News Category: Lumbar Spine

When a disc in a person’s lower back becomes herniated, it can put pressure on the joints, ligaments, and nerves of the low back. In some cases, the pressure is so bad that it can cause pain and numbness in the pelvis, low back, and down one or both legs. It can also result in a condition called cauda equina syndrome, which causes serious problems with bladder and bowel control.

While about 56% of women have low back pain during pregnancy, only about one in 10,000 pregnant women actually shows symptoms from a disc herniation. In rare cases, the symptoms from a herniated disc require immediate back surgery. Putting surgery off can mean the pain, numbness, and incontinence become permanent. But what if the patient is pregnant? Is lumbar surgery safe during pregnancy?

These authors reviewed available medical literature. They also reported on three case studies of their own patients. The three women were in their first pregnancies when they developed symptoms of numbness or pain in one or both legs. One woman also had cauda equina syndrome. The women were all between 16 and 20 weeks into their pregnancies when they sought care for their symptoms.

In all three cases, lumbar surgery was successful. All the patients reported having fewer symptoms after surgery. And all three of their babies were born healthy and on time. The woman with cauda equina syndrome had been having symptoms for six weeks before she had surgery, and she continued to have some problems with constipation and incontinence, although she was much improved. The other two women made full or nearly full recoveries.

Based on their research and the case studies, the authors conclude that MRI scans, epidural and general anesthesia, and lumbar disc surgery can be done safely during pregnancy. The surgery should only be used when other types of care aren’t working or in an emergency–such as cauda equina syndrome. The authors also recommend using a special four-poster frame that allows the woman to lie face-down during surgery without putting any pressure on the uterus or developing baby.

Accurately measuring physical impairment is easier said than done. So far, most of the strategies identified by researchers don’t work. One of the factors that makes such measurement difficult is that patients sometimes exaggerate their symptoms when they bend and twist in the doctor’s office. Patients may exaggerate their impairments on purpose–to get treatment, medication, or disability status. But many patients exaggerate their symptoms without even knowing it. They may be afraid of causing themselves pain, or they may simply be nervous about being in the doctor’s office.  

These authors used exaggeration to gauge the usefulness of one method of measuring low back impairment. They tested two groups of 100 people each. One group had low back problems, and the other group didn’t. Both groups underwent a physical examination while wearing a device to monitor their body movements. The participants bent forward, bent side to side, and twisted their trunk back and forth. They did their best with each motion on the first try. The second time they were told to move as if their back was more painful than it actually was. 

The results showed that the monitor was fairly accurate in determining which motions were real and which ones were exaggerated. This suggests that the device might be a useful way to more accurately measure low back impairment.

It also supports the theory that we tend to move our bodies in set patterns–unless, of course, we’re faking it. The monitor showed erratic patterns of movement when people tried to exaggerate their motion. They simply couldn’t fake it the same way twice.

Back pain sometimes hurts just in the low back. But it can also be a pain in the rear–and a pain in the leg. Pain from the back that shoots into the buttock or leg is called radicular pain.

Foraminal stenosis and herniated discs are two common causes of radicular back pain. In foraminal stenosis, the spine narrows and may pinch nerves as they leave the spinal cord. A herniated or bulging disc can push on the nerves leaving the spinal cord. Pressure on nerves can cause a lot of pain and weakness in the back and down the legs along the path of the nerve. Radicular back pain can be so disabling that patients may need surgery to stop the pain.

Doctors often treat radicular back pain with epidural injections of steroids, although the effectiveness of this treatment is controversial. Another method for getting steroids to the inflamed nerve is called a selective nerve-root injection. Doctors use a special kind of X-ray called a fluoroscope to guide a needle directly to the painful spinal nerve. This procedure gets more medication to the painful spot.

These researchers wanted to compare whether nerve-root injections using numbing medicine alone or in combination with steroids actually lessened radicular back pain. They were also interested to see whether patients got enough relief that they no longer wanted or needed back surgery.

