Category Archive Health A – Z

Dietary recommendations for ankylosing spondylitis

General dietary recommendations for a person with ankylosing spondylitis:

• eat a well-balanced diet, including fruit and vegetables, protein foods, dairy, cereals, and grains. This will help to maintain general good health and a healthy weight
• avoid crash dieting or fasting
• increase dietary calcium to reduce the risk of osteoporosis in later life
• drink plenty of non-alcoholic fluids, especially water
• keep your weight within the normal range. Excess body weight increases stress on joints, especially weight-bearing joints like knees and hips.

References

Symptoms, Diagnosis of Lumbago is a common disorder involving the muscles, nerves, and bones of the back. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks). The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of low back pain usually improve within a few weeks from the time they start, with 40-90% of people completely better by six weeks.

Acute low-back pain without sciatica, with some spread of discomfort to the region of the sacroiliac joint, to the outer part of the buttock as well as to the lateral and the back part of the thigh, is a unifying symptom of a very common clinical syndrome whose exact underlying cause remains often uncertain. Most patients fall then into the category of non-specific low-back pain. Probably the pathogenesis is not uniform, and the pain can arise from a variety of structures (muscles, ligament, spine). Pain which persists after 3 to 4 days should warn the clinician that a serious pathological condition may be present which requires a new approach to diagnosis and treatment.

Anatomy of the Low Back/Lumbago 

The lumbar spine consists of five vertebrae (L1–L5). The complex anatomy of the lumbar spine is a combination of these strong vertebrae, linked by joint capsules, ligaments, tendons, and muscles, with extensive innervation. The spine is designed to be strong since it has to protect the spinal cord and spinal nerve roots. At the same time, it is highly flexible, providing for mobility in many different planes.

The mobility of the vertebral column is provided by the symphyseal joints between the vertebral bodies, with an IVD in between. The facet joints are located between and behind adjacent vertebrae, contributing to spine stability. They are found at every spinal level and provide about 20% of the torsional (twisting) stability in the neck and low back segments ²⁶. Ligaments aid in joint stability during rest and movement, preventing injury from hyperextension and hyperflexion. The three main ligaments are the anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), and ligamentum flavum (LF). The canal is bordered by vertebral bodies and discs anteriorly and by laminae and LF posteriorly. Both the ALL and PLL run the entire length of the spine, anteriorly and posteriorly, respectively. Laterally, spinal nerves and vessels come out from the intervertebral foramen. Beneath each lumbar vertebra, there is the corresponding foramen, from which spinal nerve roots exit. For example, the L1 neural foramina are located just below the L1 vertebra, from where the L1 nerve root exits.

IVDs are located between vertebrae. They are compressible structures able to distribute compressive loads through osmotic pressurization. In the IVD, the annulus fibrosus (AF), a concentric ring structure of organized lamellar collagen, surrounds the proteoglycan-rich inner nucleus pulposus (NP). Discs are avascular in adulthood, except for the periphery. At birth, the human disc has some vascular supply but these vessels soon recede, leaving the disc with little direct blood supply in the healthy adult ²⁷. Hence, metabolic support of much of the IVD is dependent on the cartilaginous endplates adjacent to the vertebral body. A meningeal branch of the spinal nerve, better known as the recurrent sinuvertebral nerve, innervates the area around the disc space ²⁸.

The lumbar spine is governed by four functional groups of muscles, split into extensors, flexors, lateral flexors, and rotators. The lumbar vertebrae are vascularized by lumbar arteries that originate in the aorta. Spinal branches of the lumbar arteries enter the intervertebral foramen at each level, dividing themselves into smaller anterior and posterior branches ²⁹. The venous drainage parallels the arterial supply ³⁰.

Typically, the end of the spinal cord forms the conus medullaris within the lumbar spinal canal at the lower margin of the L2 vertebra ³¹. All lumbar spinal nerve roots stem from the connection between the dorsal or posterior (somatic sensory) root from the posterolateral aspect of the spinal cord and the ventral or anterior (somatic motor) root from the anterolateral aspect of the cord ³¹. The roots then flow down through the spinal canal, developing into the cauda equina, before exiting as a single pair of spinal nerves at their respective intervertebral foramina. Cell bodies of the motor nerve fibers can be found in the ventral or anterior horns of the spinal cord, whereas those of the sensory nerve fibers are in the dorsal root ganglion (DRG) at each level. One or more recurrent meningeal branches, known as the sinuvertebral nerves, run out from the lumbar spinal nerves. The sinuvertebral nerve, or Luschka’s nerve, is a recurrent branch created from the merging of the grey ramus communicans (GRC) with a small branch coming from the proximal end of the anterior primary ramus of the spinal nerve. This polisegmentary mixed nerve directly re-enters the spinal canal and gives off ascending and descending anastomosing branches comprising both somatic and autonomic fibers for the posterolateral annulus, the posterior vertebral body and the periostium, and the ventral meninges ^32, 33. The sinuvertebral nerves connect with branches from radicular levels both above and below the point of entry, in addition to the contralateral side, meaning that localizing pain from involvement of these nerves is challenging ³⁴. Also, the facet joints receive two-level innervation comprising somatic and autonomic components. The former convey a well-defined local pain, while the autonomic afferents transmit referred pain.

www.rxharun.com

Causes of Lumbago /Backache

The human back is composed of a complex structure of muscles, ligaments, tendons, disks and bones – the segments of our spine are cushioned with cartilage-like pads called disks. Problems with any of these components can lead to back pain. In some cases of back pain, its cause is never found.

Strain – the most common causes of back pain are:

• Strained muscles
• Strained ligaments
• A muscle spasm

Things that can lead to strains or spasms include:

• Lifting something improperly
• Lifting something that is too heavy
• The result of an abrupt and awkward movement

Structural problems –

• Sprains and strains – account for most acute back pain. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from twisting or lifting something improperly, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can also be painful.
• Intervertebral disc degeneration – is one of the most common mechanical causes of low back pain, and it occurs when the usually rubbery discs lose integrity as a normal process of aging. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. As the discs deteriorate, they lose their cushioning ability.
• Herniated or ruptured discs – can occur when the intervertebral discs become compressed and bulge outward (herniation) or rupture, causing low back pain.
• Radiculopathy – is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
• Sciatica  – is a form of radiculopathy caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve not only pain, but numbness and muscle weakness in the leg because of interrupted nerve signaling. The condition may also be caused by a tumor or cyst that presses on the sciatic nerve or its roots.
• Spondylolisthesis  – is a condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column.
• A traumatic injury  – such as from playing sports, car accidents, or a fall can injure tendons, ligaments or muscle resulting in low back pain. Traumatic injury may also cause the spine to become overly compressed, which in turn can cause an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted to the spinal cord. When spinal nerves become compressed and irritated, back pain and sciatica may result.
• Ruptured disks – each vertebra in our spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.
• Bulging disks – in much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
• Sciatica – a sharp and shooting pain that travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.
• Arthritis – patients with osteoarthritis commonly experience problems with the joints in the hips, lower back, knees and hands. In some cases spinal stenosis can develop, which is the term used to describe when the space around the spinal cord narrows.
• Abnormal curvature of the spine – if the spine curves in an unusual way the patient is more likely to experience back pain. An example is a scoliosis, a condition in which the spine curves to the side.
• Osteoporosis – bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
• Spinal stenosis  – is a narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
• Skeletal irregularities  – include scoliosis, a curvature of the spine that does not usually cause pain until middle age; lordosis, an abnormally accentuated arch in the lower back; and other congenital anomalies of the spine.
• Abdominal aortic aneurysms – occur when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally enlarged. Back pain can be a sign that an aneurysm is becoming larger and that the risk of rupture should be assessed.
• Kidney stones –  can cause sharp pain in the lower back, usually on one side.

Below are some other causes of back pain

• Cauda equina syndrome – the cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. People with cauda equine syndrome feel a dull pain in the lower back and upper buttocks, as well as analgesia (lack of feeling) in the buttocks, genitalia, and thigh. There are sometimes bowel and bladder function disturbances.
• Cancer of the spine – a tumor located on the spine may press against a nerve, resulting in back pain.
• Infection of the spine – if the patient has an elevated body temperature (fever) as well as a tender warm area on the back, it could be caused by an infection of the spine.
• Other infections – pelvic inflammatory disease (females), bladder, or kidney infections may also lead to back pain.
• Endometriosis – is the buildup of uterine tissue in places outside the uterus.
• Fibromyalgia – a chronic pain syndrome involving widespread muscle pain and fatigue.
• Sleep disorders – individuals with sleep disorders are more likely to experience back pain, compared to others.
• Shingles – an infection that can affect the nerves may lead to back pain, depending on the nerves affected.
• Bad mattress – if a mattress does not support specific parts of the body and keep the spine straight, there is a greater risk of developing back pain.

Everyday activities or poor posture

Back pain can also be the result of some everyday activity or poor posture. Examples include:

• Bending awkwardly
• Pushing something
• Pulling something
• Carrying something
• Lifting something
• Standing for long periods
• Bending down for long periods
• Twisting
• Coughing
• Sneezing
• Muscle tension
• Over-stretching
• Straining the neck forward, such as when driving or using a computer
• Long driving sessions without a break, even when not hunched
• Exertion or lifting.
• Severe blow or fall.
• Back disorders.
• Infections.
• Ruptured lumbar disk.
• Nerve dysfunction.
• Osteoporosis.
• Spondylosis (hardening and stiffening of the spinal column).
• Congenital problem.
• Childbirth.
• Often there is no obvious cause.

Jobs That Can Cause Lower Back Pain

• Airline crew (pilots, baggage handlers)
• Surgeons
• Nurses & healthcare workers
• Bus and cab drivers
• Warehouse workers
• Construction workers
• Carpet installers and cleaners
• Farmers (agricultural, dairy)
• Firefighters and police
• Janitors
• Mechanics
• Office personnel (eg, telemarketers, file clerks, computer operators)

The Symptom of Lumbago /Backache

The main symptom of back pain is, as the name suggests, an ache or pain anywhere on

• Pain in the back, and sometimes all the way down to the buttocks and legs. Some back issues can cause pain in other parts of the body, depending on the nerves affected.
• In most cases, signs, and symptoms clear up on their own within a short period. If any of the following signs or symptoms accompany back pain, people should see their doctor:
• Pain. It may be continuous, or only occur when you are in a certain position. The pain may be aggravated by coughing or sneezing, bending or twisting.
• Patients who have been taking steroids for a few months
• Drug abusers
• Patients with cancer
• Patients who have had cancer
• Patients with depressed immune systems
• Stiffness.

According to the British National Health Service (NHS), the following groups of people should seek medical advice if they experience back pain:

• Weight loss
• Elevated body temperature (fever)
• Inflammation (swelling) on the back
• Persistent back pain – lying down or resting does not help
• Pain down the legs
• Pain reaches below the knees
• A recent injury, blow or trauma to your back
• Urinary incontinence – you pee unintentionally (even small amounts)
• Difficulty urinating – passing urine is hard
• Fecal incontinence – you lose your bowel control (you poo unintentionally)
• Numbness around the genitals
• Numbness around the anus
• Numbness around the buttocks
• dull ache,
• numbness,
• tingling,
• sharp pain,
• pulsating pain,
• pain with movement of the spine,
• pins and needles sensation,
• muscle spasm,
• tenderness,
• sciatica with shooting pain down one or both lower extremities
• People aged less than 20 and more than 55 years
• Additionally, people who experience pain symptoms after a major trauma (such as a car accident) are advised to see a doctor. If low back pain interferes with daily activities, mobility, sleep, or if there are other troubling symptoms, medical attention should be sought.

Risk increases with

• Biomechanical risk factors.
• Sedentary occupations.
• Gardening and other yard work.
• Sports and exercise participation, especially if infrequent.
• Obesity.

Preventive measures

• Exercises to strengthen lower back muscles.
• Learn how to lift heavy objects.
• Sit properly.
• Back support in bed.
• Lose weight, if obese.
• Choose proper footwear.
• Wear special back support devices.

Red flag conditions indicating possible underlying spinal pathology or nerve root problems^w9

Red flags

• Onset age < 20 or > 55 years
• Non-mechanical pain (unrelated to time or activity)
• Thoracic pain
• Previous history of carcinoma, steroids, HIV
• Feeling unwell
• Weight loss
• Widespread neurological symptoms
• Structural spinal deformity

Indicators for nerve root problems

• Unilateral leg pain > low back pain
• Radiates to foot or toes
• Numbness and paraesthesia in the same distribution
• Straight leg raising test induces more leg pain
• Localized neurology (limited to one nerve root)

Diagnosis of Lumbago /Backache

Suspected disk, nerve, tendon, and other problems – X-rays or some other imaging scan, such as a CT (computerized tomography) or MRI (magnetic resonance imaging) scan may be used to get a better view of the state of the soft tissues in the patient’s back.

• Blood tests – CBC ,ESR,Hb, RBS,CRP, Serum Creatinine,Serum Electrolyte,
• Myelograms
• Discography.
• Electrodiagnostics
• Bone scans
• Ultrasound imaging
• X-rays – can show the alignment of the bones and whether the patient has arthritis or broken bones. They are not ideal for detecting problems with muscles, the spinal cord, nerves or disks.
• MRI or CT scans – these are good for revealing herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles, and bones.
• Bone scan – a bone scan may be used for detecting bone tumors or compression fractures caused by brittle bones (osteoporosis). The patient receives an injection of a tracer (a radioactive substance) into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
• Electromyography or EMG – the electrical impulses produced by nerves in response to muscles is measured. This study can confirm nerve compression which may occur with a herniated disk or spinal stenosis (narrowing of the spinal canal).

References

Causes Symptoms of Backache is a common disorder involving the muscles, nerves, and bones of the back. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks). The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of low back pain usually improve within a few weeks from the time they start, with 40-90% of people completely better by six weeks.

Acute low-back pain without sciatica, with some spread of discomfort to the region of the sacroiliac joint, to the outer part of the buttock as well as to the lateral and the back part of the thigh, is a unifying symptom of a very common clinical syndrome whose exact underlying cause remains often uncertain. Most patients fall then into the category of non-specific low-back pain. Probably the pathogenesis is not uniform, and the pain can arise from a variety of structures (muscles, ligament, spine). Pain which persists after 3 to 4 days should warn the clinician that a serious pathological condition may be present which requires a new approach to diagnosis and treatment.

Pain in the lower part of the back is commonly referred to as Lumbago. It can be defined as mild to severe pain or discomfort in the area of the lower back. The pain can be acute (sudden and severe) or chronic if it has lasted more than three months.

Most people will experience lumbago at some point in their life. It is one of the most common reasons people miss work and visit the doctor. It can occur at any age but is a particular problem in younger people whose work involves physical effort and much later in life, in the elderly.

www.rxharun.com

Anatomy of the Low Back / Backache

The lumbar spine consists of five vertebrae (L1–L5). The complex anatomy of the lumbar spine is a combination of these strong vertebrae, linked by joint capsules, ligaments, tendons, and muscles, with extensive innervation. The spine is designed to be strong, since it has to protect the spinal cord and spinal nerve roots. At the same time, it is highly flexible, providing for mobility in many different planes.

The mobility of the vertebral column is provided by the symphyseal joints between the vertebral bodies, with an IVD in between. The facet joints are located between and behind adjacent vertebrae, contributing to spine stability. They are found at every spinal level and provide about 20% of the torsional (twisting) stability in the neck and low back segments ^[rx]. Ligaments aid in joint stability during rest and movement, preventing injury from hyperextension and hyperflexion. The three main ligaments are the anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), and ligamentum flavum (LF). The canal is bordered by vertebral bodies and discs anteriorly and by laminae and LF posteriorly. Both the ALL and PLL run the entire length of the spine, anteriorly and posteriorly, respectively. Laterally, spinal nerves and vessels come out from the intervertebral foramen. Beneath each lumbar vertebra, there is the corresponding foramen, from which spinal nerve roots exit. For example, the L1 neural foramina are located just below the L1 vertebra, from where the L1 nerve root exits.

IVDs are located between vertebrae. They are compressible structures able to distribute compressive loads through osmotic pressurization. In the IVD, the annulus fibrosus (AF), a concentric ring structure of organized lamellar collagen, surrounds the proteoglycan-rich inner nucleus pulposus (NP). Discs are avascular in adulthood, except for the periphery. At birth, the human disc has some vascular supply but these vessels soon recede, leaving the disc with little direct blood supply in the healthy adult ^[rx]. Hence, metabolic support of much of the IVD is dependent on the cartilaginous endplates adjacent to the vertebral body. A meningeal branch of the spinal nerve, better known as the recurrent sinuvertebral nerve, innervates the area around the disc space ^[rx].

The lumbar spine is governed by four functional groups of muscles, split into extensors, flexors, lateral flexors, and rotators. The lumbar vertebrae are vascularized by lumbar arteries that originate in the aorta. Spinal branches of the lumbar arteries enter the intervertebral foramen at each level, dividing themselves into smaller anterior and posterior branches ^[rx]. The venous drainage parallels the arterial supply ^[rx].

Typically, the end of the spinal cord forms the conus medullaris within the lumbar spinal canal at the lower margin of the L2 vertebra ^[rx]. All lumbar spinal nerve roots stem from the connection between the dorsal or posterior (somatic sensory) root from the posterolateral aspect of the spinal cord and the ventral or anterior (somatic motor) root from the anterolateral aspect of the cord ^[rx. The roots then flow down through the spinal canal, developing into the cauda equina, before exiting as a single pair of spinal nerves at their respective intervertebral foramina. Cell bodies of the motor nerve fibers can be found in the ventral or anterior horns of the spinal cord, whereas those of the sensory nerve fibers are in the dorsal root ganglion (DRG) at each level. One or more recurrent meningeal branches, known as the sinuvertebral nerves, run out from the lumbar spinal nerves. The sinuvertebral nerve, or Luschka’s nerve, is a recurrent branch created from the merging of the grey ramus communicans (GRC) with a small branch coming from the proximal end of the anterior primary ramus of the spinal nerve. This polisegmentary mixed nerve directly re-enters the spinal canal and gives off ascending and descending anastomosing branches comprising both somatic and autonomic fibers for the posterolateral annulus, the posterior vertebral body and the periosteum, and the ventral meninges ^{[rx], [rx]}. The sinuvertebral nerves connect with branches from radicular levels both above and below the point of entry, in addition to the contralateral side, meaning that localizing pain from involvement of these nerves is challenging ^[rx]. Also, the facet joints receive two-level innervation comprising somatic and autonomic components. The former convey a well-defined local pain, while the autonomic afferents transmit referred pain.

www.rxharun.com

Causes of Lumbago /Backache

The human back is composed of a complex structure of muscles, ligaments, tendons, disks and bones – the segments of our spine are cushioned with cartilage-like pads called disks. Problems with any of these components can lead to back pain. In some cases of back pain, its cause is never found.

Strain – the most common causes of back pain are:

• Strained muscles
• Strained ligaments
• A muscle spasm

Things that can lead to strains or spasms include:

• Lifting something improperly
• Lifting something that is too heavy
• The result of an abrupt and awkward movement

Structural problems –

• Sprains and strains – account for most acute back pain. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from twisting or lifting something improperly, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can also be painful.
• Intervertebral disc degeneration – is one of the most common mechanical causes of low back pain, and it occurs when the usually rubbery discs lose integrity as a normal process of aging. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. As the discs deteriorate, they lose their cushioning ability.
• Herniated or ruptured discs – can occur when the intervertebral discs become compressed and bulge outward (herniation) or rupture, causing low back pain.
• Radiculopathy – is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
• Sciatica  – is a form of radiculopathy caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve not only pain, but numbness and muscle weakness in the leg because of interrupted nerve signaling. The condition may also be caused by a tumor or cyst that presses on the sciatic nerve or its roots.
• Spondylolisthesis  – is a condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column.
• A traumatic injury  – such as from playing sports, car accidents, or a fall can injure tendons, ligaments or muscle resulting in low back pain. Traumatic injury may also cause the spine to become overly compressed, which in turn can cause an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted to the spinal cord. When spinal nerves become compressed and irritated, back pain and sciatica may result.
• Ruptured disks – each vertebra in our spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.
• Bulging disks – in much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
• Sciatica – a sharp and shooting pain that travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.
• Arthritis – patients with osteoarthritis commonly experience problems with the joints in the hips, lower back, knees and hands. In some cases, spinal stenosis can develop, which is the term used to describe when the space around the spinal cord narrows.
• Abnormal curvature of the spine – if the spine curves in an unusual way the patient is more likely to experience back pain. An example is scoliosis, a condition in which the spine curves to the side.
• Osteoporosis – bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
• Spinal stenosis  – is a narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
• Skeletal irregularities  – include scoliosis, a curvature of the spine that does not usually cause pain until middle age; lordosis, an abnormally accentuated arch in the lower back; and other congenital anomalies of the spine.
• Abdominal aortic aneurysms – occur when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally enlarged. Back pain can be a sign that an aneurysm is becoming larger and that the risk of rupture should be assessed.
• Kidney stones –  can cause sharp pain in the lower back, usually on one side.

