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Back and Spine;

Orthopaedics and Rehab

July 3, 2019

Back and Spine;

Orthopaedics and Rehab

Douglas Dickson, M. D.

Orthopaedic Surgery

Kavita Trivedi, D.O.

Physical Medicine and Rehabilitation

About 80% of adults will experience back pain in their lives, so it’s important to be able to identify the severity of your symptoms.

In our 20s and 30s, “normal” back pain often can be attributed to factors of daily life, such as sitting too long, picking up children, or overdoing it while exercising.  

In our 40s and older, work injuries and the beginnings of arthritis and degenerative conditions are more common.

Back pain is so common, in fact, that many patients shrug off symptoms that might indicate a medical emergency.

Approximately 80% of adults will experience back pain in their lives, so it’s important to be able to identify the severity of your symptoms and track how long the pain lasts.

If back pain can be associated with a specific activity, such as lifting or twisting wrong, and the pain goes away within 72 hours after resting and applying ice, it’s usually nothing to worry about. However, if pain creeps on gradually, appears suddenly, or doesn’t go away, you might have a more serious condition. 

5 sensations that might indicate a medical emergency

1. Sharp pain rather than a dull ache: This could indicate a torn muscle or ligament, or a problem with an internal organ in the back or side.
2. Radiating pain: This pain “moves” or shoots to the glutes or legs, which could indicate a nerve compression condition.

Radiating pain could be a sign of nerve damage.

3. Sudden weakness in the legs: Limb weakness can be caused by compressed nerves in the spine due to conditions like sciatica or spinal stenosis. However, sudden leg weakness could also indicate a stroke.
4. Incontinence: Back pain paired with inability to control the bowels or bladder might be a sign of serious nerve compression or a spine infection, such as discitis or meningitis.
5. Numbness or pins and needles in the groin or glutes: This is known as saddle anesthesia and is also a sign of a serious nerve or spine condition. 

If you have leg weakness, incontinence, and numbness together, you might have cauda equina syndrome, a serious illness characterized by spinal cord nerve damage. This is a medical emergency, and patients usually need surgery immediately to decompress the nerves and reduce permanent damage.

Related reading: Get help for back, neck, and leg pain caused by spinal stenosis

Other conditions that cause back pain in older adults

We often see a range of less serious but still painful spine conditions in seniors. Most patients with these conditions will not require surgery. Physical therapy, medication, injectable anesthetics, or a combination of treatments usually can control symptoms.

• Degenerative disc disease, which can cause whole spine pain, and lumbar arthritis, which usually causes low-back pain, commonly develop with age and are considered wear-and-tear conditions.
• Sacroiliitis is an inflammation of the joints that connect your spine and pelvis. This condition can cause pain in the low back, glutes, and upper legs.
• Ankylosing spondylitis is an inflammatory arthritis that causes patients’ spines to become inflexible, resulting in a continual hunched forward position and spine pain.
• We also check for adult degenerative scoliosis and kyphosis, spine-curving conditions that can result in back pain and weakness in the lower extremities.

Take an inside look at The Spine Center at UT Southwestern, where the multidisciplinary team of physicians, nurses, and providers delivers cutting edge treatment for back pain and spine-related injuries.

Rare, non-spine conditions that cause back pain

Occasionally, our spine team finds that a patient’s back pain is caused by an underlying condition that is not spine related. 

Kidney and digestive issues, including pancreatitis and gallstones, can cause low-back discomfort that patients might assume is spine pain. In women, uterine fibroids and endometriosis are notorious for causing core pain that can radiate into the back.

Rarely, we discover that a patient with sudden, severe back pain has experienced a ruptured aneurysm, which is a weakening and tearing of part of a blood vessel. This is a medical emergency because it causes internal bleeding that can lead to a heart attack or stroke. Similarly, aortic dissection – the tearing of an inner layer of tissue in the aorta, the main vessel carrying blood from the heart to the rest of the body – sometimes causes back pain and can be fatal if not immediately treated.

Research suggests the spine is also prone to receiving cancer cells that spread from other parts of the body. Batson’s plexus, a network of veins that connect the venous system and spine, might (for unknown reasons) direct spreading cancer cells to the spine. For example, prostate cancer has been known to spread to the spine.

