introduction to back pain and neck pain

8/14/2019 Introduction to Back Pain and Neck Pain

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Introduction to back pain and neck pain

Back pain is as much a part of the human condition as the common cold. In fact,eight out of ten adults will experience an acute episode of back pain at somepoint in their lifetime. Back pain is the second most common cause of missed

workdays due to illness and the most common cause of disability.Fortunately, most episodes of back pain resolve with time: approximately 50%of patients will experience relief within two weeks and 90% within threemonths.While most episodes of back pain are self limited, !" to#$" of cases willbecome chronic. %hese chronic conditions account for &$" of the healthcareexpenditures for back pain and amount to '!$ to '($ billion dollars annually.)any different structures in the back and neck are capable of producing pain.%here are the large nerve roots that go to the legs and smaller nerves thatinnervate *supply the nerves to+ the spine itself. %he large paired back musclesmay be strained, and the bones, ligaments and oints may be in ured.In general, pain does not mean that there is actual tissue damage. -ven if the

pain is severe, there rarely is ongoing tissue damage. )ost pain syndromes aredue to inflammation, especially in the acute phase, which typically lasts for twoweeks to three months.%here are two instances in which pain is an indicator of nerve damage:

bowel and or bladder incontinence progressive weakness in the legs

%hese symptoms constitute a medical emergency and medical treatment shouldbe sought immediately. %he symptoms may be due to nerve pinching, and if nottreated immediately, the damage maybe permanent. Fortunately, this conditionis extremely rare.%ypically, younger individuals */$ to 0$ year olds+ are more likely to experience

back pain from the disc space itself *e.g. lumbar disc herniation or degenerativedisc disease+. 1lder adults *e.g. 0$ year olds and above+ tend to suffer fromdegeneration of the oints in the back *e.g. facet oint osteoarthritis+.By: Peter . !llrich" #r." $September 8, 1999Updated February 28, 2001

&ext: Introduction to common causes

Introduction to common causes of back and neck pain

Fortunately, most episodes of back pain will heal with time: approximately !$"of patients will feel relief from low back pain within two weeks, and

approximately &$" within three months, regardless of the treatment.%he ma ority of episodes of acute low back pain are due to a muscular strain andthese will usually resolve with time because muscles have a good blood supply tobring the necessary nutrients and proteins for healing to take place.'umbar spineFor patients with low back pain that lasts longer than three months, or patientswith predominantly leg pain, a more specific and definable problem for the painshould be sought. %here are several very common causes of low back and legpain:
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In youn(er adults *2$ 0$ year olds+ the disc is likely to be the pain generatorand conditions may include:

3umbar disc herniation 4egenerative disc disease Isthmic spondylolisthesis

In older adults *over 0$ years old+, the source of pain is more likely to be thefacet oints or osteoarthritis and conditions may include:

Facet oint osteoarthritis 3umbar spinal stenosis 4egenerative spondylolisthesis

In addition to the above, there are several miscellaneous causes of back pain.)er*ical spineWhile cervical *neck+ pain is less prevalent than lower back pain, there areseveral conditions that may cause pain, including:

4isc herniation

Foraminal stenosis 5tenosis with myelopathy 6ervical osteoarthritis 6ervical degenerative disc disease

7dditionally, there are several miscellaneous causes of upper extremity painrelated to cervical conditions.By: Peter . !llrich" #r." $September 8, 1999Updated February 28, 2001

&ext: 'umbar disc herniation

'umbar disc herniation

7s a disc degenerates, it can herniate *the inner core extrudes+ back into thespinal canal. %he weak spot in a disc is directly under the nerve root, and aherniation in this area puts direct pressure on the nerve, which in turn can causepain to radiate all the way down the patient8s leg to the foot *see Figure # +.7pproximately &$" of disc herniations will occur at 39 3! *lumbar segments 9and !+ or 3! 5# *lumbar segment ! and sacral segment #+, which causes pain inthe 3! nerve or 5# nerve, respectively.