Below are some other causes of back pain

• Cauda equina syndrome – the cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. People with cauda equine syndrome feel a dull pain in the lower back and upper buttocks, as well as analgesia (lack of feeling) in the buttocks, genitalia, and thigh. There are sometimes bowel and bladder function disturbances.
• Cancer of the spine – a tumor located on the spine may press against a nerve, resulting in back pain.
• Infection of the spine – if the patient has an elevated body temperature (fever) as well as a tender warm area on the back, it could be caused by an infection of the spine.
• Other infections – pelvic inflammatory disease (females), bladder, or kidney infections may also lead to back pain.
• Endometriosis – is the buildup of uterine tissue in places outside the uterus.
• Fibromyalgia – a chronic pain syndrome involving widespread muscle pain and fatigue.
• Sleep disorders – individuals with sleep disorders are more likely to experience back pain, compared to others.
• Shingles – an infection that can affect the nerves may lead to back pain, depending on the nerves affected.
• Bad mattress – if a mattress does not support specific parts of the body and keep the spine straight, there is a greater risk of developing back pain.

Everyday activities or poor posture

Back pain can also be the result of some everyday activity or poor posture. Examples include:

• Bending awkwardly
• Pushing something
• Pulling something
• Carrying something
• Lifting something
• Standing for long periods
• Bending down for long periods
• Twisting
• Coughing
• Sneezing
• Muscle tension
• Over-stretching
• Straining the neck forward, such as when driving or using a computer
• Long driving sessions without a break, even when not hunched
• Exertion or lifting.
• Severe blow or fall.
• Back disorders.
• Infections.
• Ruptured lumbar disk.
• Nerve dysfunction.
• Osteoporosis.
• Spondylosis (hardening and stiffening of the spinal column).
• Congenital problem.
• Childbirth.
• Often there is no obvious cause.

Jobs That Can Cause Lower Back Pain

• Airline crew (pilots, baggage handlers)
• Surgeons
• Nurses & healthcare workers
• Bus and cab drivers
• Warehouse workers
• Construction workers
• Carpet installers and cleaners
• Farmers (agricultural, dairy)
• Firefighters and police
• Janitors
• Mechanics
• Office personnel (eg, telemarketers, file clerks, computer operators)

The symptom of Lumbago /Backache

The main symptom of back pain is, as the name suggests, an ache or pain anywhere on

• Pain in the back, and sometimes all the way down to the buttocks and legs. Some back issuescan cause pain in other parts of the body, depending on the nerves affected.
• In most cases, signs, and symptoms clear up on their own within a short period.If any of the following signs or symptoms accompany a back pain, people should see their doctor:
• Pain. It may be continuous, or only occur when you are in a certain position. The pain may be aggravated by coughing or sneezing, bending or twisting.
• Patients who have been taking steroids for a few months
• Drug abusers
• Patients with cancer
• Patients who have had cancer
• Patients with depressed immune systems
• Stiffness.

According to the British National Health Service (NHS), the following groups of people should seek medical advice if they experience back pain:

• Weight loss
• Elevated body temperature (fever)
• Inflammation (swelling) on the back
• Persistent back pain – lying down or resting does not help
• Pain down the legs
• Pain reaches below the knees
• A recent injury, blow or trauma to your back
• Urinary incontinence – you pee unintentionally (even small amounts)
• Difficulty urinating – passing urine is hard
• Fecal incontinence – you lose your bowel control (you poo unintentionally)
• Numbness around the genitals
• Numbness around the anus
• Numbness around the buttocks
• dull ache,
• numbness,
• tingling,
• sharp pain,
• pulsating pain,
• pain with movement of the spine,
• pins and needles sensation,
• muscle spasm,
• tenderness,
• sciatica with shooting pain down one or both lower extremities
• People aged less than 20 and more than 55 years
• Additionally, people who experience pain symptoms after a major trauma (such as a car accident) are advised to see a doctor. If low back pain interferes with daily activities, mobility, sleep, or if there are other troubling symptoms, medical attention should be sought.

Risk increases with

• Biomechanical risk factors.
• Sedentary occupations.
• Gardening and other yard work.
• Sports and exercise participation, especially if infrequent.
• Obesity.

Preventive measures

• Exercises to strengthen lower back muscles.
• Learn how to lift heavy objects.
• Sit properly.
• Back support in bed.
• Lose weight, if obese.
• Choose proper footwear.
• Wear special back support devices.

Red flag conditions indicating possible underlying spinal pathology or nerve root problems^w9

Red flags

• Onset age < 20 or > 55 years
• Non-mechanical pain (unrelated to time or activity)
• Thoracic pain
• Previous history of carcinoma, steroids, HIV
• Feeling unwell
• Weight loss
• Widespread neurological symptoms
• Structural spinal deformity

Indicators for nerve root problems

• Unilateral leg pain > low back pain
• Radiates to foot or toes
• Numbness and paraesthesia in the same distribution
• Straight leg raising test induces more leg pain
• Localized neurology (limited to one nerve root)

Diagnosis of Lumbago /Backache

Suspected disk, nerve, tendon, and other problems – X-rays or some other imaging scan, such as a CT (computerized tomography) or MRI (magnetic resonance imaging) scan may be used to get a better view of the state of the soft tissues in the patient’s back.

• Blood tests – CBC ,ESR,Hb, RBS,CRP, Serum Creatinine,Serum Electrolyte,
• Myelograms
• Discography.
• Electrodiagnostics
• Bone scans
• Ultrasound imaging
• X-rays – can show the alignment of the bones and whether the patient has arthritis or broken bones. They are not ideal for detecting problems with muscles, the spinal cord, nerves or disks.
• MRI or CT scans – these are good for revealing herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles and bones.
• Bone scan – a bone scan may be used for detecting bone tumors or compression fractures caused by brittle bones (osteoporosis). The patient receives an injection of a tracer (a radioactive substance) into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
• Electromyography or EMG – the electrical impulses produced by nerves in response to muscles is measured. This study can confirm nerve compression which may occur with a herniated disk or spinal stenosis (narrowing of the spinal canal).

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References

Treatment of Backache is a common disorder involving the muscles, nerves, and bones of the back. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks). The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of low back pain usually improve within a few weeks from the time they start, with 40-90% of people completely better by six weeks.

Acute low-back pain without sciatica, with some spread of discomfort to the region of the sacroiliac joint, to the outer part of the buttock as well as to the lateral and the back part of the thigh, is a unifying symptom of a very common clinical syndrome whose exact underlying cause remains often uncertain. Most patients fall then into the category of non-specific low-back pain. Probably the pathogenesis is not uniform, and the pain can arise from a variety of structures (muscles, ligament, spine). Pain which persists after 3 to 4 days should warn the clinician that a serious pathological condition may be present which requires a new approach to diagnosis and treatment.

Treatment of Lumbago /Backache

General measures

• Bed rest for first 24 hours. Additional bed rest will be determined by the severity of the problem. Recent medical studies indicate that staying more active is better for back disorders than prolonged bed rest.
• Use a firm mattress (place a bed board under the mattress if needed).
• An ice pack or cold massage or heat applied to the affected area with a heating pad or hot water bottle.
• Physical therapy.
• Massage may help. Be sure the person is well-trained or massage could cause more harm than help.
• Wear a special back support device.
• Other options are available depending on the degree of injury, such as surgery (if disk damaged), electrical nerve stimulation, acupuncture, special shoes, etc.
• Stress reduction techniques, if needed.
• Non-Prescription Pain Relievers – Naproxen, acetaminophen, and ibuprofen each reduce inflammation and pain. Though these drugs are available over-the-counter, they are potent and taking more than the recommended dose can harm health. A doctor can help with advice about the right kind of non-prescription pain reliever to take.
• Cold and Heat – Applying a cold pack to the painful part of the back contracts inflamed muscle and relieves pain. This treatment helps a great deal when the disk has recently ruptured and swelling is at its greatest. A heating pad or warm pack helps with residual pain.
• Continued Physical Activity – Though pain or weakness seem like good reasons to rest the back, excessive bed-rest worsens the symptoms of a slipped disc. Moving around too little allows muscles to grow weaker and prevents the body from healing. Periods of rest interspersed with periods of normal activity throughout the day keep the back muscles in shape.
• Prescription Remedies –  If over-the-counter drugs fail to ease slipped disc pain, the doctor will turn to prescription medications.  These can include narcotics, such as hydrocodone or codeine. While they can do away with pain, narcotics are very addictive and induce a mental fogginess that can itself be dangerous.  More narrowly-focused medicines designed to target damaged nerves that create chronic pain may be a better choice, as they have fewer undesirable side effects. Gabapentin and Cymbalta are two drugs that act in different ways to minimize nerve pain. These drugs are less addictive than narcotics.
• Physical Therapy – Physical therapists show slipped disc sufferers ways to move that do not cause pain. Occupational therapists teach skills that allow patients to return to a productive life.
• Nutrition – In order to restore the disc we also are going to need to include different substances in our diet. There are a lot of supplements on the market, of course. If you wish to try them, that’s fine. I personally don’t like them. I have tried one with glucosamine and chondroitin, but I didn’t feel any different. So, if you have the opportunity to take these with the food or from more natural sources, it will be great. You can find these substances in sea food and animal cartilages and by digesting them we ensure the building blocks for the connecting tissue for our joints and spine. Also we will need more Omega 3 fatty acids, which can be supplied from cold pressed oils, fatty fish, flax seeds, chia and many more. Vitamins from the B group are very beneficial for people with herniated discs and all kinds of issues with the peripheral nervous system. Vitamins B1, B6 and B12 nourish the nerves and help them recover from the disk accident. Usually doctors prescribe them as a part of the treatment, but it is worth mentioning anyway.
• A good massage – A massage is one of the natural methods of relieving pain. Individuals who get a massage weekly for several months stand a better chance of alleviating back pain. A good massage provides a person with many health benefits that lessen back pain. A massage triggers the release of endorphins. Endorphins aid in decreasing anxiety and relieving pain. They offer a relaxation effect by softening muscles that are injured preventing cramping.
• Undertaking yoga – Yoga is an applicable strategy of keeping the level of back pain at minimal levels. Taking yoga sessions often is very an effective method of dealing with back pain. With yoga, there is a high likelihood of proper body functions. The use of pain prescriptions is also diminished. Patients suffering from back pain related issues do not have to rely on these prescriptions to manage pain. Incorporating laughter in yoga is a good way of exercising. Yoga incorporates simple yet appropriate exercises that enhance stretching of muscles. Laughter with yoga stimulates relieving of pain. It facilitates increased uptake of oxygen, little anxiety and production of endorphins. All these variables play an essential role in diminishing back pain.
• Adjusting sleeping position – A simple sleeping mistake can immensely contribute to back pain. A poor sleeping position can cause stress and tension on the muscles contributing to back pain. Altering one’s sleeping position and adopting a style that does not exert a lot of stress on the back is a recommended tactic. Nurturing sleeping habits such as assuming a reclining position, using wedge-shaped cushions and getting adjustable beds from reputable medical institutions are easy techniques to endorse. If a reclining position does not suit an individual, the other two techniques can be embraced.
• Heat therapy – Several considerations should be observed when using heat therapy. The right temperature ought to be set so as to ensure a patient does not face risks associated with too much exposure to heat. The key objective should be to ensure enough access of heat to the muscles to yield benefits for the patient. The adoption of heat therapy for easing back pain is determined by the magnitude of pain a person is experiencing. In cases where relatively low back pain is encountered, short heat therapy sessions are recommended. On the other hand, if an individual is experiencing prolonged back pain, long heat therapy sessions are the most applicable.
• Taking hot baths – This is a form of heat therapy that aims at relieving back pain. It guarantees permeation of heat into the muscles leading to reduced pain. Many individuals opt for this method since they believe it achieves competent results. Hot baths initiate a fast process of blood supply to stiff neck and back muscles. When this happens, the muscles relax and stretch leading to decreased back pain. To avoid interference with one’s sleeping patterns, a hot bath should be taken several hours before retiring to bed.
• Aquatic therapy – This natural technique involves physical therapy in a pool. Individuals get the best out of this therapy by relying on the resistance of water. Consistency in undertaking this therapy is what ascertains getting back pain relief. Integrating aquatic therapy in an individual’s life for the better part of the week enhances reduction of back pain quickly.
• Enlighten others – Individuals have the power to devise their own natural strategies that aid them in coping with back pain. The strategies can also be a good remedy for others going through similar circumstances. An individual can use social media platforms to equip others with important tips on how to keep back pain at bay. Further, becoming a member of associations that address back pain issues enables better communication of the knowledge gained from personal experience.

Medications

A wide range of medications are used to treat acute and chronic low back pain. Some are available over the counter (OTC); others require a physician’s prescription. Certain drugs, even those available OTC, may be unsafe during pregnancy, may interact with other medications, cause side effects, or lead to serious adverse effects such as liver damage or gastrointestinal ulcers and bleeding. Consultation with a health care provider is advised before use. The following are the main types of medications used for low back pain:

• Analgesic medications  – are those specifically designed to relieve pain. They include OTC acetaminophen and aspirin, as well as prescription opioids such as codeine, oxycodone, hydrocodone, and morphine. Opioids should be used only for a short period of time and under a physician’s supervision. People can develop a tolerance to opioids and require increasingly higher dosages to achieve the same effect. Opioids can also be addictive. Their side effects can include drowsiness, constipation, decreased reaction time, and impaired judgment. Some specialists are concerned that chronic use of opioids is detrimental to people with back pain because they can aggravate depression, leading to a worsening of the pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDS) – relieve pain and inflammation and include OTC formulations (ibuprofen, ketoprofen, and naproxen sodium). Several others, including a type of NSAID called COX-2 inhibitors, are available only by prescription. Long-term use of NSAIDs has been associated with stomach irritation, ulcers, heartburn, diarrhea, fluid retention, and in rare cases, kidney dysfunction and cardiovascular disease. The longer a person uses NSAIDs the more likely they are to develop side effects. Many other drugs cannot be taken at the same time a person is treated with NSAIDs because they alter the way the body processes or eliminates other medications.
• Anticonvulsants—drugs primarily used to treat seizures—may be useful in treating people with radiculopathy and radicular pain.
• Antidepressants – such as tricyclics and serotonin and norepinephrine reuptake inhibitors have been commonly prescribed for chronic low back pain, but their benefit for nonspecific low back pain is unproven, according to a review of studies assessing their benefit.
• Muscle Relaxants – If the muscles around the slipped disc experience painful spasms, a muscle relaxant such as Valium may be useful. The drawback to drugs like these is that they do not limit their power to the affected nerve. Instead, they have a generally relaxing effect and will interfere with daily activities.
•  Such as cyclobenzaprine (Flexeril), might be prescribed to relieve the discomfort associated with muscle spasms. However, these medicines might cause confusion in older people. Depending on the level of pain, prescription pain medicines might be used in the initial period of treatment.
• Steroids – If inflammation is severe, a doctor may also prescribe a steroid. Steroids, such as cortisone, reduce swelling quickly. A cortisone shot directly in the affected area will have an immediate effect on the displaced disc.
• Counter-irritants – such as creams or sprays applied topically stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Topical analgesics reduce inflammation and stimulate blood flow.
• Nerve Ralaxant — Pregabalin or gabapentin and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include aspirin, ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve).
• Spinal manipulation and spinal mobilization  – Are approaches in which professionally licensed specialists (doctors of chiropractic care) use their hands to mobilize, adjust, massage, or stimulate the spine and the surrounding tissues. Manipulation involves a rapid movement over which the individual has no control; mobilization involves slower adjustment movements. The techniques have been shown to provide small to moderate short-term benefits in people with chronic low back pain. Evidence supporting their use for acute or subacute low back pain is generally of low quality. Neither technique is appropriate when a person has an underlying medical cause for the back pain such as osteoporosis, spinal cord compression, or arthritis.
• Traction  – Involves the use of weights and pulleys to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Some people experience pain relief while in traction, but that relief is usually temporary. Once traction is released the back pain tends to return. There is no evidence that traction provides any longterm benefits for people with low back pain.
• Spinal injections — An injection of a cortisone-like anti-inflammatory medicine into the lower back might help reduce swelling and inflammation of the nerve roots, allowing for increased mobility.
• Biofeedback  – It is used to treat many acute pain problems, most notably back pain and headache. The therapy involves the attachment of electrodes to the skin and the use of an electromyography machine that allows people to become aware of and selfregulate their breathing, muscle tension, heart rate, and skin temperature. People regulate their response to pain by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects. The evidence is lacking that biofeedback provides a clear benefit for low back pain.
• Nerve block therapies  – Aim to relieve chronic pain by blocking nerve conduction from specific areas of the body. Nerve block approaches range from injections of local anesthetics, botulinum toxin, or steroids into affected soft tissues or joints to more complex nerve root blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. The success of a nerve block approach depends on the ability of a practitioner to locate and inject precisely the correct nerve. Chronic use of steroid injections may lead to increased functional impairment.

Surgery Lumbago /Backache

When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. It may be months following surgery before the patient is fully healed, and he or she may suffer permanent loss of flexibility.

• Vertebroplasty and kyphoplasty – are minimally invasive treatments to repair compression fractures of the vertebrae caused by osteoporosis. Vertebroplasty uses three-dimensional imaging to assist in guiding a fine needle through the skin into the vertebral body, the largest part of the vertebrae. A glue-like bone cement is then injected into the vertebral body space, which quickly hardens to stabilize and strengthen the bone and provide pain relief. In kyphoplasty, prior to injecting the bone cement, a special balloon is inserted and gently inflated to restore height to the vertebral structure and reduce spinal deformity.
• Spinal laminectomy – (also known as spinal decompression) is performed when spinal stenosis causes a narrowing of the spinal canal that causes pain, numbness, or weakness. During the procedure, the lamina or bony walls of the vertebrae, along with any bone spurs, are removed. The aim of the procedure is to open up the spinal column to remove pressure on the nerves.
• Discectomy or microdiscectomy – may be recommended to remove a disc, in cases where it has herniated and presses on a nerve root or the spinal cord, which may cause intense and enduring pain. Microdiscectomy is similar to a conventional discectomy; however, this procedure involves removing the herniated disc through a much smaller incision in the back and a more rapid recovery. Laminectomy and discectomy are frequently performed together and the combination is one of the more common ways to remove pressure on a nerve root from a herniated disc or bone spur.
• Foraminotomy – is an operation that “cleans out” or enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness, and weakness in an arm or leg. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve pressure on the nerve.
• Intradiscal electrothermal therapy (IDET) – is a treatment for discs that are cracked or bulging as a result of degenerative disc disease. The procedure involves inserting a catheter through a small incision at the site of the disc in the back. A special wire is passed through the catheter and an electrical current is applied to heat the disc, which helps strengthen the collagen fibers of the disc wall, reducing the bulging and the related irritation of the spinal nerve. IDET is of questionable benefit.
• Nucleoplasty also called plasma disc decompression (PDD) – is a type of laser surgery that uses radiofrequency energy to treat people with low back pain associated with mildly herniated discs. Under x-ray guidance, a needle is inserted into the disc. A plasma laser device is then inserted into the needle and the tip is heated to 40-70 degrees Celsius, creating a field that vaporizes the tissue in the disc, reducing its size and relieving pressure on the nerves. Several channels may be made depending on how tissue needs to be removed to decompress the disc and nerve root.
• Radiofrequency denervation – is a procedure using electrical impulses to interrupt nerve conduction (including the conduction of pain signals). Using x-ray guidance, a needle is inserted into a target area of nerves and a local anesthetic is introduced as a way of confirming the involvement of the nerves in the person’s back pain. Next, the region is heated, resulting in localized destruction of the target nerves. Pain relief associated with the technique is temporary and the evidence supporting this technique is limited.
• Spinal fusion – is used to strengthen the spine and prevent painful movements in people with degenerative disc disease or spondylolisthesis (following laminectomy). The spinal disc between two or more vertebrae is removed and the adjacent vertebrae are “fused” by bone grafts and/or metal devices secured by screws. The fusion can be performed through the abdomen, a procedure known as an anterior lumbar interbody fusion, or through the back, called posterior fusion. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together. Spinal fusion has been associated with an acceleration of disc degeneration at adjacent levels of the spine.
• Artificial disc replacement – is considered an alternative to spinal fusion for the treatment of people with severely damaged discs. The procedure involves removal of the disc and its replacement by a synthetic disc that helps restore height and movement between the vertebrae.

Other Rx of Lumbago /Backache

Chiropractic Care

Sixty percent of people with sciatica who didn’t get relief from other therapies and then tried spinal manipulation experienced the same degree of pain relief as patients who eventually had surgery, found a 2010 study in the Journal of Manipulative and Physiological Therapeutics. The 120 people in the study saw a chiropractor about 3 times a week for 4 weeks and then continued weekly visits, tapering off treatment as they felt better. In people who responded to chiropractic care, benefits lasted up to a year. “Spinal manipulation may create a response in the nervous system that relieves pain and restores normal mobility to the injured area,” says study researcher Gordon McMorland, DC, of National Spine Care in Calgary, Alberta. “It also reduces inflammation, creating an environment that promotes the body’s natural healing mechanisms.”

