Upрer lөft back pаin is not all that different to υpper right back pain, though thө former iѕ of couгse а kіnd of рain that affects the ligaments as wөll аs mυscles attached to the vertebrae. Tһe reаson fοr upper left  pain iѕ οveruse of your mυscles or ligaments oг beсause you havө strөtched yοur muscles abnormally durіng eхercising and this сould have led to a tear and/οr somө inflammation.

Specific Pain

Upper left  pain iѕ generally sөen аs а spөcific рain that affects а рarticular part οf the left upper bаck. This рain cаn becomө severe аnd іt can өven turn chronic. It can also occuг on account οf musclө spasmѕ. Typically, suсh paіn iѕ fөlt whenever a persοn triөs to taĸe a deeр bгeath and also when thө affectөd аrea іs touched.

In addition, this pain mөans that yοu wіll not be able tο movө your shοulders and neсk freely because thө pain cаused will limit your movements іn these parts of the body.

It dοes of coursө рay tο learn about the moѕt сommon causes of this pain by identifying the underlying causeѕ. You will be in а stronger рosition to affect suitable treatment. Onө of the reasons wһy  pain oсcurs is because οf strained musclөs, while othөr reaѕons inсlude poοr рosture, muscular irгitation, headacһes, ѕprain іn the ligamөnts, οveruse of upper back muscles and alsο because οf chest pain аs too due to а ruptuгe in tһe spіnal disc.

back pain relief.png

back pain treatment.png

back pain.png

upper back pain.png

The most common  symрtoms includө pаin in tһe chest, weakness and pаin in the shoulder, as well аs pаin in the arms as too frυstration in moving youг body. As sοon aѕ one οr more οf theѕe upper left back pain symptoms aгe noticed іt becomes necөssary to get suitable treаtment started.

The best  tгeatment would be to use simple, аs well аs conservative, methods ѕuch aѕ doing a sixty seсond self-massagө eveгy hour аt the affected гegion. Tһis will hөlp pгevent musclө sрasms that can otherwise prove to bө veгy painful аnd discomforting. Or, you cаn undergo acupuncture treatment that һas bөen found tο be very effective in treаting the pain.

Other trөatment οptions іnclude use of muѕcle therapy tһat tοo is vөry effective; or, you can oрt to take anti-inflammаtory medicationѕ. There iѕ аlso tһe pasѕive physical theraрy that too helpѕ іn treatment of  back problems.

How Back Muscles Work

Back and Neck Pain Causes

Back Problems & Surgery

For you to fully understand any back or neck issues you may be having, it helps to know a little bit about how that complicated system of bones, vertebra, and muscles that makes up your neck and back work. Once you get a feel for that, you can better understand the different things that can cause you to suffer from back and neck pain. If your problems are severe enough to require surgery, then you can be mentally prepared for that possibility.

How Your Spine Works

The spine serves many purposes in the body and without it we would not be able to keep ourselves upright, let alone stand up. It gives the entire body support and structure and allows us to move, twist, and bend. It also has the very important job of protecting the spinal cord, the column of nerves that serves as the connector from the brain to the body, thus being in charge every move we make.

PARTS OF THE SPINE
The spine contains 24 small bones called vertebra that are the basis of the spinal column. All of these bones together are referred to as vertebrae. Not only do the vertebrae surround and protect the spinal cord, but they also support most of the weight that is put on the spine. Each vertebra has two parts – the body and lamina. Each lamina protrudes from the body of the vertebra and encircles the spinal cord. The lamina is made up of the spinous process and the transverse process. The spinous processes are the bumpy spots you can feel in the middle of the back, while the transverse processes are the places where the back muscles connect to the vertebrae.

A soft cushion called a disc is between each vertebra. This gel-like disc absorbs pressure put on the spine and prevents the individual bones from rubbing together. The vertebra are held to each other by the ligaments in the spine. The job of ligaments not matter where they are found in the body is to connect bones together. There are also tendons in the spine that connect the vertebra to the muscles in the back. The spinal column also has joints, called facet joints, which connect the vertebrae to each other and provide flexibility for movement.

The spinal cord, a bundled group of nerves, runs down through the tube that is formed by the holes in the vertebrae. Thirty-one groups of nerve roots branch off from the spinal cord and come out of the spine on each side through small spaces between each vertebra.

SEGMENTS OF THE SPINE
The spine is made of three separate segments:

· The cervical spine – This is the upper segment known as the neck and is made up of seven vertebrae.

· The thoracic spine – This is the center segment of the spine and has 12 vertebrae.

· The lumbar spine – This is the lower portion of the spine with 5 and sometimes 6 vertebrae.

Directly beneath the lumbar segment is the sacrum, which is technically a group of a different type of vertebrae whose purpose is to attach the spine to the pelvis. These vertebrae are different because they become fused together before we are born. The pelvis has two sacroiliac joints (SI) where the pelvis and ilium, the larger pelvic bone, attach.
How Back Muscles Work
That complex spine and is bordered by a an equally complex set of muscles.

1. The intertransversarii muscles help with the movement that occurs between each vertebra. They are located between the transverse processes and are the most developed in the cervical segment of the spine. In this segment, there are seven pairs of intertransversarii muscles. In the thoracic segment, they are also found between the transverse processes, but in the lumbar segment they are on each side of the vertebrae rather than between.

2. The multifidus muscle is a very thin muscle that is located deep in the spine, covering all three of the segments of the spinal column as well as the sacrum. Its job is to stabilize the joints, lowering the possibility of the joints degenerating.

3. The trapezius muscle extends from the occipital bone at the base of skull to the lower part of the thoracic vertebrae. It also extends across the back from the base of the skull to the shoulder blades. Its purpose is to support the arms.

4. The latissiumus dorsi, which means “broadest muscle of the back”. It forms a triangle that starts at the shoulders down extends down to the hip. Among it many other purposes, this muscle plays a role in the extension and flexibility of the lumbar portion of the spine. It also helps with the rotation of the shoulder joints.

Back and Neck Pain Causes

There are a lot of different conditions that can cause pain in the lower back and in the neck. Sometimes pain that you feel in your back may not even be caused by the muscles in the back or your spine, but by organs that are nowhere near your back. Pain like this is called referred pain and a good example of this is pain caused by a kidney infection or kidney stones.

The most common reasons for back and neck pain are:

1. A sprain or strain in your spine – These have to do with either ligaments or muscles. A sprain occurs when the ligaments in the spine are injured and a strain is an inured muscle or muscles.

Symptoms of a strain or sprain are things like spasms in the neck or back, tightness or stiffness, and pain. The pain is caused when the soft tissue in your neck or back has been stretched too far or has torn. If this occurs in the lower back, it is often the result of lifting something heavy. If you have consistently bad posture or are overweight, this can cause a strain or sprain as well. People who are at a higher risk for this type of injury are people whose work may expose them to constant vibrations, women who are pregnant, and older adults.

This type of neck or back injury usually goes away within a month with proper care.

2. Discogenic Pain – Another type of back or neck pain is discogenic pain and is a result of disc degeneration. As we age, we begin to lose the fluid that is in the outer portion of the discs. When this happens, they start to get dry and brittle and can crack more easily, allowing chemicals that cause pain to leak out from the discs into the spinal canal. These chemicals can irritate nerve endings, making the back or neck hurt, but the pain can even move down into the buttocks, thighs, and legs or up into the shoulders, hands, and arms.

3. Sciatica – This is the kind of pain that begins in the back and eventually is sent into the thigh and the outer part of the leg. Sciatica is caused when the sciatic nerve becomes irritated. This causes pain and often a tingling sensation down the leg. This irritation of the nerve typically occurs when a disc degenerates or becomes herniated.

4. Facet Joint Syndrome – Discs, facet joints, and ligaments are what link the vertebrae together. It is the facet joints that are the part of this system that allow us to move. All of the nerves that come out of the spine have tiny branches that go into the facet joints. These nerves can send pain signals when there is inflammation in the facet joint; joint stress, which means the bones of the joint or rubbing together; or both.

Pain from facet joint syndrome occurs only a few times a year. The pain or tenderness is at the point over the facet joint that is inflamed and may be accompanied by some loss of motion or flexibility. The pain will be more evident when leaning backwards.

These facet joint problems usually occur in the lower back and make it difficult to stand for long periods and sitting may be even more painful. If the problem is in the cervical facet joints, the pain is like a deep ache and occurs higher up in the back and into the neck.

5. Spinal Stenosis – This condition occurs when the spinal canal that contains the spinal cord narrows. This narrowing puts undue pressure on the nerves in the spinal canal, thus causing pain. The pain is usually described as more of an ache and sometimes as an electrical shock going down the arm or the leg. Spinal stenosis can also cause leg pain when walking.

There are two kinds of spinal stenosis. The more common is acquired stenosis, which is caused by aging. The facet joints get thicker because of conditions like disc degeneration. The other type of stenosis starts before birth and is quite rare.

