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Sat 06th Sep,2008   
Causes of Back and Neck Pain
MYOFASCIAL PAIN SYNDROME

Trigger points are “taut bands” of muscle tissue that are formed after an overstretch injury. A trigger point is actually the formation of fibrous bands of collagen as a result of tearing of muscle fibers. The fibers are scar tissue that are not as extensible as regular muscle tissue. A trigger point is actually a “knot” that is felt deep in muscle tissue. They are very common in the neck, back and shoulders but may be found anywhere in the body. The trigger point results in a local pain in the muscle tissue with a typical pattern of referred pain. Many times the muscle becomes spastic and numbness in the limb, hand or foot may occur as a result. It is important to distinguish these from pinched nerves. Trigger points are a disorder known as Myofascial Pain Syndrome.

CAUSES OF NECK PAIN

WHIPLASH is the movement of the head forwards and backwards stressing the neck, as a result of trauma. It is most common after car accidents. Most often it occurs after rear ended collisions and the symptoms center around the neck region. This usually resolves rapidly but may become chronic and disabling from pain.

Signs and Symptoms:
· Suffer first few days
· Neck pain and stiffness of muscles
· Headaches and Dizziness
· Ringing of ears and Blurred Vision
· Pain in shoulders or arms
· Numbness in arms

Treatment Types:
· Soft Cervical Collar
· Ice
· Gentle early Range of Motion
· Pain medication including anti-inflammatories/muscle relaxers
· Physical therapy, traction, massage, ultrasound, injections

 CERVICAL RADICULOPATHY is an injury or irritation to the root of the nerve in the neck as it exits from the vertebrae. The nerve root symptoms in the neck cause neck pain which radiates down the arm towards the hand on the right or left. It could result in weakness or numbness in the affected area. It could be caused by a tight spinal canal or stenosis, or from a disc that is displaced and compressing the nerve as it exits.

Signs and Symptoms:
· Pain in neck, arms or hands
· Numbness
· Weakness

Treatment Types:
· Rest
· Medication
· Manual/manipulative therapy
· Pain management
· Diagnostic testing

 CERVICAL SPONDYLOSIS is a degenerative condition like arthritis most often seen in the older population. It occurs when the bones degenerate over time forming small bony spurs and thinning of the discs. The spinal canal can tighten causing spinal stenosis and press on the nerves in the neck and spinal cord. There are more injuries with this condition.

Signs and Symptoms:
· Neck pain and stiffness
· Pain radiating to the arms and hands
· Muscles spasms in the neck
· Grinding or crackling sound when moving neck
· Weakness in the arms
· Numbness in the hands

Treatment Options:
· Mostly non-surgical
· Pain medications including anti-inflammatories
· Neck bracing
· Therapy and Pain management

 CERVICAL SPRAINS are Neck sprains. This result when moving the neck in any one direction too rapidly or unexpected movements result in stretching the neck beyond a comfortable limit. The most common cause is a low to mid level trauma causing the neck to stretch to an extreme position. The soft tissues such as muscles, ligaments and tendons are the parts that actually are overstretched.

Signs and Symptoms:
· Pain back of neck or Shoulders
· Worsens with movement, has poor Range of Motion
· Headaches and stiffness
· Numbness of the hand or fingers

Treatment Options:
· Neck collars
· Pain medications
· ICE
· Therapy and Pain management
· Acupuncture
· Most resolve in less than one month

 HERNIATED DISCS aree sometimes known as a "slipped" or "ruptured" disk. Herniated disk refers to a condition in which pressure is exerted on the on nerves in the neck by one or more disks, resulting in neck pain. Disks are soft, gelatin like pads found between the bones (vertebrae) that make up the spinal column. The spinal column encases the spinal canal, a hollow space that contains the spinal cord and other nerve roots. The disks between the vertebrae allow the neck to flex, rotate or bend, and function as shock absorbers. Each disk contains a gel-like substance called the nucleus. A disk herniates or ruptures when part of the center nucleus pushes the outer edge of the disk into the spinal canal, exerting pressure on the nerves. Ruptures can occur as a result of injury, normal wear and tear associated with aging, improper lifting and excessive weight.