Acupuncture

You can get relief as soon as the first session, though it takes about 12 sessions to see improvement,” says Jingduan Yang, MD, assistant professor at the Jefferson Myrna Brind Center of Integrative Medicine at Thomas Jefferson University. A small study in the Journal of Traditional Chinese Medicine found that of 30 people with sciatica, 17 got complete relief and 10 saw symptoms improve with warming acupuncture, in which the needles are heated.

Yoga

A study in the journal Pain reported that people with chronic back pain who practiced Iyengar yoga for 16 weeks saw pain reduced by 64% and disability by 77%. Although yoga’s effects on sciatica are less clear, gentle forms may be beneficial. By strengthening muscles and improving flexibility, a yoga practice can help sciatica sufferers “move and function better so they don’t fall into a posture that aggravates sciatica,” says James W. Carson, Ph.D., a psychologist at the Comprehensive Pain Center at Oregon Health & Science University. For extra grip and stability, try these grip socks from Natural Fitness.

Massage

Don’t expect a chilled-out spa massage if you have sciatica. In this instance, trigger-point therapy is best, says Jeff Smoot, vice president of the American Massage Therapy Association. The sciatic nerve sits underneath a muscle called the piriformis, which is located beneath the glutes. “When the piriformis muscle gets tight, it pinches the sciatic nerve, causing tingling and numbness down into the leg,” says Smoot. He applies pressure to irritated and inflamed areas, or trigger points, in the piriformis muscle, as well as in muscles in the lower back and glutes. Typically, Smoot schedules treatments 7 to 10 days apart. If patients don’t see progress by the fourth visit, “they need to try another form of therapy,” he says.

Shiatsu,

Also known as finger pressure therapy, is a type of massage where pressure is applied along energy lines in the body. The shiatsu therapist applies pressure with his/her fingers, thumbs and elbows.

Topical Preparations

St. John’s wort oil, a liniment, is “one of my favorites for nerve pain,” says Tieraona Low Dog, MD, director of the fellowship at the Arizona Center for Integrative Medicine. Apply the anti-inflammatory oil two or three times a day where there’s pain. Another option: an OTC cayenne pepper plaster or cream; capsaicin, found in chiles, hinders the release of pain-causing compounds from nerves. For severe cases, Low Dog uses the prescription chile patch Qutenza, designed for shingles pain. “One application is effective for weeks,” says Low Dog.

Ice or Heat

Because the sciatic nerve is buried deep within the buttock and leg, ice or heat on the surface of the body won’t ease that inner inflammation. But the timehonored treatments can act as counterirritants—that is, “they give your body other input in the painful area, and that brings the pain down a notch,” says Ruppert. Apply an ice pack or a heating pad as needed for 15 minutes.

Devil’s Claw

The herbal medication devil’s claw is “quite a potent anti-inflammatory, working like ibuprofen and similar drugs to inhibit substances that drive inflammation,” says Low Dog. She generally starts patients on 1,500 to 2,000 mg twice a day. Look for a brand that has a standardized extract of roughly 50 mg of harpagoside, the active compound. Safety reviews show that the supplement is well tolerated by most people but should be avoided by patients with peptic ulcers or on blood-thinning medications.

Pain Relievers and Muscle Relaxants

Taking a nonsteroidal anti-inflammatory drug, either OTC (like ibuprofen) or Rx, can ease the distress. Because painful muscle spasms may also accompany a disk herniation, doctors sometimes prescribe muscle relaxants or pain-reducing tricyclic antidepressants. A caveat: “These won’t help with the pain caused by pressure on the sciatic nerve,” says A. Nick Shamie, MD, a spokesperson for the American Academy of Orthopaedic Surgeon.

Epidural Steroid Injections

People whose pain doesn’t lessen within about a month and who aren’t helped by other therapies may find their pain remedied by an x-ray-guided injection of steroid into the lower back near the sciatic nerve, says Raj Rao, MD, a spokesperson for the AAOS. “The hope is to reduce inflammation within that nerve branch,” explains Rao. Because of concerns about side effects, such as loss of bone density, the epidural shots are limited to three a year.

CBT (cognitive behavioral therapy)

CBT can help patients manage chronic back pain. The therapy is based on the principle that the way a person feels is, in part, dependent on the way they think about things.

People who can be taught to train themselves to react in a different way to pain may experience less perceived pain. CBT may use relaxation techniques as well as strategies to maintain a positive attitude. Studies have found that patients with CBT tend to become more active and do exercise, resulting in a lower risk of back pain recurrence.

Exercise and Physical Therapy

Moving is usually the last thing people dogged by sciatica want to do, but it’s important to be physically active. “Lying in bed makes it more likely that the pain will last longer,” says Ruppert. “Exercise increases blood flow to the disk and the nerve, helping to get rid of the chemicals causing the inflammation.” Take 15- to 20-minute walks. If that hurts too much, give swimming or water aerobics a try; there’s not as much pressure on the back when you’re in the water, says Ruppert. It may also be worth seeing a physical therapist, who can prescribe stretching exercises to restore flexibility to the back or moves that strengthen core muscles, helping to stabilize the spine and reduce the likelihood of a similar injury.

Pigeon pose

Pigeon Pose is a common yoga pose. It works to broadly open the hips. There are multiple versions of this stretch. The first is a starting version of the pigeon pose, known as the reclining pigeon pose. If you are just starting your treatment, you should try the reclining pose first. Once you can do the reclining version without pain, work with your physical therapist on the sitting and forward versions.

Reclining pose

1. While on the back, bring your right leg up to a right angle and grasp it with both hands behind the thigh, locking your fingers.
2. Take your left leg and place your ankle against the knee. Hold the position for a moment before changing legs. This helps stretch the tiny piriformis muscle, which sometimes becomes inflamed and presses against the sciatic nerve causing pain.
3. Repeat by switching sides and doing the same exercise with the other leg.

Sitting pose

1. Sit on the floor with your legs stretched out straight in front of you. Then bend your right leg, putting your right ankle on top of the left knee.
2. Lean forward and allow your upper body to lean toward your thigh. Hold for 15 to 30 seconds and then switch sides. This stretches the glutes and lower back.

Forward pose

1. Kneel on the floor on all fours.
2. Pick up your right leg and move it forward so that your lower leg is on the ground, horizontal to the body. Your right foot should be in front of your right knee while your right knee stays to the right.
3. Stretch the left leg out all the way behind you on the floor, with the top of the foot on the ground and toes pointing back.
4. Shift your body weight gradually from your arms to your legs so that your legs are supporting your weight. Sit up straight with your hands on either side of your legs.
5. Take a deep breath. While exhaling, lean your upper body forward over your lower leg. Support your weight with your arms as much as possible.

Knee to opposite shoulder

This simple stretch helps relieve sciatica pain by loosening your gluteal and piriformis muscles, which can become inflamed and press against the sciatic nerve.

1. Lie on your back with your legs extended outward and your feet flexed upward.
2. Clasp your hands around your knee and gently pull your right leg across your body toward your left shoulder. Hold it there for 30 seconds and then push your knee so your leg returns to its starting position.
3. Repeat for a total of 3 reps, and then switch legs. Remember to only pull your knee as far as it will comfortably go. You should feel a relieving stretch in your muscle, not pain.

Sitting spinal stretch

Sciatica pain is triggered when vertebrae in the spine compress. This stretch helps create space in the spine to relieve pressure from the sciatic nerve.

1. Sit on the ground with your legs extended straight out with your feet flexed upward.
2. Bend your right knee and place your foot flat on the floor on the outside of your opposite knee.
3. Place your left elbow on the outside of your right knee to help you gently turn your body toward the right. Hold for 30 seconds and repeat three times, then perform this stretch with your left leg bent and body turned to the left side.

Standing hamstring stretch

This stretch can help ease pain and tightness in the hamstring caused by sciatica.

1. Place your right foot on an elevated surface at or below your hip level. This could be a chair, ottoman, or step on a staircase. Flex your foot so your toes and leg are straight. If your knee tends to hyperextend, keep a slight bend in it.
2. Bend your body forward slightly toward your foot. The further you go, the deeper the stretch. Do not push so far that you feel pain.
3. Release the hip of your raised leg downward as opposed to it lifting up. If you need help easing your hip down, loop a yoga strap or long exercise band over your right thigh and under your left foot. Hold for at least 30 seconds, and then repeat on the other side.

Exercise with care

What complications are associated with 

Chronic (ongoing and lasting) pain is a complication of untreated sciatica. If the “pinched nerve” is seriously injured, chronic muscle weakness, such as a “drop foot,” might occur.

What is the outlook for people with

Sciatic pain usually goes away with time and rest. Most people with sciatica (80 percent to 90 percent) will get better without surgery. About half of affected individuals recover from an episode within six weeks.

Can sciatica be prevented?

Some sources of sciatica are not preventable, such as degenerative disc disease, back strain due to pregnancy, and accidental falls.

Although it might not be possible to prevent all cases of sciatica, you can take steps to protect your back and reduce your risk.

Practice proper lifting techniques. Lift with your back straight, bringing yourself up with your hips and legs, and holding the object close to your chest. Use this technique for lifting everything, no matter how light.
Avoid/ stop cigarette smoking, which promotes disc degeneration.
Exercise regularly to strengthen the muscles of your back and abdomen, which work to

support your spine.

Use good posture when sitting, standing, and sleeping. Good posture helps to relieve the pressure on your lower back.
Avoid sitting for long periods.

Preventing Lumbago /Backache

Steps to lower the risk of developing back pain consist mainly of addressing some of the risk factors.

Exercise – regular exercise helps build strength as well as keeping your body weight down. Experts say that low-impact aerobic activities are best; activities that do not strain or jerk the back. Before starting any exercise program, talk to a health care professional.

There are two main types of exercise that people can do to reduce the risk of back pain:

• Core-strengthening exercises– exercises that work the abdominal and back muscles, helping to strengthen muscles that protect the back.
• Flexibility – exercises aimed at improving flexibility in your core, including your spine, hips, and upper legs, may help too.

Smoking – a significantly higher percentage of smokers have back pain incidences compared to non-smokers of the same age, height and weight.

Body weight – the amount of weight people carry, as well as where they carry it, affects the risk of developing back pain. The difference in back pain risk between obese and normal-weight individuals is considerable. People who carry their weight in the abdominal area versus the buttocks and hip area are also at greater risk.

Posture when standing – make sure you have a neutral pelvic position. Stand upright, head facing forward, back straight, and balance your weight evenly on both feet – keep your legs straight and your head in line with your spine.

If you regularly use a computer, it is important to ensure that you have a chair with good back support and adopt a good posture and head position.

Posture when sitting – a good seat should have good back support, arm rests and a swivel base (for working). When sitting try to keep your knees and hips level and keep your feet flat on the floor – if you can’t, use a footstool. You should ideally be able to sit upright with support in the small of your back. If you are using a keyboard, make sure your elbows are at right-angles and that your forearms are horizontal.

Lifting things – the secret for protecting your back when lifting things is to think “legs not back”. In other words, use your legs to do the lifting, more than your back.

Keep your back as straight as you can, keeping your feet apart with one leg slightly forward so you can maintain balance. Bend only at the knees, hold the weight close to your body, and straighten the legs while changing the position of your back as little as possible.

Bending your back initially is unavoidable, but when you bend your back try not to stoop or squat, and be sure to tighten your stomach muscles so that your pelvis is pulled in. Most important, do not straighten your legs before lifting; otherwise you will be using your back for most of the work.

Do not lift and twist at the same time. If something is particularly heavy, see if you can lift it with someone else. While you are lifting keep looking straight ahead, not up nor down, so that the back of your neck is like a continuous straight line from your spine.

Moving things – remember that it is better for your back to push things across the floor, using your leg strength, rather than pulling them.

Shoes – flat shoes place less of a strain on the back.

Driving – it is important to have proper support for your back. Make sure the wing mirrors are properly positioned so you do not need to twist. The pedals should be squarely in front of your feet. If you are on a long journey, have plenty of breaks – get out of the car and walk around.

Your bed – you should have a mattress that keeps you spine straight, while at the same time supporting the weight of your shoulders and buttocks. Use a pillow, but not one that forces your neck into a steep angle.

Home Remedies for Lumbago /Backache

 Ice and Heat

Ice works wonders on lower back pain. Wrap some ice cubes in a plastic bag to prepare an ice pack. Then cover it with a towel and apply it on the painful area for 20 minutes. Repeat the same process several times a day. Then after 48 hours, you can switch to heat method. Dip a towel in warm water. Flatten and fold it on to the affected area. Place heating pad on it with a plastic cover between towel and heating pad. Leave it for 20 minutes. Do it several times a day. It reduces swelling and relaxes the nerves that are responsible for sending pain signals to the brain.

 Rest

Get sufficient rest. Don’t exhaust yourself physically and mentally. When sleeping, keep changing your positions. When you lie on back, put a pillow under your knees. Similarly, if you lie on your side, draw your knees near your chest and keep a pillow between your knees.

 Right Posture

Your sitting and standing posture are very important to keep back pain at bay. One should not be in bending position for long time whether sitting or standing. Sitting on the edge of the chair and slouching should be avoided. The angle of the chair in office should be 110 degree.

 Lemon Juice

Lemon juice is an effective home remedy for back pain. Drink lemon juice twice a day for better results.

Poppy Seeds

Prepare a mixture of poppy seeds and rock candy by grinding together 100 gm of each. Take this mixture twice a day with a glass of milk. You will get relief from back pain.

Massage with Olive Oil

Massage with olive oil to reduce stress by relaxing tensed muscles. It also helps release stiffness in joints and relieves upper back pain.

Stretching

Stretching is the easiest back pain treatment. If your job demands sitting or standing for long hours, just take a break of 5 minutes every hour and walk or simply stretch your body to avoid back pain.

Wheat

Wheat has pain minimizing component in it. Mix cuscus grass and coriander with overnight soaked wheat. Add 1 cup of milk and bring it to boil. Consume this mixture twice a day

Garlic

Eat 2-3 garlic cloves on an empty stomach every morning to get relief from back pain. You can also use garlic oil. Massage your back with this oil, cover it with warm blanket and lie on your back. Bathe using warm water after 20 minutes. This is a wonderful home remedy to treat back pain.

Ginger

The anti-inflammatory properties of ginger make it an ideal home remedy to get rid of back pain. Add ½ teaspoon of black peppercorns, ½ teaspoon of cloves and 1 teaspoon of ginger powder in a cup of boiling water to prepare herbal tea. Drink it 2-3 times a day.

• Alternatively, grate some ginger to prepare a paste. Apply it on the affected area. Then massage with eucalyptus oil.
• Put thin ginger slices in a pan of boiling water. Simmer it for 10-15 minutes. Strain and allow it to cool down at room temperature. Add honey to sweeten it. Drink it twice or thrice a day.

 Milk

Since milk is a great source of calcium, it is extremely beneficial for strong bones and preventing back pain. People of every age group should consume milk. For quick relief, add a few drops of honey and a pinch of turmeric in the milk.

Epsom Salt

A natural healer, epsom salt reduces swelling in back. It contains magnesium and sulfate which help muscles function properly, thus, provide relief from pain. Add 2 cups of Epsom salt to a tub of warm water. Let it soak for 30 minute. Take bath with this water.

 Rice

Rice is easily available in every household. It’s an effective home remedy for back pain. Put 1 cup uncooked rice in a thick sock and place it in the microwave for ½ – 1 minute. Now apply it onto the back.

Oats

Mash cooked whole oats with vinegar. Apply it on the back when hot. It soothes the aching back.

 Potatoes

Mash the peeled and boiled potatoes. Let them cool and then apply on back. You will experience relief from back pain.

 Coconut Oil

Take some coconut oil. Mix camphor in it and boil for 5-7 minutes. Allow it to cool. Store it in a bottle. Massage with this oil two times a day to cure back pain.

Capsaicin Cream

Capsaicin is an important ingredient of chilies. Apply capsaicin cream on the back. It will reduce the production of chemicals that transmit signals of pain to your brain.

Herbal Remedies for Lumbago /Backache

Willow Bark

White willow tree’s bark is considered an excellent herbal remedy for treating back pain. It has pain-relieving properties same as aspirin. So it will help reduce your back pain.

 Basil Leaves

Basil leaves are very famous for their medicinal benefits. They aid in curing lower back pain. Boil 10-12 fresh basil leaves in a cup of water until it becomes half. Add a pinch of salt to it. Drink it once or twice a day depending on the severity of your pain.

 Herbal Oils

Herbal oils like almond oil, eucalyptus oil, coconut oil or olive oil are very effective in alleviating back pain. Massage with warm oils on the painful area to relax the nerves causing pain.

Chamomile

Take some chamomile flowers. Steep them in a cup of boiling water for 15-20 minutes. Drink it 2-3 times a day. It will relax the tense muscles, thereby cure backache.

Note: – Pregnant ladies and those allergic to chamomile flowers should first consult doctor before taking this.

Ginger

 Though more studies are needed, says Dr. Kiefer, ginger extract may help with joint and muscle pain because it contains phytochemicals, which help stop inflammation. Few side effects have been linked to ginger when taken in small doses.

Feverfew

Feverfew has been used for centuries to treat headaches, stomachaches, and toothaches. Nowadays it’s also used for migraines and rheumatoid arthritis. More studies are required to confirm whether feverfew is actually effective, but the herb may be worth trying since it hasn’t been associated with serious side effects. Mild side effects include canker sores and irritation of the tongue and lips. Pregnant women should avoid this remedy.

Turmeric

 This spice has been used to relieve arthritis pain and heartburn, and to reduce inflammation. It’s unclear how turmeric works against pain or inflammation, but its activity may be due to a chemical called curcumin, which has anti-inflammatory properties. Turmeric is usually safe to use, but high doses or long-term use may cause indigestion. Also, people with gallbladder disease should avoid using turmeric.

Homeopathic Medicines for Lumbago /Backache

Rhus Tox

Rhus Tox tops the list of Homeopathic medicines for back pain. I have seen magnificent results in back pain from use of Rhus Tox. Rhus Tox is indicated for both upper and lower back pain, especially where the back pain is accompanied by intense stiffness. The back pain that arises from muscle strain also recovers wonderfully well with Rhus Tox. Persons suffering from back pain as a result of exertion or lifting heavy weights have found complete relief when prescribed Rhus Tox, making it one of the most reliable Homeopathic medicines for back pain. A prominent symptom to look out for while prescribing Rhus Tox is that the back pain gets worse with rest, while walking or hard pressure bring relief from pain.

Bryonia

In my clinical practice, Bryonia has shown marvellous results in lower back pain that worsens with the slightest of motion. Apart from motion, this pain also gets worse with standing or from turning in the bed, a key sign that Bryonia will work best. The pain may be accompanied by marked stiffness in such cases, for which Bryonia would rate among the best Homeopathic medicines for back pain. Lying down and taking rest brings relief from pain.

Aesculus

Aesculus is one of the most effective Homeopathic medicines for lower back pain that gets worse from stooping. In this case, the pain is most marked in the sacrum and hip region. The lower back feels as if it would break. Stiffness in the lower back is also intense. Aesculus is also one of the best Homeopathic medicines for back pain which gets worse when rising from a sitting position. Here it takes the person repeated efforts to rise from a chair or another sitting position.

Kali Carb

I would rank Kali Carb as one of the top grade Homeopathic medicines for back pain that arises after childbirth. The most prominent symptoms indicative of Kali Carb as the best suited Homeopathic medicines for back pain in such instances are stiffness and weakness in the lower back. The pain is very severe, with a feeling that the back might break. The back pain makes it difficult to walk. Women feel the need to lie down to get relief from the pain which may radiate to the upper back or down to the thigh and hips. Where these symptoms exist, Kali Carb comes highly recommended as one of the best Homeopathic medicines for back pain. Apart from post-partum backache, Kali Carb is also useful for backache in women before or during menses and after a miscarriage.

Cobaltum

Cobaltum ranks on top of the list of Homeopathic medicines for back pain that worsens from sitting. In such cases, the person feels better while walking or lying down. The back pain may radiate down the legs and feet in some cases, but the person will surely feel a weakness in the legs, a sure sign that Cobaltum will provide sustained relief.

Colocynth & Magnesium Phos

I have successfully treated several cases of back pain radiating down the legs and/or feet with two main Homeopathic medicines. These top rated Homeopathic medicines for back pain are Colocynth and Magnesium Phos. Among these, Colocynth is most effective Homeopathic medicine for back pain when the lower back pain radiates to the left leg and foot. Magnesium Phos brings relief when the lower back pain radiates down the right leg. The pain, in both the cases, can be of a shooting, cramping or tearing nature. However, both the medicines have proven their ability to bring lasting relief from pain and established themselves as the best Homeopathic medicines for back pain.

