Back Pain

Pain Conditions

At Bay State Pain Management, Our Expert Pain Management Specialists Provide Effective Treatments for Low Back Pain.

Back Pain

  • Upper Extremity Pain
  • Upper Back Pain
  • Lower Back Pain
  • Lower Extremity Pain

Upper Extremity Pain

One of the most common upper extremity injuries is a torn rotator cuff in the shoulder. Elbow injuries occur among both professional and recreational athletes, and can include tennis elbow and golfer’s elbow. Shoulders, elbows, wrists, and fingers can be affected by rheumatoid and osteoarthritis, and will cause upper extremity pain. Sometimes, pain, numbness, or tingling in the arm may be associated to nerve damage in the back.

  • Carpal Tunnel Syndrome
  • Rotator Cuff Tears
  • Shoulder Pain
  • Tennis Elbow And Golfer's Elbow
 

 

Upper Extremity Pain

One of the most common upper extremity injuries is a torn rotator cuff in the shoulder. Elbow injuries occur among both professional and recreational athletes, and can include tennis elbow and golfer’s elbow. Shoulders, elbows, wrists, and fingers can be affected by rheumatoid and osteoarthritis, and will cause upper extremity pain. Sometimes, pain, numbness, or tingling in the arm may be associated to nerve damage in the back.

  • Carpal Tunnel Syndrome
  • Rotator Cuff Tears
  • Shoulder Pain
  • Tennis Elbow And Golfer's Elbow

 

 

 

What is low back pain?

Low back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain in the lower back. Pain in the lower back can restrict mobility and interfere with normal functioning.

What causes low back pain?

back pain

The exact cause of low back pain can be hard to determine. In most cases, back pain may be a symptom of many different causes, including any of these:

  • Overuse, strenuous activity, or improper use (such as repetitive or heavy lifting, exposure to vibration for prolonged periods of time)

  • Injury

  • Degeneration of vertebrae (often caused by stresses on the muscles and ligaments that support the spine, or the effects of aging)

  • Infection

  • Abnormal growth (tumor)

  • Obesity (often increases weight on the spine and pressure on the disks)

  • Poor muscle tone in the back

  • Muscle tension or spasm

  • Sprain or strain

  • Ligament or muscle tears

  • Joint problems (such as spinal stenosis)

  • Smoking

  • Protruding or herniated (slipped) disk

  • Disease (such as osteoarthritis, spondylitis, compression fractures)

What are the symptoms of low back pain?

Low back pain is classified as acute (or short term) and chronic. Acute low back pain lasts from a few days to a few weeks. Most acute low back pain will resolve on its own. Chronic low back pain lasts for more than 3 months and often gets worse. The cause of chronic low back pain can be hard to find.  

These are the most common symptoms of low back pain. Symptoms may include discomfort or pain in the lower back that is:

  • Aching

  • Burning

  • Stabbing

  • Sharp or dull

  • Well-defined or vague

The pain may radiate into one or both buttocks or even into the thigh or hip area.

The symptoms of low back pain may look like other health problems. Always see your healthcare provider for a diagnosis.

How is low back pain diagnosed?

Along with a complete medical history and physical exam, tests for low back pain may include:

  • X-ray. This test uses electromagnetic energy beams to make images of bones onto film.

  • CT scan. This imaging test uses X-rays and computer technology to make detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • MRI. This test uses large magnets and a computer to make detailed images of organs and structures in the body.

  • Radionuclide bone scan. This imaging technique uses a very small amount of radioactive material that is injected into the patient's bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.

  • Electromyogram (EMG). This test checks nerve and muscle function.

CT scanHow is low back pain treated?

Treatment may include:

  • Changes in activity

  • Medicine

  • Physical rehabilitation, therapy, or both

  • Osteopathic manipulation

  • Occupational therapy

  • Weight loss (if overweight)

  • No smoking

  • A prevention program (as directed by your healthcare provider)

  • Surgery

  • Assistive devices (such as mechanical back supports)

Rehabilitation is often a part of treatment for low back pain. Generally, there are 3 phases of low back pain rehab.

  • Acute phase. During this initial phase, the physiatrist (a healthcare provider who specializes in rehab medicine) and treatment team develop a plan to reduce the initial low back pain and source of inflammation. This may include using ultrasound, electrical stimulation, or specialized injections.