Researchers selected 55 patients who had requested back surgery to relieve their pain. They were divided into two groups. Twenty-seven patients received bupivacaine, a long-acting numbing medicine. The other 28 patients received bupivicaine plus a steroid. The researchers considered the treatment a failure if the patient went ahead with surgery. From the group who received bupivicaine alone, 18 patients ended up going through with surgery. But only eight who’d gotten bupivicaine in addition to the steroid needed surgery.

The math is pretty straightforward. Out of the 55 total patients, 29 avoided surgery after being treated with nerve-root injections. And even though bupivicaine alone was helpful, the number of people helped by getting the additional steroid was significant.

This study showed no difference in pain control between the patients with spinal stenosis and patients with a herniated disc. However, the researchers questioned whether this would be the case over time. It’s been shown that herniated discs can fully recover without any treatment, while foraminal stenosis typically worsens with time. This study followed patients from 15 to 28 months. If patients with a herniated disc avoided back pain in this time frame, it is unlikely that they would need surgery in the long run. The authors conclude that treatments like nerve-root injection could be just what the doctor ordered in helping more people avoid back surgery.

Past studies have shown that some low back postures and heavy lifting at work can put the spine at risk. But how can you know when you’re bending or twisting too far, or if that box you’re about to lift weighs too much? Scientists haven’t carved that answer in stone–yet.

So how far is too far, and how much is too much? Researchers in the Netherlands have started to put some numbers to these questions. They recorded workers on videotape to see how far and how often they had to bend or twist. They also tallied how much weight the workers lifted over the course of the workday. They followed up with the workers yearly for three years. Here’s what they found.

The more people have to bend, twist, or lift at work, the higher the risk. Bending forward more than 60 degrees and twisting more than 30 degrees appeared to be the angles that mattered the most. The chance of back pain was higher for bending, especially when people did it more than 5% of the day. Lifting less than 55 pounds didn’t seem to be a problem. But when workers lifted at least 50 pounds more than 15 times a day, the incidence of back injuries gradually went up. These values are summarized below:

• bending forward at least 60 degrees for more than 5% of the day


• rotating at least 30 degrees for more than 10% of the day


• lifting more than 55 pounds more than 15 times a day.

Patients who suffer from low back pain often feel frustrated when the cause of the pain is unclear, as is often the case. Sometimes people think that the more tests they have, the closer they will get to understanding the problem. However, X-rays for low back pain–a commonly prescribed diagnostic test–have a poor record of helping doctors figure out what’s wrong. If that’s the case, why are X-rays so commonly prescribed for this condition?

A recent study conducted in Norway suggests that patients who are given adequate information and support may be less likely to want unnecessary tests. In the study, 99 patients who received X-rays for low back pain were interviewed afterward. They ranged in age from 14 to 91 years old. They were asked to rate the importance of having an X-ray for their back pain. They were also asked about their views on the usefulness of and reasons for the X-rays. Other information was collected on the patients’ condition.

Seventy-two percent of patients in the study said X-rays were very important for their condition. Men were more likely to think that X-rays were important than women. Those with worsening symptoms were more likely to think that, too. Interestingly, those who had the least real need for X-rays according to medical criteria were also more likely to think the X-rays important. This led researchers to believe that some patients may need more information or support from their doctors.

The researchers suggest that doctors should carefully explain why X-rays may not be helpful. Doctors should also try to understand the patients’ specific concerns, frustrations, and fears. They suggest that sometimes patients may ask for X-rays out of anxiety or dissatisfaction with the doctor’s explanation of their pain.

Overall, the researchers suggest that the real key is greater understanding between doctors and patients. If patients and doctors talked more about their concerns and beliefs about low back pain, fewer of these unnecessary tests might be done.

Medical professionals have long been concerned that patients with diabetes mellitus don’t do as well after spine surgery. To date, however, there has been no research to prove–or disprove–this theory. 

In this study, researchers looked at the records of 32 diabetic patients who had lumbar fusions. All patients had type I (insulin-dependent) or type II (non-insulin-dependent) diabetes for over a year. They were also diagnosed with lumbar stenosis or herniated discs that didn’t respond to conservative treatment. They all underwent decompression and fusion surgery using the same techniques.