Related reading: Prostate Cancer Awareness Guide

Existing patients may also schedule an appointment using MyChart.

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Why back pain requires a team approach to care

Whether back pain requires surgery or is manageable with conservative treatment, it’s important to see a spine specialist for diagnosis and care. The doctors at our Spine Center work as a team with experts in nerve, muscle, and bone conditions, as well as nurses and physical therapists who work closely with patients to manage symptoms and reduce the risk of recurrence.  

Each week, our multidisciplinary team meets to discuss challenging cases and educate each other on the latest research and techniques. Together, we see a range of patients with complex medical needs. For example, if a patient with a spinal infection is taking a medication that suppresses the immune system, such as immunotherapy for cancer, we work together to find an effective treatment that is safe for their unique needs.

Some medications or medical conditions put patients at greater risk for low bone density, fractured vertebrae, or back pain. In these cases, we get referrals from and collaborate with oncologists, hematologists, rheumatologists, mineral metabolism doctors, and primary care doctors to reduce patients’ risks and manage their symptoms. 

If you are worried about back pain, come see us for reassurance. The earlier you are diagnosed, the better your outcomes can be. 

If you or a loved one might benefit from a back pain consultation, call 214-645-8300 or request an appointment online.  

Laurie Zapatka was injured in a car accident 20 years ago and her condition became progressively worse. By the time she came to UT Southwestern, her mobility was severely limited. A day after posterior spinal fusion surgery, she was up and moving with “zero pain.”

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Get help for back, neck, and leg pain caused by spinal stenosis | Orthopaedics and Rehab

Too many people live with unnecessary pain related to spinal conditions. One of the most common ones I treat is spinal stenosis, in which the spinal canal narrows and puts pressure on the spinal cord and nerves.

Normal wear and tear as we age causes our spines to change. The American Academy of Orthopedic Surgeons says up to 95 percent of people 50 or older experience degenerative changes of the spine, and spinal stenosis can affect 8 to 11 percent of them.

Spinal stenosis symptoms can be managed and treated. This doesn’t always mean surgery, but if you do need surgery, know there are minimally invasive options that can make recovery a little easier than in the past. Let’s talk about what causes spinal stenosis, its symptoms, and how we can treat it.

What is spinal stenosis?

The spinal canal is the space though which the spinal cord passes. When this space narrows, it can put pressure on the spinal cord and nerves and cause pain.

There are several types of spinal stenosis, and they relate to where along the spine the narrowing occurs:

• Cervical spinal stenosis, which occurs in the neck
• Thoracic stenosis, which occurs in the mid-back
• Lumbar stenosis, which occurs in the lower back

Spinal stenosis can develop at any age, but it’s most common among people 50 and older. Some of the most common causes of spinal stenosis include:

• Aging: As noted earlier, the spine changes as we age. The ligaments become thicker or the bones and joints get bigger, resulting in a narrower spinal canal.
• Arthritis: Vertebrae, or the bones that form the spine, can begin to compress and wear against the joints that allow it to flex after years of repetitive motion. This can cause the joints to deteriorate, resulting in inflammation or the development of bone spurs, which are bony projections that form on the surface of bones.
• Congenital defect: Some people are born with a small spinal canal. This is the most common type of spinal stenosis found in young people. It might present in teens who play contact sports and experience recurring numbness or weakness in their hands, or what we call “stingers,” which are pinched nerve injuries.
• Spinal deformities: Spinal conditions such as scoliosis, in which there is a curvature of the spine, or spondylolisthesis, in which a vertebrae moves out of position onto the vertebra below it, can cause the spinal canal to narrow.

Symptoms of spinal stenosis

Spinal stenosis is a degenerative disease, which means it gets worse over time. It starts slowly, and by the time you notice pain, it’s probably been brewing for some time.

Nerves relay sensation to specific parts of the body. Pressure on these nerves can cause pain, tingling, or numbness in those body parts. Common symptoms include:

• Pain in the neck or back
• Pain that radiates down into the legs
• Tingling, numbness, or weakness in the arms, legs, or buttocks
• Muscle atrophy or motor loss in extreme cases

If you are experiencing any of these symptoms, request an appointment to talk to a doctor about whether you may have spinal stenosis or another spinal condition.