Signs and Symptoms:
· Sharp shooting pains down the arm
· Pain may extend to the hand and fingers
· Pain in the neck
· Neck stiffness
· Weakness in the arms or hands
· “pins and needles” in the arms to fingers
· worsening of pain with certain neck motions

Treatment Options:
· bed rest initially no more than 2 days
· pain medications
· muscle relaxers
· ICE compresses during muscle spasms
· Modalities and Physical Therapy
· Acupuncture
· Epidural spinal injections
· Surgery if conservative treatment fails

CAUSES OF LOW BACK PAIN

ACUTE BACK PAIN frequently results from an injury, accident or trauma when the body unexpectedly changes positions. It usually lasts several days to several weeks. Chronic low back pain lasts for at least 3 months and having at least 3 recurrences. Management of low back pain depends on the cause and duration of pain after an extensive evaluation.

BACK BASICS

The back is made up of vertebra which are large cuboidal shaped bones, which are separated by disks. The discs are soft rubbery material which act as shock absorbers.

The spinal cord courses through the vertebrae and 31 pair of spinal nerves exit between vertebrae. There are many muscles and ligaments that help support and mobilize the spine. It is many of these small soft tissues that can be major causes of pain. The abdominal muscles help support from the front side of the body. When there is an imbalance of support between the front and back, the extra stress on the back causes pain. Usually an overweight person with a distended or protuberant abdomen may experience more frequent episodes of pain compared to one with strong abdominal musculature.

Back pain is the most common reason for physician or emergency room visits in the United States followed by the common cold. About 80% of people experience back pain at some point in their lives and most are recurrent. There are several bone disorders that are associated with pain, including: different types of arthritis, spinal deformities such as scoliosis, slipped vertebrae or osteoporosis. Most of low back pain is mechanical in nature and most people do not require surgical intervention. It is extremely important for those with persistent or recurrent back pain to undergo a thorough medical evaluation. There are many non-mechanical medical causes of back pain. Some of these medical causes of back pain may be life threatening. These include gastric ulcers, kidney stones, dissecting aneurysms, prostate cancers, bone cancers, spinal tumors, rectal tears and esophagus lesions. It is important that many of these medical conditions are ruled out prior to initiating treatment for back pain. It can actually be dangerous delaying evaluation or starting treatment without evaluation. For example applying deep heat to tumors may promote tumor growth.

A physician diagnoses low back pain by taking a detailed medical history, performing a physical examination, and possibly ordering diagnostic testing. The doctor may order blood tests to determine whether the low back pain is caused by another disorder that may cause similar symptoms. Computed tomography (CT), magnetic resonance imaging (MRI), or a bone scan may be performed if the doctor needs a clearer picture of the bones or nerves, the disks between the vertebrae, and other soft tissue. An X-ray only provides a limited picture of the bones without any detail of soft tissue. Frequently plain x-rays are not ordered unless a fracture or poorly healing surgical fusion is suspected. Sometimes an electrodiagnostic evaluation can provide important data about pinched nerves. The nerve and muscle testing can determine if a pinched nerve has caused any damage. It can also be useful to help predict the expectations after a possible surgery. This is most often done if there is a radiating pain, tingling, numbness, weakness or muscle shrinkage.

After all possible medical conditions which cause back pain are eliminated, some of the common causes of mechanical or neuromusculoskeletal dysfunction are listed below. There are many different types of treatment. No one treatment protocol should be used for all patients. Many centers have different theories regarding treatment. The treatment plan designed at SPINE OPTIONS is carefully thought out after a thorough evaluation. Each patient benefits from a different combination of medication and/or treatment/therapy modalities. The team discusses each patient as they progress through the program to allow adjustments in the treatment.

LUMBAR HERNIATED DISC is sometimes known as a “slipped” or “ruptured” discs. A condition in which pressure is exerted on the nerves in the back by one or more disks. This results in back pain frequently traveling down the legs. Disks are soft, gelatin-like pads located between the hard bones (vertebrae) that make up the spinal column. The spinal column encases the spinal canal, a hollow space that contains the spinal cord and other nerve roots. The disks between the vertebrae allow the back to flex, rotate or bend, and function as shock absorbers. Each disk contains a gel-like substance called the nucleus. A disk herniates or ruptures when part of the center nucleus pushes the outer edge of the disk into the spinal canal, exerting pressure on the nerves. Ruptures can occur as a result of injury, normal wear and tear associated with aging, improper lifting and excessive weight.