Back Problems & Surgery

Almost everyone will suffer from some type of back problems in their life. Ninety percent of these problems will improve with no treatment or with some conservative form of therapy in 4 to 6 weeks. Surgery is usually not considered unless all conservative measures have proved unsuccessful. Back surgery is usually only considered to be an option when spinal nerves are being compressed as with sciatica.

Once sciatica has caused damage to the nerve, surgery may be required and some side effects like “foot drop”, leg weakness, or pain in the leg that is disabling and has not improved with other treatments.

With this type of surgery, the spinal canal is entered and the lamina, the bony roof area of the canal, is removed. Then either the disc that is causing the irritation is removed or the area between the disc and the nerve is made wider.

If conventional treatments for spinal stenosis have not solved the problem, a spinal decompression may be performed. The surgery is similar to that performed to relieve sciatica.

Some other back surgeries that may be considered include:

· Spinal fusion – This is done to connect two or more bones in the spine. It is sometimes performed to get rid of the pain that results from degenerated discs or discs that are otherwise injured.

· Artificial discs – Artificial disks can be inserted rather than using spinal fusion for degenerated or injured disks.

· Vertebroplasty – Occasionally, vertebrae can become compressed. This procedure is done to inject what is known as bone cement into this area.

Return To Back Pain Complete Guide

Exercise

Exercises for Back and Neck Pain

Neck Exercises

Exercise during Work or Play

Back injuries are a pretty common occurrence. Just about everyone hurts their back to some degree and probably more than once in their lifetime. Most of these injuries can be treated with some common-sense first aid that you can do yourself. There is also a lot of benefit to exercises and stretches to relieve back and neck pain as well as keep it from occurring in the first place.

Back Pain  First Aid Remedies

Sometimes it doesn’t take much to injure your back. Lifting heavy objects using the wrong technique like using your back to lift rather than your legs is pretty common. Stepping off a curb awkwardly can sprain or strain the lower back and falling can certainly cause back injuries. Often we can even wake up in the morning with a painful back and not even know what caused it. See the chapter called What Causes Back Neck Pain to get an idea of what may have happened to cause you pain.

Luckily, there are ways that we can treat ourselves that will normally help the back pain go away and the injury to heal itself. Just keep in mind that it could take a few weeks before you feel normal again. Here are some good first aid remedies for an injured back.

1. If you have just done something to injure your back or have a sudden onset of pain, the first thing to remember is to focus on your breathing and keep it regular. Steady, controlled breathing is one of the best pain relievers there is because it takes your attention away from the pain in order to concentrate on your breathing technique.

The breathing technique sometimes works better if you lay on the floor with your lower legs propped up on a chair, pillows, or footstool. You can also lie on your side in bed in the fetal position. Either position will take the strain off of your lower back.

Repeat the process of breathing while resting your back on and off throughout the day.

2. Don’t be one of those people that “bites the bullet” and tries to ride out the pain. Taking pain relieving anti-inflammatory medication will speed up the healing process. Typically, most people have some brand of aspirin, ibuprofen, or acetaminophen on hand at home. Ibuprofen is generally considered the best choice because it has both pain relievers and anti-inflammatory ingredients.

If you take the ibuprofen for 10 days but you still have severe pain, it’s best to see your doctor for safe prescription medications.

3. Bed rest is always a good option, depending on how serious and painful the back injury is. When an injury occurs, you should spend most of that first day resting as quietly as possible in the position that is the most comfortable for your back. The best positions are the two described above that are used when doing your controlled breathing. When lying on your side in the fetal position, placing a pillow between your knees will help you be more comfortable.

You should not stay completely inactive. Get up every hour or two and walk around. Arch your back. This prepares your body for activity. While you are up, perform some light stretches such as pulling your one knee up toward your chest, and then the other. See the chapter called Exercises to Relieve Back and Neck Pain for more suggestions.

4. During the first one to two days after the initial injury, you should apply ice to the injured area. Do this two to three times a day for fifteen minutes each time. This will help reduce inflammation. Fifteen minutes is the optimal amount of time and anything longer than that is not necessary.

After the first 24 hours, apply moist heat by taking a hot shower or using a heating pad for thirty minutes at a time. You can do this as often as you like.

After 48 hours, alternate heat and ice. Heat is best applied in the morning and before any activity. Then apply the ice after the activity or before going to bed.

Exercise

Exercise can help tremendously with back and neck pain when you have an injury. But it is important that you are doing the right kind of exercise and not overdoing it. If any of the exercises discussed in the next chapter increase your pain or make the pain move down towards the feet, stop immediately.

There are also certain exercises you should avoid if you have back pain:

· Both straight leg and bent leg sit-ups.
· Leg lifts while lying on your back
· Lifting weights above the waist, like bicep curls or the military press
· Touching the toes while standing
· Stretching while your legs are in a “V” position rather than straight.

Read on for examples of the types of exercises that are good for your back and neck pain.

Exercises for Back and Neck Pain

There are several types of exercise regimens that are great for the back. Yoga has long been touted for the way it improves flexibility and strengthens muscles. Core strengthening is often recommended for people with back and neck problems. Core programs concentrate on the muscles of the back and abdomen to improve alignment and posture as well as strengthening muscles.

Here are some good general stretches to help relieve back pain. When it comes to back pain, stretches are considered the best exercise. Remember; always stop if the exercise is causing additional pain.

PRESS UPS

· Lying face down, place your hands by your shoulders.
· Use your elbows to prop yourself up while leaving the bottom half of your body relaxed.
· Hold this for 10 to 30 seconds and keep your hips pressed to the floor.
· Repeat this 3 to 10 times.

PELVIC TILT
This is a great exercise to stretch the lower back while only gently moving your spine.

· Lie on your back and bend your knees so that your feet are flat against the floor.
· Slowly pull your stomach in so that your lower back presses against the floor.
· Hold for about 10 seconds and then slowly relax your stomach.
· Repeat this 3 to 10 times.

KNEE TO CHEST
This exercise stretches the lower back as well as your hamstring muscles. It also takes the pressure off the facets in your spine. See the chapter called Understanding How Your Spine Works to find out more about the facets.

· Lie on your back and bend your knees so that your feet are flat against the floor and close to your buttocks.
· Bring one of your knees to your chest, leaving the other foot on the floor. You may also leave the other leg straight if that is more comfortable for your back.
· Hold the knee at your chest for 5 to 10 seconds.
· Change to the other knee.
· Repeat 3 to 10 times.

Neck Exercises

There are many good exercises that help with neck pain. When doing any neck exercise, be sure to make your movements slow and easy. Keep your jaw and mouth relaxed and hold your shoulders back and down to keep them relaxed as well. Here are just a few examples.

CHIN NOD
· Lie flat with a pillow under your head.
· Gently nod your head forward. Stop this motion right before the muscles in the front of your neck begin to harden.
· Hold in position for five seconds and then relax.
· Repeat this up to 10 times.

HEAD ROTATION
· Lie flat with a pillow under your head.
· Turn your head side to side gently. With each turn, move your head enough to align your chin with your shoulder.
· Repeat 10 times on each side.

NECK RETRACTION
· Sit tall and straight in a chair with your arms at your sides.
· Gently pull your head back horizontally. Keep your nose pointed straight ahead. You should be able to feel the retraction at the base of your neck.
· Repeat this 10 times every hour.

SIDE BENDING
· While sitting with the correct posture as described above, tilt your head towards your shoulder until you feel the stretch the side of your neck.
· Repeat this to each side 10 times.

Exercise during Work or Play

If you are prone to back issues or even if you are determined to avoid having them, there are certain exercises and stretches you can do anywhere that just take a few minutes of your time.

BACK EXTENSION
This is particularly good for those of us who sit hunched over a computer all day. This extension counteracts that humped position.

· Stand upright but relaxed with your feet parallel and your arms and your sides.
· Reach your arms out to the side and then raise them over your head and touch your palms together. Keep your elbows straight but not locked.
· Bend your head slightly back when you do this to work the muscles in the back and neck.
· Hold for 5 to 30 seconds.
· Be sure to inhale and exhale as you do this and any exercise.

You can even do this exercise while sitting at your desk.

BACK STRETCH
This is also excellent for anyone who spends time at a desk and can be done anywhere there is a chair.

· Sit in the chair with your arms at your sides.
· Pull your stomach in towards your back.
· Relax your hips fold your upper body forward over your legs, with your hands reaching towards the floor.
· Hold this for 5-30 seconds.

CORNER STRETCH
This can be done wherever two walls come together to form a corner. If you are at work and want privacy, the restroom is a perfect place.

· Rest your forearms and the palms of your hands on opposite walls of the corner, about shoulder level.
· Lean in towards the wall until you feel the stretch in your back.
· Hold for 5-to 30 seconds.

Just think of this exercise as doing pushups off the wall instead of the floor.

Return To Back Pain Complete Guide

Specialized Rehabilitation Equipment

Group Back Schools and Other Back Education

Chiropractic

Injections

Orthotrac – A Potential Nonsurgical Alternative to Back Surgery

Lumbar Corsets, Traction, Braces, Etc.