Researchers followed up on these patients at least two years after their surgeries. At follow-up, 78% of them reported less back pain, and 74% had less leg pain. Ten patients had problems caused by the surgery, including delayed healing, prolonged drainage, and infections. Significantly, 91% of the patients had X-rays that showed successful fusion.

Insulin-dependent patients fared the worst. About half of them had a fair or poor outcome. Patients with other medical problems also had more complications and a less successful outcome.

Despite the complications for some groups, the researchers conclude that lumbar spine surgery can be safe and effective in patients with diabetes.

The number of people who suffer lower back pain (LBP) is staggering. In fact, it is one of the most common causes of disability and missed work days. These costs add up for individuals, employers, and society. Even with all the advanced technology now available, the medical world is still working hard to be able to understand LBP and the disability it causes. In more than 80% of LBP cases, doctors are unable to find any particular physical cause.

Getting an accurate measurement of the disability caused by LBP is not an easy task. Canadian researchers recently did tests to see whether spine movement and speed could be used to measure disability from LBP. Called kinematics, these analyses are part of the study of biomechanics. Spine kinematic tests study the motion of the spine in movements such as bending over to touch your toes. Many doctors do these tests to get an idea about disability status, but no one really knows how accurately these test results measure disability.

The researchers tested spine kinematics on 175 patients who missed four weeks of work because of LBP. Patients also filled out a survey with questions about their back problem. The kinematic scores were compared to the work status of the patients and to their reports about pain, sleep, and ability to do self-care and daily activities.

The results of the kinematic tests didn’t relate very well to either the questionnaire or the patients’ work status. Remarkably, the kinematic results didn’t always seem to improve, even when patients started to report feeling better and as they went back to work. The researchers conclude that spine kinematics, while useful in other ways, are not helpful in determining the level of disability in patients with LBP.

Electrical currents have been shown to help bones heal faster when used after certain types of surgeries. Nearly 160,000 people underwent spine fusion surgeries in 1995, and many of these patients were implanted with special cages between their spinal bones. Could electrical stimulation have  benefits after spine fusion surgery too?

Medical researchers recently tackled this question by studying the effects of electrical stimulation in the spines of 22 sheep. The researchers chose to use sheep spines because of their similarity to human spines. Each sheep had a discectomy and fusion surgery done on the lower part of the spine. A titanium cage was packed with bone and placed between the bones of the lower spine. The sheep were divided into three groups. One group didn’t get any electrical current. The other two groups received two different levels of current through a device attached to the titanium cage.

The sheep were tested every day for the first week, two months after surgery, and four months after the surgery. They went through neurologic exams, X-rays, and biomechanical testing. Tests showed that the group with the highest current had the quickest fusion rates. Healing was slowest in the group that didn’t get any electrical treatment.

Human spines won’t necessarily react to electrical stimulation the same way as a sheep’s spine. But this research suggests that electrical stimulation may help speed healing and improve the rate of fusion in certain types of back surgeries.

Opinions. Everyone’s got one, including doctors who make recommendations to their back patients about activity and work levels. A recent mail survey indicates that these recommendations vary widely. The results also show that most doctors tend to restrict the activities of their patients with back pain.

The authors mailed survey packets to 142 doctors. The surveys included questions about their training and their expertise in treating back patients. To see what they would recommend for their back patients, each doctor was given information detailing the condition of three mock patients, each with a different back problem. The physicians were asked to give their impression about how bad each patient’s problem was and to give recommendations about activity and work levels for each patient.

There was general agreement that patients with chronic back pain should limit their activities and work duties. Doctors also tended to restrict activity if the patient’s symptoms were severe. And the responses showed that doctors based their recommendations on their own personal viewpoints and attitudes about pain. These factors had more to do with the doctors’ decisions than current trends and recommendations for people with chronic low back pain. A newer approach shows improved results when patients with back pain swiftly return to normal activity.

Medical professionals continue to search for ways to put chronic low back pain in a box and nail the lid shut. Expert physical therapists have recently unveiled a new way to classify back pain. Their new system guides clinicians in finding and treating causes of pain. The new system may be just the “box” that medical science wants.

