Back Pain

Upper back pain (also known as mid-back pain)

Lower back pain is one of the main reasons Americans visit their doctor. For adults over 40, it's the 3rd cause for doctor visits after heart disease and arthritis. 80% of people will have lower back pain at some point in their lives. Nearly everyone suffering from lower back pain once will have it again. Americans spend at least $100 billion each year on lower back pain treatment. Back pain is a complex issue because there is no single way to treat it. It takes depth of understanding and skill to treat back pain successfully.

ANATOMY

The spine is made of 24 small bones (vertebrae) that are stacked on top of each other to create the spinal column. Between each vertebra is a soft, gel-like, cushion called a disc that helps absorb pressure and keeps the bones from rubbing against each other. Each vertebra is held to the others by groups of ligaments. Ligaments connect bones to bones; tendons connect muscles to bones. There are also tendons that fasten muscles to the vertebrae. The spinal column also has real joints (just like the knee or elbow or any other joints) called facet joints. The facet joints link the vertebrae together and give them the flexibility to move against each other.

Each vertebra has a hole in the center, so when they stack on top of each other they form a hollow tube that holds and protects the entire spinal cord and its nerve roots. The spinal cord itself is a large collection of nerve tissue that carries messages from your brain to the rest of your body. In order for your body to function, you need your nerves. The spine branches off into thirty-one pairs of nerve roots. These roots exit the spine on both sides through spaces (neural foramina) between each vertebra.

The spine itself has three main segments: the cervical spine, the thoracic spine, and the lumbar spine. There is another important part of the spine whish has tremendous influence but often ignored is Sacrum and pelvis. The cervical and lumbar spine are the most mobile segments and most problems are often seen there. The spine is a highly complex, mobile structure, which gets most of its stability from the muscles surrounding it.

Back pain can be:

  • .Acute: lasting less than 3 months. Most people gain relief after 4 to 6 weeks of home treatment.
  • Recurrent: a repeat episode of acute symptoms. Most people have at least one episode of recurrent lower back pain.  
  • Chronic: lasting longer than 3 months.  

Symptoms of Back pain:

Back pain can present in variety of ways, Pain can be constant or intermittent. Intensity can vary from a dull ache to searing agony. The onset may be sudden, with or without apparent reason, or gradual. Depending on cause it may start as dull ache turning in to a stabbing pain.

Pain in the back can be referred from other internal organs or structures. Most of the back pain coming from musculoskeletal system (from muscle and skeleton) is mechanical in origin. Pain can come from a single source/structure or a combination of sources/structures.

Some conditions and structures that cause back pain:
Cervical spine: Neck pain, Headache, Bulging disc, spinal stenosis
Thoracic spine: Upper back pain
Lumbar spine: Bulging disc, sciatica, spinal degeneration, Spinal stenosis, piriformis syndrome
Sacroiliac joint dysfunction

Most back problems will get better without any intervention. The key is to know when you need to seek medical help and when self-care measures alone will allow you to get better. When medical help is necessary, the decision of which treatment option to use can be difficult since there are so many to choose from. We are here to clear up some myths from the truth and give you some facts based on evidence and research which will empower you to make the right decision.

10 Myths about Lower Back Pain

Myth 1: If your back hurts, you should take it easy until the pain goes away.

Fact: People who remain active despite acute back pain do better, experience less future chronic pain (more then three months) and use fewer healthcare services than those who rest and wait for the pain to diminish. Modify your activities when needed, but stay active.

Myth 2: Bed rest is the best for back pain.

Fact: Patients who treat with bed rest miss more work due to back pain. After three weeks or three months, there is no difference in pain relief, days of limited activity, daily functioning or satisfaction with care. Continuing with regular daily activity has proven to give the fastest recovery when experiencing acute lower back pain. Modifying activities is appropriate, but keep moving! Only if really needed, one or two days of bed rest can be appropriate.

Myth 3: Injuries or heavy lifting causes most back pain.

Fact: Heavy lifting or injuries are risk factors, but do not account for most episodes. Many patients do not seem to remember a specific incident that brought on the pain, "it just seemed to happen." With spontaneous recovery being the rule, pinpointing an exact cause may not even be necessary in most cases.

Myth 4: Back pain is usually disabling.

Fact: Fear that activity will make the situation worse and delay recovery is unfounded. Actually, patients with acute back or neck pain who continue routine activities as normal as possible do better than those who try either bed rest or immediate exercise.

Myth 5: Tests (X-ray, CT-Scan and MRI) can always identify the cause of a person's pain.