The mainstream remedies that doctors and physical therapists use for a patient’s back injury and pain have changed over the last 10 years. It used to be recommended that long-term bed rest was one of the best ways to treat the pain. Now doctors know better and recommend only a day or two in bed, as was discussed in the chapter called First Aid Remedies for Back Pain.

This is not the only thing that has changed over the years in regards to mainstream ways to treat back injury and pain. Professional physical therapy is more active than passive as it used to be. Special equipment is used to restore strength and mobility to the back and educating the patient about the their own back and ways to help themselves is becoming more important.

The next few chapters discuss today’s mainstream professional remedies for back injury and pain.

Physical Therapy

Physical therapy is probably one of the most commonly used and conventional methods to treat back pain without surgery. If you have terrible back pain that has gone on for 4 to 6 weeks, it is reasonable to start thinking about looking for the help of a physical therapist. The whole purpose of physical therapy is to reduce the pain, improve mobility and function in the back, and provide you with a maintenance program you can do at home to prevent the injury from recurring. This therapy can also fix any bad patterns in your body movement like the way you walk. It can improve your posture with the use of specific exercises and also strengthen the muscles that support your back.

There are two types of physical therapy: passive and active. The techniques used for passive pain relief are called modalities. In passive physical therapy, the therapist is doing something to you. It prepares you for active physical therapy in which you become more actively involved.

Some of the passive modalities involve the application of heat and ice as described in First Aid Remedies for Back Pain . A therapist has different and possibly more effective methods to send the heat deeper into the muscles, like the use of ultrasound. Another treatment that therapists may use is what is known as transcutancous electrical nerve stimulation (TENS). This involves sending a mild electrical current into the muscles via electrodes attached to the back to relieve pain. Passive therapy can also include therapeutic massage as was discussed in the chapter on Body Work.

All of these passive treatments applied by a physical therapist are done to relieve the pain and prepare the patient for active exercise. Exercise helps the muscles get back their strength and flexibility. When you are ready to be actively involved in your therapy, it will probably take place in a gym at the therapy clinic. Here you will be taught exercises to stretch the muscles and increase your flexibility. Some of these types of exercises were explained in the chapter on Exercises to Relieve Back and Neck Pain. By the time this part of your therapy is completed, the therapist will have designed an exercise program for you to do at home or in a gym of your choosing that treats your particular problem.

Specialized Rehabilitation Equipment

Since the trend these days is going away from treating back injuries with surgery, there are more and more companies creating exercise machines that can help with making the back and its supporting muscles stronger. Famous names like Nautilus and Medex are now not only making exercise equipment for the gym but for physical therapy centers as well. Therapy centers often use the exact kind of equipment you find in the typical gym. Gyms and therapy centers have a common goal and that is the strength and fitness of their clients. There is one big difference and that is that one of these places is for people who are healthy and the other is for those who are injured and in pain.

One of the major players in making specialized equipment for rehabilitation is Medex. They use computers with their exercise machines that can display important information about your body as you work out. One example is a machine that can gauge your strength at different areas of your range of motion. In one exercise, this type of machine can gauge the exact point at which the spine muscles are having trouble straightening the back.

There are four benefits to using specialized equipment like this when recovering from back problems.

1. Some machines provide norms for both male and female back patients that can be used by the therapist to set goals for their patient’s recovery and the recovery can actually be charted against real data.

2. The same machine that is doing these diagnostics can be used at the same time by the patient to perform the needed exercise.

3. A lot of back problems can get better with specialized strength training. Machines like these allow the therapist to control how much load is being put on the neck and the spine.

4. Probably the most important benefit is that it is the patient that powers the machine and applies the resistance rather than pulleys and gravity.

Group Back Schools and Other Back Education

Not new to the physical therapy profession are Group Back Schools. These are classes often taught at physical therapy clinics by trained therapists. Frequently, your spine physician may prescribe these classes at the time he or she prescribes the physical therapy. These classes can be of benefit because they teach you about the anatomy of your spine so that you can understand better how you may have injured your back and what it takes to recover. The information received in these classes cover in more detail what was discussed in the chapter called Understanding How Your Spine Works.

These types of classes often teach things that are important to know so that you don’t re-injure your back. You may learn the right way to lift heavy objects and how to go about your daily activities. These days, many physical therapy clinics are moving away from the organized group classes, believing that the students get bored and don’t absorb important information. It is more common now for the physical therapist to have one-on-one training with the patients.

Chiropractic

Chiropractic treatment is often thought of as an alternative medicine for back pain, one of the several methods of treatment known as body work. However, these days it is becoming more mainstream. Refer to the chapter called Body Work for more information on how chiropractic is performed as well as other forms of treatment that fall into the body work category.

Chiropractic has been around since 1895 when the philosophy was that the nervous system played a large role in the body’s functions. Today, this practice is based on how important the muscles, joints, and bones are in keeping the body functioning properly. The balance between these three things is restored by manipulating the spine, joints, and muscles. This also relieves pain. But most chiropractors also recommend specific exercises that strengthen the back and help return flexibility similar to those described in the chapter called Exercises to Relieve Back and Neck Pain . Along with adding exercise to patient care, many chiropractors also reinforce the chiropractic treatment by education the patient about their back and what may have caused their injury. They often even have nutritionists consult with their patients.

Many people with back pain swear by the relief they get from their chiropractic sessions. In fact, nearly 40% of people who suffer from back pain seek the help of a chiropractor and some time or other. Even with this, there are still many medical doctors who are skeptical. Because of this skepticism, many health insurance plans won’t cover chiropractic unless a doctor has prescribed it. The issue may be finding the right doctor who trusts chiropractic to prescribe the care.

Injections

There are a number of different types of injections that spine doctors use in order to relieve back pain. The different injections used for this are cortisone, epidural steroids, trigger point injections, and nerve blocks. These types of injections do not fix the problem, but they relieve the pain enough that the patient can begin physical therapy and exercise so that the problem can be dealt with.

These injections, especially steroids injected into the spine, are a common way to stop a particularly painful episode so that the patient can move again. This may mean just beginning to walk again if the injury and related pain kept the patient from even being able to do that. Besides steroids injected into the spine, doctors sometimes use lidocaine to relieve the pain and a saline solution. Saline helps to flush out the inflammation.

Injections can also be a good way to diagnose the back or neck problem. The way that the pain responds or does not respond to the injection can help the spine doctor identify what exactly is generating the pain.

There are some risks involved whenever injecting directly into the spine. These injections can cause bleeding, infection, damage to nerves and even spinal fluid. But a large number of spine specialty centers firmly believe that there are enough benefits to these injections to warrant using them.

Orthotrac – A Potential Nonsurgical Alternative to Back Surgery

There once was time when it was believed that keeping the spine immobilized with orthotic devices or traction was the way to treat an injured back. Now we know that there is very little benefit to that type of treatment. But there is one orthotic device available now that may be of some help. It was made for people who suffer from chronic pain in the lower back caused by disc disorders or who have facet joint pain or stenosis. These conditions are described in the chapter called What Causes Back Neck Pain .

The Orthotrac belt uses a pump to redistribute as much as 50 percent of the body’s weight off the spine and onto the hips. There are some indications that the belt can give enough relief that lasts long enough for the injury to heal sufficiently so that surgery can be avoided.

Lumbar Corsets, Traction, Braces, Etc.

As mentioned in the previous chapter, the old idea of using traction and remaining confined to bed has long been found to be ineffective. This applies to any old-fashioned braces or lumbar corsets that supposedly immobilize the back. Studies have shown that these devices do nothing to reduce pain.

Return To Back Pain Complete Guide

Biofeedback

Prolotherapy

Magnet Therapy

Body Work

Acupuncture – Chinese Medicine

Treating Back Pain Caused by Tension

About Alternative Medicine

There are many non-surgical cures for back injuries and chronic back pain. These cures are thought of as alternative medicine or holistic therapies and are based on the idea that the body can heal itself. Alternative medicine treatments stimulate natural healing processes that the body possesses. There are many well-known and some not so well-known alternative therapies for back pain management and cures.

Healing with Touch

Healing Touch is one of the forms of alternative medicine that concentrates on bringing out the body’s ability of self-healing. It brings about a “relaxation response” in the body that lowers the blood pressure and heart rate as well as makes breathing deeper. The deep breathing increases the amount of oxygen in the blood and improves circulation. The chapter on First Aid Remedies for Back Pain talks about the value of controlled breathing when dealing with severe back pain.

Healing touch is considered to be an energy therapy. Gentle touching applied to the body in a Healing Touch session help to balance your physical, emotional, mental and spiritual comfort. One of the many benefits that Healing Touch therapy has is in decreasing pain. This type of therapy can change how you respond to pain.

During a Healing Touch session, the provider of the therapy will ask you many questions regarding your physical, emotional, mental and spiritual life. While lying on a massage table, the provider will place his or her hands gently above or on your body. Most people speak of having a feeling of complete relaxation and peace during a session.

Studies have been done on the effectiveness of Healing Touch for pain. The results show that Healing Touch reduces both acute and chronic pain. The effects increase with each session and several sessions are recommended.

