News Category: Lumbar Spine

In an effort to help patients with low back pain, scientists are studying how the spine moves. We know that patients with chronic low back pain have reduced motion in the spine. New three-dimensional (3D) equipment is allowing researchers to study patterns of motion.

Now that we know “how much” the spine moves, the next step is to find out “how” it moves. The “how” of spine movement is referred to as patterns of motion. Three directions of motion were studied: bending forward and back, bending to the side, and turning or rotating to one side.

In the normal, healthy spine, the spine moves through each of these motions. Some movement patterns occur at the same time. For example, bending to the side also causes the joint to turn, or rotate. This pattern of two motions together is the same for everyone who doesn’t have back pain.

In patients with chronic low back pain, it seems that there are up to three different ways to do each motion. There may be side bending and rotation to the same side or side bending with no rotation at all. Only a small number of patients with back pain have the normal side bending with rotation to the opposite side. 

This new information will help doctors connect the patient’s symptoms with back function. It may be possible for doctors to listen to patients’ symptoms and know what changes in motion are occurring inside the spine. Surgery to fuse the spine may be needed, but the hope is to find a treatment that will restore normal motion.

How about a nice backrub for that chronic, aching low back pain? A massage sounds like a good idea. But at $25 to $50 per visit, it would be nice to know that it does more than just feel good. This is especially true when at least 50 other types of pain-relieving treatment are available.

Too often, promise are made that massage will relieve pain, reduce suffering, and cure the problem. Many studies over the years have looked at the results of treatment for back pain. Sometimes massage alone is studied, while other studies compare massage to one or more other options. Results can be anything from pain relief to improved function, more range of motion, or increased strength.

Using just pain relief as a measure of effectiveness, massage does work in cases of chronic back pain. It’s even better when combined with exercises and education. But don’t sign up for a massage just yet. Several studies show that manipulation or electrical stimulation is equal to, if not better than, massage.

Again the goal is short-term pain relief. The effects of these treatments on long-term pain (more than one year) are unknown. Future studies will look at the effect of various treatments on long-term results. In the meantime, massage therapy helps improve symptoms and function. It may save money by reducing doctor visits, use of drugs, and costs of other back care services. If you want to get the most from a massage, exercise regularly and educate yourself about back care in general.

How do you know when you’ve had a real bout of back pain? Does it count as an episode if it gets better, or if it comes and goes? How do scientists who study back pain define it? This is the focus of a group of researchers in the Netherlands.

They found 1200 papers on low back pain (LBP) using an online search of the National Library of Medicine. Only 31 had an actual definition of low back pain. It would be helpful if researchers and studies used the same definitions.

Through a process of study and group discussion, these researchers offered a series of definitions. If agreed upon, these could be used in future studies. An episode of LBP occurs when pain in the low back lasts more than 24 hours. The patient is pain-free for a month before and after the actual episode.

An episode of care for LBP is defined as one or more visits for medical help. The three months before and after the episode are free of any visits. An episode of work absence because of back pain is a period of work absence with at least one day worked before and one day after back pain.

These terms may still be arbitrary, but much thought has gone into them. If scientists studying back pain agree, acceptance of these definitions could improve research results. This will make it possible to compare results of many studies.

Which strategy is better in the first few days after back pain: keep moving or go to bed? Two main goals doctors have when treating low back pain include pain relief and prevention of long-term problems. But how do doctors know which treatment works best?

Researchers collected data from studies of patients with low back pain. This information was analyzed and for doctors. The final results of all these studies have helped several countries write guidelines for the treatment of low back pain. Deciding whether rest or activity worked best was one of the questions answered.

For patients with low back pain that just started, four days of complete bed rest is no better than normal activity. In a way, the bed rest was worse because it required the worker to use sick leave. Since the outcome was the same with rest or activity, the sick leave was probably used unnecessarily. These results are based on patients who are employees and therefore should not be applied to the general population.

More than half of all pregnant women report having low back pain. For most women, this goes away after pregnancy. But for about 10 percent, back pain becomes a chronic problem. How can a woman tell if she is at risk for back pain during pregnancy? Several predictors have been identified.