  • Recovery phase. Once the initial pain and inflammation are better managed, the rehab team focuses on helping you return to normal daily activities while starting a specialized exercise program to regain flexibility and strength.

  • Maintenance phase. In this phase, you will learn ways to prevent further injury and strain to the back. You will also learn how to start a fitness program to help further increase strength and endurance.

What can I do to prevent low back pain?

The following may help to prevent low back pain:

  • Use correct lifting techniques.

  • Maintain correct posture while sitting, standing, and sleeping.

  • Exercise regularly (with proper stretching beforehand).

  • Don't smoke.

  • Maintain a healthy weight.

  • Reduce stress, which may cause muscle tension.

When should I call my healthcare provider?

Call your healthcare provider if:

  • Your pain becomes worse or spreads to your hips, thighs, or legs.

  • Your pain medicine no longer works well for you.

  • Your pain begins to interfere with your daily activities, or interferes with activities more than usual.

Living with low back pain

Most back pain will ease in a few days to a few weeks. If the pain lasts longer than 3 months, it is considered chronic and you should talk with your healthcare provider. Recovery from low back pain can take time. To prevent back pain from coming back, it's important to follow good health practices, such as:

  • Maintaining a healthy weight

  • Exercising regularly

  • Practicing good lifting techniques

  • Maintaining good posture while sitting, standing, and sleeping

  • Not smoking

Key points about low back pain

  • Specific treatment for low back pain depends on the cause of the pain and the severity. But it often includes pain medicines and muscle relaxers, physical therapy, and assistive devices such as a back support. It also may include lifestyle changes such as stress reduction, weight loss, and increased physical activity.

  • A back rehab program may be used as part of the treatment for low back pain.

  • Measures to prevent back pain include using safe lifting techniques, maintaining correct posture, staying at a healthy weight, not smoking, and reducing stress.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

There can be a number of different causes of lower back pain and making a diagnosis can be very complex because there are many muscles, ligaments, bones, and internal organs that can be affected and cause pain. In women, gynecological issues could also present themselves as a lower back pain issue. However, most causes of lower back pain in adults 30-60, is muscle strain. By lifting a heavy object, twisting or making a sudden move, the muscles or ligaments can stretch or tear. Even microscopic tears can cause pain.

For adults over 60, pain is typically related to degeneration of the joints and discs in the spine. Two of the most common causes of lower back pain in older adults are spinal stenosis and osteoarthritis.

Lower Extremity Pain

hip Injuries to the knee are fairly common, especially among athletes. Meniscus tears are extremely common among professional athletes, as they are required to place extreme force and pressure on their knees as they pivot and move. Like lower back pain, Hip pain can be caused by arthritis, pelvic, muscles, internal organs, and back issues. It can also be caused by a joint in the pelvis called the SI Joint but can also be due to sciatica or other nerve damage in the back.  

  • Achilles Tendonitis
  • Extruded Discs
  • Foot Pain
  • Hammertoe
  • Heel Spurs
  • Hip Bursitis
  • Hip Osteoarthritis
  • Hip Pain
  • Inguinal Pain
  • Knee Pain
  • Leg Pain
  • Piriformis Syndrome
  • Plantar Fasciitis
  • Plantar Fasciitis And Achilles Tendonitis
  • Sacroiliac Joint Pain
  • Overview
  • What Is it?
  • Diagnosis
  • Causes
  • Common Symptoms
  • Treatment Guidelines

Back Pain  

Back Pain NeuroSpine Oregon

As the leading cause of physician’s visits and time away from work, back pain affects 7 out of 10 people in the U.S. every year. Causation of back pain varies, but those with chronic back pain often find it debilitating and suffer from limited quality of life. 

