FAQ Category: Lumbar Spine

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 the spinal nerve. This can happen because of arthritic changes in the spine, disc protrusion, tumors, or other changes in bone structure.

Treatment usually ranges from medications and bed rest to active exercise and physical therapy. You may want to ask your doctor about steroid injections. These have been used successfully for many years.

Recently, injection technique has improved with a new X-ray imaging called fluoroscopy. Fluoroscopy allows the doctor to guide the needle right to the problem area and inject the medication directly at the nerve. There are fewer complications with this treatment than with blind injection. You may only need one injection. Treating with this type of injection works best before symptoms are present a full year and when the treatment is combined with a rehabilitation program.

There are entire laboratories devoted to the study of human movement. Today’s technology allows researchers to place electrodes on muscles to record electrical activity. Researchers then use this information to make calculations. Other systems use today’s new optical technology to record body motion down to a “nanosecond,” one billionth of a second.

New equipment is available to measure movement when the body is placed in certain positions. The same movement can be observed outside the apparatus to show how the body works to adjust for back pain.

There are even ways to measure how much force is placed through the spine with different movements or when lifting different weights. The person being tested stands on a platform called a force plate that provides this kind of information. Again, various measurements can be taken as the person lifts and moves.

Many studies have shown the importance of proper lifting methods. For example, lifting heavy weights from below the waist without bending the knees puts much more pressure on the low back than bending the knees while lifting. Likewise, lifting and holding objects away from the body (with the arms straight) increases the forces through the spine.

Other studies have shown that lifting when the back already hurts increases the stress on the back by up to 75 percent. In the injured worker, at least 10 extra muscles forcefully contract to help protect the back. The overall effect is a powerful compressive force through the spine. This can cause more damage to the spine.

Research has shown that extra force through the spine can cause problems. This force can come from lifting objects that are heavy or awkward. Body weight also adds a compressive force through each bone of the spine.

Forces on the spine are much greater for people with low back pain. This happens because extra muscles contract during lifting to help protect the back. Researchers have measured the activity of muscles during lifting for people with back pain, and it is clear that being overweight adds to the forces.

Weight loss for anyone who is overweight is highly recommended. Weight loss helps reduce the load on the spine, possibly preventing future problems. Talk to your doctor or nutritionist about healthy ways to lose weight.

Screws of this type can break after surgery. Screw breakage doesn’t necessarily mean that the bones haven’t grown (fused) together. The bone fracture may have healed, but the device was overloaded. This can happen with certain movements or excessive, repeated movements.

Screws inserted to support the bones of the spine break in a small percentage of patients. The manufacturer has identified how much force or load the screws can handle. Some movements and positions exceed that load and place patients at risk for screw breakage.

Researchers have been able to test various body positions and movements to see how much load they put on the spine. Actively straightening the back to sit up puts more stress on the healing bone. In the early phases of recovery from this surgery, a more relaxed sitting position is better.

Other movements to be avoided include bending forward or backward in the standing position and walking long distances. The load on the spine varies from person to person depending on how long ago the surgery took place, how weak the muscles were before surgery, and how much pain is present after surgery.

“Spondyl(o)” refers to the backbone or vertebra, and “olisthesis” means slipping. Spondylolisthesis is a slipping forward of one bone over another, mainly in the low back area. It is most often caused by a defect in the bony ring on the back of the spinal column. Some people develop the defect in the bone, but the vertebra never slips forward. Others may put extra stress on the bone and this causes slipping. This is especially likely when the activity or sport is combined with a rapid growth spurt.

Athletes with symptoms due to spondylolisthesis may be restricted from activities such as gymnastics that place high strain on the injured vertebra. Doctors sometimes place the athlete in a rigid brace or cast for three to four months.

Severe forward movement of the bone can put pressure on the spinal nerves. This can cause extreme back pain, nerve pain down the leg, and even changes in bowel and bladder function. If enough slipping occurs, and the condition isn’t corrected with rest and bracing, surgery may be required.

Hundreds of studies show that people who smoke have a harder time with healing. They take longer to recover from surgery. In the case of spinal fusion, smokers are more likely to have poor results. Compared to nonsmokers, smokers are almost three times more likely to experience nonunion of bone after a fracture or surgery.