Signs and Symptoms:
· Shooting pain into the buttocks or Sciatica
· Local severe back pain
· Burning in the back
· Weakness in one leg
· Changes in bowel or bladder activity
· Lack of sensation in one leg
· “pins and needles” in one leg

Treatment Options:
· bed rest for no more than 2 days
· muscle relaxers
· pain medications
· ICE early on for muscle spasms
· Heating modalities
· Physical therapy/Acupuncture/Massage Therapy
· Electrical Stimulation
· Laser therapy
· Epidural spinal injections
· Surgical evaluation if conservative treatment fails

LUMBAR RADICULOPATHY is an injury or irritation to the root of the nerve in the back as it exits from the vertebrae. The nerve root symptoms in the back cause back pain which radiates down the leg towards the foot on the right or left. It could result in weakness or numbness in the affected area. It could be caused by a tight spinal canal or stenosis, or from a disc that is displaced and compressing the nerve as it exits.

Signs and Symptoms:
· Pain in back, leg or foot
· Numbness
· Weakness

Treatment Types:
· Rest
· Medication
· Manual/manipulative therapy
· Pain management
· Diagnostic testing

SCIATICA is a sharp, often shooting pain that radiates down from your buttock to the back of one thigh and into your leg. It occurs when a protruding disk in your lower spinal column presses on the roots of your sciatic nerve. It often feels like a stabbing pain deep in the buttock and worse with sitting. The large sciatic nerve can also be compressed in the deep muscles of the buttock. The nerve may also become irritated by the chemicals found inside of the disc. The large nerve is formed by the nerve roots in the lowest part of the spine, and it is as big as a garden hose. Most sciatica is recurrent and most often it may be resolved without surgery. It is also a type of lumbar radiculopathy or “pinched nerve”.

Signs and Symptoms:
· Stabbing pain in the buttock
· Back pain going down one leg
· Leg cramping
· Pain in one leg or both buttocks
· Numbness in the leg to the foot
· Burning pain down the back of the leg
· Symptoms worsening with sitting, coughing, sneezing

Treatment Options:
· First relieve the inflammation with medications
· Apply heat or cold to release spasms and reduce pain
· Use muscle relaxers for spasms
· Relative rest for a few weeks
· Cortisone injections
· Stretching exercises
· Heating modalities including laser therapy
· Physical therapy

 SPINAL STENOSIS occurs when the spinal canal, which encases and protects the spinal cord and nerve roots, narrows and pinches the spinal cord and nerves. The result is low back pain as well as pain in the legs. Stenosis may pinch the nerves that control muscle power and sensation in the legs. This is usually a slow process which occurs over many years and is related to arthritis. The process occurs with aging and results in thickening of the ligaments, formation of bone spurs and deterioration of the disc material.

Signs and Symptoms:
· Local midline back pain going into legs
· Difficulty walking
· Stooped posture
· Numbness in the feet
· Weakness in the legs
· Decreased walking tolerance
· Falls
· Early muscle fatigue with exercise
· Heaviness of legs

Treatment Options:
· Usually conservative (non-surgical)
· Posture exercises
· Pain medications
· Relative rest between activities
· Strengthening exercises
· Aerobic exercises
· Epidural spinal injections

 SPONDYLOLYSIS is a stress fracture in one of the bones (vertebrae) that make up the spinal column. It usually affects either the fourth or the fifth lumbar vertebra in the lower back and is the most common cause of low back pain in adolescent athletes. It is most common in active athletes such as gymnasts, weightlifters, football players or dancers. It may also be hereditary making you vulnerable to having fractures from weak bones. It is most often as a result of overstretching or hyperextending. It results in a severe localized pain.

SPONDYLOLISTHESIS is caused by a slippage of the vertebrae out of alignment. It is graded by degree based on a percentage of slippage. It is frequently a result of stress fractures in young people which results in weakness between the bones. In older patients it is a result of degeneration of the disks which allows the vertebral bones to slip. With a large slippage the bones may start to press on nerve roots, the spinal canal or painful structures.

If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to slip out of place. This condition is called spondylolisthesis. In adults, is usually caused by degenerative disk disease and often affects women over 40 years of age. If too much slippage occurs, the bones may begin to press on nerves and surgery may be necessary to correct the condition. Rapid growth alone may cause slippage in the younger population.

Signs and Symptoms:
· May be a slight back pain
· Pain spreads across the lower back
· Muscle spasms
· Tightening of the hamstrings
· Back stiffness
· Difficulty walking
· Compression of nerves if significant
· Changes in posture

Treatment Options:
· Rest from activity until symptoms resolve
· Pain medications
· Use of a back brace temporarily
· Physical therapy for posture activities
· Strengthening of the back and abdominal muscles
· Regular monitoring of slippage by x-ray
· Spinal injections for pain and inflammation
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