Diagnosis of spinal stenosis starts with discussing your medical history and symptoms. If we suspect spinal stenosis, we’ll likely get high-resolution imaging such as a magnetic resonance imaging (MRI) or computerized tomography (CT) scan. Once we confirm it’s spinal stenosis, we can discuss treatment options.

How we treat spinal stenosis

There isn’t one “right” treatment for spinal stenosis. What works for one person may not work for another.

We always try to start with the most conservative methods, such as:

• Anti-inflammatories or muscle relaxants
• Cortisone injections
• Physical therapy

These treatments work for the vast majority of spinal stenosis patients, with only a small percentage needing surgery. Remember, spinal stenosis is a degenerative disease, and these methods are most effective at the early stage, underscoring the importance of early diagnosis and treatment.

If these methods don’t bring pain relief, you may need surgery to make more room for the spinal cord and nerves in the spinal canal. I know many people are scared by the thought of back surgery, but these aren’t the surgeries of years past. We offer a number of minimally invasive options, which require smaller incisions and a shorter recovery period, allowing you to more quickly get back to daily activities.

You and your doctor will examine the best options for your situation. If you don’t feel comfortable, get a second opinion. You shouldn’t have to live with back pain or tingling, numbness, or weakness in your arms and legs. Talk with your doctor to find the cause of your pain and to begin a treatment plan.

Lumboischialgia – causes, treatment | MOTRIN®

Author, editor and medical expert – Anna Yurievna Budovskaya.

Editor and medical expert – Harutyunyan Mariam Harutyunovna

Number of views: 35 841

Last update date: 12/29/2022 9 0003

Average reading time: 6 minutes

Content:

Causes of sciatica
Symptoms of sciatica
Diagnosis of lumboischialgia
Treatment of lumboischialgia
Prevention of lumboischialgia

Pain in the lower back during life occurs in more than 70% of people, most often in young people aged 35 to 55 years. Lumbosacral pain is one of the most common causes of temporary disability ^1.2 .

Pain in the lower back is called variously ³ :

• lumbalgia – if it is felt only in the lower back;
• lumboischialgia – when pain occurs not only in the lumbar region, but also spreads to the lower limb;
• lumbago – in cases where there is acute and intense pain in the lower back (lumbar backache).

In all these cases, back pain is a serious symptom that requires alertness and a mandatory visit to a doctor. In this article, we will talk in detail about lumboischialgia: why it occurs, how to alleviate unpleasant symptoms and prevent their recurrence.

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Causes of lumboischialgia

In more than 90% of cases, doctors do not find any serious disease (inflammation, infection, tumor, or fracture) that could cause lumboischialgia attacks ² . The most common causes of pain are complications of lumbar osteochondrosis, such as displacement of the vertebrae or a herniated disc ³ . In the elderly, lumboischialgia is usually due to degenerative processes (disc destruction) in the lumbar spine ^2.9 , and in young and middle-aged people it is often due to reflex irritation of the nerves, for example, when the intervertebral disc bulges ^9.12 .

Intervertebral discs are structures that serve as shock absorbers during the movement of the spine. Each disc has a nucleus pulposus and a fibrous (dense) annulus that prevents the nucleus from going beyond the disc ¹³ .

In a herniated disc, the intervertebral disc moves outward and irritates the pain receptors of the annulus fibrosus. This causes reflex muscle spasms, which provoke pain in the lower back and lower limbs ⁹ .

At risk of developing lumboischialgia are people whose work is associated with lifting weights or “twisting” loads that are inadequate for the spine. Such movements during work are usually performed by loaders, locksmiths, as well as athletes – gymnasts, tennis players, skiers ¹¹ . However, osteochondrosis and its complications in the form of lumboischialgia are also often found in people of “sedentary” professions, for example, office workers and drivers of vehicles who are forced to stay in one, sometimes very uncomfortable for the spine, position for a long time.0035 11 .

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Symptoms of sciatica

Lumbosciatica can occur due to sudden movement, bending over, lifting heavy objects or falling ⁹ . For many, the pain is aggravated by straining, coughing, sneezing, staying in one position for a long time, and even sitting in a deep chair ⁹ . At the moment of the attack, the person takes a forced position, usually leaning to the healthy side, or lies with his leg pressed to his stomach to relieve pain ⁹ .