Actually, there are five such boxes, or categories, in the new system. The categories describe spinal movements and positions that people tend to use during routine activities. The system is based on the idea that people with back pain may have developed unhealthy habits in how they move or position their spine. These incorrect positions or movements happen over and over again during daily activities. The authors call these faulty movement patterns lumbar movement dysfunctions. Over time, these dysfunctional movements can cause soreness. They may eventually lead to a full-blown back problem.

The classification system is useful for identifying which lumbar movement dysfunction is to blame. First the problem is classified in one of the five categories. Patients are then shown how to avoid the positions and movements that may be causing the pain, thus keeping their pain “in the box.” Strategies are suggested for positioning the spine safely during exercise and activity. Even routine activities like bending and reaching may need to be modified to help the spine stay balanced.

The authors present a case study of a 55-year-old woman who had been dealing with back pain on and off for 40 years. When she came for help, she had been in pain for 10 weeks and hadn’t gotten any relief with standard treatments. She felt pain whenever she bent back or twisted her trunk to the left. The lumbar movement dysfunction was categorized as “rotation with extension.” Her physical therapist showed her ways to avoid moving or positioning her spine in rotation or extension during exercise and routine activities. After this one treatment, she came back and reported having 75% less pain in her back. Over the next three months and a total of eight physical therapy visits, her functional scores went from “severe disability” to “minimal disability.” And the activities that used to cause her pain no longer gave her problems.

Had she kept on doing the same harmful movements, it is likely she would still be having problems. The authors acknowledge that other factors might have played into the patient’s improvement. They encourage future research to validate this approach for helping people nail the lid on low back pain.

A fresh approach for helping injured workers get back to work sooner is gaining ground. The newer ideas may eventually replace outmoded ones that are based on back pain myths. One such myth is that back pain happens because of physical loads and forces from activity (like work). Treatment is thus aimed at limiting the patient’s activity. Health providers who cling to this idea often caution their patients about doing too much. These doctors may even order patients to rest in bed.

However, new evidence shows that workers with back pain do better when encouraged to get back to normal activities as soon as possible. Researchers studied how well this new approach helped workers with back pain get back on the job.

The study was done in Norway and included 457 patients, all of whom had been out of work for more than eight weeks. The participants were randomly placed in either a control or treatment group. The control group simply followed the advice of their general practitioner. Patients in the treatment group were given a thorough evaluation by a spine doctor and a physiotherapist. When there were no major medical concerns, the patients were informed about their good prognosis and were shown ways to stretch, train, and walk as part of a home program. They also got advice about how to take care of their back, and they were encouraged to resume normal activity.

The researchers gauged the success of treatment by the number of people who got back to work. People in the treatment group got back to work sooner than those in the control group. And by the end of the study period, a higher percentage of patients completing the treatment program had gotten back to work. These patients, say the authors, “seem to benefit from maintaining activity as normal as possible, as compared with inactivity and bed rest.”

There are several themes in this new model of treatment. Medical professionals examine and inform patients. Health providers offer enthusiasm and instill optimism about the positive benefits and results of treatment. They encourage patients to get back to normal life activities by helping them overcome fears of having pain. In this way patients avoid becoming inactive and show a greater ability to get back to work.

Dispelling old myths takes time. So it shouldn’t be expected that practitioners would readily move toward this new approach to back care. The growing volume of studies with results like the ones in this article may help speed acceptance of the new model.

If sticking with exercise were easy, more people with chronic low back pain would probably do it, and most would reap the positive benefits. Participants in a recent study kept doing their exercises long after finishing a four- to eight-week period of intensive physical therapy. They actually did exercises more frequently at three months than they did when first evaluated. And they exercised even more by the twelfth month.

Their efforts paid off. People reported having less pain and being able to do more activities. They also showed more strength and flexibility. Their muscles performed better, and they were able to lift more. These scores improved by the third month, and the results were even better a year later.