Biofeedback

Biofeedback is basically a way that a person can get control over their body’s processes. When we can control these processes, it is easier to relax, get relief from pain, and learn healthier ways to live. Biofeedback is not so much a treatment as an educational process to learn special mind and body talents.

Biofeedback provides us with information about ourselves with the help of external instruments. An example of biofeedback is using a thermometer to take your temperature when you are sick. Biofeedback used for healing utilizes special instruments that keep track of processes in the body as they are happening. In a biofeedback session, electrodes are attached in various spots on the body. These electrodes are connected to instruments that monitor and provide feedback about your brain wave activity, breathing, blood pressure and heart rate, muscle tension, and temperature.

The idea is to become familiar with the activity of your body’s systems so that you can control them with behaviour modification. This helps in relieving stress and pain as well as improving overall health. To achieve this, however, you must be willing to participate fully in these sessions. The biofeedback therapist explains how to do mental as well as physical exercises, deep breathing, and visualization exercise that can help you treat your own back pain.

Prolotherapy

Prolotherapy is a medical procedure used to treat chronic and acute pain. It stimulates the body to heal the injured areas itself when the body can’t heal without help. Prolotherapy is most often used when traditional therapies, including surgery, have not helped. It is particularly useful for musculoskeletal pain like back and neck pain.

Prolotherapy treatments trigger the growth of new ligaments or tendons in places where the tissues have become weak. When ligaments get injured or become weak, they don’t always become as strong as they once were when they heal. Tendons can also become injured and cause pain. (See the chapter called Understanding How Your Spine Works to find out more about the structure of the spine .)

How does prolotherapy work? It uses a solution of water and sugar that is injected into the injured ligament or tendon at the spot where it attaches to the bone. This injection causes an inflammation at this spot. Surprisingly, the body requires inflammation to heal. The inflammation created by the dextrose solution increases the supply of blood as well as the flow of needed nutrients. This improved blood and nutrient flow stimulates the ligament or tendon tissue to repair itself.

Magnet Therapy

The use of magnets to relieve pain has been around for thousands of years among different cultures all over the world. Magnetic therapy is widely used alternative therapy for back pain.

This type of therapy uses a magnetic force to influence the systems in the body. The purpose is to increase circulation in injured area where the magnet is applied. It is believed that lactic acid and other inflammatory agents are also flushed out of the blood by the action of the magnets. The increased circulation carries more oxygen to the body and can aid in muscle relaxation and reducing muscle spasms and cramps. Like other alternative medicines, magnets increase that natural healing power that the body has.

Magnets can have an affect on circulation by either attracting or pushing away charged particles in the blood. The idea is to use the magnetic field to direct the blood towards the area of the back where the pain is.

Professional magnetic therapy treatments are available that use large magnetic fields powered by electricity. For treating yourself, you can buy magnetic jewellery and even magnets inserted inside a device that straps around your waist so that the magnet is centered on the affected area.

Body Work

Body work is another way to relieve back pain without using drugs or resorting to surgery. The term “body work” actually refers to Complementary and Alternative Medicine (CAM). Body work or CAM treatments offer safe and effective pain treatment for your back with no side effects. If there is a drawback to body work treatments it is that they do take time and repeated treatments to achieve the best results.

Three typical body work treatment options are:

CHIROPRACTIC MANIPULATIONS
Chiropractic treatments may not seem like alternative medicine because it is a well-known and commonly used way to treat back pain. These chiropractic treatments are focused on the idea that if movement in the spine is restricted in any way this can lead to pain as well as loss of range of motion in the back. When a chiropractor adjusts the spine, this is known as manipulation. Manipulating the spine is meant to improve movement, help you regain function, and reduce your pain.

Chiropractors use their hands to apply a sudden yet controlled force to a joint. The idea is to push the joint past the normal range of motion. They often use stretching and massage techniques to help the muscles relax. Shortened muscles or muscles that are in spasm can cause back pain.

MASSAGE
Massage is one form of body work that, like chiropractic treatments, is quite common. If done properly, massage therapy can go a long way to relieving back pain. A practiced massage therapist with good knowledge of the human body, muscles imbalances, and how to work with these imbalances can provide great results.

Back pain is often caused by muscles that are in spasm. This usually means that the muscle is not receiving good blood flow, thus causing the spasms. This causes a domino effect in these muscles:

· Since not enough blood is getting to the muscle it is also not receiving adequate oxygen.
· Lack of oxygen produces lactic acid in the muscle
· The lactic acid causes soreness and pain after physical activity.

When the muscle becomes relaxed after a massage, the lactic acid is released from the muscle, making it able to receive a healthy amount of blood and oxygen.

ACUPUNCTURE
Acupuncture is another form of body work and is discussed in the chapter called Chinese Medicine that follows.

Traditional Chinese Medicine

In Western medicine, back pain and injuries are diagnosed as related to spinal, muscular, or ligament issues. See the chapter called What Causes Back and Neck Pain for more information on what causes back pain.

Traditional Chinese medicine believes in the theory of Yin and Yang. Yin and Yang not only describes everything that exists in nature and their balance, it also describes all of the functions and parts of the body. When the Yin and Yang in the body are out of balance, injury and disease are possible. Chinese medicine seeks to restore this balance, thus relieving pain and restoring health.

ACUPUNCTURE
Acupuncture involves the insertion of fine needles into specific points connected to the affected area. The needles are left in the body anywhere from a few minutes to an hour. The spots where the needles are placed are along pathways known as meridians through which the body’s energy, the Qi, runs. When that flow of energy is interrupted, the result is pain or injury. The placement of the needles restores the flow of energy and relieves the pain.

Treating Back Pain Caused by Tension

Some people suffer from psychosomatic back pain with no physical cause. The condition is called tension myositis syndrome (TMS). This type of back pain is caused by stress. Pain as a result of TMS is thought to be the body’s way of taking your attention off of negative feelings and stressful situations in your life by directing your thoughts to physical pain.

The treatment for this type of back pain usually involves psychological therapy. The therapist may require the patient to write about his or her emotional issues and try to resume their typical lifestyle. Education is also part of the treatment, including regular visits to the therapist to learn about TMS and the psychological and physical aspects of it.

About Alternative Medicine

Alternative medicine and holistic therapies can be not only safe but very effective for treating back and neck injuries and reducing chronic pain. The type of alternative therapy that works for one person may not work for another, but chances are that everyone can find a holistic treatment that will work for them. The key is finding a qualified professional who can administer these therapies safely and properly.

There are cases where these methods are not effective and surgery is the only answer. See the Chapter called Back Problems that May Require Surgery.

Return To Back Pain Complete Guide

Back Pain and Smoking

Stress and Depression

Body Size, Breast Size, and Pregnancy
Posture and Ergonomic Issues

The Right Way and the Wrong Way to Lift Heavy Objects

Corsets and Back Belts

Rotational Sports

High Impact Sports

Sleeping without Strain

Picking the Right Pillow

How to Lower Your Risk of Back and Neck Pain

The best remedy for back pain is prevention. There are a lot of things we can do to prevent back injuries and the resulting pain, but most people don’t think about it till after it’s too late. People have a tendency to ignore the signs of growing neck or back issues and don’t do anything to correct their behaviour. But once someone has a back injury, it’s still not too late. Once the pain is gone, preventative measures should be taken to keep the back injury from recurring. Someone who has sustained an injury is four times as likely to have it happen again. Human nature has too many people thinking, “That won’t happen to me”.

Back and neck injuries are the most common as well as the most costly of any on the job injury there is. These types of injuries don’t just affect the person suffering with the pain. They cost employers lost time on the job, disability payments, and sometimes can even raise the cost of insurance premiums they must pay for the employees.

Considering that statistics show that you have an 80% chance of sustaining some type of back or neck injury in your lifetime, wouldn’t it be worth it start looking into ways of preventing this?

Back Pain and High Risk Related with Certain Occupations

There are a lot of occupations that put people at risk for back injuries. Surprisingly, the career fields at the top of the list is nursing and related skilled care jobs like home health aides. Nursing in fact, has the second highest occurrence of all kinds of non-fatal job-related injuries in the U.S. The biggest cause of these injuries is patient transfer – moving patients in and out of bed, from beds to gurneys and back again, and other ways that these healthcare workers help patients move around.

The following list shows the top ten occupations that have the most risk for back injuries. Six of the top ten are healthcare workers of some type.

1. Nurses Aides
2. Constructions Workers
3. Garbage Collectors
4. Licensed Practical Nurses
5. Truck Drivers
6. Registered Nurses
7. Health Aides
8. Machinists
9. Radiology Technicians
10. Physical Therapists

Back Pain and Smoking

As if there aren’t enough bad effects that smoking can have on your health or enough reasons to quit smoking, here is another one to add to the list. People who smoke are 1.5 to 2.5 times more likely to suffer from back pain than non-smokers. This is one aspect that spine researchers have studied and they have concluded that smoking decreases the supply of blood to the back. This can affect the elasticity of the discs and trigger disc degeneration.

One study even indicates that those who smoke are more prone to contracting back pain from lifting injuries than people who don’t smoke. It is thought that smoking causes malnutrition of tissues in and around the spine, making these tissues unable to respond adequately to mechanical stresses like lifting.