Cimicifuga & Kalmia

Two highly recommended Homeopathic medicines for back pain in the cervical region are Cimicifuga and Kalmia. I have seen remarkable results with use of Cimicifuga in cervical back pain accompanied by stiffness, contraction and sensitiveness in the neck. If pressure worsens the neck pain, Cimicifuga will offer effective treatment. However, in cases where the cervical pain radiates down the arm or hands, Kalmia has proved to be one of the most helpful Homeopathic medicines for back pain treatment. Persons feeling a weakness, numbness or tingling sensation in the arms and hands along with neck pain also recover fully well with use of Homeopathic medicine Kalmia.

Ruta & Hypericum

Ruta and Hypericum are highly suitable Homeopathic medicines for back pain resulting from injury. Ruta is prescribed for a back that is sore and bruised from injury. The pain is most marked over the sacrum and coccyx region. The injured person may feel a weakness in the lower back. Where such symptoms are noted, Ruta is the most prominent among Homeopathic medicines for back pain and has shown effective results. Homeopathic medicine Hypericum is recommended when pain from the tailbone radiates up the spine and down the limbs after injury. The pain is very sharp and intense. Motion, walking and stooping all make the pain worse. The spine is very tender and sensitive to touch in such cases where Hypericum has shown best results.

References

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926733/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479671/
• http://www.backpaineurope.org/
• https://bestpractice.bmj.com/info/evidence-information/
• https://www.ncbi.nlm.nih.gov/pubmed/2138352
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857557/
• https://en.wikipedia.org/wiki/Low_back_pain
• https://en.wiktionary.org/wiki/lumbago
• https://www.sciencedirect.com/science/article/pii/S0002961034901793
• https://www.sciencedirect.com/science/article/pii/S0003277814000380
• https://www.sciencedirect.com/science/article/pii/S0034709412701836
• https://www.sciencedirect.com/topics/medicine-and-dentistry/low-back
• https://www.sciencedaily.com/releases/2013/10/131017080104.htm
• https://www.sciencedaily.com/releases/2017/11/171129090431.htm
• https://www.sciencedaily.com/releases/2017/11/171129090431.htm
• https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
• https://nccih.nih.gov/health/pain/spinemanipulation.htm
• https://books.google.com/books/about/Low_Back_Pain.html?id=ualzJ7SXVWYC
• https://books.google.com/books/about/Acute_Lumbago.html?id=XbowAAAAIAAJ
• https://books.google.com/books/about/Sciatic_Lumbago_and_Brachialga.html?id=d9NfGwAACAAJ
• https://medlineplus.gov/backpain.html
• https://onlinelibrary.wiley.com/doi/full/10.1002/art.34347
• https://link.springer.com/article/10.1007/s00420-002-0332-6
• https://link.springer.com/content/pdf/10.1007/s00420-002-0332-6.pdf
• https://link.springer.com/article/10.1007/BF00435945
• https://www.webmd.com/back-pain/back-pain-treatment
• https://www.healthline.com/health/back-pain
• https://www.netdoctor.co.uk/conditions/aches-and-pains/a2845/low-back-pain-lumbago/
• https://www.medicalnewstoday.com/articles/322123.php

 

Backache is a common disorder involving the muscles, nerves, and bones of the back. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks). The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of low back pain usually improve within a few weeks from the time they start, with 40-90% of people completely better by six weeks.

Acute low-back pain without sciatica, with some spread of discomfort to the region of the sacroiliac joint, to the outer part of the buttock as well as to the lateral and the back part of the thigh, is a unifying symptom of a very common clinical syndrome whose exact underlying cause remains often uncertain. Most patients fall then into the category of non-specific low-back pain. Probably the pathogenesis is not uniform, and the pain can arise from a variety of structures (muscles, ligament, spine). Pain which persists after 3 to 4 days should warn the clinician that a serious pathological condition may be present which requires a new approach to diagnosis and treatment.

Pain in the lower part of the back is commonly referred to as Lumbago. It can be defined as mild to severe pain or discomfort in the area of the lower back. The pain can be acute (sudden and severe) or chronic if it has lasted more than three months.

Most people will experience lumbago at some point in their life. It is one of the most common reasons people miss work and visit the doctor. It can occur at any age but is a particular problem in younger people whose work involves physical effort and much later in life, in the elderly.

Anatomy Backache

The lumbar spine consists of five vertebrae (L1–L5). The complex anatomy of the lumbar spine is a combination of these strong vertebrae, linked by joint capsules, ligaments, tendons, and muscles, with extensive innervation. The spine is designed to be strong, since it has to protect the spinal cord and spinal nerve roots. At the same time, it is highly flexible, providing for mobility in many different planes.

The mobility of the vertebral column is provided by the symphyseal joints between the vertebral bodies, with an IVD in between. The facet joints are located between and behind adjacent vertebrae, contributing to spine stability. They are found at every spinal level and provide about 20% of the torsional (twisting) stability in the neck and low back segments ^[rx]. Ligaments aid in joint stability during rest and movement, preventing injury from hyperextension and hyperflexion. The three main ligaments are the anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), and ligamentum flavum (LF). The canal is bordered by vertebral bodies and discs anteriorly and by laminae and LF posteriorly. Both the ALL and PLL run the entire length of the spine, anteriorly and posteriorly, respectively. Laterally, spinal nerves and vessels come out from the intervertebral foramen. Beneath each lumbar vertebra, there is the corresponding foramen, from which spinal nerve roots exit. For example, the L1 neural foramina are located just below the L1 vertebra, from where the L1 nerve root exits.

IVDs are located between vertebrae. They are compressible structures able to distribute compressive loads through osmotic pressurization. In the IVD, the annulus fibrosus (AF), a concentric ring structure of organized lamellar collagen, surrounds the proteoglycan-rich inner nucleus pulposus (NP). Discs are avascular in adulthood, except for the periphery. At birth, the human disc has some vascular supply but these vessels soon recede, leaving the disc with little direct blood supply in the healthy adult ^[rx]. Hence, metabolic support of much of the IVD is dependent on the cartilaginous endplates adjacent to the vertebral body. A meningeal branch of the spinal nerve, better known as the recurrent sinuvertebral nerve, innervates the area around the disc space ^[rx].

The lumbar spine is governed by four functional groups of muscles, split into extensors, flexors, lateral flexors, and rotators. The lumbar vertebrae are vascularized by lumbar arteries that originate in the aorta. Spinal branches of the lumbar arteries enter the intervertebral foramen at each level, dividing themselves into smaller anterior and posterior branches ^[rx]. The venous drainage parallels the arterial supply ^[rx].

Typically, the end of the spinal cord forms the conus medullaris within the lumbar spinal canal at the lower margin of the L2 vertebra ^[rx]. All lumbar spinal nerve roots stem from the connection between the dorsal or posterior (somatic sensory) root from the posterolateral aspect of the spinal cord and the ventral or anterior (somatic motor) root from the anterolateral aspect of the cord ^[rx]. The roots then flow down through the spinal canal, developing into the cauda equina, before exiting as a single pair of spinal nerves at their respective intervertebral foramina. Cell bodies of the motor nerve fibers can be found in the ventral or anterior horns of the spinal cord, whereas those of the sensory nerve fibers are in the dorsal root ganglion (DRG) at each level. One or more recurrent meningeal branches, known as the sinuvertebral nerves, run out from the lumbar spinal nerves. The sinuvertebral nerve, or Luschka’s nerve, is a recurrent branch created from the merging of the grey ramus communicans (GRC) with a small branch coming from the proximal end of the anterior primary ramus of the spinal nerve. This polisegmentary mixed nerve directly re-enters the spinal canal and gives off ascending and descending anastomosing branches comprising both somatic and autonomic fibers for the posterolateral annulus, the posterior vertebral body and the periostium, and the ventral meninges ^{[rx, rx]}. The sinuvertebral nerves connect with branches from radicular levels both above and below the point of entry, in addition to the contralateral side, meaning that localizing pain from involvement of these nerves is challenging ^[rx]. Also, the facet joints receive two-level innervation comprising somatic and autonomic components. The former convey a well-defined local pain, while the autonomic afferents transmit referred pain.

www.rxharun.com

Causes of Backache

The human back is composed of a complex structure of muscles, ligaments, tendons, disks and bones – the segments of our spine are cushioned with cartilage-like pads called disks. Problems with any of these components can lead to back pain. In some cases of back pain, its cause is never found.

Strain – the most common causes of back pain are:

• Strained muscles
• Strained ligaments
• A muscle spasm

Things that can lead to strains or spasms include:

• Lifting something improperly
• Lifting something that is too heavy
• The result of an abrupt and awkward movement

Structural problems –

• Sprains and strains – account for most acute back pain. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from twisting or lifting something improperly, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can also be painful.
• Intervertebral disc degeneration – is one of the most common mechanical causes of low back pain, and it occurs when the usually rubbery discs lose integrity as a normal process of aging. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. As the discs deteriorate, they lose their cushioning ability.
• Herniated or ruptured discs – can occur when the intervertebral discs become compressed and bulge outward (herniation) or rupture, causing low back pain.
• Radiculopathy – is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
• Sciatica  – is a form of radiculopathy caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve not only pain, but numbness and muscle weakness in the leg because of interrupted nerve signaling. The condition may also be caused by a tumor or cyst that presses on the sciatic nerve or its roots.
• Spondylolisthesis  – is a condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column.
• A traumatic injury  – such as from playing sports, car accidents, or a fall can injure tendons, ligaments or muscle resulting in low back pain. Traumatic injury may also cause the spine to become overly compressed, which in turn can cause an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted to the spinal cord. When spinal nerves become compressed and irritated, back pain and sciatica may result.
• Ruptured disks – each vertebra in our spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.
• Bulging disks – in much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
• Sciatica – a sharp and shooting pain that travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.
• Arthritis – patients with osteoarthritis commonly experience problems with the joints in the hips, lower back, knees and hands. In some cases spinal stenosis can develop, which is the term used to describe when the space around the spinal cord narrows.
• Abnormal curvature of the spine – if the spine curves in an unusual way the patient is more likely to experience back pain. An example is a scoliosis, a condition in which the spine curves to the side.
• Osteoporosis – bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
• Spinal stenosis  – is a narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
• Skeletal irregularities  – include scoliosis, a curvature of the spine that does not usually cause pain until middle age; lordosis, an abnormally accentuated arch in the lower back; and other congenital anomalies of the spine.
• Abdominal aortic aneurysms – occur when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally enlarged. Back pain can be a sign that an aneurysm is becoming larger and that the risk of rupture should be assessed.
• Kidney stones –  can cause sharp pain in the lower back, usually on one side.

Below are some other causes of back pain

• Cauda equina syndrome – the cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. People with cauda equine syndrome feel a dull pain in the lower back and upper buttocks, as well as analgesia (lack of feeling) in the buttocks, genitalia, and thigh. There are sometimes bowel and bladder function disturbances.
• Cancer of the spine – a tumor located on the spine may press against a nerve, resulting in back pain.
• Infection of the spine – if the patient has an elevated body temperature (fever) as well as a tender warm area on the back, it could be caused by an infection of the spine.
• Other infections – pelvic inflammatory disease (females), bladder, or kidney infections may also lead to back pain.
• Endometriosis – is the buildup of uterine tissue in places outside the uterus.
• Fibromyalgia – a chronic pain syndrome involving widespread muscle pain and fatigue.
• Sleep disorders – individuals with sleep disorders are more likely to experience back pain, compared to others.
• Shingles – an infection that can affect the nerves may lead to back pain, depending on the nerves affected.
• Bad mattress – if a mattress does not support specific parts of the body and keep the spine straight, there is a greater risk of developing back pain.

Everyday activities or poor posture

Back pain can also be the result of some everyday activity or poor posture. Examples include:

• Bending awkwardly
• Pushing something
• Pulling something
• Carrying something
• Lifting something
• Standing for long periods
• Bending down for long periods
• Twisting
• Coughing
• Sneezing
• Muscle tension
• Over-stretching
• Straining the neck forward, such as when driving or using a computer
• Long driving sessions without a break, even when not hunched
• Exertion or lifting.
• Severe blow or fall.
• Back disorders.
• Infections.
• Ruptured lumbar disk.
• Nerve dysfunction.
• Osteoporosis.
• Spondylosis (hardening and stiffening of the spinal column).
• Congenital problem.
• Childbirth.
• Often there is no obvious cause.

Jobs That Can Cause Lower Back Pain

• Airline crew (pilots, baggage handlers)
• Surgeons
• Nurses & healthcare workers
• Bus and cab drivers
• Warehouse workers
• Construction workers
• Carpet installers and cleaners
• Farmers (agricultural, dairy)
• Firefighters and police
• Janitors
• Mechanics
• Office personnel (eg, telemarketers, file clerks, computer operators)

The Symptom of Backache

The main symptom of back pain is, as the name suggests, an ache or pain anywhere on

• Pain in the back, and sometimes all the way down to the buttocks and legs. Some back issuescan cause pain in other parts of the body, depending on the nerves affected.
• In most cases, signs, and symptoms clear up on their own within a short period.If any of the following signs or symptoms accompany a back pain, people should see their doctor:
• Pain. It may be continuous, or only occur when you are in a certain position. The pain may be aggravated by coughing or sneezing, bending or twisting.
• Patients who have been taking steroids for a few months
• Drug abusers
• Patients with cancer
• Patients who have had cancer
• Patients with depressed immune systems
• Stiffness.

According to the British National Health Service (NHS), the following groups of people should seek medical advice if they experience back pain:

• Weight loss
• Elevated body temperature (fever)
• Inflammation (swelling) on the back
• Persistent back pain – lying down or resting does not help
• Pain down the legs
• Pain reaches below the knees
• A recent injury, blow or trauma to your back
• Urinary incontinence – you pee unintentionally (even small amounts)
• Difficulty urinating – passing urine is hard
• Fecal incontinence – you lose your bowel control (you poo unintentionally)
• Numbness around the genitals
• Numbness around the anus
• Numbness around the buttocks
• dull ache,
• numbness,
• tingling,
• sharp pain,
• pulsating pain,
• pain with movement of the spine,
• pins and needles sensation,
• muscle spasm,
• tenderness,
• sciatica with shooting pain down one or both lower extremities
• People aged less than 20 and more than 55 years
• Additionally, people who experience pain symptoms after a major trauma (such as a car accident) are advised to see a doctor. If low back pain interferes with daily activities, mobility, sleep, or if there are other troubling symptoms, medical attention should be sought.

Risk increases with

• Biomechanical risk factors.
• Sedentary occupations.
• Gardening and other yard work.
• Sports and exercise participation, especially if infrequent.
• Obesity.

Preventive measures

• Exercises to strengthen lower back muscles.
• Learn how to lift heavy objects.
• Sit properly.
• Back support in bed.
• Lose weight, if obese.
• Choose proper footwear.
• Wear special back support devices.

Red flag conditions indicating possible underlying spinal pathology or nerve root problems^w9

Red flags

• Onset age < 20 or > 55 years
• Non-mechanical pain (unrelated to time or activity)
• Thoracic pain
• Previous history of carcinoma, steroids, HIV
• Feeling unwell
• Weight loss
• Widespread neurological symptoms
• Structural spinal deformity

Indicators for nerve root problems

• Unilateral leg pain > low back pain
• Radiates to foot or toes
• Numbness and paraesthesia in same distribution
• Straight leg raising test induces more leg pain
• Localised neurology (limited to one nerve root)

Diagnosis of Backache

Suspected disk, nerve, tendon, and other problems – X-rays or some other imaging scan, such as a CT (computerized tomography) or MRI (magnetic resonance imaging) scan may be used to get a better view of the state of the soft tissues in the patient’s back.

• Blood tests – CBC ,ESR,Hb, RBS,CRP, Serum Creatinine,Serum Electrolyte,
• Myelograms
• Discography.
• Electrodiagnostics
• Bone scans
• Ultrasound imaging
• X-rays – can show the alignment of the bones and whether the patient has arthritis or broken bones. They are not ideal for detecting problems with muscles, the spinal cord, nerves or disks.
• MRI or CT scans – these are good for revealing herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles and bones.
• Bone scan – a bone scan may be used for detecting bone tumors or compression fractures caused by brittle bones (osteoporosis). The patient receives an injection of a tracer (a radioactive substance) into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
• Electromyography or EMG – the electrical impulses produced by nerves in response to muscles is measured. This study can confirm nerve compression which may occur with a herniated disk or spinal stenosis (narrowing of the spinal canal).

Treatment of Backache

General measures

• Bed rest for first 24 hours. Additional bed rest will be determined by the severity of the problem. Recent medical studies indicate that staying more active is better for back disorders than prolonged bed rest.
• Use a firm mattress (place a bed board under the mattress if needed).
• An ice pack or cold massage or heat applied to the affected area with a heating pad or hot water bottle.
• Physical therapy.
• Massage may help. Be sure the person is well-trained or massage could cause more harm than help.
• Wear a special back support device.
• Other options are available depending on the degree of injury, such as surgery (if disk damaged), electrical nerve stimulation, acupuncture, special shoes, etc.
• Stress reduction techniques, if needed.
• Non-Prescription Pain Relievers – Naproxen, acetaminophen, and ibuprofen each reduce inflammation and pain. Though these drugs are available over-the-counter, they are potent and taking more than the recommended dose can harm health. A doctor can help with advice about the right kind of non-prescription pain reliever to take.
• Cold and Heat – Applying a cold pack to the painful part of the back contracts inflamed muscle and relieves pain. This treatment helps a great deal when the disk has recently ruptured and swelling is at its greatest. A heating pad or warm pack helps with residual pain.
• Continued Physical Activity – Though pain or weakness seem like good reasons to rest the back, excessive bed-rest worsens the symptoms of a slipped disc. Moving around too little allows muscles to grow weaker and prevents the body from healing. Periods of rest interspersed with periods of normal activity throughout the day keep the back muscles in shape.
• Prescription Remedies –  If over-the-counter drugs fail to ease slipped disc pain, the doctor will turn to prescription medications.  These can include narcotics, such as hydrocodone or codeine. While they can do away with pain, narcotics are very addictive and induce a mental fogginess that can itself be dangerous.  More narrowly-focused medicines designed to target damaged nerves that create chronic pain may be a better choice, as they have fewer undesirable side effects. Gabapentin and Cymbalta are two drugs that act in different ways to minimize nerve pain. These drugs are less addictive than narcotics.
• Physical Therapy – Physical therapists show slipped disc sufferers ways to move that do not cause pain. Occupational therapists teach skills that allow patients to return to a productive life.
• Nutrition – In order to restore the disc we also are going to need to include different substances in our diet. There are a lot of supplements on the market, of course. If you wish to try them, that’s fine. I personally don’t like them. I have tried one with glucosamine and chondroitin, but I didn’t feel any different. So, if you have the opportunity to take these with the food or from more natural sources, it will be great. You can find these substances in seafood and animal cartilages and by digesting them we ensure the building blocks for the connecting tissue for our joints and spine. Also, we will need more Omega 3 fatty acids, which can be supplied from cold-pressed oils, fatty fish, flax seeds, chia, and many more. Vitamins from the B group are very beneficial for people with herniated discs and all kinds of issues with the peripheral nervous system. Vitamins B1, B6, and B12 nourish the nerves and help them recover from the disk accident. Usually, doctors prescribe them as a part of the treatment, but it is worth mentioning anyway.
• A good massage – A massage is one of the natural methods of relieving pain. Individuals who get a massage weekly for several months stand a better chance of alleviating back pain. A good massage provides a person with many health benefits that lessen back pain. A massage triggers the release of endorphins. Endorphins aid in decreasing anxiety and relieving pain. They offer a relaxation effect by softening muscles that are injured preventing cramping.
• Undertaking yoga – Yoga is an applicable strategy of keeping the level of back pain at minimal levels. Taking yoga sessions often is a very effective method of dealing with back pain. With yoga, there is a high likelihood of proper body functions. The use of pain prescriptions is also diminished. Patients suffering from back pain related issues do not have to rely on these prescriptions to manage pain. Incorporating laughter in yoga is a good way of exercising. Yoga incorporates simple yet appropriate exercises that enhance the stretching of muscles. Laughter with yoga stimulates relieving of pain. It facilitates increased uptake of oxygen, little anxiety and production of endorphins. All these variables play an essential role in diminishing back pain.
• Adjusting sleeping position – A simple sleeping mistake can immensely contribute to back pain. A poor sleeping position can cause stress and tension on the muscles contributing to back pain. Altering one’s sleeping position and adopting a style that does not exert a lot of stress on the back is a recommended tactic. Nurturing sleeping habits such as assuming a reclining position, using wedge-shaped cushions, and getting adjustable beds from reputable medical institutions are easy techniques to endorse. If a reclining position does not suit an individual, the other two techniques can be embraced.
• Heat therapy – Several considerations should be observed when using heat therapy. The right temperature ought to be set so as to ensure a patient does not face risks associated with too much exposure to heat. The key objective should be to ensure enough access to heat to the muscles to yield benefits for the patient. The adoption of heat therapy for easing back pain is determined by the magnitude of pain a person is experiencing. In cases where relatively low back pain is encountered, short heat therapy sessions are recommended. On the other hand, if an individual is experiencing prolonged back pain, long heat therapy sessions are the most applicable.
• Taking hot baths – This is a form of heat therapy that aims at relieving back pain. It guarantees the permeation of heat into the muscles leading to reduced pain. Many individuals opt for this method since they believe it achieves competent results. Hot baths initiate a fast process of blood supply to stiff neck and back muscles. When this happens, the muscles relax and stretch leading to decreased back pain. To avoid interference with one’s sleeping patterns, a hot bath should be taken several hours before retiring to bed.
• Aquatic therapy – This natural technique involves physical therapy in a pool. Individuals get the best out of this therapy by relying on the resistance of water. Consistency in undertaking this therapy is what ascertains getting back pain relief. Integrating aquatic therapy in an individual’s life for the better part of the week enhances reduction of back pain quickly.
• Enlighten others – Individuals have the power to devise their own natural strategies that aid them in coping with back pain. The strategies can also be a good remedy for others going through similar circumstances. An individual can use social media platforms to equip others with important tips on how to keep back pain at bay. Further, becoming a member of associations that address back pain issues enables better communication of the knowledge gained from personal experience.

