. The person giving the test is usually a trained professional such as a physical or occupational therapist. They are aware of your health history and previous injury. The test is usually designed to start slowly and build up.

Patients are often given the chance to rate the activity. For example, you may be asked on a scale from one to 10 to say if a load is light (one) or too heavy (10). Patients may be told to stop the activity if the load is an eight or more. The therapist will also stop you if there’s a concern about poor lifting posture.

Vital signs, such as heart rate and blood pressure may be measured. You won’t be allowed to go past a maximum level. This is decided based on your age. A heart monitor may be used to measure this throughout the activity. Sometimes, the therapist just measures vital signs at regular time periods.

Before starting, talk with the person giving the test. Explain your concerns and see what he or she has to say.

Disability usually refers to difficulty carrying out tasks or activities of daily life. The patient can’t take care of him or herself. For example, disability from a back injury might mean the person can no longer get dressed or bathe without help.

Impairment describes problems at the tissue level. Impairment is any loss of normal physical or mental abilities. Impairments are usually the result of disease, illness, or injury. Impairments occur at the level of tissue, or organs. Impairment from a back injury might cause a disc to rupture or ligament to tear.

Doctors and therapists use these terms to describe what patients can and can’t do based on actual physical changes in the body.

A lipoma is a benign fat tumor. The term “intradural” tells us its location. The dura is a fibrous covering to protect the brain and spinal cord. Intradural means the tumor is inside this lining.

Lipomas are benign, not malignant. This means they stay where they are and don’t travel to other parts of the brain or nervous system. Even so, a benign lipoma can cause problems. If it grows large enough, it can put pressure on nearby nerves or spinal cord.

Muscle weakness, changes in sensation, loss of bowel and bladder control, or other symptoms can occur. The lipoma can be removed if it is growing and/or causing problems.

An abscess is a pocket of pus from an infection. Epidural is a location outside the outermost covering of the brain and spinal cord. An epidural abscess usually occurs as a result of a chronic infection. This can be an ear infection, sinus infection, or bladder or kidney infection.

Sometimes, an infection of the disc material between the bones of the spine can cause an epidural abscess. The symptoms of low back pain and leg muscle weakness suggest an infection in the spinal cord, rather than the brain.

The usual treatment is a course of antibiotics. Sometimes, surgery is also needed.

Stenosis means a closing or narrowing of a space. In the spine, there is an opening from the neck to the base of the spine. The spinal cord passes through this canal. As we age, changes in the spine cause this space to get smaller.

Narrowing of the space puts pressure on the spinal cord and spinal nerves as they exit the cord. This causes pain, numbness, and weakness in the low back and legs. Bending forward opens the space. Extending the spine backwards narrows it even more.

At the same time, there can be a decrease in blood flow to the nerves and spinal cord. Other soft tissue in the area also gets pinched. Both of these factors add to the painful symptoms.

Spinal stenosis is a narrowing of the opening for the spinal cord and spinal nerves. These pass through each of the bones from the neck to the low back.

Surgery is one treatment option for stenosis. It’s usually used in cases such as yours where pain relief has been minimal. Nonsteroidal antiinflammatories (NSAIDs) such as aspirin, ibuprofen, and some prescription drugs are the first choice. Steroid injections, physical therapy, and bracing are also tried.

When these fail, surgery to remove pressure on the spinal cord and spinal nerves can be done. This operation has good results for relief of symptoms. There are risks, though, especially for older patients. Another new option is the use of an implant.

An oval-shaped spacer can be placed between the spinous processes of the vertebrae. This is the bump you feel that we call the “backbone.” It’s an extension from the main body of the vertebra. The implant puts the spine at that level in a slightly flexed position. This relieves the symptoms and allows the patient to walk again.

Don’t despair. There are still several options left. First, it’s possible that the nerve wasn’t completely destroyed the first time. The body will work very hard to heal or repair anything that’s damaged. Some doctors advise having the procedure repeated a second time.

Second, the local anesthetic can spread beyond the facet joint. This will give pain relief from causes other than the facet joint. For example, if there is a narrowing of the disc space, pressure is placed on the facet joints.

Further testing may help find more answers for you. See your doctor and report the pain you’re having.

Despite our advances in technology, there are some things that can’t be easily seen. Some conditions are still diagnosed based on the patient’s history, signs and symptoms, and tests performed by the doctor or therapist. Facet joint syndrome is one of those problems.

The facet joints allow movement in the spine. This includes bending forward, backward, and sideways. Twisting, rotating, and turning also occur at the facet joint. Like all joints, this one has a lining and fluid that can wear thin and dries out with aging.

Pain from a facet joint problem is usually dull and deep. The patient has trouble pointing to just one area of pain. Sitting or standing too long makes it worse. Combining two movements, such as twisting and bending bring on the pain. Slouch sitting seems to make it better … at least for a short time.

The only way to know for sure is to inject the joint with a local anesthetic. Complete relief of pain with local injection confirms the diagnosis.

