Back Pain and Neck Pain Treatment in Plano, TX & Allen, TX
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One of the most common medical problems in the United States. Eight out of ten people will develop a back problem at some time during their lives. It is the second most common cause of missed work days and is the leading cause of disability between the ages of 19-45. Approximately 80 billion dollars is spent because of back pain each year, and the cost keeps growing.
No matter what the treatment form, most episodes of back pain resolve within 8-12 weeks. In some individuals, back pain will become chronic. It becomes especially important for these people to become proactive about their back pain. A person with back pain becomes proactive by eating properly, stopping smoking, exercising on a regular basis, and pacing their activities in order to prevent worsening of their underlying spine problem. Although there may be no “quick fix” to a back problem, many individuals can be treated effectively and lead productive life styles.
Back conditions usually do not develop suddenly. Your back is subject to many repeated stresses or injuries over your lifetime. Everything from falling off your bike as a child, to lifting a heavy sofa to carrying around extra weight for several years may contribute to a spine condition. These repeated stresses or injuries add up over your lifetime, resulting in degeneration of the spine.
The goal of a spine treatment program is to improve symptoms and to slow the progression of the degenerative process in the spine. Usually this involves a joint effort between the individual with back pain, the treating physician, and other allied health care professionals such as physical therapists.
Anatomy of the Spine
The spine has three main parts:
- The spinal column-bones and discs
- Neural elements-the spinal cord and nerve roots
- Supporting structures-muscles and ligaments
The spinal column consists of individual bones called vertebrae. The vertebrae provide support and protection to the spinal cord. The spine contains seven cervical vertebrae (C1-7) in the neck; twelve thoracic vertebrae (T1-T12) in the mid-back; five lumbar vertebrae (L1-L5) in the lower back; five fused bones in the sacrum; and three to five fused bones forming the coccyx or tailbone.
On the front side of the spine, the vertebrae are connected by intervertebral discs. The discs contain a harder outer ring called the annulus fibrosis and an inner jelly filled center called the nucleus pulposus. The annulus connects the vertebrae while the nucleus provides shock absorption properties of the spine and allows the spine to flex and bend. On the back side of the spine, a pair of joints called the facet joints allows the spine to twist and bend forward.
Nerves connecting the brain to the body make up the spinal cord. The spinal cord runs through the center of each protective vertebra. Nerves branch off from the spinal cord to organs and muscles including the arms and legs. The nerves carry messages from the brain to the organs, muscles, and limbs.
The soft tissue supporting structures of the spine, the muscles and ligaments, enable the spine to function in an upright position, and allow the trunk to move in a variety of positions. They are vital to maintaining stability to the spine.
Risk Factors for Back Pain
A risk factor is something that increases your odds of developing a disease or condition. The following are risk factors for developing back pain:
- Lack of regular exercise
- Family members with back conditions
- Previous back injuries due to lifting a heavy object, improper lifting, sudden twisting or bending, bad posture, prolonged sitting or standing, vibration from vehicles or heavy equipment
- Prior back surgery
- Psychological factors
- Low job satisfaction
- Interpersonal relationship problems
- Fatigue or lack of sleep
- Alcohol or drug abuse
- Excessive stress
- Pain relievers such as acetaminophen, aspirin, or ibuprofen
- Muscle relaxers
- Cortisone pills or injections
- Antidepressants for chronic pain
- Hot or cold packs
- Stretching and strengthening exercises
- Electrical Stimulation
- Relaxation training
- Chiropractic manipulation
- Exercise regularly
- Stop smoking
- Lose weight
- Sleep on a firm mattress
- Use good posture to reduce stress on your spine
- Avoid sitting or standing in one position for prolonged periods of time
- When lifting, hold the object close to your chest, maintain a straight back, and use your legs to slowly rise
- Consider job retraining if your profession requires too much heavy lifting or sitting
Causes of Back Pain
There are many causes of back pain, the most common of which is a sprain or strain of muscles or ligaments. Muscle spasm can occur after twisting or bending awkwardly, or from a simple sneeze or cough. The majority of muscle spasms tend to get better over time. Severe cases of muscle spasms are treated with medication, physical therapy, or injections.
Disc problems are common causes of back pain. Discs are usually moist, like a sponge with water in it. After a disc injury, or as we age, discs lose water and deteriorate in a process called disc degeneration.
The earliest form of injury to a disc is in the form of tears or fissures in the annulus fibrosis (outer portion) of the disc. The annulus fibrosis is like a large round ligament that prevents the nucleus pulposus (inner portion) of the disc from pushing outward. Tears in the annulus heal by scar formation resulting in tissue that is not as strong as normal tissue. The repeated cycle of many annular tears healing by scar formation lead to a disc that begins to degenerate.
As a disc degenerates it becomes stiff, narrows, and losses it’s ability to act as a shock absorber. Bone from the vertebrae above and below the disc may grow forming bone spurs. If bone spurs get large enough, they may cause pressure on nerves in the spinal canal, causing pain, numbness, and weakness in the arms or legs. The combination of disc degeneration and bone spur formation in the spine is called spondylosis. Any narrowing within the spinal canal, from bone spur formation or from any other cause is called spinal stenosis. Spondylosis or spinal stenosis can occur at any level in the spine-cervical, thoracic, or lumbar.