  • Back Pain
  • Bulging Disc Syndrome
  • Bulging Disc Versus A Herniated Disc
  • Bulging Disc Vs Herniated Disc
  • Cervical Radiculopathy
  • Disc Herniation
  • Facet Joint Syndrome
  • Failed Back Surgery Syndrome
  • Lower Back Pain
  • Post Laminectomy Syndrome
  • Prolapsed Disc
  • Sciatica
  • Scoliosis
  • Spinal Stenosis
  • Spine Surgery Pain
  • Thoracic Pain
  • Upper Back Pain
  • Vertebral Body Fracture
  • Vertebral Compression Fracture

anatomy-spine

BACK AND NECK BASICS

 

Anatomy of the Spine

The vertebral column, also called the backbone, is made up of 33 vertebrae that are separated by spongy disks and classified into 4 distinct areas. The cervical area consists of 7 bony parts in the neck; the thoracic spine consists of 12 bony parts in the back area; the lumbar spine consists of 5 bony segments in the lower back area; 5 sacral* bones; and 4 coccygeal* bones (the number of coccygeal bones can vary from 5 to 3).

(* By adulthood, the 5 sacral vertebrae fuse to form 1 bone, and the 4 coccygeal vertebrae fuse to form 1 bone.)

What is back and neck pain?

Back pain can range from a mild, dull, annoying ache, to persistent, severe, disabling pain. Pain in your back can limit your ability to move. It can interfere with normal functioning and quality of life. Always talk with your healthcare provider if you have persistent pain.

Neck pain occurs in the area of the cervical vertebrae in your neck. Because of its location and range of motion, your neck is often left unprotected and at risk for injury.

Pain in your back or neck area can come on suddenly and intensely. Chronic pain lasts for weeks, months, or even years. The pain can be constant or come and go.

How are back and neck pain diagnosed?

Your healthcare provider will ask about your health history and do a physical exam. He or she may also do X-rays of the affected areas, as well as an MRI. This allows a more complete view.  The MRI also makes pictures of soft tissues such as ligaments, tendons, and blood vessels. The MRI can help spot infection, tumor, inflammation, or pressure on your nerve. Sometimes a blood test may help diagnose arthritis, a condition that can cause back and neck pain.

What causes back and neck pain?

Even with today's technology, the exact cause of back and neck pain is hard to find. In most cases, back and neck pain may have many different causes. They include:

  • Overuse, strenuous activity, or improper use, such as repetitive or heavy lifting

  • Trauma, injury, or fractures

  • Breakdown of vertebrae, often caused by stresses on the muscles and ligaments that support your spine, or the effects of aging

  • Infection

  • Abnormal growth, such as a tumor or bone spur

  • Obesity. This put extra weight on your spine, and pressure on your disks.

  • Poor muscle tone

  • Muscle tension or spasm

  • Sprain or strain

  • Ligament or muscle tears

  • Joint problems, such as arthritis

  • Smoking

  • Slipped disk (protruding or herniated disk) and pinched nerve

  • Osteoporosis and compression fractures

  • Problems of your vertebrae and bones that you were born with (congenital)

  • Abdominal problems, such as an aortic aneurysm 

What are the symptoms of back and neck pain?

Symptoms linked to back pain may include:

  • Dull, burning, or sharp pain in your back.  The pain can be limited to a single spot or cover a large area.

  • Leg numbness or tingling above or below your knee

  • Stiffness or aching that occurs anywhere along your spine from your neck to your tailbone

  • Sharp, shooting pain that spreads from your low back to your buttocks, down the back of  your thigh, and into your calf and toes

  • Consistent ache in the middle or lower part of your back, especially after standing or sitting for a long period

Loss of bladder and bowel control, with weakness in both legs, are symptoms of a serious condition that needs medical attention right away.

Symptoms linked to neck pain can be:

  • Arm numbness or tingling

  • Headaches

  • Shoulder pain

  • Sharp shooting pain or a dull ache in your neck

Pain that occurs suddenly in your back or neck from an injury is acute pain. Acute pain comes on quickly and may leave sooner than chronic back or neck pain. This type of pain should not last more than 6 weeks.

Pain that may come on quickly or slowly and lingers for 3 months or greater is chronic pain. Chronic pain is less common than acute pain.

How are back and neck pain treated?

In many cases, acute back or neck pain may simply improve with some rest. Over-the-counter medicines such as acetaminophen or ibuprofen may also help with the discomfort. Try to move gently during this period, so that you won't become stiff and lose mobility.

If you have chronic pain of your back and neck, try several remedies before considering surgery. These include:

  • Hot or cold packs as advised by your healthcare provider

  • Certain exercises to strengthen muscles and ease pain, such as stretching and flexing. Your healthcare provider can show you these exercises. Physical therapy can also help you find the correct exercises.