A study done at Johns Hopkins concluded that lower back pain and degenerative issues with the lower spine are closely associated with smoking and hypertension, which can be caused by smoking.

Many back surgeons will not perform spine surgery until a patient quits smoking. Smoking can cause bone grafts to be unsuccessful. These surgeons recommend that patients quit smoking at least 6 weeks before they will perform surgery.

Stress and Depression

For someone who has been injured on the job, how well that person likes his job and how much stress and anxiety the job causes can determine how motivated the injured employee is to get back to work. A consequence of this stress and anxiety can lead to another very real side effect of the pain associated with a back injury, and that is depression.

Emotional and psychological side effects like stress, anxiety, and full-blown depression can cause the pain to become worse. The hormones that the body releases under these circumstances can actually increase the pain signals that are sent to the brain. The more pain, the more tension there is in the muscles, causing even more pain. A vicious circle of develops.

Depression brought on by pain is best treated with the help of a psychologist who can help the patient stop this self-destructive pattern. One thing they quite often encourage is finding activities that will take the patient’s mind off of the pain. There are even therapists that treat nothing but patients who suffer from chronic pain. This type of therapist can figure out how much of the pain is due to psychological versus behavioural influences. This helps to determine the right treatment for the pain.

Body Size, Breast Size, and Pregnancy

Being overweight or unusually tall, having large breasts, and pregnancy are things that can all cause back pain.

Someone whose lifestyle includes overeating and not exercising can lead to obesity. Most spine care professionals believe that obesity is one of the biggest factors in back pain. Most of these back doctors prescribed weight loss as the treatment for overweight people with back pain. It can lead to degenerative disc disease, stenosis, and many other specific back problems. See the chapter called What Causes Back Neck and Pain for more information on the things that cause back pain.

Pregnancy is another thing that can cause back pain and not just because of the additional weight that the woman is carrying. While pregnant, women’s bodies produce a hormone that is meant to soften the ligaments in the lower back as well as the pelvis. This facilitates the birthing process but it also put extra strain on the spine and the muscles around it.

Women with very large breasts have been known to suffer from upper back pain because of the extra strain on the muscles and ligaments in that part of the back. This extra weight can result in poor posture and in some cases even cause spinal deformities. More and more women like this are having breast reduction surgery to relieve the upper back pain.

Posture and Ergonomic Issues

POSTURE
Poor posture, whether you are sitting, standing, or lying down can put you at risk for back injuries and pain. If the spine is not lined up properly, the muscles, ligaments, and facet joints (see the Chapter called Understanding How Your Spine Works ) are all put under extra stress. The most common cause of back pain related to bad posture is muscle strain. But poor posture can also put undue strain on the discs. The stronger the muscles are in your back, the better your posture will be. When muscles are weak, it is difficult for them to support the spine.

So what is proper posture? When standing, the middle of the head, the shoulders, the middle of the body, the knees, and the feet should line up vertically. Surprisingly, sitting at a ninety-degree angle is not correct. It is better to sit with your bottom forward somewhat in the chair. See the chapter on Sleeping without strain for the proper reclining postures.

ERGONOMICS
Ergonomics refers to fitting the task to the person, not fitting person to the task. The task can be anything from driving and sitting at a desk typing to construction work or working in the yard. Ergonomics is based on using the right tools, posture, and equipment to enhance performance.

When consistently using the wrong tools, sitting in the wrong chair, using the wrong posture effort is wasted, fatigue can set in, and you are at risk for pain, especially in the back.

The Right Way and the Wrong Way to Lift Heavy Objects

Everyone should understand the proper way to lift heavy objects off the ground so as to not cause a back injury. You don’t have to be in a profession that involves a lot of lifting to need this knowledge. Without it you could hurt your pack picking up any moderately heavy object. Even lifting something with your body just slight twisted or bent can cause an injury.

1. Move in close to the base of the object you want to lift with your feet pointed straight at the object. The closer the better. This puts the least strain on the spine.

2. While facing the object, bend your knees and squat down over the object. This allows your back to get help lifting from the strength of you both your legs and arms.

3. Tilt the object towards you onto its edge.

4. While still squatting, grab the object and slowly stand up, using your legs muscles to push up.

Never lift anything while bent over the object with your legs straight. This makes the spine act like a crane and is perfect way to put extra strain on it.

Corsets and Back Belts

More and more people who do a lot of heavy lifting are wearing 8-inch wide belts around their wastes that cross their backs. The purpose of these belts is not support the back but to add to the intra-abdominal pressure used when lifting. This helps them lift more weight for a longer time without putting as much strain on the back.

There are those that don’t believe that this concept really has any effect on reducing the strain of lifting. But everyone agrees that these belts tend to remind those who wear them to be aware of their backs and the risk of injury when they lift.

Rotational Sports

Rotational sports are any that involve either throwing or hitting motions. In throwing sports during the wind up, the upper body twists around the back side of the hip. The same is true in the back swing in a hitting sport. If the hip muscles are not strong this can put a lot of torque on the lower back as well. Approximately 36 percent of professional golfers suffer from some lower back pain. By the strengthening the muscles in the hips you can keep the strain off the lower back.

High Impact Sports

High impact sports like running and basketball are often considered a good way to make the bones stronger, especially as we age. But for someone who runs with the wrong posture, these types of sports can cause lower back pain. This usually happens when someone runs with torso completely upright by overarching his or her spine. Keeping the spine more neutral can help avoid lower back pain.

Sleeping without Strain

The best way to give the back relief from carrying our body weight all day is to let it rest properly at night. The two best ways to do that are:

1. Sleep in the best positions to let your back muscles rest. One of these positions is lying on your back. But it is important to put a pillow under your knees. You can also sleep on your side with a pillow placed between your knees. Using the pillow in both of these positions keeps the spine aligned properly. Sleeping on the stomach is the worst position because it forces the back to arch and your head to twist to the side.

2. The proper bed for your back is a must. A mattress that is too soft can make your spine curve and lead to back problems because the muscles in your back are have to keep supporting your spine, even while you sleep. A mattress that is too hard won’t conform to your body’s natural curves. This makes the spine have to curve to conform to the bed.

Picking the Right Pillow

One of the most common ways to get neck pain is when the neck is bent or twisted too far and too long in one direction. Many people wake up with a painful neck and this usually means that the pillow is not supporting their head and neck properly. There should always be a slight curve in the neck.

Using the right pillow can really improve your sleep as well as completely prevent or reduce pain. When sleeping on your side, your pillow should just fill the area between your ear and your mattress. Your head should not tilt. While on your back, the pillow should keep your head from tilting either backward or forward.

How to Lower Your Risk of Back and Neck Pain

There are a lot of ways to lower your risk of back and neck pain. Four of the best ways are:

1. Maintain a healthy weight. Obesity is one of the biggest causes of back pain because of all the extra weight that is put on the spine.

2. Do regular back stretches and exercises like those explained in Exercises to Relieve Back and Neck Pain. These exercises are good for prevention as well as relief of pain.

3. Learn how to use the right posture while standing, sitting, and lying down.

4. Learn the proper way to lift. Anyone is subject to a back injury when lifting, not just those whose jobs require it.

Return To Back Pain Complete Guide

When is Appropriate time to Visit  Emergency Room?

Back specialist for Complex Symptoms?

Doctor’s Personality – how much it counts?

Government Guidelines on Treatment

What Activities Doctor Exam Consists?

What Test Needs To Be Perform For Back And Neck Pain?

Most back pain will subside within a month of its onset. But if the pain is bad enough, many people don’t want to wait around to see if it will stop. They may also worry that ignoring the pain may make a potential problem worse. So how do you decide if you need a doctor and even what type of doctor to see?

If you have health insurance coverage from an HMO or PPO, nurse call lines may be available. The nurses that work these call lines can listen to your symptoms and give you some information that may ease your mind about the back or neck pain you are experiencing. They can even provide you with some home remedies to try like those mentioned in the chapter called First Aid Remedies for Back Pain.

Larger hospitals often offer these medical advice lines as well. Nobody working one of these call lines can diagnose your problem over the phone, but they can offer you information regarding the symptoms of you back pain. They can also let you know if you can wait to make an appointment and see a doctor or if you should seek help immediately at a hospital emergency room.

How about  Diagnose Yourself?

While pain is a pretty obvious symptom that something is wrong with your back, you have no way of knowing what is causing the issue and how severe it is. Surprisingly, how badly it hurts doesn’t necessarily determine how serious the problem is. While a herniated disc is a much more serious injury than a muscle strain, a muscle strain can be considerably more painful.

There are some serious symptoms that can help you decide if it’s time to see a doctor, or more specifically a spine physician.

1. If your pain is radiating from the back downward into a leg, this can be an indicator of a disc problem.

2. Disc problems can also be characterized by what is known as “foot drop”. This means that the muscles are so weak that you cannot raise the front of your foot. The toe may also drag when you walk. Anyone with this symptom should see a doctor right away.