Here are some of the reasons why more people kept up with their exercises. First, to be part of the study, participants had to make progress with their exercises during their treatment sessions. Second, by taking on the responsibility of working the settings on the exercise equipment, they became independent in doing the exercises. People are more likely to stick with exercises when they feel self-sufficient and don’t feel passive while doing their program. Third, the doctors and physical therapists instilled confidence by giving lots of positive feedback and showing support, even when people felt some pain during their exercises. Patients were encouraged to do all their exercises and to go about their activities, even when they were having pain. The ones who did reported having less pain overall and were having an easier time doing their activities.

The authors conclude that people who have chronic low back pain can do regular exercises, and those who do can achieve the benefits of sticking with them.

For many years there has been a controversy about the connection between back pain and what doctors can see on X-rays and other special pictures of the spine. The problem is that about 30% of people without any back pain show abnormal findings on pictures of the spine. Also, some people with severe back pain have entirely normal spine pictures. Is there really a connection between abnormal back pictures and back pain?

A seven-year study showed that there is, in fact, a connection between abnormal spine pictures and low back pain. The study also looked at men who did different types of labor. The results also suggest that the type of work can affect the odds of developing certain types of back pain.

Groups of Finnish machine workers, carpenters, and office workers were examined and questioned about back pain two times, with three years in between examinations. Each man was asked the same set of questions both times and then underwent a magnetic resonance imaging (MRI) study of his lower spine. The men were divided into groups that had no back symptoms, low back pain that stays in the lower back (local back pain), or back pain that moves from the lower spine down into the leg (sciatic pain).
 
An MRI produces a very clear picture of the bones, discs, and overall structure of the spine. A team of three radiologists (physicians that read imaging tests) checked for signs of abnormal wear and tear (degeneration) or bulging of the discs within the spine. Then the researchers determined whether the men with pain had abnormal MRI pictures. They also looked to see if the type of work made a difference in the men’s risk for getting back pain.

The pictures showed that when signs of wear and tear were present on the MRI, the chances of back pain were significantly higher. There was a strong connection between degeneration or bulging on the MRI and sciatic pain. However, the chances of having local low back pain did not seem to be affected by the number of worn, degenerated discs seen on the MRI pictures.

Machine drivers (including bulldozer operators, longshoremen, and heavy equipment operators) do a lot of sitting on large machines that are constantly vibrating. They do not have a lot of opportunities to get up, move, or change position. Occasionally they have to lift heavy materials. These men had the highest risk of all types of back pain. Over 50% of them suffered from sciatic pains.

Carpenters do a lot of lifting, carrying, and moving around on the job. Their chances of having an accident are high due to climbing, uneven work surfaces, and obstacles at the work site. Their chances of having lower back pain were about as high as the machine operators, but far fewer of the carpenters had sciatic pain. Office workers had the lowest chance of having lower back pain.

So researchers concluded that your type of work does indeed affect your risk of back problems. And if you are having low back pain, chances are that a MRI study will show degeneration or bulging discs.

What if your family physician were trained to do some of the same basic moves used by chiropractors and physical therapists to help with low back problems? By adding these techniques to regular office visits, would you get better sooner, need less medication, and feel better about the care you received?

This study was designed to address such questions. Thirty-one general physicians trained for a total of 18 hours in how and when to use a set of manual therapy treatments that are more commonly given by physical therapists, osteopathic physicians, and chiropractors. The participants were shown five muscle energy techniques, treatments that rely on the patient’s own muscle power to help stretch joints and soft tissues. They also learned how to use three different adjustment techniques.

A total of 295 patients with back pain were randomly placed into two groups. Half received a medical back care program alone. The other half got the same medical care program plus the hands-on treatments. Patients in both groups were evaluated every two weeks over a period of two months to see which approach worked best. The researchers compared how fast patients got better, how long they were off work, their ability to do their activities, and their level of satisfaction with their care.

The patients’ answers showed that the extra hands-on treatments did help a few patients, at least a little. But differences between both groups were minor. Patients who received hands-on care were prescribed fewer muscle relaxation medications. But the number of visits, special X-ray tests, and the number of referrals to other health providers were about the same for each group. And both groups ended up needing about the same number of prescriptions for painkillers.

The hands-on treatment did have immediate benefits for some patients. Fourteen percent showed complete recovery after only one visit.