  • Aerobic exercise may help with your overall fitness and strength

  • Certain anti-inflammatory medicines or muscle relaxants may be used, as advised by your provider

  • Braces or corsets for extra support

  • Shots (injections) for pain relief in the area

  • Nerve block. This eases pain signals from  the affected nerve.

  • Acupuncture

  • Osteopathic manipulation

 

  • Pain Management
  • Possible Complications
  • Prevention
  • When should I call my healthcare provider
  • Key points

   

Back Pain NeuroSpine Oregon

How are back and neck pain managed?

Acute back pain usually gets better without special treatment. Using acetaminophen or ibuprofen will decrease pain and help you rest. Surgery and special exercises are generally not used with acute pain.

For severe, disabling, or chronic back and neck pain, rehabilitation programs can be designed to meet your needs. The type of program will depend on the type and severity of your pain, injury, or disease. Your active involvement is key to the success of rehab programs.   

The goal of back and neck rehab is to help you manage disabling pain,. It's also important to return you to your highest level of functioning and independence, and improve your quality of life. The focus of rehab is on easing pain and improving movement.

To help reach these goals, back and neck rehab programs may include:

  • Exercise programs to improve range of motion, increase muscle strength, improve flexibility and mobility, and increase endurance

  • Help with assistive devices that keep you independent

  • Education and counseling

  • Pain management methods

  • Help to quit smoking

  • Gait (walking) and movement retraining

  • Stress management

  • Nutritional counseling

  • Ergonomic assessments and work-related injury prevention programs

  • Job counseling

 

What are possible complications of neck and back pain?

Complications of back and neck pain may include: 

  • Loss of productivity. Back pain is the most common reason for disability in working adults.

  • Nerve damage. If your back pain is from a herniated disk, pressure on the spinal nerves may cause a variety of problems, such as weakness, numbness, or severe shooting pain that travels from the back to the leg.

  • Depression. Back or neck pain can disrupt all aspects of life. This includes work, physical exercise, social activities, and sleep. The anxiety and stress caused by the change in movement and pain can lead to depression.

  • Weight gain. Loss of movement and inability to exercise can lead to weight gain and the loss of muscle strength.

It is a good idea to see a healthcare provider if you have numbness or tingling, or if your pain is severe and does not get better with medicine and rest. If you have trouble urinating, have weakness, pain, or numbness in your legs, fever, or unintentional weight loss, call your healthcare provider right away.

Can I prevent neck and back pain?

The following may help to prevent back and neck pain:

  • Practice correct lifting techniques. Don't lift heavy items. When you do lift something, bend your legs, keep your back straight, and then slowly lift your body and the object.

  • Wear a seat belt in motor vehicles in case of a collision.

  • Use telephones, computers, and other equipment correctly.

  • Maintain correct posture while sitting, standing, and sleeping.

  • Exercise regularly. Learn back-strengthening exercises to keep your back muscles strong. Warm up with stretching exercises before doing back exercises.

  • Do exercises that improve your balance.

  • Don't smoke.

  • Stay at a healthy weight

  • Reduce emotional stress that may cause muscle tension.

  • Get enough vitamin D and calcium in your diet.

When should I call my healthcare provider?

See your healthcare provider if you have:

  • Loss of bladder or bowel control, with weakness in either leg. These symptoms attention right away.

  • Severe back or neck pain that does not decrease with medicine and rest

  • Pain after an injury or a fall

  • Weakness, numbness, or tingling in your legs or arms

  • Fever of 100.4°F (38°C) or higher, or as advised by your healthcare provider

  • Unintentional weight loss

Key points about back and neck pain

  • Back and neck problems range from minor aches to severe, disabling pain

  • Often, the reason for your pain can't be found.

  • See a healthcare provider if you have numbness or tingling, severe  pain that does not improve with medicine and rest, trouble urinating, weakness, pain, or numbness in your legs, fever, unintentional weight loss, or pain after a fall.

  • Often, back and neck pain will improve over time. See your healthcare provider if your pain is not decreasing.

  • Use prevention strategies to keep yourself healthy and injury-free.

  • For severe, disabling, or chronic back pain, consider an individualized rehabilitation program.

