What is low back pain?

The low back pain is a common complaint experienced by almost everyone at some point. The pain is felt in the lumbar region, the area that starts below the ribcage. The pain can be mild to severe and may last for days to months.

Causes

There are different possible causes of low back pain. These include lumbar strain, nerve irritation, certain conditions of the bones and joints, and lumbar radiculopathy.

Lumbar Strain

Lumbar strain is a form of stretch injury affecting the ligaments, tendons, and/or muscles of the lower back. It’s the most common cause of low back pain and may occur as a result of improper use, overuse, or trauma.

Nerve Irritation

Nerve irritation can occur as a result of impingement or mechanical pressure by bone or other tissues. It may also happen as a result of a disease that occurs anywhere along the nerve pathway – from the roots of the spinal cord to the skin surface.

Conditions of the Bones and Joints

Some of the bone and joint conditions that can cause lower back pain include scoliosis, spinal bifida, osteoarthritis, and osteoporosis.

Lumbar Radiculopathy

Lumbar radiculopathy is a condition caused by damage to the intervertebral disk. It can be a result of wear and tear, traumatic injury, or both.

Symptoms of Low Back Pain

The severity and quality of low back pain vary. It can be mild, moderate, or severe. It can be dull, achy, stabbing, or sharp type of pain, depending on the underlying cause.

Many people with low back pain find that their pain worsens with sitting, bending and lifting, standing, and walking.

The pain comes and goes and may extend to other areas such as the buttocks or the upper hip area.

Diagnosing Low Back Pain

Diagnosing low back pain involves a review of the patient’s medical history as well as a thorough physical examination. The doctor will review the patient’s injury history, other medical conditions, and symptoms felt including their duration and progression.

As part of the physical examination, the doctor may ask the patient to bend forward, backward, and side to side to determine pain and limitations in movement.

Nerve function of the lower extremities may also be checked. This involves checking of the reflexes, strength, and sensation of the knees and ankles.

To help confirm the diagnosis, the doctor may recommend additional tests such as X-rays, magnetic resonance imaging (MRI) scan, computed tomography (CT) scan, bone density test, and bone scan.

How It Is Treated

Treatment for low back pain depends largely on the underlying cause of it.

Treatment plans for low back pain fall into three different categories – medications, physical therapy, and surgery.

Medications

Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), narcotic pain medications, and steroids may be recommended to help alleviate the pain.

Physical Therapy

In many cases, medications are combined with physical therapy to provide relief to patients suffering from debilitating back pain.

Surgery

Surgery is only advised when the patient has tried the nonsurgical methods and still doesn’t find any improvement in their low back pain.

Spinal fusion and disk replacement are some of the surgical options for low back pain.

What is a Herniated Disk?

A herniated disk is a medical condition that involves the disks between the individual bones (vertebrae) that make up the spine. A disk is like a jelly donut. It has a softer center encased in a tougher exterior comprised of connective tissues. A disk can be found between each pair of vertebrae. They are responsible for absorbing shock and providing flexibility within the spine.

A herniated disk can happen if some of the softer part of the disk leaks or pushes out through a tear of its tougher exterior. It can be a result of aging, smoking, improper lifting, sudden pressure, repetitive strenuous activities, and excessive body weight.

Symptoms of a Herniated Disk

When the softer part of the disk pushes out, it can irritate the nearby nerves resulting in pain, numbness, and weakness on the arms or legs.

Pain is the most common symptom of a herniated disk. If it happens in the lower back, the pain can be felt at the lower extremities – the buttocks, thighs, and calves. In some cases, the pain can also be felt in some parts of the feet. If the herniated disk occurs in the neck, the pain is most intense in the shoulders and arms. The pain may be felt in other areas if the spine is moved in different positions or when one coughs.

There can also be numbness/tingling sensation and/or muscle weakness in the part of the body served by the affected nerves.

Diagnosing a Herniated Disk

A medical history and thorough physical exam will help in diagnosing a herniated disk. The physical exam is meant to determine which nerve roots are affected.

To confirm the diagnosis, the doctor may order a magnetic resonance imaging (MRI) scan to see clear images of the intervertebral disks.

How It Is Treated

Initially, a patient with the herniated disk is recommended for nonsurgical interventions. These include rest, over-the-counter pain medications, muscle relaxants, ice compress, rest, and easing of physical activities.

Only a small percentage of patients with the herniated disk is recommended for surgery. These are patients who don’t find any relief from nonsurgical interventions.

Surgical interventions for herniated disk include lumbar microdiscectomy (if the lower back is affected) and cervical discectomy and fusion (if the neck is affected).

What is Cervical Radiculopathy?

Cervical radiculopathy is a medical condition characterized by pain and/or neurological symptoms following a condition that irritates or compresses a nerve in the cervical spine (neck).