The most common risk factor is low back pain before pregnancy or during an earlier pregnancy. A job with physical labor is another common predictor. Other risk factors include age (younger women), smoking, and lower income level.

The exact cause of back pain among pregnant women is unknown. There are several changes during pregnancy that add to the risk of this problem. These include changes in hormones, rapid weight gain, and abdominal muscle weakness. Treatment with a physical therapist is often advised.
 
Physical therapy treatment for pregnant women with back pain should be different from patients who aren’t pregnant. This is because of the physical, biological, and mechanical changes that occur during pregnancy. A physical therapist can check each spinal level for changes in motion. This could be increased motion or a loss of motion. Muscle strength and flexibility will also be tested.

A treatment program to restore movement, improve posture, and stretch muscles can be provided. Each of these must be modified for the changes in a woman’s body during pregnancy. Physical therapists are actively studying how to do this safely and effectively. For example, stomach muscles get stretched out during pregnancy. Along with expected weight gain, this can weaken the abdominal muscles. Regular sit-ups can actually cause separation of the abdominal muscles and are therefore not advised. Therapists teach how to brace the abdominal muscles during exercise to avoid this problem.

Only a few studies are available to show which physical therapy methods are best for pregnant patients with low back pain. More studies are needed to show what works best for this group of patients.

Pain in the lower back or hips is one of the most common complaints of pregnancy. Unfortunately, for many women the pain doesn’t go away after giving birth.

These researchers compared the way two groups of women lifted a box. All the women recently had babies. One group had back pain that began during pregnancy, and the other group had no back pain. Joint movements were tracked as all the women stood up, bent over, and picked up a box that weighed about 20 pounds. The researchers noted that the women with back pain made some movements more slowly. They also used different joints at different times to help them lift.

The results suggest two possible reasons for back pain after pregnancy. One possibility is from a strain in the muscles and tissues of the lower back that help with bending. The other possible reason is weakness in the supportive muscles that hold the lower spine stable. Identifying the cause could help refine exercises and therapy that work for pregnant women with back pain. Then these new mothers might actually be able to pick up their growing babies without feeling pain.

Back pain with leg pain is often caused by a disc pressing against a nerve root in the low back. This occurs where the nerve leaves the spinal column. The condition is called lumbar radiculopathy. It is the number one cause of low back pain in adults. Some people have chronic pain over many years from this condition. Finding a treatment that works for this problem is the goal of many scientists.

The first step in treating this kind of back pain is to understand the cause of the pain. Whenever a body part is injured or damaged, the immune system works to repair it. One single event can trigger a series of responses in the body. This is like a single drop of water joining many other drops to form a waterfall. The effect is called a cascade.

The immune system has a cascade response to nerve root injury. The chemicals released to help heal the body are called neurotransmitters. These have an indirect effect on the nerve tissue.

Scientists now understand that there is a “bigger picture” to this healing response. Once the injury sets up the cascade, the overall nervous system takes part, too. White blood cells and many different neurotransmitters are quick to arrive at the site of damage.

Somehow, these chemicals are able to enter the spinal cord and affect the entire nervous system. This kind of broader cascade is referred to as a “central process.” The final result is pain that doesn’t go away.

How can this waterfall of events be stopped? The next step in discovery is to find out how the uptake of chemicals occurs. This in turn will direct scientists how to interrupt the cascade and keep chronic back and leg pain from happening.

Neck and back pain are major concerns for workers around the world. Work slowdown and absent workers cost companies and countries millions of dollars every year. People with chronic back pain may end up retiring on disability. Is it possible to predict who will have to retire because of disabling back pain?

A study of almost 35,000 working men and women gives some news about this. Risk factors such as smoking, obesity, general health, burn out, and job tasks were compared. Some risk factors are better than others to predict who will have a future disability.

Physically hard work is the biggest risk for disability from back pain. The second greatest risk is “burn out,” an overall feeling of being tired and worn out. The risk goes up when smoking, excess weight, and inactivity are added to the first two factors. The risk goes up again if the person has other diseases or general poor health.

When it comes to risk factors for retirement because of back pain disability, a physically demanding job is number one. Poor health and burn out add to this risk. Treatment for back pain alone isn’t enough to prevent disability retirement. Paying attention to the health, social, and emotional needs of workers is also important.