There are 2 forms of lumboischialgia:

• In neuropathic the source of pain is the root of the spinal nerve, which turned out to be compressed by a displaced vertebra or herniated disc ³ . When squeezing the root (radiculopathy), the pain is sudden, shooting and intense ³ . Since the sciatic nerve is part of the root ¹⁴ , the pain “radiates” to one leg, but does not have clear boundaries and can “move” within the lower limb ³ .
• Reflex occurs due to irritation of the muscles, joints and ligaments in the lumbar region ¹¹ . At the same time, aching and more often bilateral pain is observed, which is most pronounced in the buttocks and thighs, rarely goes below the knee ³ . Sometimes discomfort is felt constantly ³ .

Consult your doctor if you experience any pain. Often low back pain is a manifestation of specific conditions that require emergency care ³ .

The following danger symptoms (“red flags”) are distinguished for lumboischialgia ² :

• under 18 and over 50 years of age;
• recent back injury;
• long-term treatment with hormonal drugs;
• dramatic weight loss;
• persistent progressive pain that does not improve with rest;
• soreness, which is felt not only in the back, but also in the perineum, vagina, rectum, sometimes associated with urination or defecation;
• increased body temperature;
• marked spinal deformity.

If on the background of lumboischialgia you have found at least one “red flag” – immediately seek help from a specialist ⁵ .

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Diagnosis of lumboischialgia

Pain in the lumbar region radiating to the gluteal region and the leg (or both legs) can be a manifestation of acute lumboischialgia (lasts up to 6 weeks) and chronic (troubles more than 12 weeks ) ³ . Often it goes away on its own ⁵ , but in order for the problem not to become chronic, you need to be examined by a doctor in time and exclude serious diseases.

If you have frequent symptoms of sciatica, you should contact your general practitioner. If necessary, he will refer you to a neurologist, traumatologist, rheumatologist and other specialists ² .

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Treatment of lumboischialgia

Pain relief is one of the important tasks of the syndrome therapy ¹¹ . For this purpose, non-drug, medical and surgical methods can be used ^{8. 11} .

For the symptomatic treatment of acute and chronic sciatica, non-steroidal anti-inflammatory drugs are used ^4,6,11 , which relieve pain and increase the functional activity of patients ¹¹ . Motrin® is a drug from the NSAID group, the active ingredient of which is naproxen. The drug is indicated for adults and adolescents from 15 years of age with lumboischialgia as an anesthetic ⁷ .

Tablets should be taken whole (including with meals) and washed down with a sufficient amount of liquid ⁷ . To relieve the pain of sciatica, you can take as follows: starting dose – 2 tablets (500 mg), and then one tablet (250 mg) up to 4 times a day (every 8 hours). In this case, usually the daily dose used to relieve pain is 2-3 tablets (500-750 mg). It is allowed to use the drug as an anesthetic without consulting a doctor for up to 5 days. If unpleasant symptoms persist or worsen, be sure to consult a specialist ⁷ .

Non-drug methods of pain relief include ^3.8 :

• therapeutic exercises;
• manual therapy;
• acupuncture;
• massage.

If there is pain in the lower back that radiates to the leg, experts recommend maintaining physical activity and avoiding bed rest – this has a beneficial effect on the course of the pathology and helps to recover faster ^6,8,11 .

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Prevention of lumboischialgia

To prevent attacks of pain, it is important to follow the recommendations of doctors: 5 2 ;

Lumbosciatica is a problem that can affect both the elderly and young people ¹ . It indicates the resulting complications of osteochondrosis and requires careful attention ³ . With a properly organized work schedule, sufficient physical activity and timely access to a doctor, exacerbations and complications of chronic back pain can be avoided ¹¹ .

The information in this article is for reference only and does not replace professional medical advice. For diagnosis and treatment, contact a qualified specialist.