Tobacco reduces the blood supply to a wound and increases a person’s perception of pain. This means longer hospitalization, greater blood loss during surgery, and more pain medications after surgery.

Most physicians request a six-month break from smoking before surgery. Some will accept six weeks with a commitment to not smoke for up to six months during the recovery phase. The final outcome is well worth the effort.

The exact mechanism by which smoking affects the muscles, bones, and other tissues of the body is still unknown. It may be that smoking speeds up bone loss at the cellular level. This kind of change causes backbone deformities and loss of stability in the spine. It could also be that smoking affects the metabolism of the disc between the bones in the spine. This could lead to disc degeneration.

Another theory is that smoking affects blood vessels and reduces blood supply to the spine. Without enough blood, the bones and tissues don’t get enough nutrition. Back pain could also be intensified by the effects of smoking on the nervous and hormonal systems.

Specific exercises for the low back and pelvis seem to help with back and sacroiliac pain. In particular, contracting the abdominal muscles that wrap around the waist (transverse abdominals) with one of the back muscles (multifidus) creates a natural corset or brace. This can reduce sacroiliac joint pain and prevent further pain.

Studies have shown that these exercises have a “nutcracker” effect on the sacroiliac joint. The force of the muscles contracting actually squeezes the bones that form the sacroiliac joint together. This action tightens the joint and helps hold it steady.

A physical therapist trained in spinal stabilization exercises can design a program that is safe and works for you.

The first step is to have a physician diagnose the problem. There are many possible medical causes of back pain that must be ruled out before conservative treatment–or treatment without surgery–can be tried. These causes include infection, ulcers, gastrointestinal disease, and cancer, among others.

Conservative treatment is planned for “mechanical” back pain. This is back pain caused by damage or injury to muscles or the surrounding soft tissues. There are many conservative treatments for low back pain. These include medications, exercise and physical activity, acupuncture, electrical stimulation, relaxation, and weight loss.

Spinal stabilization exercises may help with back pain. These exercises target the muscles in the low back and pelvis. Research suggests there may even be some benefit to contracting the muscle that wraps around the waist(transversus abdominals) along with a muscle in the back (multifidus). The effect of these two muscles contracting together is to form a self-brace or corset to support the low back. This decreases painful symptoms and reduces further back or sacroiliac pain.

Once your doctor has cleared you for conservative care, you can see a physical therapist. The therapist will evaluate your back strength, movement, and posture. Then he or she can prescribe a program of exercises to treat your specific problem.

These exercises target the muscles along the spine. Strengthening these muscles helps hold the spine steady during activity. Coordinating the action of these muscles helps control the joints of the low back.

The muscles can be trained to limit unwanted movement. This is especially important when injury or damage to the ligaments and capsules has occurred. (These are the supporting tissues around the joints.)

In particular, the sacroiliac joint can cause major pain when it is loose from injury. Spinal stabilization exercises tighten up the joint and make the low back area stiffer. This helps prevent further injury to the tissues of the low back.

Protective splinting is very common with all kinds of pain, including back pain. This is done by contracting all the muscles surrounding the painful area. This decreases movement at that site. Often the person is also holding the breath. The combination of muscle contraction and holding the breath means the body is not getting enough blood to the hurt area. This slows down the healing process.

Splinting has a good purpose in the beginning. But sometimes the body heals and the muscles are still contracting too hard and too long. This becomes a problem in recovery. Fortunately, the body “remembers” how to move normally, so it doesn’t take long to restore this function. The physical therapist is the best one to help with this problem.

The coordination of the trunk, limbs, and pelvis during walking is the subject of research today. Advanced technology is making it possible to record movements at different speeds and look for patterns. These movement patterns are then compared for people with and without low back pain.

Researchers have found that at slower speeds the coordination pattern of the trunk and pelvis is the same with or without back pain. When the walking speed increases, the “normal” person (without pain) changes the movement pattern, and movement is no longer coordinated between these two body parts. For the person with back pain, however, the pattern stays the same at all speeds.

This suggests that the person with back pain contracts muscles to hold the spine rigid or locked in one position. Using muscles to protect or guard in this way is called splinting. Once the back pain is gone, the body may not be able to return to normal movement. The protective splinting is no longer needed, but the body is stuck in that phase.

