by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
Information, in part, from the Arthritis Foundation
While strain and sprain are the most likely cause of spine pain in younger people, the most common cause of spine pain in people past the age of 50 is probably arthritis.
Spine pain, particularly in the low back, is most common in the 40 to 70 year old age group. Up to 90 per cent of people will have an episode of neck or low back pain at some point in their lives.
While most patients will recover from their episode, about ten per cent will go on to develop chronic spine problems.
The amount of money spent on spine pain due to arthritis, including the cost of treatment, legal, and economic (days lost from work, etc.) is enormous and estimates run as high as 50 billion dollars annually.
While the cause of back pain is usually benign, it's important to eliminate the more serious causes of low back pain such as tumor, infection, aortic aneurysm, or fracture.
The spine is comprised of a stack of vertebrae, each separated from the other by a disc containing a soft center that acts as a cushion. The vertebrae and discs are supported by a complex series of muscles, ligaments, and tendons. The spinal cord runs down through a central canal in the vertebral column. At each disc level, the spinal cord sends out a pair of nerve roots- one to each side. These nerve roots provide innervation to the upper trunk and arms for the cervical spine and the hips and legs for the lumbar spine.
Spine pain is caused by a number of different problems including trauma, inflammation, degenerative and mechanical processes, infection, and malignancies. Approximately, 90 per cent of patients have a mechanical problem accounting for their spine pain.
In most cases of back pain, a history of trauma, repetitive motion, or other activity is found. Sometimes the episode is relatively trivial. A patient may state they were “just leaning over the sink and brushing my teeth”, or “just bending over to pick up the newspaper”, or "I was just turning my head to view oncoming traffic."
Strain refers to pain due to unexpected stretching of muscles or nerves. Multiple causes for strain include repetitive motion, unexpected movement, lifting, and twisting of the trunk. Physical examination will reveal limited range of motion, significant muscle spasm, and tenderness of the muscles that lie alongside the spine.
Factors predisposing to strain include occupations or hobbies that cause repetitive motion in the spine, obesity, deconditioning, poor posture, and prolonged exposure to vibration (heavy equipment operators).
Another key point is that the spine shares an interdependent relationship with the hips, knees, ankles and feet. So... any problem occurring lower down will eventually lead to low back problems and, subsequently, neck problems. An example would be a patient with a significant leg length discrepancy.
Structures in the spine that are often responsible for pain syndromes are the discs and the facet joints. The discs can herniate – i.e., the gel inside the disc extrudes causing pressure on the nerve root. The discs can also degenerate and cause nerve root pressure. The facet joints can develop arthritis and cause nerve root irritation as well.
Significant arthritis in the spine either in the facet joints or in the disc can lead to narrowing of the spinal canal – a condition called spinal stenosis. Spinal stenosis pain is aggravated by standing, walking, or extension of the spine.
"Radiculopathy" is used to describe a “pinched nerve.” Radiculopathy symptoms include pain, numbness, tingling, and weakness. If a radiculopathy is present in the cervical spine, the radiculopathy symptoms will present in the neck, upper chest and back, and down the arms.
Radiculopathy in the low back is termed “sciatica.” Sciatica is pain that radiates into the buttock and down the outside of the leg. This is due to pressure on a nerve root from either disc disease or arthritis in the facet joint... or both. Sciatica due to disc herniation is aggravated by sitting or bending forward.
Sometimes low back pain will radiate down the front of the thigh. It is important to rule out hip disease, inguinal hernia, pressure on the femoral nerve, aneurysm of the aorta, and kidney disease.
Unusual symptoms that are a tip off to more serious problems include pain at night that interferes with sleep (malignancy), pain and stiffness in the morning (ankylosing spondylitis), pain accompanied by fever or weight loss (infection or tumor), back pain accompanied by numbness in a “saddle distribution” and loss of bladder/bowel control (cauda equina syndrome – pressure on all the nerve roots in the lower part of the spine- this is a neurosurgical emergency!)
Physical examination should evaluate range of motion, the presence or absence of muscle spasm, the presence or absence of nerve root compression signs, deep tendon reflexes, and muscle strength.
A careful examination of organ systems is mandatory to exclude the less common causes of low back pain in patients where the history is suspicious.
The laboratory may be useful in the workup to exclude systemic causes of spine arthritis.
Electrical testing can determine the presence of radiculopathy (pinched nerve).
Many spine arthritis syndromes don’t have x-ray findings, and the majority of older patients will have x-ray abnormalities that are not symptomatic.
CAT scanning and magnetic resonance imaging are more sensitive and specific.
Spine pain treatment is dependent on diagnosis. For the 90 per cent of patients who have mechanical spine pain, a number of modalities work. For acute spine syndromes, bed rest for 24 to 48 hours may be helpful. No longer... since prolonged bed rest is detrimental.
Aggressive physical therapy is often helpful. Spinal manipulation (chiropractic) may be beneficial as well.
Specific stretching and strengthening exercises accompanied by non impact aerobic exercise is one of the more helpful modalities.
Anti inflammatory drugs and muscle relaxants are useful in alleviating symptoms.
For patients with chronic problems, a number of modalities have been used with varying degrees of success. Soft tissue and epidural injections are often helpful. Transcutaneous electrical nerve stimulation (TENS) has also been used with some success.
Prolotherapy has its advocates for patients who have ligamentous abnormalities.
Recent studies have also shown botulinum toxin injections may be helpful for patients with mechanical back problems associated with muscle spasm.
Surgery is indicated for patients who have intractable pain with a well-defined anatomic reason for the pain and who have a progressive neurological deficit.
Get more information about spine arthritis and related topics as well as...
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Second Opinion Arthritis Treatment Kit
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