Muscles in the buttocks extend through the hip and play a major role in movement. These muscles help stabilize the pelvis when the trunk or back rotates above. Buttock muscles also help when the body is pushed off balance.

The buttock muscles work hard during all walking or running movements. By working with other muscles, the buttock muscles transfer the force and load from the legs to the back. These muscles also help keep your pelvis level and steady when standing on one leg. It may not seem like this happens very often, but half of walking involves standing on one leg.

Several studies show that the strength of the buttock muscles is directly linked to low back pain. Weaker muscles mean a greater chance of back pain.

Exercise is becoming recognized as more and more important in good health. Some doctors call exercise a “powerful drug.” A fitness program is advised at the end of a rehab program. This can be done at home with the right equipment, in a YMCA, or other fitness center.

Your physical therapist can help you transition from one stage to the next. Your program should include warm-up exercises, an aerobic component, strength training, and endurance. Stretching is also important. New studies suggest that stretching is just as good when done after an exercise program as before.

Patient’s beliefs about health care are a strong factor in treatment results. Researchers have shown that this occurs in a wide range of patients and settings. Sometimes, it only affects a few patients while at other times, a large number of patients are helped. The reasons for this are unknown.

A new study from the University of California (Los Angeles) looked at four groups of low back pain patients. The patients received medical care with and without physical therapy and chiropractic care with and without physical modalities. Modalities included heat, cold, ultrasound, and electrical muscle stimulation.

Patients in the physical therapy group had the best outcome. The authors of the study think this is because patients in physical therapy got the most attention. Patients were told what to expect in treatment. They also received education about back care.

After this type of surgery, patients are usually allowed to get up and out of bed by the second or third day. A physical therapist will teach your father how to safely move from the bed to a chair or from the bed to a standing position. Exercises to improve muscle strength and restore function will be part of the rehabilitation process.

How fast patients get better depends on several factors. Loss of muscle strength often occurs before surgery when the patient is in pain and can’t exercise. Sometimes wound pain after surgery limits how much the patient can do.

Rehabilitation is also limited by how much pressure the surgical site can withstand. Special implants used to hold the bone together are stressed by walking or exercises performed too often. To prevent breakage of these screws, the patient may be taught to avoid certain movements, such as bending forward or backward in the standing position.

Several different kinds of stress have been linked to low back pain. All of these can be experienced as mild, moderate, or severe.

Occupational physical stress includes exposure to vibration through driving or using machines, lifting or carrying heavy objects, and bending forward or twisting. Occupational mental stress includes monotonous work (doing the same thing over and over), time pressure, and fear of failure. Environmental stress includes noise and the presence of heat, vapors, dust, or other toxic agents.

Stress can also come from work schedule (shift work, night shifts, piecework), work pace, and the way in which work tasks are done. All of these things can impact back injury and pain. Additionally, when work negatively influences private life (family, recreation, social events), back problems tends to increase.

Many studies have been done on low back pain and disc problems. It’s true that women with jobs that involve a lot of sitting are at greater risk than men in similar positions for disc problems. It’s also true that accidental back injuries increase a person’s risk of disc injury regardless of gender.

Risk factors for developing disc problems include motor vehicle accidents, smoking, evening or night-shift work, and genetic factors. Work stress and lack of physical activity during leisure time increase the risk of disc problems.

MRI (magnetic resonance imaging) is a way to look inside the body, especially at soft tissue structures such as the nerves, spinal cord, and disc material between the bones of the spine.

In the case of disc material, MRI shows the disc structure, amount of disc herniation, and disc height. Disc degeneration can begin even before it shows up on MRI, but MRI shows early, mild changes. MRI is also useful in showing changes over time.

A small study of 41 adults used MRI to show the spine and discs at the time of injury and again five years later. In all cases, patients had no symptoms at first. Almost half showed significant progression of disc degeneration during the five years. The authors related the disc changes to a lack of sports activity, night shift work, and impaired health in the disc at the start of the study.

“Lumbar” refers to the low back area, specifically the five bones (vertebrae) in the low back. “Osteophytes” (also called bone spurs)are bony outgrowths that sometimes form around joints, including the joints in the back. These are most common with osteoarthritis.

With osteoarthritis, there is damage to the joint surface. This causes the joint space to narrow and places increased pressure on the joint surface. Osteophytes develop as a result of the joint’s attempt to make new bone to replace the damaged bone. Osteophytes are actually a form of bone remodeling that goes overboard.

Osteophytes can put pressure on a nerve as it leaves the spine. Large osteophytes can press against the spinal cord. Either of these situations can lead to pain, loss of motion, numbness, weakness, and even loss of bowel and bladder function.

Early treatment for symptoms due to bone spurs includes medication and physical therapy. Surgery may be required for some people.

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

Steroid medication is known to alter or stop the release of these irritating chemicals and even block pain signals. A new method has been developed to inject medication directly at the site of inflammation. This method, called fluoroscopy, has improved the results of injections by reducing pain, improving motion, and preventing more involved surgery.