Physical therapists are using this kind of information to develop exercise programs. Specific exercises to “unlock” the spine may be helpful in these cases.

They might be. Research has shown that people with sacroiliac joint pain often have problems with urinary frequency (having to urinate often) and urinary incontinence (inability to control the bladder). One reason for this may be the way the muscles around the bladder work with other muscles to form a force field.

A healthy force field gives strength to the structures holding the bladder in place. At the same time, the pressure within the abdomen increases from these muscles contracting. This helps support the low back and sacroiliac joint.

Whenever someone develops problems with urinary function, a doctor should be consulted. Once the physician rules out the possibility of a more serious problem, such as pressure on the nerves to the bladder, the condition of the muscles can be evaluated. A nurse or physical therapist with training in urinary or bladder problems can help you retrain these important muscles.

The diaphragm is a large, flat muscle that rests under the lungs and goes across the entire chest cavity. It has two big jobs. First, the diaphragm is the major muscle of breathing. When taking a breath in, the diaphragm moves down to allow more air in the lungs. When breathing out, the diaphragm moves back to its resting position.

The diaphragm can also be used to increase pressure inside the abdomen. This is an important function when performing tasks that increase the load on the low back.

Anytime the low back or sacroiliac joints are injured, nearby muscles such as the diaphragm can be affected. When the stomach muscles and diaphragm stop working together, sacroiliac joint pain can increase. Some people find their pain is controlled by learning to coordinate these muscles while doing activities. Physical therapists design specific programs of exercise to address these types of symptoms.

The trunk is the main part of the body. It does not include the head or the limbs but everything in between (front to back, top to bottom).

The thorax is also known as the chest. It is between the neck and the bottom of the ribs. The thorax includes the ribs, part of the spine, and all of the organs inside the chest.

The pelvis refers to four bones in the lower part of the trunk. These include the sacrum, coccyx (tailbone), and the iliac bones (where you rest your hands when you place them on your “hips”).

When walking at slow speeds, these body parts move together in a smooth, coordinated pattern. This is called in-phase coordination. At faster speeds, the body actually switches to a pattern of movement that is out of coordination, sometimes called anti-phase coordination.

For someone with back pain, the muscles around the trunk and pelvis contract and hold, locking the body in a rigid position. This means the body can only use the in-phase coordination pattern, no matter what the walking speed. This can cause problems. A specific exercise program set by a physical therapist can help restore normal movement.

Using good lifting techniques is very important. It is also important to pay attention to how you are moving, especially if your work requires lifting and turning, carrying, or stacking.

When turning, be careful to turn the entire body, including the feet. Avoid twisting the upper body to move an item from one spot to another. This is especially important when lifting and turning repetitively.

When carrying objects, keep them as close to your body as possible. Spread your legs and bend your knees (not your back) when lowering heavy objects below the waistline. When stacking, do not exceed your maximum lifting capacity. When stacking overhead, do not hold your breath. Breathe out as you lift up.

By monitoring your own movement patterns, you may be able to see other ways of lifting safely.

Several researchers believe that back belts may lead to muscle weakness because they transfer the load from the back to the abdomen, pelvis, and legs.

Studies have shown that when a back belt is in place, the electrical activity of the back muscles is decreased. This means the muscles are not active or contracting. Over time, this can have a “detraining” effect on the muscles of the back. Once the belt is no longer used, the injury rate goes up. More research is needed to confirm this theory.

Whether or not a back belt offers any real protection remains controversial. Studies have reported all kinds of findings. Studies of specific belts and how they compare to one another are not yet available.

An occupational therapist in Taiwan did a study to look at the effects of belt pressure on back muscles. The results of the study suggest that the belt used may make a difference. In this case, an elastic belt with four semi-rigid bars on the back was used.

The belt was positioned to line up with the tenth rib, covering most of the trunk down to the pelvis. Belt pressure could be adjusted with Velcro fasteners that stretched the elastic portion of the binder. The general idea is to help the trunk form a cylinder so that the muscles can work together. The more the muscles contract together, the more the force is transferred away from the back.
 
More information is needed before any particular type or brand of belt can be recommended over another.