Medications

• Analgesic medications  – are those specifically designed to relieve pain. They include OTC acetaminophen and aspirin, as well as prescription opioids such as codeine, oxycodone, hydrocodone, and morphine. Opioids should be used only for a short period of time and under a physician’s supervision. People can develop a tolerance to opioids and require increasingly higher dosages to achieve the same effect. Opioids can also be addictive. Their side effects can include drowsiness, constipation, decreased reaction time, and impaired judgment. Some specialists are concerned that chronic use of opioids is detrimental to people with back pain because they can aggravate depression, leading to a worsening of the pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDS) – relieve pain and inflammation and include OTC formulations (ibuprofen, ketoprofen, and naproxen sodium). Several others, including a type of NSAID called COX-2 inhibitors, are available only by prescription. Long-term use of NSAIDs has been associated with stomach irritation, ulcers, heartburn, diarrhea, fluid retention, and in rare cases, kidney dysfunction and cardiovascular disease. The longer a person uses NSAIDs the more likely they are to develop side effects. Many other drugs cannot be taken at the same time a person is treated with NSAIDs because they alter the way the body processes or eliminates other medications.
• Anticonvulsants—drugs primarily used to treat seizures—may be useful in treating people with radiculopathy and radicular pain.
• Antidepressants – such as tricyclics and serotonin and norepinephrine reuptake inhibitors have been commonly prescribed for chronic low back pain, but their benefit for nonspecific low back pain is unproven, according to a review of studies assessing their benefit.
• Muscle Relaxants – If the muscles around the slipped disc experience painful spasms, a muscle relaxant such as Valium may be useful. The drawback to drugs like these is that they do not limit their power to the affected nerve. Instead, they have a generally relaxing effect and will interfere with daily activities.
•  As cyclobenzaprine (Flexeril) – which might be prescribed to relieve the discomfort associated with muscle spasms. However, these medicines might cause confusion in older people. Depending on the level of pain, prescription pain medicines might be used in the initial period of treatment.
• Steroids – If inflammation is severe, a doctor may also prescribe a steroid. Steroids, such as cortisone, reduce swelling quickly. A cortisone shot directly in the affected area will have an immediate effect on the displaced disc.
• Counter-irritants – such as creams or sprays applied topically stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Topical analgesics reduce inflammation and stimulate blood flow.
• Nerve Relaxant — Pregabalin or gabapentin and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include aspirin, ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve).
• Spinal manipulation and spinal mobilization  – Are approaches in which professionally licensed specialists (doctors of chiropractic care) use their hands to mobilize, adjust, massage, or stimulate the spine and the surrounding tissues. Manipulation involves a rapid movement over which the individual has no control; mobilization involves slower adjustment movements. The techniques have been shown to provide small to moderate short-term benefits in people with chronic low back pain. Evidence supporting their use for acute or subacute low back pain is generally of low quality. Neither technique is appropriate when a person has an underlying medical cause for the back pain such as osteoporosis, spinal cord compression, or arthritis.
• Traction  – involves the use of weights and pulleys to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Some people experience pain relief while in traction, but that relief is usually temporary. Once traction is released the back pain tends to return. There is no evidence that traction provides any long-term benefits for people with low back pain.
• Spinal injections — An injection of a cortisone-like anti-inflammatory medicine into the lower back might help reduce swelling and inflammation of the nerve roots, allowing for increased mobility.
• Biofeedback  – It is used to treat many acute pain problems, most notably back pain and headache. The therapy involves the attachment of electrodes to the skin and the use of an electromyography machine that allows people to become aware of and self-regulate their breathing, muscle tension, heart rate, and skin temperature. People regulate their response to pain by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects. The evidence is lacking that biofeedback provides a clear benefit for low back pain.
• Nerve block therapies  – aim to relieve chronic pain by blocking nerve conduction from specific areas of the body. Nerve block approaches range from injections of local anesthetics, botulinum toxin, or steroids into affected soft tissues or joints to more complex nerve root blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. The success of a nerve block approach depends on the ability of a practitioner to locate and inject precisely the correct nerve. Chronic use of steroid injections may lead to increased functional impairment.

Surgery For Backache

When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. It may be months following surgery before the patient is fully healed, and he or she may suffer permanent loss of flexibility.

• Vertebroplasty and kyphoplasty – are minimally invasive treatments to repair compression fractures of the vertebrae caused by osteoporosis. Vertebroplasty uses three-dimensional imaging to assist in guiding a fine needle through the skin into the vertebral body, the largest part of the vertebrae. A block of glue-like bone cement is then injected into the vertebral body space, which quickly hardens to stabilize and strengthen the bone and provide pain relief. In kyphoplasty, prior to injecting the bone cement, a special balloon is inserted and gently inflated to restore height to the vertebral structure and reduce spinal deformity.
• Spinal laminectomy – (also known as spinal decompression) is performed when spinal stenosis causes a narrowing of the spinal canal that causes pain, numbness, or weakness. During the procedure, the lamina or bony walls of the vertebrae, along with any bone spurs, are removed. The aim of the procedure is to open up the spinal column to remove pressure on the nerves.
• Discectomy or microdiscectomy – may be recommended to remove a disc, in cases where it has herniated and presses on a nerve root or the spinal cord, which may cause intense and enduring pain. Microdiscectomy is similar to a conventional discectomy; however, this procedure involves removing the herniated disc through a much smaller incision in the back and a more rapid recovery. Laminectomy and discectomy are frequently performed together and the combination is one of the more common ways to remove pressure on a nerve root from a herniated disc or bone spur.
• Foraminotomy – is an operation that “cleans out” or enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness, and weakness in an arm or leg. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve pressure on the nerve.
• Intradiscal electrothermal therapy (IDET) – is a treatment for discs that are cracked or bulging as a result of degenerative disc disease. The procedure involves inserting a catheter through a small incision at the site of the disc in the back. A special wire is passed through the catheter and an electrical current is applied to heat the disc, which helps strengthen the collagen fibers of the disc wall, reducing the bulging and the related irritation of the spinal nerve. IDET is of questionable benefit.
• Nucleoplasty also called plasma disc decompression (PDD) – is a type of laser surgery that uses radiofrequency energy to treat people with low back pain associated with mildly herniated discs. Under x-ray guidance, a needle is inserted into the disc. A plasma laser device is then inserted into the needle and the tip is heated to 40-70 degrees Celsius, creating a field that vaporizes the tissue in the disc, reducing its size and relieving pressure on the nerves. Several channels may be made depending on how tissue needs to be removed to decompress the disc and nerve root.
• Radiofrequency denervation – is a procedure using electrical impulses to interrupt nerve conduction (including the conduction of pain signals). Using x-ray guidance, a needle is inserted into a target area of nerves and a local anesthetic is introduced as a way of confirming the involvement of the nerves in the person’s back pain. Next, the region is heated, resulting in localized destruction of the target nerves. Pain relief associated with the technique is temporary and the evidence supporting this technique is limited.
• Spinal fusion – is used to strengthen the spine and prevent painful movements in people with degenerative disc disease or spondylolisthesis (following laminectomy). The spinal disc between two or more vertebrae is removed and the adjacent vertebrae are “fused” by bone grafts and/or metal devices secured by screws. The fusion can be performed through the abdomen, a procedure known as an anterior lumbar interbody fusion, or through the back, called posterior fusion. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together. Spinal fusion has been associated with an acceleration of disc degeneration at adjacent levels of the spine.
• Artificial disc replacement – is considered an alternative to spinal fusion for the treatment of people with severely damaged discs. The procedure involves removal of the disc and its replacement by a synthetic disc that helps restore height and movement between the vertebrae.

Other Rx of Backache

Chiropractic Care

Sixty percent of people with sciatica who didn’t get relief from other therapies and then tried spinal manipulation experienced the same degree of pain relief as patients who eventually had surgery, found a 2010 study in the Journal of Manipulative and Physiological Therapeutics. The 120 people in the study saw a chiropractor about 3 times a week for 4 weeks and then continued weekly visits, tapering off treatment as they felt better. In people who responded to chiropractic care, benefits lasted up to a year. “Spinal manipulation may create a response in the nervous system that relieves pain and restores normal mobility to the injured area,” says study researcher Gordon McMorland, DC, of National Spine Care in Calgary, Alberta. “It also reduces inflammation, creating an environment that promotes the body’s natural healing mechanisms.”

Acupuncture

You can get relief as soon as the first session, though it takes about 12 sessions to see improvement,” says Jingduan Yang, MD, assistant professor at the Jefferson Myrna Brind Center of Integrative Medicine at Thomas Jefferson University. A small study in the Journal of Traditional Chinese Medicine found that of 30 people with sciatica, 17 got complete relief and 10 saw symptoms improve with warming acupuncture, in which the needles are heated.

Yoga

A study in the journal Pain reported that people with chronic back pain who practiced Iyengar yoga for 16 weeks saw pain reduced by 64% and disability by 77%. Although yoga’s effects on sciatica are less clear, gentle forms may be beneficial. By strengthening muscles and improving flexibility, a yoga practice can help sciatica sufferers “move and function better so they don’t fall into a posture that aggravates sciatica,” says James W. Carson, Ph.D., a psychologist at the Comprehensive Pain Center at Oregon Health & Science University. For extra grip and stability, try these grip socks from Natural Fitness.

Massage

Don’t expect a chilled-out spa massage if you have sciatica. In this instance, trigger-point therapy is best, says Jeff Smoot, vice president of the American Massage Therapy Association. The sciatic nerve sits underneath a muscle called the piriformis, which is located beneath the glutes. “When the piriformis muscle gets tight, it pinches the sciatic nerve, causing tingling and numbness down into the leg,” says Smoot. He applies pressure to irritated and inflamed areas, or trigger points, in the piriformis muscle, as well as in muscles in the lower back and glutes. Typically, Smoot schedules treatments 7 to 10 days apart. If patients don’t see progress by the fourth visit, “they need to try another form of therapy,” he says.

Shiatsu,

Also known as finger pressure therapy, is a type of massage where pressure is applied along energy lines in the body. The shiatsu therapist applies pressure with his/her fingers, thumbs and elbows.

Topical Preparations

St. John’s wort oil, a liniment, is “one of my favorites for nerve pain,” says Tieraona Low Dog, MD, director of the fellowship at the Arizona Center for Integrative Medicine. Apply the anti-inflammatory oil two or three times a day where there’s pain. Another option: an OTC cayenne pepper plaster or cream; capsaicin, found in chiles, hinders the release of pain-causing compounds from nerves. For severe cases, Low Dog uses the prescription chile patch Qutenza, designed for shingles pain. “One application is effective for weeks,” says Low Dog.

Ice or Heat

Because the sciatic nerve is buried deep within the buttock and leg, ice or heat on the surface of the body won’t ease that inner inflammation. But the timehonored treatments can act as counterirritants—that is, “they give your body other input in the painful area, and that brings the pain down a notch,” says Ruppert. Apply an ice pack or a heating pad as needed for 15 minutes.

Devil’s Claw

The herbal medication devil’s claw is “quite a potent anti-inflammatory, working like ibuprofen and similar drugs to inhibit substances that drive inflammation,” says Low Dog. She generally starts patients on 1,500 to 2,000 mg twice a day. Look for a brand that has a standardized extract of roughly 50 mg of harpagoside, the active compound. Safety reviews show that the supplement is well tolerated by most people but should be avoided by patients with peptic ulcers or on blood-thinning medications.

Pain Relievers and Muscle Relaxants

Taking a nonsteroidal anti-inflammatory drug, either OTC (like ibuprofen) or Rx, can ease the distress. Because painful muscle spasms may also accompany a disk herniation, doctors sometimes prescribe muscle relaxants or pain-reducing tricyclic antidepressants. A caveat: “These won’t help with the pain caused by pressure on the sciatic nerve,” says A. Nick Shamie, MD, a spokesperson for the American Academy of Orthopaedic Surgeon.

Epidural Steroid Injections

People whose pain doesn’t lessen within about a month and who aren’t helped by other therapies may find their pain remedied by an x-ray-guided injection of steroid into the lower back near the sciatic nerve, says Raj Rao, MD, a spokesperson for the AAOS. “The hope is to reduce inflammation within that nerve branch,” explains Rao. Because of concerns about side effects, such as loss of bone density, the epidural shots are limited to three a year.

CBT (cognitive behavioral therapy)

CBT can help patients manage chronic back pain. The therapy is based on the principle that the way a person feels is, in part, dependent on the way they think about things.

People who can be taught to train themselves to react in a different way to pain may experience less perceived pain. CBT may use relaxation techniques as well as strategies to maintain a positive attitude. Studies have found that patients with CBT tend to become more active and do exercise, resulting in a lower risk of back pain recurrence.

Exercise and Physical Therapy

Moving is usually the last thing people dogged by sciatica want to do, but it’s important to be physically active. “Lying in bed makes it more likely that the pain will last longer,” says Ruppert. “Exercise increases blood flow to the disk and the nerve, helping to get rid of the chemicals causing the inflammation.” Take 15- to 20-minute walks. If that hurts too much, give swimming or water aerobics a try; there’s not as much pressure on the back when you’re in the water, says Ruppert. It may also be worth seeing a physical therapist, who can prescribe stretching exercises to restore flexibility to the back or moves that strengthen core muscles, helping to stabilize the spine and reduce the likelihood of a similar injury.

Pigeon pose

Pigeon Pose is a common yoga pose. It works to broadly open the hips. There are multiple versions of this stretch. The first is a starting version of the pigeon pose, known as the reclining pigeon pose. If you are just starting your treatment, you should try the reclining pose first. Once you can do the reclining version without pain, work with your physical therapist on the sitting and forward versions.

Reclining pose

While on the back, bring your right leg up to a right angle and grasp it with both hands behind the thigh, locking your fingers.

• Take your left leg and place your ankle against the knee. Hold the position for a moment before changing legs. This helps stretch the tiny piriformis muscle, which sometimes becomes inflamed and presses against the sciatic nerve causing pain.
• Repeat by switching sides and doing the same exercise with the other leg.

Sitting pose

• Sit on the floor with your legs stretched out straight in front of you. Then bend your right leg, putting your right ankle on top of the left knee.
• Lean forward and allow your upper body to lean toward your thigh. Hold for 15 to 30 seconds and then switch sides. This stretches the glutes and lower back.

Forward pose

• Kneel on the floor on all fours.
• Pick up your right leg and move it forward so that your lower leg is on the ground, horizontal to the body. Your right foot should be in front of your right knee while your right knee stays to the right.

Stretch the left leg out all the way behind you on the floor, with the top of the foot on the ground and toes pointing back.

• Shift your body weight gradually from your arms to your legs so that your legs are supporting your weight. Sit up straight with your hands on either side of your legs.
• Take a deep breath. While exhaling, lean your upper body forward over your lower leg. Support your weight with your arms as much as possible.

Knee to opposite shoulder

This simple stretch helps relieve sciatica pain by loosening your gluteal and piriformis muscles, which can become inflamed and press against the sciatic nerve.

• Lie on your back with your legs extended outward and your feet flexed upward.
• Clasp your hands around your knee and gently pull your right leg across your body toward your left shoulder. Hold it there for 30 seconds and then push your knee so your leg returns to its starting position.
• Repeat for a total of 3 reps, and then switch legs. Remember to only pull your knee as far as it will comfortably go. You should feel a relieving stretch in your muscle, not pain.

Sitting spinal stretch

Sciatica pain is triggered when vertebrae in the spine compress. This stretch helps create space in the spine to relieve pressure from the sciatic nerve.

• Sit on the ground with your legs extended straight out with your feet flexed upward.
• Bend your right knee and place your foot flat on the floor on the outside of your opposite knee.
• Place your left elbow on the outside of your right knee to help you gently turn your body toward the right. Hold for 30 seconds and repeat three times, then perform this stretch with your left leg bent and body turned to the left side.

Standing hamstring stretch

This stretch can help ease pain and tightness in the hamstring caused by sciatica.

• Place your right foot on an elevated surface at or below your hip level. This could be a chair, ottoman, or step on a staircase. Flex your foot so your toes and leg are straight. If your knee tends to hyperextend, keep a slight bend in it.
• Bend your body forward slightly toward your foot. The further you go, the deeper the stretch. Do not push so far that you feel pain.
• Release the hip of your raised leg downward as opposed to it lifting up. If you need help easing your hip down, loop a yoga strap or long exercise band over your right thigh and under your left foot. Hold for at least 30 seconds, and then repeat on the other side.

Exercise with care

What complications are associated with 

Chronic (ongoing and lasting) pain is a complication of untreated sciatica. If the “pinched nerve” is seriously injured, chronic muscle weakness, such as a “drop foot,” might occur.

What is the outlook for people with

Sciatic pain usually goes away with time and rest. Most people with sciatica (80 percent to 90 percent) will get better without surgery. About half of affected individuals recover from an episode within six weeks.

Can sciatica be prevented?

Some sources of sciatica are not preventable, such as degenerative disc disease, back strain due to pregnancy, and accidental falls.

Although it might not be possible to prevent all cases of sciatica, you can take steps to protect your back and reduce your risk.

Practice proper lifting techniques. Lift with your back straight, bringing yourself up with your hips and legs, and holding the object close to your chest. Use this technique for lifting everything, no matter how light.
Avoid/ stop cigarette smoking, which promotes disc degeneration.
Exercise regularly to strengthen the muscles of your back and abdomen, which work to

support your spine.

Use good posture when sitting, standing, and sleeping. Good posture helps to relieve the pressure on your lower back.
Avoid sitting for long periods.

Preventing of Backache

Steps to lower the risk of developing back pain consist mainly of addressing some of the risk factors.

Exercise – regular exercise helps build strength as well as keeping your body weight down. Experts say that low-impact aerobic activities are best; activities that do not strain or jerk the back. Before starting any exercise program, talk to a health care professional.

There are two main types of exercise that people can do to reduce the risk of back pain:

• Core-strengthening exercises– exercises that work the abdominal and back muscles, helping to strengthen muscles that protect the back.
• Flexibility – exercises aimed at improving flexibility in your core, including your spine, hips, and upper legs, may help too.

Smoking – a significantly higher percentage of smokers have back pain incidences compared to non-smokers of the same age, height and weight.

Bodyweight – the number of weight people carry, as well as where they carry it, affects the risk of developing back pain. The difference in back pain risk between obese and normal-weight individuals is considerable. People who carry their weight in the abdominal area versus the buttocks and hip area are also at greater risk.

Posture when standing – make sure you have a neutral pelvic position. Stand upright, head facing forward, back straight, and balance your weight evenly on both feet – keep your legs straight and your head in line with your spine. If you regularly use a computer, it is important to ensure that you have a chair with good back support and adopt a good posture and head position.

Posture when sitting – a good seat should have good back support, armrests and a swivel base (for working). When sitting try to keep your knees and hips level and keep your feet flat on the floor – if you can’t, use a footstool. You should ideally be able to sit upright with support in the small of your back. If you are using a keyboard, make sure your elbows are at right-angles and that your forearms are horizontal.

Lifting things – the secret for protecting your back when lifting things is to think “legs not back”. In other words, use your legs to do the lifting, more than your back.

Keep your back as straight as you can, keeping your feet apart with one leg slightly forward so you can maintain balance. Bend only at the knees, hold the weight close to your body, and straighten the legs while changing the position of your back as little as possible.

Bending your back initially is unavoidable, but when you bend your back try not to stoop or squat, and be sure to tighten your stomach muscles so that your pelvis is pulled in. Most important, do not straighten your legs before lifting; otherwise you will be using your back for most of the work.

Do not lift and twist at the same time. If something is particularly heavy, see if you can lift it with someone else. While you are lifting keep looking straight ahead, not up nor down, so that the back of your neck is like a continuous straight line from your spine.