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References

1. WHO Priority diseases and reasons for inclusion 2013 6.24 Low back pain https : //www . who . int/medicines/areas/priority_medicines/Ch6_24LBP.pdf
2. Parfenov Vladimir Anatolyevich, Golovacheva Veronika Alexandrovna Diagnosis and treatment of acute nonspecific lumbosacral pain // Therapeutic archive. 2019. No. 8. URL: https : //cyberleninka . ru/article/n/diagnostika-i-lechenie-ostroy-nespetsificheskoy-o-krpoyasnichtsovoy-boli
3. Levin O. S., Chimagomedova A.Sh., Shugurova I.M., Nikitina A.N. Modern approaches to the diagnosis and treatment of chronic back pain // STPN. 2020. No. 3-4. URL: https : //cyberleninka . ru/article/n/sovremennye-podhody-k-diagnostike-i-lecheniyu-hronicheskoy-boli-v-spine
4. Shirokov Vasily Afonasevich, Potaturko A.V., Terekhov N.L. Non-steroidal anti-inflammatory drugs, muscle relaxants and vitamins of group B in the treatment of lumboischialgia // Neurology, neuropsychiatry, psychosomatics. 2020. №6. URL: https : //cyberleninka . ru/article/n/nesteroidnye-protivovospalitelnye-preparaty-miorelaksanty-i-vitaminy-gruppy-v-v-lechenii-lyumboishialgii
5. Shakhabov I.V., Polishchuk N.S. Evaluation of recommendations for the appointment of magnetic resonance imaging in the provision of outpatient care in a planned form for pain at the level of the lumbar spine // ORGZDRAV: News. Opinions. Education. Vestnik VSHOUZ. 2020. No. 3 (21). URL: https://cyberleninka. ru/article/n/otsenka-rekomendatsiy-po-naznacheniyu-…
6. Parfenov Vladimir Anatolievich, Isaikin A.I., Kuzminova T.I., Chernenko O.A., Milovanova O.V., Romanova A.V., Samkhaeva N.D., Shor Yu.M. Treatment of patients with acute and subacute lumbodynia and lumboischialgia // Neurology, neuropsychiatry, psychosomatics. 2019. No. 3. URL: https : //cyberleninka . en/article/n/lechenie-patsientov-s-ostroy-i-podostroy-lyumbalgiey-i-lyumboishialgiey
7. Instructions for use of the drug MOTRIN ® tablets //Reg.number P N002874/01// GRLS RF. – URL: https : //grls . rosminzdrav . en/Grls_View_v2.aspx?routingGuid=868bad0c-d10e-47a9-b9d8-2595d9a01ac7&t=
8. Parfenov V.A., Parfenova E.V. Questions of therapy of chronic nonspecific lumbalgia // MS. 2020. No. 8. URL: https://cyberleninka.ru/article/n/voprosy-terapii-hronicheskoy-nespetsif…
9. Shostak N.A., Pravdyuk N.G. Back pain and comorbidity – diagnosis, treatment tactics. Outpatient surgery. 2016;(3-4):44-50. https://www.a-surgeon.ru/jour/article/view/59
10. Vertkin A.L., Karateev A.E., Kukushkin M.L., Martynov A.I., Parfenov V.A., Yakhno N.N., Knorring G.Yu. National guidelines for the management of patients with back pain for internists and general practitioners of polyclinics. Therapy. 2018; 3 (21) https://therapy-journal.ru/ru/archive/article/36103
11. Russian Interregional Society for the Study of Pain. Clinical guidelines Diagnosis and treatment of musculoskeletal (non-specific) pain in the lower back, 2019https : //painrussia . en/educational-programs/2020/zoom/%D0%9A%D0%A0_%D0%91%D0%A1_%D0%A0%D0%9E%D0%98%D0%91_2020_%D1%84%D0% B8%D0%BD%D0%B0%D0%BB%20(1).pdf
12. Diagnosis of viscero-vertebral and vertebro-visceral pain syndrome in lumbar osteochondrosis. Drivotinov B.V., Gamanovich A.I., Medical Journal No. 4 2012 From 46-50.
13. Big Medical Encyclopedia (BME), edited by Petrovsky B.V., 3rd edition. Spine.https : //xn--90aw5c . xn--c1avg/index . php/%D0%9F%D0%9E%D0%97%D0%92%D0%9E%D0%9D%D0%9E%D0%A7%D0%9D%D0%98%D0%9A (accessed : 05.10.2021)
14. Big Medical Encyclopedia (BME), edited by Petrovsky B.V., 3rd edition. Sciatic nerve. https : //xn--90aw5c . xn--c1avg/index . php/%D0%A1%D0%95%D0%94%D0%90%D0%9B%D0%98%D0%A9%D0%9D%D0%AB%D0%99_%D0%9D%D0% 95%D0%A0%D0%92 (date of access: 05.10.2021)
15. Frick et al. Efficacy and safety of naproxen sodium and ibuprofen for pain relief after oral surgery. Current Therapeutic Research. 1993;54(6):619-27.