When it comes to back pain, doctors need a place to start. Knowing how severe the pain is gives doctors useful information for treatment. A survey called the Dallas Pain Questionnaire  (DPQ) may be just the right tool to help doctors. It is a short series of questions that looks at back pain in adults who are still working. It shows how pain affects function and emotions.

Many studies now show the need to consider various components of chronic back pain, including pain intensity, feelings, and level of function. The DPQ looks at four areas of life, including daily activities, work, anxiety or depression, and social interest. The answers to these questions help doctors classify patients.

The DPQ divides patients into several groups. On one end is the group with minor difficulty. At the other end are those patients with significant chronic low back pain. It further points out patients with emotional distress.

A simple and practical tool like the DPQ is just what doctors need. It helps them find out what stage of chronic back pain a patient is in. The grouping of patients points out the workers who are seriously disabled by their pain. It guides the doctor in deciding who can return to work and who can’t.

There’s a weak but important link between pain, disability, and quality of life (QOL) in patients with low back pain. These are the findings of a study conducted in Spain at seven primary care centers of the Spanish National Health System. There were 195 patients in the study.

Even when treatment improved the patients’ pain, they didn’t necessarily get better. Disability and QOL remained unchanged after measurable changes in pain. Why is that? Studies show pain is influenced by physical factors such as how the muscles, joints, and ligaments work. Disability is linked more closely to psychological and social factors.

This study confirms these same findings from other reports. The authors suggest using separate measures for pain and disability. They point out that QOL depends more on how long the pain lasts than how intense it is. It’s likely that other factors besides pain also affect QOL, but more study is needed to identify them.

In this study, the researchers found QOL worsened the longer the pain lasted. In fact the measure of QOL doubled from day one to day 14. In this study, the QOL test measured several areas of health: mobility, self-care, main activity, family or leisure activities, pain, and mood.

The authors conclude that treatment must focus on improving pain, disability, and QOL. It’s likely that separate treatment programs are needed for each factor. Improving just one factor doesn’t always change the others.

For years studies have shown few therapies that work in the treatment of chronic low back pain. Doctors have tried “usual care,” which means rest, then activity, along with pain relievers.

But science may be making some progress in this area. Intense treatment with many types of care may be working. The concept is called a multidisciplinary rehabilitation program (MRP). MRP treatment involves physical therapy, psychological treatment, education, and relaxation.

Researchers in Germany put MRP to the test. They compared two groups of patients with chronic low back pain. Group one received usual care, while group two had MRP four hours every day, three days each week, for three weeks.

The results are very promising. The MRP group improved in physical and mental health with fewer days missed at work. In the authors’ opinion the MRP program was very successful.

The authors hope the program could be offered as group therapy rather than individual therapy. If MRP can be started earlier in the episode of back pain, chronic pain might be reduced. The program could be copied and offered everywhere as part of community medicine.

The doctors behind this study see MRP as a means of improving health quality of life for patients with chronic low back pain. They recommend more studies to confirm these early results before planning community-based MRP programs.

Where do people get help when they have back pain? In any given year, one-third of all adults have at least one episode of back pain. Back pain is the second leading cause of visits to the doctor in the United States. Notably, only about 12 percent of adults with back pain see their medical doctor.

How are other people handling their back pain? Chiropractic care, massage therapy, and relaxation techniques are the three top choices. In fact, one-third of all adult back and neck pain patients get help outside the medical world.

Other health care services such as chiropractic, yoga, massage, homeopathy, and acupuncture are called complementary and alternative medicine (CAM) therapies. Chiropractic care is the most commonly used CAM. Twenty-five percent of back and neck pain patients combine medical care along with CAM therapies.

Patients most likely to use CAM are women with pain in more than one area of the neck and back. Level of education, income, and general health don’t seem to influence who seeks help from CAM. Most patients rate CAM as “very helpful.” The effectiveness of these therapies remains unknown.

It appears from this study that only a small number of patients seek care just from a medical doctor. Also, people tend to combine CAM with care from their medical doctor. Future studies are being planned to look at the cost, harms, and benefits of CAM therapies.