'5 ner*e impin(ement can cause weakness in extension of the big toeand potentially in the ankle *foot drop+. umbness and pain can be felt ontop of the foot, and the pain may also radiate into the buttocks.

+, ner*e impin(ement may cause loss of the ankle reflex and orweakness in ankle push off *e.g. patients cannot do toe rises+. umbnessand pain can radiate down to the sole or outside of the foot *see Figure2 +.

In most cases, if a patient8s low back and or leg pain is going to resolve it will doso within about six weeks. While waiting to see if the disc will heal on its own,several conservative treatment options can help reduce the pain and discomfort.
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;hysical therapy 1steopathic chiropractic manipulations on steroidal anti inflammatory drugs * 57I4s+ 1ral steroids *e.g. prednisone or methyprednisolone+ 7n epidural *cortisone+ in ection

If the pain continues after six weeks, it is reasonable to considermicrodiscectomy surgery as an option to alleviate the pain. 7 microdiscectomyessentially acts as a microdecompression of the nerve root to provide the nervewith a better healing environment.


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people over the age of 0$ have degenerated discs, it is highly uncommon forthem to suffer from degenerative disc disease.-reatment optionsFor most people, degenerative disc disease can be successfully treated withconservative care. )ost patients will experience low grade continuous buttolerable pain that will occasionally flare *intensify+. %he fre=uency and intensityof the flares can be managed with an exercise program that consists of:

hamstring stretching dynamic lumbar stabili?ation exercises low impact aerobic conditioning

on prescription medications, such as 57I4@s and acetaminophen, may behelpful in alleviating low back pain, and stronger therapies, such as oral steroidsor epidurals, may be prescribed to treat severe flares.For patients who are unable to function because of the pain, or who arefrustrated with their activity limitations, lumbar spinal fusion surgery is anoption. Fusion surgery works because it stops the motion at a painful motionsegment.7 one level fusion does not significantly change the mechanics in the back, and atwo level fusion may also be considered for patients with severe, disabling pain.%hree level fusions change the mechanics of the back substantially and are notrecommended *the back is designed for movement, and limiting the movementand altering the muscle composition can in and of itself cause pain+.When performed udiciously by an experienced surgeon trained in doing fusionsurgery, a fusion surgery can be an effective option for patients to enhance theiractivity level and overall =uality of life. ;articularly now that minimally invasivetechni=ues *73IF with anterior interbody cages+ are available to do the fusion,the surgery carries little morbidity *eg. post operative discomfort+, saves moreof the normal anatomy of the low back, and has a high rate of fusion.By: Peter . !llrich" #r." $September 8, 1999Updated February 28, 2001Back to common causes &ext: Isthmic spondylolisthesis

Isthmic spondylolisthesis

5pondylolisthesis is a 3atin term for slipped *ertebral body . Forapproximately !" of the population, a stress fracture occurs *usually betweenthe ages of five and seven+ in the lowest lumbar vertebral segment *3!+. 7s aresult, the 3! vertebral body slips forward on the 5# *sacral #+ vertebral body.%his process is almost never due to trauma *see Figure # +.

%his occurrence often results in no noticeable symptoms, and probably ($" ofpeople never even know they have the problem. In the 2$" who do develop lowback pain, their pain is usually due to disc de(eneration in young adulthood.Without the stabili?ing effect of the bony arch, the disc is forced to work harderto resist shear forces *forward subluxation+. %he disc is designed to function veryeffectively in compression, but tends to break down when shear forces areapplied to it.;ain can also come from the fracture itself, and the reparative tissue within maybecome irritated and generate pain.
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7lthough low back pain is usually the predominant symptom, some patientsexperience leg pain due to nerve pinching. %he leg pain will generally be worsewhen the patient stands or walks, and it is almost always the 3! nerve that ispinched.For the most part, both the conservative and surgical treatments are identical toboth treatments for de(enerati*e disc disease .By: Peter . !llrich" #r." $September 8, 1999Updated February 28, 2001Back to common causes &ext: acet /oint
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introduction to back pain and neck pain

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