Moving things – remember that it is better for your back to push things across the floor, using your leg strength, rather than pulling them.

Shoes – flat shoes place less of a strain on the back.

Driving – it is important to have proper support for your back. Make sure the wing mirrors are properly positioned so you do not need to twist. The pedals should be squarely in front of your feet. If you are on a long journey, have plenty of breaks – get out of the car and walk around.

Your bed – you should have a mattress that keeps you spine straight, while at the same time supporting the weight of your shoulders and buttocks. Use a pillow, but not one that forces your neck into a steep angle.

Home Remedies for Lumbago /Backache

 Ice and Heat

Ice works wonders on lower back pain. Wrap some ice cubes in a plastic bag to prepare an ice pack. Then cover it with a towel and apply it on the painful area for 20 minutes. Repeat the same process several times a day. Then after 48 hours, you can switch to heat method. Dip a towel in warm water. Flatten and fold it on to the affected area. Place heating pad on it with a plastic cover between towel and heating pad. Leave it for 20 minutes. Do it several times a day. It reduces swelling and relaxes the nerves that are responsible for sending pain signals to the brain.

 Rest

Get sufficient rest. Don’t exhaust yourself physically and mentally. When sleeping, keep changing your positions. When you lie on back, put a pillow under your knees. Similarly, if you lie on your side, draw your knees near your chest and keep a pillow between your knees.

 Right Posture

Your sitting and standing posture is very important to keep back pain at bay. One should not be in a bending position for a long time whether sitting or standing. Sitting on the edge of the chair and slouching should be avoided. The angle of the chair in the office should be 110 degrees.

 Lemon Juice

Lemon juice is an effective home remedy for back pain. Drink lemon juice twice a day for better results.

Poppy Seeds

Prepare a mixture of poppy seeds and rock candy by grinding together 100 gm of each. Take this mixture twice a day with a glass of milk. You will get relief from back pain.

Massage with Olive Oil

Massage with olive oil to reduce stress by relaxing tensed muscles. It also helps release stiffness in joints and relieves upper back pain.

Stretching

Stretching is the easiest back pain treatment. If your job demands sitting or standing for long hours, just take a break of 5 minutes every hour and walk or simply stretch your body to avoid back pain.

Wheat

Wheat has pain minimizing component in it. Mix cuscus grass and coriander with overnight soaked wheat. Add 1 cup of milk and bring it to boil. Consume this mixture twice a day

Garlic

Eat 2-3 garlic cloves on an empty stomach every morning to get relief from back pain. You can also use garlic oil. Massage your back with this oil, cover it with warm blanket and lie on your back. Bathe using warm water after 20 minutes. This is a wonderful home remedy to treat back pain.

Ginger

The anti-inflammatory properties of ginger make it an ideal home remedy to get rid of back pain. Add ½ teaspoon of black peppercorns, ½ teaspoon of cloves and 1 teaspoon of ginger powder in a cup of boiling water to prepare herbal tea. Drink it 2-3 times a day.

• Alternatively, grate some ginger to prepare a paste. Apply it on the affected area. Then massage with eucalyptus oil.
• Put thin ginger slices in a pan of boiling water. Simmer it for 10-15 minutes. Strain and allow it to cool down at room temperature. Add honey to sweeten it. Drink it twice or thrice a day.

 Milk

Since milk is a great source of calcium, it is extremely beneficial for strong bones and preventing back pain. People of every age group should consume milk. For quick relief, add a few drops of honey and a pinch of turmeric in the milk.

Epsom Salt

A natural healer, epsom salt reduces swelling in back. It contains magnesium and sulfate which help muscles function properly, thus, provide relief from pain. Add 2 cups of Epsom salt to a tub of warm water. Let it soak for 30 minute. Take bath with this water.

 Rice

Rice is easily available in every household. It’s an effective home remedy for back pain. Put 1 cup uncooked rice in a thick sock and place it in the microwave for ½ – 1 minute. Now apply it onto the back.

Oats

Mash cooked whole oats with vinegar. Apply it on the back when hot. It soothes the aching back.

 Potatoes

Mash the peeled and boiled potatoes. Let them cool and then apply on back. You will experience relief from back pain.

 Coconut Oil

Take some coconut oil. Mix camphor in it and boil for 5-7 minutes. Allow it to cool. Store it in a bottle. Massage with this oil two times a day to cure back pain.

Capsaicin Cream

Capsaicin is an important ingredient of chilies. Apply capsaicin cream on the back. It will reduce the production of chemicals that transmit signals of pain to your brain.

Herbal Remedies for Lumbago /Backache

Willow Bark

White willow tree’s bark is considered an excellent herbal remedy for treating back pain. It has pain-relieving properties same as aspirin. So it will help reduce your back pain.

 Basil Leaves

Basil leaves are very famous for their medicinal benefits. They aid in curing lower back pain. Boil 10-12 fresh basil leaves in a cup of water until it becomes half. Add a pinch of salt to it. Drink it once or twice a day depending on the severity of your pain.

 Herbal Oils

Herbal oils like almond oil, eucalyptus oil, coconut oil or olive oil are very effective in alleviating back pain. Massage with warm oils on the painful area to relax the nerves causing pain.

Chamomile

Take some chamomile flowers. Steep them in a cup of boiling water for 15-20 minutes. Drink it 2-3 times a day. It will relax the tense muscles, thereby cure backache.

Note: – Pregnant ladies and those allergic to chamomile flowers should first consult doctor before taking this.

Ginger

 Though more studies are needed, says Dr. Kiefer, ginger extract may help with joint and muscle pain because it contains phytochemicals, which help stop inflammation. Few side effects have been linked to ginger when taken in small doses.

Feverfew

Feverfew has been used for centuries to treat headaches, stomachaches, and toothaches. Nowadays it’s also used for migraines and rheumatoid arthritis. More studies are required to confirm whether feverfew is actually effective, but the herb may be worth trying since it hasn’t been associated with serious side effects. Mild side effects include canker sores and irritation of the tongue and lips. Pregnant women should avoid this remedy.

Turmeric

 This spice has been used to relieve arthritis pain and heartburn, and to reduce inflammation. It’s unclear how turmeric works against pain or inflammation, but its activity may be due to a chemical called curcumin, which has anti-inflammatory properties. Turmeric is usually safe to use, but high doses or long-term use may cause indigestion. Also, people with gallbladder disease should avoid using turmeric.

Homeopathic Medicines for Lumbago /Backache

Rhus Tox

Rhus Tox tops the list of Homeopathic medicines for back pain. I have seen magnificent results in back pain from use of Rhus Tox. Rhus Tox is indicated for both upper and lower back pain, especially where the back pain is accompanied by intense stiffness. The back pain that arises from muscle strain also recovers wonderfully well with Rhus Tox. Persons suffering from back pain as a result of exertion or lifting heavy weights have found complete relief when prescribed Rhus Tox, making it one of the most reliable Homeopathic medicines for back pain. A prominent symptom to look out for while prescribing Rhus Tox is that the back pain gets worse with rest, while walking or hard pressure bring relief from pain.

Bryonia

In my clinical practice, Bryonia has shown marvellous results in lower back pain that worsens with the slightest of motion. Apart from motion, this pain also gets worse with standing or from turning in the bed, a key sign that Bryonia will work best. The pain may be accompanied by marked stiffness in such cases, for which Bryonia would rate among the best Homeopathic medicines for back pain. Lying down and taking rest brings relief from pain.

Aesculus

Aesculus is one of the most effective Homeopathic medicines for lower back pain that gets worse from stooping. In this case, the pain is most marked in the sacrum and hip region. The lower back feels as if it would break. Stiffness in the lower back is also intense. Aesculus is also one of the best Homeopathic medicines for back pain which gets worse when rising from a sitting position. Here it takes the person repeated efforts to rise from a chair or another sitting position.

Kali Carb

I would rank Kali Carb as one of the top grade Homeopathic medicines for back pain that arises after childbirth. The most prominent symptoms indicative of Kali Carb as the best suited Homeopathic medicines for back pain in such instances are stiffness and weakness in the lower back. The pain is very severe, with a feeling that the back might break. The back pain makes it difficult to walk. Women feel the need to lie down to get relief from the pain which may radiate to the upper back or down to the thigh and hips. Where these symptoms exist, Kali Carb comes highly recommended as one of the best Homeopathic medicines for back pain. Apart from post-partum backache, Kali Carb is also useful for backache in women before or during menses and after a miscarriage.

Cobaltum

Cobaltum ranks on top of the list of Homeopathic medicines for back pain that worsens from sitting. In such cases, the person feels better while walking or lying down. The back pain may radiate down the legs and feet in some cases, but the person will surely feel a weakness in the legs, a sure sign that Cobaltum will provide sustained relief.

Colocynth & Magnesium Phos

I have successfully treated several cases of back pain radiating down the legs and/or feet with two main Homeopathic medicines. These top rated Homeopathic medicines for back pain are Colocynth and Magnesium Phos. Among these, Colocynth is most effective Homeopathic medicine for back pain when the lower back pain radiates to the left leg and foot. Magnesium Phos brings relief when the lower back pain radiates down the right leg. The pain, in both the cases, can be of a shooting, cramping or tearing nature. However, both the medicines have proven their ability to bring lasting relief from pain and established themselves as the best Homeopathic medicines for back pain.

Cimicifuga & Kalmia

Two highly recommended Homeopathic medicines for back pain in the cervical region are Cimicifuga and Kalmia. I have seen remarkable results with use of Cimicifuga in cervical back pain accompanied by stiffness, contraction and sensitiveness in the neck. If pressure worsens the neck pain, Cimicifuga will offer effective treatment. However, in cases where the cervical pain radiates down the arm or hands, Kalmia has proved to be one of the most helpful Homeopathic medicines for back pain treatment. Persons feeling a weakness, numbness or tingling sensation in the arms and hands along with neck pain also recover fully well with use of Homeopathic medicine Kalmia.

Ruta & Hypericum

Ruta and Hypericum are highly suitable Homeopathic medicines for back pain resulting from injury. Ruta is prescribed for a back that is sore and bruised from injury. The pain is most marked over the sacrum and coccyx region. The injured person may feel a weakness in the lower back. Where such symptoms are noted, Ruta is the most prominent among Homeopathic medicines for back pain and has shown effective results. Homeopathic medicine Hypericum is recommended when pain from the tail bone radiates up the spine and down the limbs after injury. The pain is very sharp and intense. Motion, walking and stooping all make the pain worse. The spine is very tender and sensitive to touch in such cases where Hypericum has shown best results.

References

Symptoms, Causes of Piriformis Syndrome is a neuromuscular condition characterized by hip and buttock pain. This syndrome is often overlooked in clinical settings because its presentation may be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction. The ability to recognize piriformis syndrome requires an understanding of the structure and function of the piriformis muscle and its relationship to the sciatic nerve. The authors review the anatomic and clinical features of this condition, summarizing the osteopathic medical approach to diagnosis and management. A holistic approach to diagnosis requires a thorough neurologic history and physical assessment of the patient based on the pathologic characteristics of piriformis syndrome. The authors note that several nonpharmacologic therapies, including osteopathic manipulative treatment, can be used alone or in conjunction with pharmacotherapeutic options in the management of piriformis syndrome.[Rx]

Piriformis syndrome (PS) is a painful musculoskeletal condition, characterized by a combination of symptoms including buttock or hip pain due to compressed and/or irritated sciatic nerve by the piriformis muscle as it passes deeply through your buttock, resulting in pain. It is an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve.[Rx]

Piriformis syndrome is an often misdiagnosed cause of sciatica, leg, or buttock pain, and disability. The sciatic nerve may be compressed within the buttock by the piriformis muscle, with pain increased by muscular contraction, palpation, or prolonged sitting. A thorough medical history and physical examination are essential to proper diagnosis. Diagnostic testing may be used to differentiate piriformis syndrome from other causes of sciatica, lower extremity weakness, and pain. This article reviews the pathophysiology and management of piriformis syndrome.

The piriformis is a flat, pyramid-shaped muscle that lies parallel to (in line with) the gluteus medius muscle’s back margin and underneath the gluteus maximus muscle in the hip area.

Pain in your buttocks and radiating sciatic pain is sometimes the result of piriformis syndrome, or tightening and irritation of the piriformis muscle.

Anatomy of Piriformis Syndrome

Sciatic nerve

• Inferior to piriformis
• Superior to superior gemellus

Muscles

External rotators of the thigh include (superior to inferior)

• Piriformis
• Superior gemellus
• Obturator internus
• Inferior gemellus
• Obturator externus
• Quadratus femoris

Causes of Piriformis Syndrome

• Muscle spasm in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as the sacroiliac joint or hip
• Repetitive, improper movements or physical activities, such as those commonly found in long-distance running, sitting for lengthy periods of time and/or sports
• Sudden injury, trauma or accident causing irritation to the piriformis muscle or nearby areas, such as the hip or sacroiliac joint
• Previous injuries near the back, pelvis, piriformis muscle or sciatic nerve
• an injury, such as a fall, a blow to the area, or a car accident
• overuse, such as from frequent running, excessive exercise, or over-stretching
• a sedentary lifestyle, especially with long periods of sitting
• changing from a sedentary lifestyle to more frequent exercise
• buttock muscles wasting away
• Tightening of the muscle, in response to injury or spasm
• Swelling of the piriformis muscle, due to injury or spasm
• Bleeding in the area of the piriformis muscle.
• muscle tension and excess weight due to pregnancy

Causes of piriformis syndrome include the following: [2]

• Trauma to the hip or buttock area
• Piriformis muscle hypertrophy (often seen in athletes during periods of increased weightlifting requirements or pre-season conditioning)
• Sitting for prolonged periods (taxi drivers, office workers, bicycle riders)

Symptoms of Piriformis Syndrome

• Tenderness, pain, numbness or tingling in the buttocks or along the back of the leg that intensifies without activity
• Pain in the buttock or hip area is the most common symptom.
• Pain may radiate from the buttock area down into the lower leg along the path of the sciatic nerve. Some patients may complain of low back pain.
• There may be numbness and tingling in the buttock area, which can sometimes radiate down to the lower leg.
• Pain with bowel movements may be present.
• Women can sometimes experience painful intercourse.
• There may be tenderness in the buttock area when pressure is applied. Certain patients may have a palpable “sausage-shaped” mass in the buttock area from piriformis muscle contraction/spasm.
• Difficulty participating in daily activities
• Aching, soreness or tightness in the buttocks that can worsen with long periods of sitting, running or walking up or down stairs
• A noticeably reduced range of motion through the hip joint
• Discomfort when light pressure is applied over the p
• Sciatic pain is sharp and searing, rather than dull, and is described as “pins and needles.” You may also experience numbness and weakness in this leg. This pain can be debilitating and make it difficult to stand and walk.

Common complaints associated with piriformis syndrome include

• Pain that becomes more severe following prolonged periods of sitting
• A dull and achy pain located in the gluteus region
• Numbing sensations within the feet
• Pain walking up stairs or an incline
• A headache
• Muscle weakness in the lower limbs
• Difficulty walking
• Reduced range of motion within the hip joint
• Radiating pain
• Abdominal pain, pelvic pain, or groin pain
• Muscle spasms
• Pain during bowel movements
• In women, pain during intercourse

References

Test Diagnosis of Piriformis Syndrome is a neuromuscular condition characterized by hip and buttock pain. This syndrome is often overlooked in clinical settings because its presentation may be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction. The ability to recognize piriformis syndrome requires an understanding of the structure and function of the piriformis muscle and its relationship to the sciatic nerve. The authors review the anatomic and clinical features of this condition, summarizing the osteopathic medical approach to diagnosis and management. A holistic approach to diagnosis requires a thorough neurologic history and physical assessment of the patient based on the pathologic characteristics of piriformis syndrome. The authors note that several nonpharmacologic therapies, including osteopathic manipulative treatment, can be used alone or in conjunction with pharmacotherapeutic options in the management of piriformis syndrome.[Rx]

Piriformis syndrome (PS) is a painful musculoskeletal condition, characterized by a combination of symptoms including buttock or hip pain due to compressed and/or irritated sciatic nerve by the piriformis muscle as it passes deeply through your buttock, resulting in pain. It is an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve.[Rx]

Piriformis syndrome is an often misdiagnosed cause of sciatica, leg, or buttock pain, and disability. The sciatic nerve may be compressed within the buttock by the piriformis muscle, with pain increased by muscular contraction, palpation, or prolonged sitting. A thorough medical history and physical examination are essential to proper diagnosis. Diagnostic testing may be used to differentiate piriformis syndrome from other causes of sciatica, lower extremity weakness, and pain. This article reviews the pathophysiology and management of piriformis syndrome.

The piriformis is a flat, pyramid-shaped muscle that lies parallel to (in line with) the gluteus medius muscle’s back margin and underneath the gluteus maximus muscle in the hip area.

Pain in your buttocks and radiating sciatic pain is sometimes the result of piriformis syndrome, or tightening and irritation of the piriformis muscle.

Anatomy of Piriformis Syndrome

Sciatic nerve

• Inferior to piriformis
• Superior to superior gemellus

Muscles

External rotators of the thigh include (superior to inferior)

• Piriformis
• Superior gemellus
• Obturator internus
• Inferior gemellus
• Obturator externus
• Quadratus femoris

Causes of Piriformis Syndrome

• Muscle spasm in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as the sacroiliac joint or hip
• Repetitive, improper movements or physical activities, such as those commonly found in long-distance running, sitting for lengthy periods of time and/or sports
• Sudden injury, trauma or accident causing irritation to the piriformis muscle or nearby areas, such as the hip or sacroiliac joint
• Previous injuries near the back, pelvis, piriformis muscle or sciatic nerve
• an injury, such as a fall, a blow to the area, or a car accident
• overuse, such as from frequent running, excessive exercise, or over-stretching
• a sedentary lifestyle, especially with long periods of sitting
• changing from a sedentary lifestyle to more frequent exercise
• buttock muscles wasting away
• Tightening of the muscle, in response to injury or spasm
• Swelling of the piriformis muscle, due to injury or spasm
• Bleeding in the area of the piriformis muscle.
• muscle tension and excess weight due to pregnancy

Causes of piriformis syndrome include the following: [2]

• Trauma to the hip or buttock area
• Piriformis muscle hypertrophy (often seen in athletes during periods of increased weightlifting requirements or pre-season conditioning)
• Sitting for prolonged periods (taxi drivers, office workers, bicycle riders)

Symptoms of Piriformis Syndrome

• Tenderness, pain, numbness or tingling in the buttocks or along the back of the leg that intensifies without activity
• Pain in the buttock or hip area is the most common symptom.
• Pain may radiate from the buttock area down into the lower leg along the path of the sciatic nerve. Some patients may complain of low back pain.
• There may be numbness and tingling in the buttock area, which can sometimes radiate down to the lower leg.
• Pain with bowel movements may be present.
• Women can sometimes experience painful intercourse.
• There may be tenderness in the buttock area when pressure is applied. Certain patients may have a palpable “sausage-shaped” mass in the buttock area from piriformis muscle contraction/spasm.
• Difficulty participating in daily activities
• Aching, soreness or tightness in the buttocks that can worsen with long periods of sitting, running or walking up or down stairs
• A noticeably reduced range of motion through the hip joint
• Discomfort when light pressure is applied over the p
• Sciatic pain is sharp and searing, rather than dull, and is described as “pins and needles.” You may also experience numbness and weakness in this leg. This pain can be debilitating and make it difficult to stand and walk.

Common complaints associated with piriformis syndrome include

• Pain that becomes more severe following prolonged periods of sitting
• A dull and achy pain located in the gluteus region
• Numbing sensations within the feet
• Pain walking up stairs or an incline
• A headache
• Muscle weakness in the lower limbs
• Difficulty walking
• Reduced range of motion within the hip joint
• Radiating pain
• Abdominal pain, pelvic pain, or groin pain
• Muscle spasms
• Pain during bowel movements
• In women, pain during intercourse

Diagnosis of Piriformis Syndrome

• A medical history – in which you answer questions about your health, symptoms, and activity.
• A physical exam to assess your strength – reflexes, sensation, stability, alignment, and motion. You may also need blood tests.
• Magnetic resonance imaging (MRI) scan – which uses magnetic fields and computers to produce three-dimensional images of your spine & nerve.
• A myelogram – an X-ray of the spinal canal after injection of contrast material — which can pinpoint pressure on the sciatic nerve
• Magnetic resonance neurography – This form of magnetic resonance imaging (MRI) test looks for inflammation in the nerves.
• FAIR Test – The flexion, adduction, and internal rotation test flex the hip to stretch the piriformis and compress the sciatic nerve. It measures delays in sciatic nerve signals due to its compression under the piriformis.

Piriformis syndrome tests

There are also a few specific tests for piriformis syndrome that have been highlighted in scientific studies.

Needle electromyography studies

The straight-leg raise test

Pain will shoot down the back of your leg when your leg is raised straight (typically by a partner) while you lie on your back. This is indicative of irritation of the sciatic nerve, though it is not specific to piriformis syndrome.