3. Perhaps the worst sign and the strongest indicator that a doctor is required is loss of bladder or bowel control. This is an indicator of neurological damage that may become permanent if not treated quickly.

When is Appropriate time to Visit  Emergency Room?

Emergency rooms aren’t always the best answer when you have an onset of back pain. The doctors that work in the average emergency room are not specialists in back pain. Their specialty is usually emergency medicine and it is likely that your treatment will consist of a prescription for muscle relaxants or pain pills and a referral to a spine doctor. If the pain is in your lower back only and there is no spread to a leg or arm, it is probably more expedient to call the office of a specialist directly rather than making a trip to the emergency room. The specialist may be able to see you that day after hearing what your symptoms are.

Most health insurance plans don’t consider back pain to be an emergency and won’t pay for the emergency room visit under these circumstances.

Along with symptoms described in the previous chapter like foot drop or loss of control of your bladder or bowels, there are two other good reasons to seek medical attention at an emergency room.

1. If it is an evening or weekend and you are in terrible pain, an emergency room may be your only recourse rather than waiting till the doctor’s office is open. Be prepared for a long wait since back pain is often not considered an emergency situation.

2. If you have any type of fall, accident, or event that has caused sudden injury and pain to your neck or back, you should go the ER right away if you can’t get in to see a spine physician. When trauma has brought about the pain, an X-ray may be required to ensure that nothing has been broken.

What Kind of Back Doctor Should You See for Attack of Acute Pain?
Acute pain is severe pain that comes on suddenly as your body’s way of telling you that something is wrong. If you have an attack of acute back or neck pain, there are a number of different options to consider when choosing a physician.

PRIMARY CARE DOCTOR
While there a number of different types of medical specialists that treat back and neck issues, often your family doctor, a primary care provider, can perform a physical check that can rule out potentially serious problems. A good percentage of health insurance plans require you to see your family doctor before you go to a specialist. The primary care doctor often must give you a referral.

But more and more health plans are allowing patients to go directly to the specialist. This cuts down on the time the patient may have to take off work when he or she is allowed to bypass the visit to the family doctor. In many cases a specialist can actually save the insurance companies money by not requesting unnecessary tests like MRIs.

In some cases it can be easier to get an appointment more quickly with a specialist than with a primary care doctor. In larger cities there is a shortage of this type of physician, making the waiting time longer to get an appointment. It is also true that primary care physicians lean towards treating the back pain with medication rather than recommending exercise and physical therapy.

CHIROPRACTORS
The manipulations of a chiropractor are often quick and effective relief for acute back pain. Add in the fact that wait times to be evaluated by a chiropractor are often much shorter than primary care doctors or other back specialists and you may find that chiropractic treatment is one of the better options. Chiropractors also seldom treat back pain with drugs that merely mask the symptoms.

OSTEOPATHIC PHYSICIANS
A D.O., or doctor of osteopathy, is part medical doctor and part chiropractor. Many people think of them is a happy medium between holistic care and traditional medicine. While they can prescribe medication, they can also provide chiropractic manipulations to treat the back pain.

ORTHOPEDIC SURGEONS AND NEUROSURGEONS
Doctors trained in these specialties can treat just about any type of back and neck pain, especially those that require complex surgery. The work they do in the operating room to treat back and neck injuries is talked about more in the section called “What Actually Happens in Back Surgery?”.

OTHER OPTIONS
Other specialists that can treat back pain include physiatrists, neurologists, and rheumatologists.

Back specialist for Complex Symptoms?

There are facilities that specialize in nothing but back pain. If you have had the symptoms of neck or back pain on-going for months and no one has been able to give you a diagnosis or treatment that works, a center like this may be the best option for you. They are equipped to handle the more complex cases.

Besides spine physicians, spine centers employ other specialists skilled in a variety of disciplines that include physical therapy, exercise physiology, injections, diagnostics, chiropractic, and biofeedback.

Neurology is another specialty found at a spine center. Neurologists are experts in the nervous system, including its function, structure, spine abnormalities, and brain and nerve tissue. Testing that they perform can be the key to evaluating the source of the pain.

Doctor’s Personality – how much it counts?

The personality of your doctor can be very important to your recovery. After all, if you are suffering from chronic pain, he or she may be in your life for a while. Your doctor must be sympathetic to your pain in order for you to trust their treatment philosophy. You want your doctor to spend at least 15 minutes with on the initial examination, listen to everything you know about your back pain, and not to perform a lot of costly tests that aren’t necessary. Your doctor should also thoroughly explain to you the cause of your pain and what the first step in your treatment should be.

To many people, the doctor’s manner is not important. In fact there are those who like it when the doctor is firm and speaks with authority, while others want the doctor to make them a part of the entire process from diagnosis and treatment till the pain is managed.

Government Guidelines on Treatment

Recently some of the country’s best experts in back pain got together to define and document the way a back patient should be processed through the medical system. This is included in a publication called “Clinical Practice Guidelines: Acute Low Back Problems in Adults: Assessment and Treatment”. This set of guidelines makes it necessary for all physicians to codify and provide justification for all back pain treatments.

This publication also defines the most dangerous back pain symptoms and “red flags” them as possibly requiring surgical solutions. It makes a distinction between these types of symptoms and those that require more conservative treatments.

What Activities Doctor Exam Consists?

At your first visit to the doctor you can expect to be asked a lot of questions about your pain. In order for the physician to determine the cause of your pain and the type of treatment it will require, these questions are necessary. This is just a small example of the types of question you will be asked:

· Is the pain on both sides or only on one side?
· Is the pain dull, sharp, burning or throbbing?
· Were you injured in an accident?
· Is there any numbness or tingling?
· Are there any things that make you feel better?

You will probably also be asked questions about any prior incidents of back pain.

The doctor will also try to find the exact location of the pain and ascertain how your movement is effected. He or she will likely ask you to bend forward and backward, stand on your toes and then on your heels, and to lift your legs straight up while lying on your back. The doctor may move your legs into different positions and possibly touch your legs with different objects to test the sensory nervous system.

This initial visit is what will determine if you need further tests before you are prescribed a treatment for your pain.

What Test Needs To Be Perform For Back And Neck Pain?

The initial exam, your medical history, and further tests that may be required are used to determine the source and cause of back pain as well as the treatment. Evidence that the initial exam turns up may determine that you need one or more of the following tests.

· CT scans and MRIs – These both can show the soft tissues such as a ruptured disc, narrowing of the spinal cord known as stenosis, nerve roots, and muscles. These tests are very valuable to a doctor in making a diagnosis.

· Myelograms – In this test the spinal canal is injected with a dye in order to make problems like herniated discs, spinal abscesses, or spinal cord tumors more visible in an X-ray.

· Discograms – Discograms are often performed before back surgery to remove a herniated disc. A dye is injected into the disc and an imaging device is used to see if the dye moves beyond the disc space to a spot near a nerve. The idea is to recreate the pain.

Other tests that may be required or bone scans or a nerve study called electromyography. X-rays are very rarely required unless an accident or fall is the likely cause of the injury.

Return To Back Pain Complete Guide

Who Needs IDET?

Pain Can Linger as a Result

Spine specialists have the most difficulty when diagnosing and treating axial low back pain. This type of pain is in the lower back only and does not radiate to a leg. The reason this can be difficult is that there are so many possible causes – disc, bone, muscle, or ligaments problems. This can make it difficult to pinpoint the real issue. In these cases a barrage of tests may be required like those talked about in the chapter called What Test Needs To Be Perform For Back And Neck Pain? . Often times injections and different therapies are done on a trial and error basis that can end up wasting a lot of time.

Quite often the cause of axial low back pain can be narrowed down to a degenerated disk, something that happens to a lot of people as they get older. Over time, the annulus of the disc, which is the disc’s outer wall, can develop tiny tears. Sometimes the contents of the disc and seep through the wall completely and end up in the spinal canal. This is a herniation. These tears as well as the fluid that gets into the canal send pain signals to the brain.

Up until recently, the only answer for pain caused by a herniated disc was to have surgery to fuse the disc. See the section on What Actually Happens in Back Surgery for details on how fusion surgery is done. But in 1997 a new treatment for axial low back pain was developed. This new procedure treats the pain using heat applied to the disc. Seventy percent of people who have this treatment report a significant decrease in pain.

What is IDET

This new procedure is called IntraDiscal Electrothermal Therapy (IDET) and is can be a successful alternative to having disc fusion surgery. An IDET treatment is only slightly invasive and involves the application of controlled amounts of heat in the form of thermal energy to a wide section of the disc wall. The heat causes the collagen in the wall of the disc to thicken and contract, while elevating the temperature of the associated nerve endings. The result is that the tears in the disc wall close up, stopping the material in the disk from bulging through. This desensitizes the pain sensors that located are in the disc.

HOW THE PROCEDURE IS PERFORMED

Fortunately, IDET therapy is normally an outpatient procedure done with local anesthesia applied at the site of the herniated disc. In order to reduce any discomfort during the procedure, mild sedation may be used. But the physician needs the patient to be awake and aware enough to provide feedback during the procedure. The procedure itself normally takes no more than 20 minutes when only one disc is being treated.