CAUSES OF BACK PAIN

  • Lumbar Disk Disease (Herniated Disk)
  • Sciatica
  • Osteoarthritis

Lumbar Disk Disease (Herniated Disk)

What is lumbar disk disease?

The vertebral column, or backbone, is made up of 33 vertebrae that are separated by spongy disks. The spine is divided into 4 areas:

  • Cervical spine: The first 7 vertebrae, located in the neck

  • Thoracic spine: The next 12 vertebrae, located in the chest area

  • Lumbar spine: The next 5 vertebrae, located in the lower back

  • Sacral spine: The lowest 5 vertebrae, located below the waist, also includes the 4 vertebrae that make up the tailbone (coccyx)

The lumbar spine consists of 5 bony segments in the lower back area, which is where lumbar disk disease occurs.

  • Bulging disk. With age, the intervertebral disk may lose fluid and become dried out. As this happens, the spongy disk (which is located between the bony parts of the spine and acts as a “shock absorber”) becomes compressed. This may lead to the breakdown of the tough outer ring. This lets the nucleus, or the inside of the ring, to bulge out. This is called a bulging disk.

  • Ruptured or herniated disk. As the disk continues to break down, or with continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is a ruptured, or herniated, disk. The fragments of disk material can then press on the nerve roots located just behind the disk space. This can cause pain, weakness, numbness, or changes in sensation.

Most disk herniations happen in the lower lumbar spine, especially between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral vertebra (the L4-5 and L5-S1 levels).

What causes lumbar disk disease?

Lumbar disk disease is caused by a change in the structure of the normal disk. Most of the time, disk disease happens as a result of aging and the normal break down that occurs within the disk. Sometimes, severe injury can cause a normal disk to herniate. Injury may also cause an already herniated disk to worsen.

damaged lumbarWho is at risk for lumbar disk disease?

Although age is the most common risk, physical inactivity can cause weak back and abdominal muscles, which may not support the spine properly. Back injuries also increase when people who are normally not physically active participate in overly strenuous activities. Jobs that require heavy lifting and twisting of the spine can also cause back injuries.

What are the symptoms of lumbar disk disease?

The symptoms of lumbar disk disease vary depending on where the disk has herniated, and what nerve root it is pushing on. These are the most common symptoms of lumbar disk disease:

  • Intermittent or continuous back pain. This may be made worse by movement, coughing, sneezing, or standing for long periods of time.

  • Spasm of the back muscles

  • Sciatica. This is pain that starts near the back or buttock and travels down the leg to the calf or into the foot.

  • Muscle weakness in the legs

  • Numbness in the leg or foot

  • Decreased reflexes at the knee or ankle

  • Changes in bladder or bowel function

The symptoms of lumbar disk disease may look like other health conditions. Always see your healthcare provider for a diagnosis.

CT scanHow is lumbar disk disease diagnosed?

In addition to a complete medical history and physical exam, you may have one or more of the following tests:

  • X-ray. A test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

  • MRI. A procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

  • Myelogram. A procedure that uses dye injected into the spinal canal to make the structure clearly visible on X-rays.

  • CT scan. An imaging procedure that uses X-rays and computer technology to make detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • Electromyography (EMG). A test that measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle.

How is lumbar disk disease treated?

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

  • Bed rest

  • 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 programs

  • Weight control

  • Use of a lumbosacral back support

  • Medicine to control pain and relax muscles

If these measures fail, you may need surgery to  remove the herniated disk. Surgery is done under general anesthesia. Your surgeon will make an incision in your 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 disk. Your surgeon will remove the herniated part of the disk and any extra loose pieces from the disk space.

After surgery, you may be restricted from activity for several weeks while you heal to prevent another disk herniation. Your surgeon will discuss any restrictions with you.

What are possible complications of lumbar disk disease?

Lumbar disk disease can cause back and leg pain that interferes with daily activities. It can lead to leg weakness or numbness and trouble with bowel and bladder control.

What can I do to prevent lumbar disk disease?

Maintaining a healthy weight, participating in regular exercise, and using good posture can lessen your risk for lumbar disk disease. Smoking increases the risk for disk herniation and should be stopped.

Living with lumbar disk disease

Conservative therapy requires patience. But sticking with your treatment plan can reduce back pain and minimize the chance of worsening pain or damage to the disk. Conservative measures and surgery can both take time to be effective.