When a back injury requires surgery, fusion is often the method of repair. Small pieces of bone are placed alongside the damaged area. This builds a bridge of bone to support the spine. Sometimes metal screws or plates are used to immobilize the area and speed healing. A quick and complete healing of the bone is important for full recovery after fusion.

Bone can be stimulated to grow with the right kind of treatment. Doctors are studying electrical and electromagnetic fields to aid the healing process. The U. S. Food and Drug Administration (FDA) approved the use of this treatment method in 1979. Since that time, this has moved from being implanted surgically to a strap-on unit in current use.

The first-ever study of this device in humans has been reported. Over 200 patients in 10 centers were included. Only those patients with bone grafts (but no metal implants) took part in the study. Everyone wore the device over the fusion, but not everyone received the stimulation. For purposes of the study, the patients and doctors didn’t know who had an active unit. For those with the active unit, the combined magnetic fields were applied every day for 30 minutes.

Treatment of spinal fusion with combined magnetic fields seems to be most effective in women. Fusion occurred in 67 percent of women with active devices. This was compared with only 35 percent of those women with a device that wasn’t active. There was no significant difference among men with or without the active device. Researchers don’t know how to explain this. Perhaps there is a difference in body functions between men and women. Or maybe women truly are more magnetic.

The usual treatment for back pain with signs of paralysis from a disc problem is surgery. Numbness, muscle weakness, and loss of movement have generally been red flags in this condition. Surgery is often recommended in these cases. A new study has been published to challenge this widely accepted practice.

Seventeen different groups of doctors participated in this study. Patients with leg pain or sciatica from the disc pressing on a spinal nerve root were observed. Half were treated with surgery to remove pressure from the nerve root. The other half received nonsurgical treatment.

Both groups were measured at one, three, and six months for pain level, muscle strength, return to work status, and use of pain medication. Recovery rates were equal for both groups (around 70 per cent). If both treatments work equally well, what are the important factors to predict recovery?

The only difference between those who got better and those who didn’t for both treatments is age. Younger patients are more likely to recovery fully no matter which treatment is used. Return to work was based on whether or not the patient had improved enough or recovered fully.

Surgical treatment of sciatica with signs of paralysis isn’t always more effective than medical management without surgery. This is a new finding about a standard treatment used for years. More studies are needed to confirm this finding. Complete paralysis still usually requires immediate surgery.

Spinal stenosis is a common problem in older adults, causing low back and leg pain. Spinal stenosis is a narrowing of the opening where the spinal nerve roots pass from the spinal column. It is usually caused by changes in the spine that occur with aging. These changes include bone spurs, thinning of the discs, thickening of the ligaments, and overgrowth of the joint cartilage.

Pressure on the nerves from these changes causes painful symptoms, numbness and tingling, and pain with walking. Surgery to take pressure off the spinal nerve is sometimes the only treatment to successfully reduce pain. This procedure is called a nerve root decompression. The result of this treatment is varied and not always successful in reducing pain.

However, pain isn’t the only measure of success. Improved physical and social function is also important to most patients. Doctors in a London hospital interviewed patients at six weeks, six months, and one year after surgery for spinal stenosis. Most improvements occur by the six-week and six-month mark for pain and physical function, but social function continued to get better for up to a year.

Surgery for spinal stenosis may not be successful in getting rid of all your pain. If you are facing surgery to reduce symptoms from spinal stenosis, you may want to think about other factors. For example, surgery may enable you to sleep better, walk longer, and get out more. These changes may not be immediate, but you may continue to improve for up to one year after surgery.

Sometimes, surgery is needed for back pain. Two or more bones may be fused together to prevent movement at that level. This is called a spinal fusion. There are some problems that can occur after spinal fusion. Disc herniation is one of these rare problems.

The disc is a spongy material between each vertebra in the spine. It is encased in a protective material and held in place by ligaments and fibrous tissue. Injury or damage to any of these structures can cause disc herniation. The disc material pushes out of its normal space and can begin to press on the spinal cord or spinal nerves, causing low back and leg pain.