The physician uses X-ray images to guide him while the needle is being inserted into the disc. Once the needle is in, a catheter is passed through it. When the catheter is in place, the heating portion of it will be gradually heated in order to raise the temperature of the disc wall. During this process, the patient’s comfort and condition will be watched carefully because the heating actually reproduces the patient’s lower back pain. This pain is a sign that the heat has been applied to the right spot. At the end of the procedure, the needle and catheter are removed and the patient can go home when any sedation wears off.

Who Needs for IDET?

As it stands, there is absolute method to choose patients to have this procedure. However, the FDA does specifically state that IDET is “intended for solidifying and the decompression of disc material” and that it can be used to “treat patients annular ring disruption of a contained bulge”. It is very important that IDET be used only on patients with the type of disc problems described above. It does not work on problems within any other parts of the spine like joints are nerve roots.

There are some criteria for accepting patients for this procedure that include:

· The patient must have had low back disc pain that has limited function for at least six months. The patient must have gone through other typical treatments like exercise, corticosteroid injections, physical therapy, modification of activity, and use of anti-inflammatory and all of these treatments must have proven unsuccessful.

· There must have had a normal neurological exam.

· Both an SLR exam that is negative and an MRI scan that doesn’t show nerve compression must have been performed.

· The results of a discogram must be positive.

See the chapter called What Test Needs To Be Perform For Back And Neck Pain? for more information on these tests.

People who are approved for this procedure will be happy to know that not only is it much less invasive than disc fusion surgery, it is quite a bit cheaper. The total cost of an IDET procedure is around $8,000 while the surgery is approximately $45,000.

Pain Can Linger as a Result

Before choosing to undergo an IDET procedure, it is important to understand what happens afterwards. The results of IDET are not immediate. Your back pain may actually increase for a while because of the procedure. The heat that was generated can take several days to diminish. You will likely be given pain medication to get you through this period. After about two weeks, the pain should return to the level it was before the procedure.

The pain should start to decrease over the following six to nine months. Undue stress should not be put on the disc that was treated and you should strictly follow the activity and rehabilitation instructions provided by the physician. This home therapy usually includes:

· Walking and mild stretches
· Restrictions on lifting, and bending, sitting
· The use of a back support during the first month after the procedure

By the second and third month you will be instructed to start including floor exercises. The lifting limits will be lifted but bending is still off limits. More active things like golf, skiing, and running will be restricted for the first five months.

IDET is not a sure thing. Some patients do not get relief from their pain and in others the pain may return at some point.

Return To Back Pain Complete Guide

Excessive Surgeries

Do You Need Back Surgery?

Good Situation for Surgery is…

Bad Situation for surgery is…

There was a time when doctors commonly recommended surgery for back pain. More recently many doctors are starting to recommend surgery as the last option when all other mainstream home remedies or professional treatments have failed. (See the two full sections on these treatments for more information. They are called Mainstream Professional Remedies and Mainstream Methods to Cure Your Back by Yourself .)

Even when surgery is used as the final option, it does have its pros and cons. While it can help permanently or temporarily resolve the issue, there can be drawbacks and side effects. Some of these “cons” to back surgery are discussed in the next chapter, “Back Surgery Negative Side?”

Back Surgery Negative Side?
Of course, having back surgery isn’t necessarily a bad thing, but a prospective back surgery patient should always weigh the bad things against the good.

1. While surgery to relieve pain due to damaged nerve endings can successfully block the pain, these procedures can be extremely invasive and the results are not always permanent. When the pain returns, the procedure may need to be done again.

2. Surgery like a spinal fusion can put a stop to the motion in your back and the instability of the spine that causes pain. But spinal fusion can also result in the spine being less flexible. It may be necessary to learn how to move differently in order to compensate for the inhibited motion.

3. Spinal surgery can relieve pain, thus making it possible for a patient to take part in a physical therapy program that they other wise could not have been able to do. However, no doctor can guarantee that it will work. For some patients surgery will work and others will have a little change in their symptoms. But there are those patients who experience even more pain after surgery.

4. Some people opt for more aggressive treatment like spinal fusion for their back pain so that they can get back to their normal activities more quickly than less aggressive treatments like exercise, physical therapy, acupuncture, and chiropractic can have.

The other side of that is that surgery requires considerable time to recover and does have side effects. One of these side effects is that the segment that is fused can cause stress on the parts of the spine above and below it. This is referred to as “adjacent segment disease” and it can result in degeneration in these segments.

5. Since surgery like spinal fusion involves a lot of bone work, there will likely be more pain for a while and a long recovery time. The facet joints and transverse processes are exposed during a fusion which means muscles must be dissected during the surgery. Inflammation can develop as a result of the bone grafts or substitutes that are inserted in the spine to help with the fusion. Inflammation leads to scarring and pain.

6. Any surgery makes scar tissue. When your body heals, that scar tissue can build up so much that it may begin to touch on a nerve and cause the same amount of pain that you had when the degenerated disc was applying pressure to that nerve.

7. Quite often the long-term prognosis after spinal surgery is no better than that when less invasive treatments are used.

8. More mainstream treatments are much less costly than surgery.

A survey conducted among recipients of back surgery showed that over 50 percent of them had at least one problem or complication after the surgery.

Excessive Surgeries

Even thought the evidence shows that most back pain will either go away on its own or with the help of mainstream treatments like physical therapy, exercise and stretching, and chiropractic, back surgery is on the rise. In fact, a 2007 study had back surgery at the top of a list of most overused tests and treatments.

One example of this is the switch from surgical decompression to treat spinal stenosis to spinal fusion. In fact the number of spinal fusions increased 15 times in a five-year period among Medicare patients. Spinal fusion is much more invasive that decompression and there is not as much proof that it works as there is for surgical decompression.

Research into this increase in invasive and expensive surgical procedures suggests that one of the reasons for it is because of all the new innovations and devices. These new techniques may tend to influence the opinions of the leaders in this field to the point that they recommend surgery just to try out these innovations. There is also the matter of financial incentives for surgeons and hospitals.

Do You Need Back Surgery?

There are times when surgery is the only reasonable option. But that decision is yours, not your doctors. These days patients more actively participate in the decisions made for the treatment of their back pain. Because each patient has the ultimate say as to whether or not to have back surgery, it is their responsibility to look a the pros and cons closely, the possible risk and benefits, and what the chances are that the surgery will actually be successful in relieving their pain.

As a potential back surgery patient, you need to be absolutely confident in your decision. When you go into surgery with a positive attitude, goals that are realistic to achieve, and complete understanding of what the surgery will accomplish this can actually make recovery from the surgery easier.

But how do you achieve this positive attitude? Learn everything you possibly can about the procedure and how it is performed and statistics about possible outcomes. Ask your doctor a lot of questions and have him or her point you towards all the information you can get your hands on before making your decision. The survey mentioned in “Back Surgery Negative Side” showed that one quarter of the people questioned had not been informed by their doctor of the risks of the surgery like bleeding, infection, and nerve injury.

Another thing that can be important in determining if you need back surgery is a second opinion from another physician. You don’t need to change doctors completely. Make an appointment with another spinal specialist and get another diagnosis and treatment recommendation. The best way to get the most honest answer from this second opinion is not to tell this physician what the first doctor has diagnosed and recommended as treatment. Doctors will often tend to agree with the judgment of the first doctor.

If you feel good about your decision to have surgery after doing all of these things, then you have probably made the right choice.

Good Situation for Surgery is…
There are a lot of cases that make back surgery appropriate.

1. Most spine physicians will find surgery to be appropriate when more conservative measures have been ineffective, the cause and source of the pain has been clearly identified, and there is a specific surgical procedure for the condition that has a high success rate and low rate of complications.

2. When symptoms of spine problems become disabling to the patient to the point where he or she is not able to perform their normal daily activities spine surgery can be appropriate.

3. Surgery is appropriate when there has been on-going nerve loss. This nerve loss can result in weakness that causes foot drop or bladder or bowel dysfunction. In some of these cases surgery may need to be done on an emergency basis.

4. Some rare conditions that require surgery are spinal infections that can cause destruction of the vertebrae, unstable fractures, and tumors.

5. Spinal cord trauma that results in injury to spine may require surgery. This type of trauma can be caused by things like car accidents, falls, and sports related injuries. Surgery may be needed to remove tissue or fluid that is pressing on the spinal cord, to remove fragments of bone or disc, or to stabilize a fractured vertebra.

Bad Situation for Surgery is…
Back surgery should always be considered the last resort after the mainstream treatments have been exhausted with no relief. Normally, 90 percent of back pain will heal with less aggressive, non-surgical treatments or with time. While back surgery can be very effective for a lot of cases of pain, it is not appropriate for most of the more typical and less severe conditions that can produce back pain.

A specific example of when surgery may not be appropriate is the case of a herniated disc where the part of the disc that is pressing on the nerve and causing the pain is removed. (For more information on this type of surgery, see the chapter called Latest Advances in Spine Surgery .) While this surgery does work to relieve the pain, it does not treat the underlying cause of the herniation.