Also known as “pinched nerve,” cervical radiculopathy is often caused by “wear and tear” changes in the spine. This is often the case for older people. For younger people, cervical radiculopathy is often sustained from a sudden injury that results in a herniated disk. When the herniated disk bulges out towards the spinal canal, it can put pressure on the nerve root, resulting in pain and weakness in the areas supplied by the affected nerve.

Symptoms of Cervical Radiculopathy

Pain is the most common symptom of cervical radiculopathy. It spreads into the neck, arm, shoulders, chest, and/or upper back.

People suffering from pinched nerve experience different types of pain. Some describe their pain as dull, general pain while there are those who describe their pain as severe, burning, or sharp.

Aside from pain, cervical radiculopathy may also cause a tingling sensation, accompanied by muscle weakness and/or numbness in the fingers or hands. When there is muscle weakness and/or numbness in the fingers or hands, one may experience difficulty in gripping or lifting objects as well as doing day-to-day tasks such as eating or getting dressed.

Diagnosing Cervical Radiculopathy

Cervical radiculopathy is only diagnosed after discussing with the patient’s medical history and after a thorough physical examination. During the physical exam, the doctor performs tests to determine muscle weakness, loss of sensation, or change of reflexes on the neck, shoulder, arms, and hands.

Additional tests may be required to confirm the diagnosis. These include X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, and/or electromyography.

How It Is Treated

In many cases, patients with cervical radiculopathy get better without any form of treatment. Some have pain that goes away quickly while it takes longer for some.

Patients who do not experience any relief in symptoms require further evaluation and treatment.

There are non-surgical and surgical methods of managing cervical radiculopathy. Initially, the patient will be recommended for a more conservative nonsurgical treatment method such as the use of a soft cervical collar, physical therapy, steroid injections, and/or medications (e.g. NSAIDs, narcotics).

If there is no relief from symptoms after a period of time of using nonsurgical treatment, the patient will be recommended for surgery. The three main surgical options for pinched nerve are anterior cervical diskectomy and fusion (ACDF), artificial disk replacement (ADR), and posterior cervical laminoforaminotomy.

 

What is cervical spondylosis?

Cervical spondylosis is a common age-related condition affecting the joints and discs of the neck. Also known as arthritis of the neck, cervical spondylosis affects over 85 percent of adults age 60 and above.

Neck arthritis often causes pain and stiffness in the neck although there are some who don’t have symptoms at all.

Like the rest of the body, the joints and discs of the cervical spine slowly degenerate as one ages. These wear and tear changes eventually lead to cervical spondylosis. Some of these changes that can lead to this condition include herniated disks, dehydrated disks, bone spurs, and stiff ligaments.

Herniated Disks
Aging can cause changes on the exterior of the spinal disks. They can develop cracks which can lead to leakage of the internal cushioning material. This can press the spinal cord and neck, causing numbness and sciatica.

Dehydrated Disks

Starting at the age of 40, most people’s spinal disks begin to shrink and dry out. This can cause more bone-to-bone contact in the vertebrae.

Bone Spurs

Bone spurs are overgrowths of bones. They are the result of the body’s way to grow extra bone to make the spine stronger. These extra bones can press on sensitive areas of the spine, resulting in pain.

Stiff Ligaments

Ligaments or cords of tissue that connect one bone to another can stiffen with age. When spinal ligaments stiffen, it can make the neck less flexible.

Symptoms of Cervical Spondylosis

In most cases, cervical spondylosis doesn’t cause any symptoms at all. When symptoms occur, they usually include neck stiffness and pain. The pain can be mild to severe and at times, can go worse by looking up or down for a long period of time and by doing activities that keep the neck on the same position for a prolonged period of time.

Other symptoms that may accompany pain and neck stiffness include a headache, popping noise or sensation when the neck is turned, loss of balance, difficulty in walking, and muscle spasms in the neck and shoulders. If there is narrowing of the space for the spinal cord or nerve roots, there can be numbness and weakness in the arms, hands, and fingers.

Diagnosing Cervical Spondylosis

A thorough physical examination is needed to diagnose cervical spondylosis. The doctor will conduct an examination of the neck, shoulders, arms, and legs. He/she may do several tests to identify changes or problems in the strength, touch sensation, flexibility, blood flow, gait, and reflexes.

Aside from the physical exam, the doctor may also order diagnostic tests to help confirm the diagnosis. Some of these tests may include X-rays, magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, myelogram, and electromyography.

How It Is Treated

Many cases of cervical spondylosis can be managed through physical therapy, the use of a soft cervical collar, ice and heat compress, steroid-based injections, and medications such as NSAIDs and muscle relaxants.

Surgery is often not recommended unless the doctor determines that the spinal nerve is being pinched by a herniated disk or the spinal cord is being compressed. Surgery may also be recommended if the symptoms are not alleviated through more conservative methods.