When two or more bones of the spine are fused together, movement between the fused bones stops. The segments just above and below the fusion have to move more than normal. This extra movement can cause wear and tear on the discs above and below the spot where the spine is fused. The result can be a disc herniation.

Anyone with a previous fusion in the low back can have a disc herniation later. Returning symptoms of back and leg pain after a fusion surgery should be checked by a doctor. This could be the first indication of disc herniation. Early treatment with physical therapy may help prevent surgery. In some cases, another surgery to treat the new disc herniation may be needed.

Age and injury can cause the discs between the bones of the spine to wear down. This condition is called degenerative disc disease, or DDD. Most people with DDD get better without needing surgery. They may see a physical therapist, use a brace, or take medications. However, a small number of patients just don’t get better, even after years of trying different treatments.

Surgery is sometimes a final step for these patients. Fusion surgery is commonly used to treat pain from DDD. However, past results have not been all that promising for patients who still had severe pain prior to surgery despite many nonsurgical treatments.

Equally disturbing is the fact that pain sometimes remains high even after fusion surgery. In this study, a group of doctors used an aggressive way to stop movement in the problem part of the low back. They fused the spine in front and back and used screws and plates to hold the spine in place. The results were good. Many of the patients (88 percent) were able to get back to work, and most patients were highly satisfied with the results.

Adults with DDD usually get better without surgery. When surgery is needed, the spine can be fused in one or more places. In some cases of severe and disabling pain, doctors may fuse the spine from the front and back with a good result.

Many studies report how often back pain occurs. If the pain isn’t measured the same way in each study, then it’s a lot like comparing apples to oranges. Researchers in Canada are trying to set the record straight.

A survey about low back pain was sent to adults in the Saskatchewan province. About eight percent of the adults between 20 and 69 years reported low back pain. The measure was taken over a six-month period of time.

Compared to other similar studies, eight percent is high. New information about back pain reports that there are many factors that cause this problem. These include stress, smoking status, quality of life, and the presence of other diseases or conditions.

In Saskatchewan, back pain was more common in people with previous neck pain. Other factors that increased back pain included living in a rural area, being single, and having previous back pain. This information is important for health planners. Knowing how many new cases of back pain will occur in the next six months is helpful. The next step is to find ways to prevent painful back episodes.

Back pain of unknown cause is called nonspecific back pain. It is very common. In fact, seven out of every 10 adults will have nonspecific back pain at some point in their lives. Low back pain in the United States causes lost wages and medical expenses that add up to millions of dollars every year. In cases of nonspecific back pain, there is no infection or fracture. No trauma has occurred and there is no disease present. Many people probably have pain from problems with nerve tissue, but this has not been proven.
A new treatment for nonspecific back pain has been developed in Spain. This is called neuroreflexotherapy. In this treatment, the doctor puts staples in the back and ear at places called trigger points. The staples are left for 90 days or more. They work by blocking the release of substances that cause back pain. These staples also release natural pain relievers.

Twenty-one doctors in seven centers in Spain have been using neuroreflexotherapy. They have compared the results with people who have not received this kind of treatment. The patients receiving neuroreflexotherapy had better results with less pain and better quality of life. The treatment time was shorter with lower costs.

The European approach to nonspecific back pain may offer a new method of treatment. Doctors are trying to use the nervous system to affect the pain. Early results are positive and have been repeated in several studies.

There are many ways to treat low back pain, but which method is the best? How do treatments stack up against each other? A group of chiropractors and physical therapists compared four of their treatment methods.

These four types of treatment included education (called back school), joint manipulation, myofascial therapy, and manipulation combined with myofascial therapy. Joint manipulation is performed by both physical therapists and chiropractors. Myofascial therapy is a way to move and stretch the soft tissues.

Surprisingly, there were no differences in results of the four treatment methods. Two hundred patients were treated with one of the four methods. All groups showed big changes in pain and activity after three weeks. These changes were kept for six months. There wasn’t any further improvement by the end of six months.

Back school therapy and hands-on treatment by chiropractors or physical therapists had the same results. They all seem to be equally effective in treating recent low back pain. The question still remains as to whether people who receive no treatment would do as well as the groups who got these treatments.