Suffer lower back pain?
Since Hoboken411 is a true community site, I’m always on the lookout for helpful informational contributions from both local residents as well as business owners.
Today’s article couldn’t come at a better time, since I recently re-injured my back myself! Courtesy of Dr. Alex Visco, from East Coast Spine, Joint and Sports Medicine:
Low back pain? It might not be a disc problem.
By Alex Visco, MD
Do you remember the last time you had an episode of really bad back pain? Maybe it was when you were moving that couch and heard a “pop” and then couldn’t move for two days? Maybe it was when you were driving on the 8th hole and you doubled over in pain after your backswing? Maybe it was when you lifted your three-year-old last week and realized that she was getting a little too heavy and you were getting a little too old? Or maybe you would rather not say?
Well, there are any number of interesting ways to hurt your back. If you’ve hurt your back before, you may have felt pain, but the last thing you should have felt is lonely. The back pain club is a big one, with new members everyday.
In fact, up to 90% of us will experience lower back pain at some point in our lives. Lower back pain is second only to the common cold when it comes to problems that doctors encounter most frequently. Most of the time a person with acute low back pain will see their primary care physician. The doctor may prescribe an anti-inflammatory medication and maybe even a muscle relaxant. The patient may also be instructed to take it easy for a few days. Usually these simple interventions work well and, in most cases, acute low back pain gets better. However, when low back pain persists beyond a few weeks, its time for a closer look.
You may have heard that a “disc” can be a cause of significant low back pain. Terms such as “herniated disc” or “bulging disc” are a little more descriptive, but all essentially identify the “disc” as the cause of pain. An injured disc can cause low back pain, but this is not always the case. In the lower back, or more correctly, the lumbar spine, there are many anatomic structures that can cause pain. Among them are the intervertebral discs (the “discs” we have been talking about), facet joints, spinal nerve roots, vertebrae and muscles and ligaments of the lumbar spine. In fact, any part of the back that has a nerve supply is capable of communicating pain messages to the brain. All of the above mentioned structures qualify in this regard.
Read all about the various causes of the pain, as well as effective treatment methods after the jump!
(lower back pain, continued…)
Here is some more detail about the nature and function of these various parts of the lumbar spine:
Vertebrae: The vertebrae are simply the bones that give the lumbar spine its form and strength. In the lower back there are five vertebrae. These bones are uniquely designed to allow for a wide range of movement.
Intervertebral discs: The discs are found between the vertebrae and essentially serve as shock absorbers for the lumbar spine. The outer part of the disc is relatively firm, but the inner part is more like a gelatinous fluid. It is this inner part of the disc that is frequently found to be “herniated”. The outer part of the disc has a nerve supply and therefore it can cause significant pain when injured.
Facet joints: The facet joints are found where two vertebrae meet behind the discs and spinal cord. Although they are small, they are true joints just like the knee or shoulder. Likewise, they can become inflamed or arthritic and cause significant pain.
Nerve roots: At each level of the lumbar spine, nerves that derive from the spinal cord exit the spine and travel down into the pelvis and the lower extremities. These nerves serve various functions, including transmitting sensory information, such as pain and touch, to the brain from the lower part of the body. When the nerve root is injured, a shooting, burning or electrical type pain may be felt in the buttocks or legs. You may have heard this condition called “sciatica” or a “pinched nerve”. The medical term is radiculopathy (or radiculitis). The most common cause for nerve root injury is compression by a herniated disc.
Muscles and Ligaments: There are a number of muscles and ligaments associated with the lumbar spine. Their purpose is to provide strength to overall structure of the lumbar spine and to allow for a wide range of voluntary movements. Nerve endings are found in muscles and ligaments and injury or trauma can cause low back pain.
The key to treating on-going low back pain is to identify the part of the lumbar spine that is the primary pain generator. The first step in that process is an extensive examination of the musculoskeletal system and a full and complete patient history. These are invaluable to the physician trying to make an accurate diagnosis. For instance, low back pain that is worse with bending or sitting is more consistent with pain from a disc, whereas pain with bending backwards is typical of pain from a facet joint.
It must also be remembered that it is as important to determine what is not causing back pain as what is causing back pain. As there are serious medical disorders that can present with back pain, these possibilities must always be considered. Only by asking the right questions and performing a thorough physical examination can most of these problems be ruled out.
Once an initial diagnosis is made based on history and physical, imaging studies such as x-ray or MRI may be ordered to gather further information about the anatomy of the lumbar spine. A treatment plan is then tailored to address what has been identified as the most likely pain generator. Treatment can differ significantly depending on what structure is causing pain, so the importance of an accurate diagnosis cannot be overemphasized.
While the above details some of the more common pain producing structures in the lumbar spine, there are other, less common causes for low back pain. Each patient is unique and everything needs to be considered during a careful and thoughtful medical evaluation. Low back pain can be challenging for both the patient and physician. In most cases, however, once a proper diagnosis is made and the right treatment is prescribed, the prognosis for improvement is good. So just remember, don’t be so quick to blame your disc the next time your back acts up!
Stay tuned for future articles… Thanks, Dr. Visco!