As for the doctors, more than half who used the hands-on techniques reported feeling optimistic that they were providing improved care for their patients. Still, the physicians didn’t always follow the directions when doing the hands-on moves. On average, the doctors only used three of the eight treatment choices. Yet when more than four maneuvers were used, patients showed faster improvement by an average of 2.5 days.

The authors emphasize that the results of doctors in this study should not be compared with the results achieved by experts in manual therapy. The mixed results of this study suggest that doctors who get limited training won’t necessarily work miracles for everyone. But there seem to be possible benefits when doctors use some hands-on techniques in the exam room.

New advances in medicine and science are making it possible to narrow down and locate pain-causing tissues in people with chronic low back pain. Frequently, the lumbar disc is the source of pain. Scientists have also discovered that the outer ring of the disc is rich in pain sensors.  

Intradiscal electrothermal therapy (IDET) is a newer surgical procedure that lets doctors work on the painful disc without causing harm to the other tissues in the area. During the procedure, a special heating element called a catheter is placed inside the sore disc using a special needle. The element is heated for about 17 minutes. The heat treatment is believed to shrink the disc fibers and cauterize pain sensors.

Does it work?  Resources say that more than 75% of the people treated with IDET are highly satisfied. But does the procedure weaken the spine? This is the question the authors sought to answer in this study.

Researchers tested how well four human cadaver spines could withstand movements before and after IDET treatment. They set up a testing device that put pressure on to the spine similar to the forces caused by routine activities. Then the spines were tested for three types of movement: bending forward and back, bending side to side, and turning in each direction. 

The spines held steady. In fact, IDET didn’t change the spines’ ability to withstand pressures and movements common with daily activities.

The authors acknowledge that their study has limitations. They tested few cadavers, had a short time between IDET and retesting the spines, and tested only the middle and upper joints of the lumbar spine. The authors stressed that future studies will need to look at the effect of IDET on the tissues inside the disc. Nevertheless, their research suggest that IDET doesn’t appear to weaken spinal segments of the lumbar spine.

What triggered my low back pain (LBP)? Simple question–complicated answer. Studies have found several factors that raise the risk of developing LBP. Known risk factors include:

• previous episodes of back pain


• injuries


• smoking


• sedentary work.


• poor social support


• lack of social confidence


• work that involves whole-body vibrations


• dealing with heavy loads at work


• low education levels


• low off-work exercise levels


• low levels of influence over work conditions


• high demands during off-work time


• high amounts of overtime work


• work with a high risk of accidents


• social disturbances at work


• technical disturbances at work.

For men, the risks of LBP were excessively high when they dealt with heavy loads at work, had many demands outside of work, did sedentary work, or had a combination of poor social relationships and lots of overtime work.

Women were at especially high risk for LBP when they worked with heavy loads, did sedentary work, smoked, or had a combination of work that involved whole-body vibrations and a lack of influence over work conditions.

Although exercise is routinely prescribed for people with low back pain, its role in treatment is still unclear. A recent study showed what appeared to be significant benefits of exercise in the areas of pain, disability, and physical fitness. But the authors weren’t sure whether the favorable results could be attributed to the exercises alone.

The authors followed two groups of people with low back pain. Both groups were given a fitness test. At first, both groups showed lower scores on the fitness test than others of their same age and sex. Patients with low back pain took part in exercise sessions three times week for six weeks. In each session, they did up to 20 minutes of aerobic exercise, five minutes of stretching, and muscle toning exercises for the upper and lower body.

After the six-week program, the exercisers showed significant improvements in their fitness scores. Their scores afterward were much higher than the other group of patients. Even more surprising, they scored higher than the healthy subjects who took the fitness test. Their reports of pain and disability also showed remarkable improvements after the exercise program ended.

At first glance, the results seem to show that exercise really helped people with low back pain. Because of some of the limitations in the study, however, it is still not clear whether exercise alone should be credited for all the improvements. The authors acknowledge that patients might have achieved better results because some of them received other treatments over the course of the exercise program. This makes it impossible to determine whether one of the other treatments, the exercise, or all the strategies together improved the patients’ conditions.