When should I call my healthcare provider?

Call your healthcare provider if your pain increases or if you start having trouble with bowel or bladder control.

Key points about lumbar disk disease
  • Lumbar disk disease may occur when a disk in the low back area of the spine bulges or herniates from between the bony area of the spine.

  • Lumbar disk disease causes lower back pain and leg pain and weakness that is made worse by movement and activity.

  • The first step in treatment is to reduce pain and reduce the risk of further injury to the spine.

  • Surgery may be considered if the more conservative therapy fails.

Sciatica

Sciatica is defined as lower back pain that travels down to the buttock, the leg and even to the foot. It is caused by a nerve root in the lower spine becoming compressed, which causes pain and numbness, which travels along the sciatic nerve, which affects the buttocks, legs and feet.

  • It is an ongoing pain, not an intermittent pain the lasts a few days or weeks, then subsides.
  • It is a pain that is worse in the leg and foot, than it is in the back itself.
  • It’s typically felt on just one side of the body.
  • Pain is usually worse after long periods of time standing still or sitting, but it is somewhat relieved when walking
  • May be accompanied by weakness, numbness or difficulty moving the leg or foot.

What is sciatica?

Sciatica, also called lumbar radiculopathy, is a pain that originates along your sciatic nerve. This nerve extends from the back of your pelvis down the back of your thigh. Your sciatic nerve is the main nerve in your leg. It is also the largest nerve in your entire body.

What causes sciatica?

Usually, sciatica is caused by a herniated (or bulging) disk in your spine that presses on your sciatic nerve.

Other reasons for pressure on your sciatic nerve may include:

  • Obesity

  • Poor posture

  • Tumor

  • Abscess

  • Blood clot

  • Awkward sitting position

  • Any nerve disorders

Health conditions such as diabetes or Lyme disease can cause symptoms of sciatica. Sometimes, the cause for your sciatica can't be identified.

What are the symptoms of sciatica?

These are the most common symptoms of sciatica:

  • Lower back pain that radiates or spreads down your buttock and the back of one thigh

  • Pain that extends from your buttock down to your foot

  • Numbness (in severe cases)

  • Weakness (in severe cases)

The symptoms of sciatica may look like other conditions or health problems. Always see your healthcare provider for a diagnosis.

How is sciatica diagnosed?

Along with a complete medical history and physical exam, tests for sciatica may include:

  • X-ray. Electromagnetic energy beams make images of internal tissues, bones, and organs onto film.

  • MRI. Large magnets, radio waves, and a computer make detailed images of organs and structures in your body.

  • Electromyography and nerve conduction study (EMG and NCS). A procedure done together to record and analyze electrical impulses in your muscles. During the EMG, thin needles are placed in your muscle to record electrical activity. The NCS is often done along with the EMG to determine if a nerve is working normally. Electrodes are then placed in various locations on your skin along the nerve pathway. When stimulating the nerve at various places, your healthcare provider can then determine the specific site of your injury.

How is sciatica treated?

Sciatica usually heals on its own with rest and time. To help relieve the pain, treatment may include:

  • Nonsteroidal anti-inflammatory (NSAIDs) medicines such as ibuprofen

  • Heat or cold applied to the sore muscles

  • Movement (keeping your body in motion minimizes inflammation)

  • Osteopathic manipulation

  • Surgery (to repair your herniated disk, if the condition persists)

What are possible complications of sciatica?

Because sciatica is caused by pressure on a nerve in your spine, complications may develop if the pressure is not relieved. Possible complications of unrelieved nerve compression include:

  • Increased pain

  • A slipped or herniated disc

  • Loss of feeling or weakness in your affected leg

  • Loss of bowel or bladder function

  • Permanent nerve damage

When should I call my healthcare provider?

Call your healthcare provider if:

  • You develop back pain when you have a history of cancer.

  • You have a high fever.

  • Your pain worsens.

  • You lose feeling in your affected leg or notice weakness in your leg.

  • You develop problems with your bowels or bladder.

  • Your pain returns after successful treatment of your sciatica.

Key points about sciatica

  • Sciatica most commonly occurs in people between the ages of 30 and 50 years.