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If the patient has back pain above the waist, it is necessary to conduct an examination with subsequent diagnosis. This may be a symptom of a disease of the spine, heart, digestive system, muscles, or pathology of another anatomical structure. Pain in this area occurs in people of any age, but more often elderly patients turn to specialists with such a complaint. To make an accurate diagnosis and prescribe therapeutic measures, laboratory and instrumental studies are needed.

CMRT specialist tells

Bulatsky S.O.

Orthopedist • Traumatologist • 16 years of experience

Publication date: September 23, 2021

Verification date: January 30, 2023

All facts have been verified by a doctor.

Contents of the article

Causes of pain in the back above the lower back on the sides

Varieties

Which doctor to contact

Diagnostic methods

Treatment of pain in the back above the waist

Rehabilitation

After the main course of treatment, the patient may need a long recovery to return to normal life.

Depending on the disease that caused a sharp pain in the back on the right above the waist, the patient is prescribed manual therapy, exercise therapy, diet or physiotherapy.

In the rehabilitation center “Laboratory of Movement” specialists use modern methods of rehabilitation.

Consequences

Prevention of soreness in the back above the waist

Other related articles:

Pinching of the spine in the lower back

Patients often ask the doctor about the treatment of acute pain when the back is stuck in the lower back, what to do in this case. This is an infringement of a nerve or nerve bundle passing in the lumbosacral region. Due to severe pain, a person cannot walk normally, therefore, in such a situation, emergency medical care is often required. When a nerve is pinched in the lower back, a specialist can quickly relieve the pain. Fully study the pathology is possible only after the diagnosis.

Aortic aneurysm

Ascending aortic aneurysm (AAA) is the most dangerous among the most complex diseases of the circulatory system. The expansion of the lumen of the largest artery in the human body, more than 2 times its normal maximum diameter, is the main cause of massive internal bleeding and thrombosis. And only timely detection and competent medical correction can eliminate the threat to health and return to a full life.

Heart failure

Heart failure is a dangerous clinical syndrome that is the outcome of many cardiopathologies. Violation of the anatomical and functional properties of the heart significantly impairs the quality of life of patients and is considered the most common cause of death. Therefore, it is very important to detect the disease in a timely manner and carry out competent complex treatment.

Cyst of the spine in the lumbosacral region

Cyst in the spine is a rare pathology characterized by the appearance of a neoplasm with liquid hemorrhagic or cerebrospinal fluid contents. With a small size, it is asymptomatic, it is detected by chance during MRI diagnostics. Large cysts provoke compression of the nerve roots, blood vessels, which leads to the appearance of chronic pain, circulatory disorders. A vertebrologist and a neurologist are engaged in conservative treatment, and a neurosurgeon is involved in surgical treatment.

Dorsalgia of the lumbar spine

Dorsalgia is a complex non-specific pain symptom radiating to various areas of the back. A common pathological condition diagnosed in more than 70% of clinical cases. The cause of occurrence is dystrophic changes in the spine, physical activity, stress, trauma. The main symptom is back pain of varying intensity for three to four weeks. For treatment, they turn to a neurologist, who, based on the results of CT, MRI and other methods, makes a diagnosis and prescribes treatment.

Back strain

The most common cause of acute muscle pain is back strain. The tension that causes pain in the structures that provide support, protection and movement of the spine is associated with microtraumatization of muscle fibers. It can happen at any age, in any profession. And although in general such damage has a favorable prognosis, sometimes there is a threat of chronic myofascial pain syndrome. Therefore, a condition called “pulled back” is a reason to see a doctor.

Violation of spinal statics

Violation of spinal statics – pathological relationship between the structures of the segments, excessive mobility or stiffness of the vertebrae. The condition often develops against the background of a degenerative-destructive process – osteochondrosis. Clinical manifestations depend on the affected area, include pain syndrome, curvature of the vertebral column, neurological disorders. Treatment of spinal static function disorders implies an individual approach, it can be conservative or surgical.

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