Even though there is a question of just how effective exercise can be for people with low back pain, the authors believe their study “supports the hypothesis that a course of active treatment, such as exercise or conditioning, in conjunction with other forms of treatment, may be helpful in the management of patients with chronic low back pain.”

A popular form of treatment for people with disc pain in the low back is the lumbar extension exercise. The basic principle is to bend the spine backwards to try and ease low back pain. Some people get nearly immediate relief. However, the treatment is not a magic bullet for people with disc pain. Sometimes, the pain doesn’t go away. The pain may even become worse. This study may shed some light on why some patients get relief and others don’t.

One theory behind this treatment is that bending the spine backwards squeezes the disc material forward, away from pain-sensitive soft tissues like the nerves and ligaments. A second theory has to do with pain from pressure on the back part of the disc. The disc is made up of a central nucleus pulposus, surrounded by rings of ligament-like material known as the annulus. The outer rings of the annulus are richly supplied with pain sensors, so injury or pressure on this part of the disc can hurt. If pain comes from the annulus on the back part of the disc, it makes sense that getting pressure off these sore tissues would feel better.

To measure disc pressure in various positions of the spine, a team of researchers tested the discs of 19 cadaver spines. To make the tests more life-like, the discs were altered to behave as though they were degenerated. Backward bending works differently when the discs are degenerated because the spine tends to pivot on the joints along the back of the spine. This shifts the forces onto the bony ring of the vertebra and can take pressure off the back part of the disc. 

A key discovery is that backward bending didn’t always take pressure off annular rings near the back of the disc. In fact, when the spines were bent back two degrees, only seven out of nine spines showed less pressure. Discs that registered lower pressures in a neutral position tended to have less pressure on the annular rings near the back of the disc when the spine was bent backward.

These differences might explain why some people get better with extension exercises and others don’t. “The results,” say the authors, “caution against making predictive rules based on anatomic or pathologic assumptions.” In other words, patients are unique, and their symptoms may react differently to lumbar extension exercises.

Many clinicians who treat patients with chronic low back pain believe their patients need to do conditioning exercises for the heart and lungs. They believe these patients limit activity because of their pain, which leads to poor overall fitness. So patients with chronic low back pain are generally prescribed exercises to improve their aerobic stamina.

The first part of this study involved forming an equation to predict fitness levels in people with chronic low back pain. The authors then tested the long-held notion that these patients are generally less fit. The new formula showed that people with chronic low back pain had similar scores when compared with subjects who don’t have pain. The authors found that the patient group with chronic low back pain is “moderately fit” and not significantly deconditioned as commonly thought. However, the authors still suggest that people with chronic low back pain should be given aerobic conditioning exercises in order to help improve their overall ability to do their activities. 

When the fire of low back pain burns out of control, it may be time to fight fire with fire. A newer surgical treatment for disc problems called intradiscal electrothermal therapy (IDET) may come to the rescue. This type of procedure shows promise as an alternate treatment for people with bad back pain.

In IDET, doctors use a TV screen to guide a special needle into the sore disc. They then slip a heating element through the needle and into the injured zone. When the temperature of the element is raised, it is believed to shrink disc material, reducing a bulge or closing off a torn portion. It also seems to have a calming effect on pain sensors within the sore disc.

Doctors recently tested the benefit of this kind of treatment. They chose 25 patients with chronic low back pain who were having problems after at least six months of non-operative treatments. These patients were considered to be candidates for lumbar fusion surgery, but instead they chose to undergo the IDET procedure.

Before having IDET, they rated their pain  on a scale between zero and 10. They also filled out a form about their ability to function on a day-to-day basis. The authors checked back with the patients an average of seven months after surgery to measure their new pain and functional levels.

The surgery made a measurable difference. The pain levels of nineteen patients (80%) went down at least two points on the 10-point pain scale. Eighteen patients (72%) either stopped using pain pills or were able to get by with significantly less medication. They also reported improvements in being able to sit for longer time periods. The authors also found that patients who went through IDET treatment used less pain medication.

Future studies are needed to confirm this preliminary report. Yet these results suggest that IDET will likely become helpful way to extinguish the fire of chronic low back pain.