The straight-leg raise test can cause sciatica-like pain if you have piriformis syndrome, but might also indicate the presence of low back problems

Knees against resistance test

This test can be performed while sitting.

Attempt to push your knees out against resistance (provided by a partner or rope). If this causes pain, piriformis syndrome is likely.

Pain might also occur if you attempt to abduct your hips from a sitting position against resistance provided by a partner or a rope.

Piriformis stretch test

Finally, two maneuvers which put a stretch on the piriformis muscle can also be used to test for piriformis pain.

Having a partner rotate your hip and leg inwards while you lie on your back with your knees straight can produce pain, as can lying on your unaffected side and rotating the painful side across your body with your knee bent.

One test which can produce piriformis-specific pain is a supine internal leg rotation, assisted by either by a partner or a rope, as illustrated here.

Stretching the piriformis in this position can elicit pain (red area) if you have piriformis syndrome

Though these piriformis-specific tests can help confirm the presence of piriformis syndrome, they are not accurate enough to rule it out.

But here’s the kicker

Hopayian et al.’s review study found no one technique to be reliable or accurate enough to endorse; rather, they cited the more general symptom of aggravation or modulation of piriformis pain when you stretch or tension the piriformis muscle.

You might also be able to feel a thickening in the piriformis muscle itself, deep within your glutes, but this is also not enough by itself to definitively diagnose piriformis syndrome.

Differential Diagnosis

The differential diagnosis includes: [11]

• Hamstring injury
• Lumbosacral disc injuries
• Lumbosacral discogenic pain syndrome
• Lumbosacral facet syndrome
• Lumbosacral radiculopathy
• Lumbosacral spine sprain
• Lumbosacral spondylolisthesis
• Lumbosacral spondylolysis
• Sacroiliac joint injury/dysfunction
• Inferior gluteal artery aneurysm or pseudoaneurysm
• Malignancy/tumors
• Arteriovenous malformations

References

Treatment Exercise of piriformis syndrome is a neuromuscular condition characterized by hip and buttock pain. This syndrome is often overlooked in clinical settings because its presentation may be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction. The ability to recognize piriformis syndrome requires an understanding of the structure and function of the piriformis muscle and its relationship to the sciatic nerve. The authors review the anatomic and clinical features of this condition, summarizing the osteopathic medical approach to diagnosis and management. A holistic approach to diagnosis requires a thorough neurologic history and physical assessment of the patient based on the pathologic characteristics of piriformis syndrome. The authors note that several nonpharmacologic therapies, including osteopathic manipulative treatment, can be used alone or in conjunction with pharmacotherapeutic options in the management of piriformis syndrome.[Rx]

Treatment of Piriformis Syndrome

Clinical treatment options include

• Botox injections that can reduce muscle spasms and relieve pain.
• Prescription pain medications or muscle relaxants. A person should discuss the risks and benefits of pain medication with their doctor, as these drugs can be addictive.
• Corticosteroid or anesthetic injections.
• Alternative treatments, such as acupuncture, chiropractic manipulation, and trigger point therapy.
• Physical therapy to regain use of the piriformis, and to prevent wasting related to disuse and dysfunction in surrounding muscles.

Physiotherapy

• Stretching exercises and massage,
• Avoidance of contributory activities as noted before
• Stretching exercises
• Local ice/heat
• Custom foot orthotics
• Gait correction
• Ultrasound  to provide deeper heat
• Injections – steroids, botulinum toxin, lidocaine
• Surgery.

The best piriformis stretch (that actually works!)

This is exactly what is accomplished in the stretches recommended by Douglas Keskula and Michael Tamburello in a 1992 article on treatments for piriformis syndrome.

Supine piriformis stretch with a crossover (moving left knee towards right shoulder)
,
Supine piriformis stretch without a crossover (moving heel towards right shoulder)

Supine piriformis stretch assisted by opposite leg (moving right knee towards right

You should be gentle with the stretches, not overly aggressive—this may put too much stress on the already-irritated piriformis.

Piriformis exercises

Strengthening exercises are also recommended in several different scientific papers.

As the piriformis works as an abductor and rotator of the hip, strengthening both the piriformis itself and the other hip muscles that surround it is a primary goal of treatment.

A 2010 case report by Jason Tonley and a group of fellow physical therapists describes in detail a strengthening protocol used to successfully treat piriformis syndrome in a 30-year-old recreational athlete who displayed many of the classic signs of poor hip muscle coordination: inward knee rotation during single-leg squats and poor hip abduction and external rotation strength.

To address this, the authors prescribed a 14-week, three-step program for hip muscle rehabilitation.

• The first phase consisted only of glute bridges and clamshell leg lifts, both using a theraband for resistance.

• After four weeks, the patient progressed to weight-bearing exercises: standing mini-squats (with a theraband), “monster walk” side steps (also with a band), a “sit-to-stand” exercise, and single-leg mini-squats.

• Following four weeks of the second phase, the patient progressed to lunges, deep squats, and even plyometric-style hops and landings (with the intent to prepare him to return to basketball and tennis, his principle sports).

In all phases of rehab, the patient progressed over time to three sets of fifteen repeats of each exercise.

These are the piriformis stretches I have been looking for! Great detail!CLICK TO TWEET

A similar program designed for runners is illustrated below. Start gradually, but build up over time to three sets of 15 repeats of each exercise.

Phase I: Four weeks

a. Clamshell exercise, adding resistance with theraband

b. Glute bridge with theraband (hold, for up to two minutes)

c. Side leg lift

Phase II: Four weeks

Do all Phase I exercises, and add the following:

a. Standing mini-squats with a theraband

b. “Monster walk” side steps (continuously moving in one direction, then moving back the other), also with a band

c. Single-leg “sit-to-stand” from chair

d. Single-leg mini-squats off a step

Phase III: 6 weeks.

Do all phase I and II exercises, and add the following:

a. Front and diagonal lunges

While the rehab program in Conley et al. was immensely successful with their patient, a case report obviously isn’t as useful as a randomized clinical trial.

It’s unclear how useful this program would be for other athletes with piriformis syndrome, but given the lack of high-quality studies, and the dearth of research on treatments specifically for athletes, Conley et al.’s program is still a pretty good place to start.

Consider this:

Combining these strength exercises with the stretches described above should address both muscle weakness and tightness.

These stretches and exercises were just what I needed for my piriformis syndrome!

Other research on piriformis syndrome has focused on treatments for more stubborn cases.

Is this you?

Some isolated studies describe injections into the piriformis muscle, either of a local anesthetic like lidocaine or of a corticosteroid. Studies indicate that pain relief from injections is highly variable, with some patients experiencing long-lasting relief, and others getting none at all.

You won’t believe this:

Some newer trials have even investigated BOTOX injections (the muscle-paralyzing drug better-known for its use in cosmetic surgery) for treating recalcitrant piriformis syndrome.

Given how little is known about injectable treatments for piriformis syndrome, especially considering that none of the studies on this topic involved athletes, it’s hard to draw any concrete recommendations—these options are something you should discuss with your doctor.

Looking for a last resort?

Surgical release of the piriformis muscle has also been described in multiple papers as a last-resort treatment for piriformis syndrome. As with injectable treatments, studies on surgical patients invariably focus on sedentary people, often with additional existing back or spine problems, so it’s nearly impossible to extract any information useful to a runner. Again, talk to a trusted doctor if you are considering surgery.

Other Piriformis Syndrome Treatment Options

Though there’s not much in the literature about treating piriformis syndrome in runners, it occurs commonly enough for several “folk treatments” and workarounds to have emerged. Among these are:

1. Having a massage or stretching out the piriformis muscle and reduce tightness. One way many runners do so is by rolling their glute muscles on a tennis ball or a lacrosse ball (perfectly shaped to put controlled pressure on the glute area).
2. Deep tissue massage techniques are also popular, and they may well accomplish the same goal as the “myofascial release” massage techniques that are described in some case studies by physical therapists.
3. Another popular method to address piriformis syndrome is to simply avoid doing things that irritate the piriformis muscle: prolonged sitting, in particular, can be very irritating, so modifying your routine so you don’t need to sit as often or for as long can be helpful.
4. Standing desks are becoming more popular, and taking a short break every hour or so allows you to get your piriformis stretches in, too. If nothing else, experimenting with different sitting surfaces (harder, softer, flatter, or more contoured) might also reduce irritation.
5. If you are still able to do some running, avoiding workouts or conditions which irritate your piriformis will also help—common culprits include high speeds, uphills and downhills, and tight turns.

Of course, it goes without saying that none of this is supported by scientific research, so you’ll have to experiment with what works for you and what does not.

Summary of treatment for piriformis syndrome

Conservative treatments

These are methods that are fairly simple, inexpensive, and can be done on your own at home.

Before jumping right into treatment, it is important to emphasize that these treatments have been developed specifically with piriformis syndrome in mind, not buttock or sciatic pain in general.

Remember

If you’re not sure whether you have piriformis syndrome, you should see a doctor to get a proper diagnosis. Other injuries which cause similar symptoms will require different treatments.

Stretching routine incorporating the following exercises.

Begin by stretching very gently, building up over time to three sets of 5-10 individual stretches, each held for five seconds. Over time, you can build up to 60 seconds for each stretch.

Supine piriformis stretch with a crossover

Supine piriformis stretch without a crossover

Supine piriformis stretch assisted by opposite leg

Hip strengthening exercises

Based on Conley et al.’s paper, with a few minor modifications to make the exercises more relevant for runners. Start gradually, but build up over time to three sets of 15 repeats of each exercise.

Phase I: four weeks

1. Clamshell exercise, adding resistance with theraband
2. Glute bridge with theraband (hold for up to two minutes)
3. Side leg lift

Phase II: four weeks

Do all phase I exercises, and add the following:

1. Standing mini-squats with a theraband
2. “Monster walk” side steps, also with a band
3. Single-leg “sit-to-stand” from the chair
4. Single-leg mini-squats off a step

Phase III: 6 weeks.

Do all phase I and II exercises, and add the following:

1. Front and diagonal lunges

Gentle daily rolling

Use a foam roller (making sure you do not make these 4 mistakes), tennis ball, or lacrosse ball to loosen up the piriformis muscle and glutes.

This article breaks piriformis syndrome into helpful phases, a must read!

Piriformis syndrome treatment for those who have tried everything else

These are treatments with more cost and less certainty about outcomes but may prove useful when you are fed up of your pain.

Working with a physical therapist to develop a specialized rehab program

Because the literature is so sparse on appropriate exercises for treating piriformis syndrome in runners, it might make sense to see a PT if your case is particularly troublesome or long-lasting.

That way, you can address any aspects of your own individual muscular tightness or weakness that might contribute to your injury

Active Release Technique or Graston Technique

These soft tissue mobilization exercises don’t have any support in the scientific literature but have been praised anecdotally by some, though not all, runners with piriformis syndrome.

Injections of a local anesthetic, corticosteroid, or BOTOX

If you have a recalcitrant case of piriformis syndrome that has not responded to many months of conservative rehab, you can talk to your doctor about an injectable treatment.

If all else fails, surgery is a final alternative.  This is also something you should consult with a trusted doctor about.

Additional exercise

You may do all of these exercises right away.

• Gluteal stretch – Lie on your back with both knees bent. Rest the ankle on your injured side over the knee of your other leg. Grasp the thigh of the leg on the uninjured side and pull toward your chest. You will feel a stretch along the buttocks on the injured side and possibly along the outside of your hip. Hold the stretch for 15 to 30 seconds. Repeat 3 times.
• Standing hamstring stretch – Put the heel of the leg on your injured side on a stool about 15 inches high. Keep your leg straight. Lean forward, bending at the hips, until you feel a mild stretch in the back of your thigh. Make sure you don’t roll your shoulders or bend at the waist when doing this or you will stretch your lower back instead of your leg. Hold the stretch for 15 to 30 seconds. Repeat 3 times.
• Resisted hip abduction – Stand sideways near a door with your injured side further from the door. Tie elastic tubing around the ankle on your injured side. Knot the other end of the tubing and close the knot in the door near the floor. Pull the tubing out to the side, keeping your leg straight. Return to the starting position. Do 2 sets of 15. For more resistance, move farther away from the door.
• The plank –  Lie on your stomach resting on our forearms. With your legs straight, lift your hips off the floor until they are in line with your shoulders. Support yourself on your forearms and toes. Hold this position for 15 seconds. (If this is too difficult, you can modify it by placing your knees on the floor.) Repeat 3 times. Work up to increase your hold time to 30 to 60 seconds.
• Side plank – Lie on your side with your legs, hips, and shoulders in a straight line. Prop yourself up onto your forearm with your elbow directly under your shoulder. Lift your hips off the floor and balance on your forearm and the outside of your foot. Try to hold this position for 15 seconds and then slowly lower your hip to the ground. Switch sides and repeat. Work up to holding for 1 minute. This exercise can be made easier by starting with your knees and hips flexed toward your chest.
• Prone hip extension with bent leg – Lie on your stomach with a pillow under your hips. Bend the knee on your injured side. Draw your belly button in towards your spine and tighten your abdominal muscles. Lift your bent leg off the floor about 6 inches (15 centimeters). Keep your other leg straight. Hold for 5 seconds. Then lower your leg and relax. Do 2 sets of 15.
• Clam exercise – Lie on your uninjured side with your hips and knees bent and feet together. Slowly raise your top leg toward the ceiling while keeping your heels touching each other. Hold for 2 seconds and lower slowly. Do 2 sets of 15 repetitions.

References

Treatment of Spinal Disc Herniation, Exercise, Home Remedies. Lumbar disc herniation is a common condition that frequently affects the spine in young and middle-aged patients.1,5,11 The lumbar intervertebral disc is a complex structure composed of collagen, proteoglycans, and sparse fibrochondrocytic cells that serve to dissipate forces exerted on the spine. As part of the normal aging process, the disc fibrochondrocytes can undergo senescence, and proteoglycan production diminishes. This leads to a loss of hydration and disc collapse, which increases strain on the fibers of the annulus fibrosus surrounding the disc. Tears and fissures in the annulus can result, facilitating a herniation of disc material, should sufficient forces be placed on the disc. Alternatively, a large biomechanical force placed on a healthy, normal disc may lead to extrusion of disc material in the setting of catastrophic failure of the annular fibers.5

Treatment of Spinal Disc Herniation

Before discussing surgery as an option, the surgeon may initiate the following nonoperative treatments. Specific treatment for lumbar disk disease will be determined by your health care provider based on

• Your age, overall health, and medical history
• The extent of the condition
• Type of condition
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

Typically, conservative therapy is the first line of treatment to manage lumbar disk disease. This may include a combination of the following:

• Bed rest
• Patient education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disk)
• Physical therapy, which may include ultrasound, massage, conditioning, and exercise
• Weight control
• Use of a lumbosacral back support

Medications Treatment of Spinal Disc Herniation

• Analgesics – Prescription-strength drugs that relieve pain but not inflammation.
•  Antidepressants: A Drugs that block pain messages from your brain and boost the effects of endorphins (your body’s natural painkillers).
• Corticosteroids: Also known as oral steroids, these medications reduce inflammation.
• Muscle Relaxants: These medications provide relief from spinal muscle spasms.
• Neuropathic Agents: Drugs(pregabalin & gabapentin) that address neuropathic—or nerve-related—pain. This includes burning, numbness, and tingling.
• Opioids – Also known as narcotics, these medications are intense pain relievers that should only be used under a doctor’s careful supervision.
• Topical Medications – These prescription-strength creams, gels, ointments, patches, and sprays help relieve pain and inflammation through the skin.
• NSAIDs – Prescription-strength drugs that reduce both pain and inflammation. Pain medicines and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include aspirin, ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve).
• Calcium & vitamin D3 – to improve bones health and healing fracture.
• Glucosamine & diaceraine can be used to tightening the loose tension and regenerate cartilage or inhabit the further degeneration of cartilage.
• Corticosteroid to healing the nerve inflammation and clotted blood in the joints.
• The dietary supplement to remove the general weakness & improved the health.

There is little evidence to suggest that drug treatments are effective in treating a herniated disc.

• NSAIDs and cytokine inhibitors don’t seem to improve symptoms of sciatica caused by disc herniation.
• We found no evidence examining the effectiveness of analgesics, antidepressants, or muscle relaxants in people with a herniated disc.
• We found no evidence of sufficient quality to judge the effectiveness of epidural injections of corticosteroids.

With regard to non-drug treatments, spinal manipulation seems to be more effective at relieving local or radiating pain in people with acute back pain and sciatica with disc protrusion compared with sham manipulation, although concerns exist regarding possible further herniation from spinal manipulation in people who are surgical candidates.

• Neither bed rest nor traction seems effective in treating people with sciatica caused by disc herniation.
• We found insufficient evidence of advice to stay active, acupuncture, massage, exercise, heat, or ice to judge their efficacy in treating people with a herniated disc.

About 10% of people have sufficient pain after 6 weeks for surgery to become a consideration.

• Both standard discectomy and microdiscectomy seem to increase self-reported improvement to a similar extent.
• We found insufficient evidence judging the effectiveness of automated percutaneous discectomy, laser discectomy, or percutaneous disc decompression.

Surgical Treatment of Spinal Disc Herniation

When these conservative measures fail, surgery for removal of a herniated disk may be recommended. Surgery is done under general anesthesia. An incision is placed in the lower back over the area where the disk is herniated. Some bone from the back of the spine may be removed to gain access to the area where the disk is located. Typically, the herniated part of the disk and any extra loose pieces of disk are removed from the disk space.

Surgical treatment for a herniated disc will be based on the following

• The history, severity, and duration of pain
• Whether or not the patient has received previous treatments for disc disorders and how effective the treatments were
• Whether or not there is any evidence of neurologic damage such as sensory loss, weakness, impaired coordination, or bowel or bladder problems

Surgery for patients with disc disorders of the spine is usually recommended for those patients who do not find relief with non-operative treatment over a period of 6-12 weeks. Surgery is also recommended in patients who have a neurologic deficit (numbness, weakness or reduced function due to pressure on the spinal cord or nerves). Early intervention in those cases is best in order to maximize the likelihood of neurologic recovery.

Your surgeon may perform the following surgical procedures:

• Microdiscectomy: A procedure that uses a microscope and microsurgical tools to remove the portion of the disc that is pressing against the nerve, relieving the pressure caused by a herniated disc. Microdiscectomy is frequently performed for herniated discs in the cervical, thoracic, and lumbosacral spine. This procedure is performed under general anesthesia through a small skin incision over the spine. The muscles of the spine are gently elevated or spread apart to expose a small segment of the spine. A small amount of the back part of the spine, called the lamina and facet joint, is trimmed under high magnification of the microscope to provide safe access to the spinal canal. Using microsurgical techniques, our neurosurgeons identify and remove the herniated piece of the disc while protecting the compressed nerve. Most patients may go home either on the day of surgery or the next morning.
• Anterior (from the front) or lateral (from the side) surgical approaches may be required for large or calcified thoracic disc herniations that cause spinal cord compression.
• Anterior Cervical Discectomy and Fusion (ACDF): a procedure that involves the removal of the herniated disc in the cervical spine through the front of the neck. A fusion surgery may be required to make the spine stable after the discectomy.

After surgery, restrictions may be placed on the patient’s activities for several weeks while healing is taking place to prevent another disk herniation from occurring. Your surgeon will discuss any restrictions with you.

Others Treatment of Spinal Disc Herniation

Chiropractic Care

Sixty percent of people with sciatica who didn’t get relief from other therapies and then tried spinal manipulation experienced the same degree of pain relief as patients who eventually had surgery, found a 2010 study in the Journal of Manipulative and Physiological Therapeutics. The 120 people in the study saw a chiropractor about 3 times a week for 4 weeks and then continued weekly visits, tapering off treatment as they felt better. In people who responded to chiropractic care, benefits lasted up to a year. “Spinal manipulation may create a response in the nervous system that relieves pain and restores normal mobility to the injured area,” says study researcher Gordon McMorland, DC, of National Spine Care in Calgary, Alberta. “It also reduces inflammation, creating an environment that promotes the body’s natural healing mechanisms.”

Acupuncture

“You can get relief as soon as the first session, though it takes about 12 sessions to see improvement,” says Jingduan Yang, MD, assistant professor at the Jefferson Myrna Brind Center of Integrative Medicine at Thomas Jefferson University. A small study in the Journal of Traditional Chinese Medicine found that of 30 people with sciatica, 17 got complete relief and 10 saw symptoms improve with warming acupuncture, in which the needles are heated.

Yoga

A study in the journal Pain reported that people with chronic back pain who practiced Iyengar yoga for 16 weeks saw pain reduced by 64% and disability by 77%. Although yoga’s effects on sciatica are less clear, gentle forms may be beneficial. By strengthening muscles and improving flexibility, a yoga practice can help sciatica sufferers “move and function better so they don’t fall into a posture that aggravates sciatica,” says James W. Carson, Ph.D., a psychologist at the Comprehensive Pain Center at Oregon Health & Science University. For extra grip and stability, try these grip socks from Natural Fitness.