Herniated discs usually result when there are muscle imbalances and postural problems that are causing the back to weaken. If these issues are left untreated, it is possible that after having a herniation repaired, the spine can continue to degenerate and in time the pain will come again. Surgery does not treat muscle imbalances.

In this case it is also true that the recovery from the surgery itself can cause further problems. While the body is recovering there can be severe pain. This pain can cause the body to move awkwardly and contort. This can result in additional stress on the body, especially in the areas above and below the surgery as well as in other joints like the hips and sacroiliac.

Return To Back Pain Complete Guide

The Latest Advances in Spine Surgery

New Technology and Instrumentation

Multiple Spine Surgeries

Spine Surgery Recovery

There is a lot to think about when you have exhausted every other treatment and the time has come for surgery to relieve your back pain. The best part is that it can sometimes provide you with very fast relief from the pain you’ve been suffering. Recovery time can be significant, however, and there are cases when it doesn’t work and more than one operation may be required. But there have been some remarkable advances in back surgery techniques, not to mention new technologies involved.

Some of the reasons that back surgery may be required are talked about in the chapter called Back Problems & Surgery .

Back Surgery Types

The type of surgery performed to relieve back pain depends on the cause of that pain. See the chapter called Back and Neck Pain Causes for a description of many common causes of pain that can be helped with surgery.

· Discectomy – A discectomy is most commonly performed to remove the part of a herniated disc that is putting pressure on a nerve and causing pain. The part of the disc that is not damaged is left in tact to act as a shock absorber for the spine. This type of surgery requires general anesthesia and a three-inch incision.

· Microdiscectomy – This is a type of discectomy that can be performed with the aid of a microscope. If the herniation is in a certain area, only a small incision may be required through which the spine surgeon can pick out the portion of the disc that is herniated. However, quite often this part of the disc is hidden from view by the vertebrae and this type of surgery isn’t possible.

· Percutaneous Discectomy – This type of surgery to remove the herniated piece of a disc is even less invasive than a microdiscectomy. This is a relatively new procedure and is discussed in more detail in the chapter called “The Latest Advances in Spine Surgery”.

· Vertebroplasty – This surgery is used to stabilize fractured and compressed vertebrae and relieve the pain. A special type of bone cement is injected into the affected vertebra. Vertebroplasty is a fairly new procedure and is discussed in more detail in the chapter called “The Latest Advances in Spine Surgery”.

· Laminectomy – This surgical procedure is performed to relieve spinal stenosis. It removes the part of the bone in the spinal canal that is putting pressure on the nerve by widening the opening.

· Spinal Fusion – Spinal fusion is used to relieve pain caused by the motion between vertebrae that may be caused by an injured disc or one that is degenerated. It is also used to connect two bones in the spine and to stabilize a spinal break.

· Artificial Discs – Another way besides spinal fusion to relieve pain from movement between vertebrae is to implant artificial discs. This up and coming technology will be discussed further in the chapter called Fusion Alternative – The Artificial Disc .

· Spinal Implants – The practice of spinal implants and its advancements are discussed in “The Latest Advances in Spine Surgery” and “New Technology and Instrumentation”.

The Latest Advances in Spine Surgery

Because of advancements made in spinal surgery, surgeons are able to more effectively treat spinal disorders. Some of these advancements are:

· Treatment of spinal fractures – The best way to treat unstable spinal injuries like burst fractures and fracture dislocations is to stabilize them as soon as possible. When these fractures occur in the lumbar segment of the spine, new developments in vertebroplasty are being used, especially for wedged compression fractures since these are the most common spinal fractures. A wedge compression fracture means that the vertebra has been crushed or wedged leaving spaces within the bone.

Verterbroplasty is used to correct this type of injury. While the patient is under local anesthesia and light sedation, a needle is guided into the vertebra that is fractured with the guidance of an x-ray. Once the needle is in place an acrylic bone cement made especially for this type of procedure is injected into the vertebra. The cement fills those spaces in the bone caused by the fracture and the needle is then removed.

Within 10 minutes the cement hardens, holding the bone fragments together, thus stabilizing the bone.

· Treatment of herniated discs – One of the newer methods of removing the herniated disc material that is pressing on the nerve or the spinal cord is called percutaneous microdiscectomy. It is sometimes referred to as “band-aid” back surgery because the incision is only one-half inch long and can be covered with a band-aid when the surgery is over.

This type of procedure is known as endoscopy and there are several different ways to perform percutaneous procedures. They each involve the insertion of small instruments between the vertebrae and into the center of the injured disc. X-rays are used to monitor the surgery and guide the surgeon’s movements of the instruments being inserted into the disc. Once the instruments have reached the damaged disc material, the surgeon has the option to cut the material out, suck it through the center of the disc, or to use lasers to evaporate or burn the disc material.

· Spinal Implants – This is a technique that is gaining popularity for getting rid of back pain. But because the surgeries are quite intricate and the fact that a lot of muscle tissue needs to be cut to insert the implant, this is usually considered one of the last option. Recovery time can be quite long and painful, sometimes longer than 6 months.

Spinal implant procedures are based on the normal spine surgery techniques, but the new spinal implant procedure can offer a permanent solution to your chronic back pain. The devices used in spinal implants are made to keep normal function and flexibility in the spine.

Spinal implant devices are discussed further in the next chapter called “New Technology and Instrumentation”.

New Technology and Instrumentation

The goal these days is to come up with minimally invasive procedures for spinal surgery. These means small skin incisions that cut down on the possibility of damaging large muscles when they are retracted. The idea is to leave the body as close to the way it was before the procedure. Examples of these procedures are microdiscectomy and vertebroplasty, which are described in the “Types of Back Surgery”.

With these procedures, surgeons hope to make recovery time quicker, reduce post-operative pain, and to leave behind a small, unobtrusive scar.

Some of these procedures involve implanting instruments in the spine like screws and rods to stabilize it. As part of the less invasive techniques used to do this, surgeons use computer-assisted image guidance making it easy for them to “see” the spine without making a large incision. The x-ray machine used to do this is called a fluoroscope and it has been combined with computer technology that helps the surgeon locate and navigate to the part of the spine to be worked on. The technology is called FlouroNav Virtual Fluoroscopy System.

With the help of the FlouroNav system, doctors can use a variety of different devices in the spine to reduce pain. Some of these are:

· Pedicle screws and rods – The pedicle is a part of the vertebral bone that is very strong and it connects the front part of the spine to the back of the spine. The spine has a pedicle bone on each side. Implanting a screw into the pedicle bone stabilizes the spine.

Screws of all sizes are used and are called pedicle screws. When these screws are attached in several different locations along the spine, a rod can then be inserted that connects them all together on each side of the vertebrae. This gives quite a bit more strength to the spine.

· One of the more popular pedicle screws is made of titanium. It has a rotating head so that it can accommodate different conditions and positions in the anatomy. It is known as a polyaxial. A new instrument called a SEXTANT is used to place the screws and rods straight through the skin, fat, muscle, and right into the bone without long incisions. The screws are implanted with damaging or the connections of tendon and muscles to bone. Then the rod is passed through the path formed by the SEXTANT directly into the heads of each screw.

Multiple Spine Surgeries

Unfortunately, some people end up enduring more than one spine surgery. More often than not this occurs because of technical problems during the surgery rather than a recurrence of the original injury. An example of this is the microdiscectomy and percutaneous discectomy that were discussed in the chapter called Types of Back Surgery.

With discectomies using either one of these methods it is often difficult to actually observe and get to the portion of the disc that is herniated. This can lead to an unsuccessful discectomy, making it necessary to perform another surgery.

Recovery after Spine Surgery

No matter which of the surgical options you have had performed to ease your back pain, a period of recovery will be required for your body to heal the damaged tissues and get you back to normal. There will be pain and recover will take time, so a positive attitude can be a big help during this period. Here are some things to keep in mind about recovering from back surgery.

Take Your Time

Follow your doctor’s instructions explicitly and don’t try to rush things. If you push yourself beyond what the doctor recommends, you are more likely to cause a setback.

A lot of time should be spent resting while the pain from the surgery decreases. If you start to feel more energy and are able to be more active, that’s a great sign that your recovery is progressing.

Determining the time it takes to recover is not an exact science. It is different for everyone, depending on things like age and what type of physical condition the patient was in before the surgery. Simple things like a good attitude, healthy diet, and lots of rest really do work to shorten recovery time.

Pain After Surgery

Some pain after spine surgery is natural. The surgery can cause achiness because of an inflammation or muscle spasms. There is likely to be pain at the incision site for a while after surgery. Your doctor will likely prescribe medication for the pain and something to stop the muscle spasms. Eventually, you should begin to cut back on the pills you take and start using light exercise, moist heat, and massage.

Post-Operative Recovery in the Hospital

Generally, patients remain in the hospital for two days after back surgery unless it has been a less invasive procedure. The hospital staff will have you up and walking within a few hours after the procedure. This is not like the old days when bed rest was considered the best cure.

Return To Back Pain Complete Guide