Bulging Disc, Protruding Disc, Herniated Disc, Extruded Disc
Over time, because of injury or degeneration, discs start to change shape. Many terms describe this change in shape including bulging, protruding, herniated, prolapsed, slipped. They generally describe a disc that is displaced beyond the limits of the intervertebral disc space.
The earliest change in shape many times is in the form of a disc bulge-a wide based extension of the disc. Often, disc bulges do not cause pain. As the degenerative process progresses, the central, nucleus pulposus portion of the disc can extend through a tear in the outer annular wall of the disc, resulting in a focal protrusion or herniation of the disc. Disc protrusions can cause symptoms of pain, numbness, or weakness from nerve root pinching. In some individuals however, disc protrusions will not cause any symptoms. A disc extrusion is a severe version of a disc protrusion in which a large portion of the nucleus pulposus is displaced through the wall of the disc. A disc extrusion is almost always symptomatic.
Lumbar facet joint are small pairs of joints on the back side of the spine where the vertebrae meet. These joints provide stability to the spine by interlocking two adjacent vertebrae. Facet joints also allow the spine to bend forward (flexion), bend backward (extension), and twist.
Inflammation of facet joints can occur from injuries or from arthritis. Many times, particularly in the case of injuries, one may not see abnormalities on an x-ray or MRI.
The term lumbar stenosis refers to any narrowing of the spinal canal. There are many causes of spinal stenosis; the most common is degeneration of the spine, which occurs almost inevitably as a part of the aging process.
Several factors contribute to the narrowing of the spinal canal with degenerative changes. First, wear and tear causes the facet joint to enlarge into the spinal canal. Second, the major ligament of the spinal canal, the ligamentum flavum, undergoes hypertrophy (enlargement) and buckling. Third, the intervertebral discs may bulge backwards or herniate into the canal. Fourth, the vertebrae may slip forward in a condition called spondylolisthesis. Finally, these changes may be superimposed on a congenitally narrow canal.
The hallmark of lumbar stenosis is pain in the back and legs which is aggravated by standing and walking and relieved by sitting or forward bending. The syndrome of pain induced by walking is known as neurogenic claudication (from the Latin claudico, to limp). Neurogenic claudication must be distinguished from is vascular claudication, or leg pain on walking caused by insufficient blood flow to the legs. The features which help to distinguish neurogenic from vascular claudication are the following:
- Pain occurs after varying amounts of exercise, with standing, or with coughing. Vascular claudication is reliably produced with a fixed amount of exercise, such as walking a certain number of blocks, and is rare at rest.
- Pain relief with rest is variable and slow, usually requiring sitting or stooping. Resting in a standing position is usually not enough to relieve the pain and may even aggravate the pain. In contrast, the pain of vascular insufficiency is usually quickly relieved by resting in a standing position. This is the main distinguishing feature.
- Pain from spinal stenosis is usually in a distribution of a spinal nerve rather than the muscles exercised.
- Sensory loss is also in a nerve root distribution, while with vascular insufficiency it is in a stocking-glove distribution.
- Signs of vascular insufficiency should be absent: diminished pulses, foot pallor on elevation, and decreased temperature of the feet.
Spondylolysis and Spondylolisthesis
The most common cause of low back pain in adolescent athletes is a stress fracture in one of the vertebrae that make up the spinal column. Technically, this condition is called spondylolysis (spon-dee-low-lye-sis). It usually affects either the fourth or the fifth lumbar vertebra in the lower back. The fracture site is called a pars defect.
If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the top vertebrae can shift forward on top of the bottom vertebrae. This condition is called spondylolisthesis (spon-dee-low-lis-thee-sis).
In adults, a spondylolisthesis is usually caused from degenerative changes in the spine. If too much slippage occurs, the bones may begin to press on nerves and surgery may become necessary to correct the condition.
- Genetics: There may be an inherited aspect to spondylolysis. An individual may be born with a thin vertebral bone and therefore may be predisposed to this condition. Rapid growth spurts in a teen may also encourage slippage.
- Overuse: Several types of athletics, such as gymnastics, weight lifting and football, put a great deal of stress on the bones in the lower back. They also require that the individual constantly over-stretch (hyperextend) the spine. In either case, the excessive stress can lead to fractures of the vertebrae.
- Spondylolisthesis may also develop because of degenerative changes in the vertebral joints and certain medical conditions such as cerebral palsy.
The sacroiliac joint connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest). The joint:
- Transmits all the forces of the upper body to the pelvis (hips) and legs
- Acts as a shock-absorbing structure
- Does not have much motion
The sacroiliac joint can become inflamed from an acute injury or from chronic postural abnormalities such as undue stress on the joint following low back fusion surgery. Pain from sacroiliac joint abnormalities can occur in the low back, buttock/hip, abdomen, groin, or legs.
Ankylosing spondylitis primarily affects the spine or back. In a person with ankylosing spondylitis, the joints and ligaments that normally permit the spine to move become inflamed and stiff. The bones of the spine may grow together, causing the spine to become rigid and inflexible. Other joints such as the hips, shoulders, knees, or ankles also may become involved.
Other rare causes of back pain include:
- Benign or malignant tumors
- Problems of the digestive tract or genitourinary tract
- Vascular problems such as an aneurysm or hardening of the arteries