Fact: Large numbers of pain-free people show spine abnormalities on X-rays, MRI and CT-Scans. People who have never experienced back pain or sciatica (leg pain from a back pain condition) demonstrate in 20-30% of the cases a herniated/bulging disk on a MRI. Spinal stenosis, which is rare in younger adults, occurs in about one fifth of the over-60, pain-free group. Detecting an abnormality on an imaging test only proves one thing: the patient has a spinal abnormality! (The relationship between abnormality and pain always needs to be established).

Myth 6: Everyone with back pain should have some form of imaging (X-ray, MRI, and CT-Scan) before starting any kind of treatment.

Fact: Most patients with acute back pain simply will get better on their own (about 90 percent). Many physicians now advocate imaging tests (after serious conditions are ruled out) only for those patients that fail to recover naturally and after conservative management. The imaging should always support the physical examination findings in order to consider further intervention. An example of conservative management is specialized physical therapy like we provide at Synergy Therapeutic Group. Don't forget, at  STG we treat the impairment, not the imaging.

Myth 7:  If you have a herniated/ruptured disk, you must have surgery.

Fact: According to a new study that questions the need to operate on disk injuries, people with herniated disks in their lower backs usually recovered eventually without surgery. Therefore, in most cases, there is no harm in waiting and choosing non-operative approaches.

This study appears in the November 22-29 issue of the Journal of the American Medical Association (JAMA) and is the only large and well-designed trial to compare surgery for Back Pain and Sciatica relief with non-surgical, non-invasive options such as physical therapy methods, waiting, and anti-inflammatory drug use.

Patients are often told that if they delay back surgery they may risk permanent nerve damage, perhaps a weakened leg or even risk losing bowel or bladder control. But nothing like that occurred in this two-year study comparing surgery with preferring to wait and choose non-invasive techniques, in nearly 2,000 patients who suffer from back and leg pain due to herniated disks and sciatica.

The study involved 13 spine clinics in 11 states. The treatment was decided at random. Patients who did not have surgery generally received different non-invasive treatments.
Most specialists agree that surgery is only appropriate when there is a combination of:

  • definite disc herniation on an imaging test  
  • orresponding physical examination findings, e.g. signs of nerve root irritation ( sciatica, pinched nerve in neck/back)  
  • .failure to respond to non-surgical treatment (at least eight weeks) (e.g. specialized Physical Therapy, as we provide at ('Synergy Therapeutic Group') 

Studies show that the disc shrinks naturally over time: about 90% of patients will experience gradual improvement over six weeks, leaving only ten percent of patients with a symptomatic disk herniation who might require surgery.

Consider all options

Before you agree to back surgery, consider getting a second opinion from a qualified spine specialist. Back and leg pain can be a complex issue that may require a team of health professionals to diagnose and treat. To prevent recurrent back problems, use good body mechanics, keep your back muscles conditioned with regular exercise and stretching and control your weight.

Myth 8:  Managing lower back pain with drugs is both an effective and inexpensive alternative to surgery.

FACT:  Pain relief drugs have a lot of negative side effects, including new injuries, while the pain is artificially disguised.

MYTH 9: I have to go back to the chiropractor regularly to stay pain free.

FACT:   After initial treatments are over you should be able to self manage your condition and symptoms. If you have to go back again and again to get some relief then the treatment was not right for you.

MYTH 10: Physical therapy didn't work before, why will it work now?

FACT:  Back pain is a complex issue. Though somebody has back pain it may not be from the spine. Source and structure causing back pain must be identified to produce great result. When you go to a traditional physical therapist, the chance of having immediate results are slim. Since 90% will get better no matter what type of therapy they get, we are talking about the last 10%. Here at STG we treat the cause, not the symptoms and in the process we produce the best technology and best techniques available.

Research has shown that most back pain that does not go away after traditional, conservative treatment. Relief usually comes from one of three structures in the back: the facet joints, the discs or the sacroiliac joint and its surrounding soft tissues (internal as well as external). The above structures are inter-related. Affecting one may affect the others but often bulging discs are thought to be a more valid consideration as a source of pain as we are able to see them in imaging such as MRI's. We are expert in treating back conditions which did not get better with traditional physical therapy, shots or previous surgeries.

My pain was about an 8 or 9 on a scale of 10. After 16 treatments when I left the office the last time it was a 0. This is after about 20 years of back pain. (John, DuQuoin, IL)

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the valuable opinion of your health care professional. You should always talk to your licensed health care professional for diagnosis and treatment.

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