Massage

Don’t expect a chilled-out spa massage if you have sciatica. In this instance, trigger-point therapy is best, says Jeff Smoot, vice president of the American Massage Therapy Association. The sciatic nerve sits underneath a muscle called the piriformis, which is located beneath the glutes. “When the piriformis muscle gets tight, it pinches the sciatic nerve, causing tingling and numbness down into the leg,” says Smoot. He applies pressure to irritated and inflamed areas, or trigger points, in the piriformis muscle, as well as in muscles in the lower back and glutes. Typically, Smoot schedules treatments 7 to 10 days apart. If patients don’t see progress by the fourth visit, “they need to try another form of therapy,” he says.

Topical Preparations

St. John’s wort oil, a liniment, is “one of my favorites for nerve pain,” says Tieraona Low Dog, MD, director of the fellowship at the Arizona Center for Integrative Medicine. Apply the anti-inflammatory oil two or three times a day where there’s pain. Another option: an OTC cayenne pepper plaster or cream; capsaicin, found in chiles, hinders the release of pain-causing compounds from nerves. For severe cases, Low Dog uses the prescription chile patch Qutenza, designed for shingles pain. “One application is effective for weeks,” says Low Dog.

Ice or Heat 

Because the sciatic nerve is buried deep within the buttock and leg, ice or heat on the surface of the body won’t ease that inner inflammation. But the time-honored treatments can act as counterirritants—that is, “they give your body other input in the painful area, and that brings the pain down a notch,” says Ruppert. Apply an ice pack or a heating pad as needed for 15 minutes.

Devil’s Claw

The herbal medication devil’s claw is “quite a potent anti-inflammatory, working like ibuprofen and similar drugs to inhibit substances that drive inflammation,” says Low Dog. She generally starts patients on 1,500 to 2,000 mg twice a day. Look for a brand that has a standardized extract of roughly 50 mg of harpagoside, the active compound. Safety reviews show that the supplement is well tolerated by most people but should be avoided by patients with peptic ulcers or on blood-thinning medications.

Epidural Steroid Injections

People whose pain doesn’t lessen within about a month and who aren’t helped by other therapies may find their pain remedied by an x-ray-guided injection of steroid into the lower back near the sciatic nerve, says Raj Rao, MD, a spokesperson for the AAOS. “The hope is to reduce inflammation within that nerve branch,” explains Rao. Because of concerns about side effects, such as loss of bone density, the epidural shots are limited to three a year.

Physiotherapy in Herniated Disc

In stage 1&2 of herniated disc physiotherapy must be applied to cure herniated his.I n the case of stage 3&4, physiotherapy can’t be applied due to avoiding another case of foot drop.

In accordance with NIH journal

Both hot and cold therapies offer their own set of benefits, and your physical therapist may alternate between them to get the best results. Your physical therapist may use heat to increase blood flow to the target area. Blood helps heal the area by delivering extra oxygen and nutrients. Blood also removes waste byproducts from muscle spasms. Conversely, cold therapy (also called cryotherapy) slows circulation. This reduces inflammation, muscle spasms, and pain. Your physical therapist may place an ice pack on the target area, give you an ice massage, or even use a spray known as fluoromethane to cool inflamed tissues.

8 Best Exercises For Slipped Disc In Lower Back

Our spinal cord is supported by a number of muscles. Relevant exercises help relieve the pain and reduce the symptoms. Muscle exercises of those muscles associated with the affected area are necessary. Patients must know the region that has a slipped disc and then opt for exercises related to that muscle. The list of best exercises for the slipped disc are mentioned as follows:

1. Abdominal Isometrics – It can be performed either on floor, mat or bed. This exercise involves moving your lower back towards the surface at which you are performing this exercise. Leg movement must be reduced in this exercise and stomach muscles must be made active. This reduces pain in lower back because of the attachment of abdominal muscles to the lower side of the vertebral column. Ten repetitions are effective.
2. Crunches – Lie on a flat surface with knees bent. Cross your arm under your head, raise your head and chest in such a manner that your rib cage curl interiorly towards your backbone. Perform this exercise slowly and gradually. In the beginning, perform fewer crunches and repeat it daily and increase the number of turns as you gain strength.
3. Lower back extension – Lie in an upside down position, raise your upper body with the help of elbow and hold up yourself in an elevated position for a short span of time and then slowly lower down. Please make sure that during this exercise you do not raise your pelvis girdle (hip region).
4. Bilateral knee to the chest – Lay down on a flat surface and draw your knee towards your abdominal region, repeat it 5 times and then switch leg. You can also increase the number of turns each time you repeat it.
5. Iso-hip flexion – Lay down over a flat surface and draw your knees towards your chest region in a 90-degree position with your stomach. Place your hands over your knees and then exert your hand pressure to lower your knee. Then utilize the knee pressure to resist the downward movement of your legs, in all both movements should just exert pressure and allow no movements. This position should be maintained for a few seconds and then lowered slowly and gradually.
6. Air bike – Sit on a chair with your chest and shoulders supported. Align your knees and feet together and then bring them towards your body and perform a pedaling motion in the air then repeat the same motion while moving your knees farther away from the body. Follow ten repetitions each time and increase its number as you gain strengths
7. Hamstring stretch: Lie on a flat surface with your knees bent, place your hands under your knees and then slightly pull your leg towards your chest, repeat it with another leg. This exercise must involve a stretch over lower thigh muscle
8. Lumbar roll: Lie on a flat surface with your knee bent and your feet lying on the floor then move your legs together towards the right side and then towards your left side. Repeating these movements 5 times on each side.

The above mentioned best exercises for the slipped disc can be followed but if pain increases or muscle pain is persisting then quit these exercises right away. These exercises not only help in reducing the pain but they also activate efficient muscle movement. Along with these exercise tips, proper body postures must be also maintained to prevent further disc damages.

Home Remady for Herniated Disc/Slip Disc

 Consciousness

In case of PLID home remedies are not special treatment just only home practice & creating public awareness. All should be done in PLID stage 1&2

Walking

Walking every day keeps muscle disorders away. Walking can also help to prevent herniated disc. Walk on a flat road for 20 minutes as many times as you can in a day. Take longer steps as it will help you to keep away the pain of herniated disc. Do not give strain to yourself as it might increase the pain.

 Rest

Rest is essential for patients suffering from a herniated disc. Take short rest periods from time to time. When you are sleeping make sure you don’t stay in the same position for a long time. Do not sleep on your stomach. Also, take care of the mattress you are sleeping on. Don’t let it be too soft and spongy. Buy a mattress that has a good surface area and is soft in nature.

Physiotherapy And Yoga( only home practice)

Physiotherapy is a very cheap and good way of getting rid of a herniated disc from itself. Therapists will teach your proper exercises and stretches which will improve the disc shape to a great extent.

You will notice good differences while performing daily chores after just 4-5 sessions of therapy.

Physiotherapy also promotes faster healing of the disorder.

Turmeric

Turmeric contains curcumin which is a very good anti-oxidant and anti-inflammatory agent. This is why it stops the gel-like fluid inside the discs from coming out and bulge. It also shows antihistamine properties which help to reduce pain because of slowed blood circulation to the area of pain.

Dimethyl Sulfoxide (DMSO)

Dimethyl sulfoxide is a derivative from sulfur which has antioxidant properties as well as the organic sulfur present in it helps in the growth of new cells and detoxification of the body. The growth of new cells helps to replace the old cells of the discs and prevent the fluid from leaking outside.

 Massage With Essential Oils

Massage with essential oils on the full body, especially on the spine and lower back regions, will help in good blood circulation and promote the growth of new cells. It will help relieve pain and promote better absorption of oxygen and nutrients. Essential oils will also regenerate the cells of the disc and hence stop the disc from getting slipped.

 Acupressure And Acupuncture

In both techniques, the pressure is used for relieving the pain from the swelled area. In acupressure fingers, tips and elbow are used and acupuncture needles are used. But this should be done with the help of an experienced practitioner and not alone.

This is not recommended for patients having high blood pressure and for women who are pregnant.

 TENS

TENS stands for Transcutaneous Electrical Nerve Stimulation and this is one of the best remedies for the herniated disc at home. This treatment uses low voltage electric current which is applied to the affected area and helps the body to release endorphin which decreases the pain.

 Cayenne Pepper

 Diet

Diet is necessary to keep away all types of bad conditions that might affect you. Drink a lot of water and eat a balanced diet. Take excess of fibers and proteins. During this condition, you should avoid dairy products and red meat. Also, avoid fat-free foods.

 Epsom Salt

Epsom salt is one of the widely used natural painkiller and anti-inflammatory agent.

You can use this by adding 3-4 cups of salt in a hot water bath. Stay inside the bath for 15 minutes. It will help you achieve maximum relaxation.

Do not use this remedy if you are diabetic or pregnant. If you are on any type of medication consult your doctor before bathing in Epsom salt.

 Horsetail

Horsetail is a herb which has high quantities of minerals in it. It nourishes our tissues and has the ability to heal broken bones and torn ligaments.

All you need to do is add some horsetail leaves to half a liter of water. Boil on low heat till the water quantity reduces to half its quantity. Cool the solution and filter it off. You can drink 5 ml of the solution thrice a day. It will heal herniated disc very fast.

California Poppy

California poppy is anti-inflammatory and analgesic in nature. This is what makes it a good treatment for the herniated disc.

You can tear the leaves of California poppy into small pieces and make a paste out of it using water. Use little hot water so that when you apply the paste to the affected area it is still warm.

 White Willow Bark

White willow bark is used for reducing the discomfort of herniated discs. The chemical structure of this drugs shows a marked similarity to aspirin hence acts as an analgesic but doesn’t irritate your gut. It is also astringent and anti-inflammatory in nature.

This herb might react with drugs hence do consult your doctor if you are on any kind of medication.

 Comfrey Leaves

Comfrey leaves have the power to heal bones and connective tissues of the body. All you need to do is take some fresh leaves and add it to cold water. Let it remain undisturbed for around 12 hours. After 12 hours heat the above solution and filter it. Add the filtrate to bath water and take a bath in it 2 times a day. Do not consume it orally because it contains hepatic-toxin alkaloids.

Boswellia

Boswellia is a naturally occurring painkiller which is a very effective remedy for a herniated disc.

All you can do is make a decoction of Boswellia and consume it 2 times a day to reduce pain and discomfort associated with herniated discs.

Boswellia is an organic painkiller that effectively treats the problem of a herniated disc. It is also an herbal cure for osteoarthritis.

Omega-3 Fatty Acids

Omega-3 Fatty acids are helpful in decreasing the inflammation and pain experienced due to herniated disc disorder. This acid forms collagen which is used by the broken discs for repairing itself.

Eat foods that are high in this kind of fats like fish, almonds, sprouts, and walnuts.

Colchicine

Colchicine is an active amino-alkaloid found in the plant of Kurchi or autumn crocus. This powder is obtained by crushing the seeds of the plant. It has anti-inflammatory properties which are effective against the slipped disc.

Make a paste with kurchi powder and honey and consume it once a day.

You can also make tea out of the powder or mix the powder in milk and have it once or twice a day.

Burdock

Burdock contains a lot of anti-oxidants which is helpful to detoxify the body and remove all kinds of harmful substances and decrease the pain and inflammation in your body. It also treats arthritis.

Burdock can be consumed as a decoction once or twice a day.

Passionflower

Passionflower is helpful for slipped discs because the essential oils present is antispasmodic in nature. It reduces pain and inflammation.

You can massage with passionflower essential oil or take capsules made from it, however, do consult your doctor before taking capsules.

Additional Tips

• If you are overweight, try to lose some pounds.

• Exercise every day.

• Lift things in a proper way, as guided by a therapist. Do not lift heavy weights.

• Stop smoking and drinking.

• Always make sure you are in the right posture whatever activity you may be doing.

• Wear flat and soft shoes. Avoid heels.

• Walk and move around cautiously.

Slipped discs can be really painful but with the right treatment and precautions, you can become as fit as you were before. So start taking home remedies and consult a doctor whenever you feel any kind of severe pain.

References

Spondylolysis refers to a posterior defect of the vertebral body occurring at the pars interarticularis. Typically, this defect results from trauma or chronic repetitive loading and hyperextension. If this instability leads to translation of the vertebral body, this is spondylolisthesis.[rx][rx] This process requires either a fracture or deformation of the posterior spinal elements resulting in elongation of the pars interarticularis. This condition can potentially occur in all age groups, with the underlying cause varying based on the age. If the slip progresses to the point of neurologic compromise, then surgical intervention may be necessary to decompress and stabilize affected segments.[rx] Absent any motor deficits, a nonoperative course of analgesia, activity modification, and injections should be the initial therapeutic approach for several months.[rx]

Types of Spondylolysis

Pars defects (spondylolysis) subdivide into five categories according to the Wiltse-Newman Classification[rx]:

• Dysplastic – congenital abnormalities/attenuated pars (approximately 20%)
• Isthmic – lesions in the pars resulting from a stress fracture or acute fractures (approximately 50%)
  • Type II-A – pars fatigue fracture
  • Type II-B – pars elongation due to a healed fracture
  • Type II-C – pars acute fracture
• Degenerative – degeneration of the intervertebral discs that results in segmental instability and alterations of the articular processes
• Traumatic – an acute fracture that results in fractures to various regions of the neural arch
• Pathological – bone disease such as tumors and infections that result in lesions to the pars

Causes of Spondylolysis 

A clinical syndrome caused by compression on the spinal cord that is characterized by

• clumsiness in hands
• gait imbalance
• degenerative cervical spondylosis (CSM) 
  
• compression usually caused by anterior degenerative changes (osteophytes, disc-osteophyte complex)
• degenerative spondylolisthesis and hypertrophy of ligamentum flavum may contribute
• a most common cause of cervical myelopathy

Congenital stenosis

Symptoms usually begin when congenital narrowing combined with spondylotic degenerative changes in older patients

• OPLL 
  
• tumor
• epidural abscess 
  
• trauma
• cervical kyphosis

Neurologic injury

• mechanism of injury can be
• direct cord compression
• ischemic injury secondary to compression of the anterior spinal artery

Associated conditions

• lumbar spinal stenosis 
• tandem stenosis occurs in the lumbar and cervical spine in ~20% of patients
• tends to be slowly progressive and rarely improves with nonoperative modalities
• progression characterized by steplike deterioration with periods of stable symptoms
• early recognition and treatment prior to spinal cord damage is critical for good clinical outcomes

Risk factors

Sports involving repetitive or forceful hyperextension of the spine, especially when combined with rotation are the main mechanism of injury for spondylolysis. The stress fracture of the pars interarticularis occurs on the side opposite of activity. For instance, for a right-handed player, the fracture occurs on the left side of the vertebrae.^[rx]

Spondylolysis has a higher occurrence in the following activities:^[rx]

• Baseball
• Military service
• Tennis
• Diving
• Cheerleading
• Gymnastics
• Gridiron Football
• Association Football
• Wrestling
• Weightlifting
• Roller Derby
• Cricket
• Pole Vault
• Rugby
• Volleyball
• Gym
• Ultimate Frisbee (especially during impact from laying out)
• Ballet
• Muay Thai

Although this condition can be caused by repetitive trauma to the lumbar spine in strenuous sports, other risk factors can also predispose individuals to spondylosis. Males are more commonly affected by spondylolysis than females.^[rx] In one study looking at youth athletes, it was found that the mean age of individuals with spondylolisthesis was 20 years of age.^[rx] Spondylolysis also runs in families suggesting a hereditary component such as a predisposition to weaker vertebrae.^[rx]

Risk Factors 

The lists below are the factors that you will have a higher risk of getting neck pain and cervical spondylosis:

• Genetics – if your family has a history of neck pain
• Smoking – clearly linked to increased neck pain
• Occupation – jobs with lots of neck motion and overhead work
• Mental health issues – depression/anxiety
• Injuries/trauma – car wreck or on-the-job injury

Symptoms of Spondylolysis 

• neck pain and stiffness
• axial neck pain (oftentimes absent)
• an occipital headache common
• extremity paresthesias
• diffuse non dermatomal numbness and tingling
• weakness and clumsiness
• weakness and decreased manual dexterity (dropping object, difficulty manipulating fine objects)
• Gait instability patient feels “unstable” on feet
• weakness walking up and downstairs
• gait changes are the most important clinical predictor
• urinary retention rare and only appear late in disease progression, not very useful in diagnosis due to the high prevalence of urinary conditions in this patient population
• Cervical pain aggravated by movement
• Referred pain (occiput, between the shoulder blades, upper limbs)
• Retro-orbital or temporal pain (from C1 to C2)
• Cervical stiffness—reversible or irreversible
• Vague numbness, tingling, or weakness in upper limbs
• Dizziness or vertigo
• Poor balance
• Rarely, syncope triggers a migraine, pseudo-angina
• Poorly localized tenderness
• Limited range of movement (forward flexion, backward extension, lateral flexion, and rotation to both sides)
• Minor neurological changes like inverted supinator jerks (unless complicated by myelopathy or radiculopathy)

Diagnosis of Spondylolysis 

• Other non-specific neck pain lesions—acute neck strain, postural neck ache, or whiplash
• Fibromyalgia – and psychogenic neck pain
• Mechanical lesions—disc prolapse or diffuse idiopathic skeletal hyperostosis
• Inflammatory disease—rheumatoid arthritis, ankylosing spondylitis, or polymyalgia rheumatica
• Metabolic diseases—Paget’s disease, osteoporosis, gout, or pseudo-gout
• Infections—osteomyelitis or tuberculosis
• Malignancy—primary tumors, secondary deposits, or myeloma

Motor signs

• Weakness in triceps and hand intrinsics
• Atrophy of intrinsic hand muscles
• Clumsiness with fine motor skills
• The proximal weakness of the lower extremities
• weakness usually difficult to detect on physical exam
• lower extremity weakness is more concerning finding
• finger escape sign when the patient holds fingers extended and adducted, the small finger spontaneously abducts due to the weakness of intrinsic muscle grip and release test normally a patient can make a fist and release 20 times in 10 seconds. myelopathic patients may struggle to do this

Upper motor neuron signs

• Hoffman’s sign (quick flexion of both the thumb and index finger when the middle fingernail is snapped)
• Inverted radial reflex (flexion of the fingers in response to the brachioradialis reflex)
• Pathological clonus
• Babinski sign

Sensory dysfunction

• Glove-like sensory loss in hands
• Proprioceptive dysfunction

Proprioception dysfunction

• due to dorsal column involvement 
  
• occurs in advanced disease
• associated with a poor prognosis

Decreased pain sensation

• pinprick testing should be done to look for the global decrease in sensation or dermatomal changes
• due to the involvement of lateral spinothalamic tract 
  

• vibratory changes are usually only found in a severe case of long-standing myelopathy

Assessment tools

• Lhermitte sign
• Romberg test
• 9-Hole peg test
• Grip and release test (observe a decreasing number of cycles)
• Timed gait, 30-m walking test
• Tandem gait

Upper motor neuron signs (spasticity)

• Hyperreflexia – may be absent when there is concomitant peripheral nerve disease (cervical or lumbar nerve root compression, spinal stenosis, diabetes)
• Inverted radial reflex – tapping distal brachioradialis tendon produces ipsilateral finger flexion
• Hoffmann’s sign  – snapping patients distal phalanx of the middle finger leads to spontaneous flexion of other fingers
• Sustained clonus > three beats defined as sustained clonus, sustained clonus has poor sensitivity (~13%) but high specificity (~100%) for cervical myelopathy
• Babinski test  – considered positive with the extension of the great to toe-to-heel walk patient has difficulty performing
• Romberg test – patient stands with arms held forward and eyes closed loss of balance consistent with posterior column dysfunction
• provocative tests – Lhermitte Sign >test is positive when extreme cervical flexion leads to electric shock-like sensations that radiate down the spine and into the extremities

[Rx]

Radiographs

• recommended views cervical AP, lateral, oblique, flexion, and extension views
• general findings degenerative changes of uncovertebral and facet joints
• osteophyte formation
• disc space narrowing
• decreased sagittal diameter
• cord compression occurs with canal diameter is < 13mm
• lateral radiograph important to look for the diameter of the spinal canal
• a Pavlov ratio of less than 0.8 suggests a congenitally narrow spinal canal predisposing to stenosis and cord compression

Sagittal alignment

• C2 to C7 alignment determined by tangential lines on the posterior edge of the C2 and C7 body on lateral radiographs in a neutral position
• local kyphosis angle the angle between the lines drawn at the posterior margin of most cranial and caudal vertebral bodies forming the maximum local kyphosis
• oblique radiograph important to look for foraminal stenosis which often caused by uncovertebral joint arthrosis
• flexion and extension views important to look for angular or translational instability look for compensatory subluxation above or below the spondylotic/stiff segment
• sensitivity/specificity changes often do not correlate with symptoms 70% of patients by 70 yrs of age will have degenerative changes seen on plain x -rays.

References