  • It is pain that starts along your sciatic nerve and spreads down your buttock and the back of one thigh.

  • It is usually caused by a herniated (or bulging) disk in your spine that presses on your sciatic nerve.

  • Sciatica usually heals on its own with rest and time.

Osteoarthritis

What is osteoarthritis?

Arthritis is a condition that causes pain and inflammation in joints. Osteoarthritis (OA) is the most common type. It's a long-term (chronic), degenerative joint disease. Degenerative means that it gets worse over time. It affects mostly middle-aged and older adults. OA causes the breakdown of joint cartilage. It can occur in any joint. But it most often affects the hands, knees, hips, or spine.

What causes osteoarthritis?

OA can be called primary or secondary. Primary OA has no known cause. Secondary OA is caused by another disease, infection, injury, or deformity. OA starts with the breakdown of cartilage in the joint. As the cartilage wears down, the bone ends may thicken and form bony growths. These growths are called bone spurs. Bone spurs can limit joint movement. Bits of bone and cartilage may float in the joint space. Fluid-filled cysts may form in the bone. These can also limit joint movement.

Who is at risk for osteoarthritis?

The risk factors of OA include:

  • Heredity. Some genetic problems may lead to OA. These include slight joint defects or joints that are too loose.

  • Extra weight.  Being overweight can put stress on such joints as the knees over time.

  • Injury or overuse.  Severe injury to a joint, such as the knee, can lead to OA. Injury may also result from overuse or misuse over time.

What are the symptoms of osteoarthritis?

The most common symptom of OA is pain after overuse or inactivity of a joint. Symptoms usually happen slowly over years. Symptoms can occur a bit differently in each person. They may include:

  • Joint pain

  • Joint stiffness, especially after sleep or inactivity

  • Less movement in the joint over time

  • A grinding feeling in the joint when moved, as the cartilage wears away (in later stages)

The symptoms of OA can be like other health conditions. Make sure to see your healthcare provider for a diagnosis.

How is osteoarthritis diagnosed?

The process starts with a health history and a physical exam. You may also have X-rays. This test uses a small amount of radiation to create images of bone and other body tissues.

How is osteoarthritis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is. The goal of treatment is to ease joint pain and stiffness, and improve joint movement. Treatment may include:

  • Exercise.Regular exercise may help ease pain and other symptoms. This may include stretching and strength exercises.

  • Heat treatment. Treating the joint with heat may help ease pain.

  • Physical and occupational therapy.  These types of therapy may help ease joint pain, improve joint flexibility, and reduce joint strain. You may use splints and other assistive devices.  

  • Weight maintenance. Keeping a healthy weight, or losing weight if needed, may help to prevent or ease symptoms.

  • Medicines.These may include pain relievers and anti-inflammatory medicines. You might take these by mouth as a pill. Or you may rub them on your skin in a cream.

  • Injections of a lubricant into the joints.These liquids mimic normal joint fluid.

  • Joint surgery. You may need surgery to repair or replace a joint that has severe damage.

Talk with your healthcare providers about the risks, benefits, and possible side effects of all treatments.

What are possible complications of osteoarthritis?

Because OA causes joints to get worse over time, it can cause disability. It can cause pain and movement problems. These can make you less able to do normal daily activities and tasks.

Living with osteoarthritis

Although there is no cure for OA, it's important to help keep joints working. You can ease pain and inflammation. Work on a treatment plan with your healthcare provider. The plan may include medicine and therapy. Work on lifestyle changes that can improve your quality of life. These may include:

  • Losing weight. Extra weight puts more stress on weight-bearing joints, such as the hips and knees.

  • Exercising.Some exercises may help ease joint pain and stiffness. These include swimming, walking, low-impact aerobic exercise, and range-of-motion exercises. Stretching exercises may also help keep the joints flexible.

  • Balancing activity and rest. To reduce stress on your joints, alternate between activity and rest. This can help protect your joints and ease your symptoms.

  • Using assistive devices. Canes, crutches, and walkers can help to keep stress off certain joints and improve balance.

  • Using adaptive equipment. Reachers and grabbers allow you to extend your reach and reduce straining. Dressing aids can help you get dressed more easily.

  • Managing use of medicines. Long-term use of some anti-inflammatory medicines can lead to stomach bleeding. Work with your healthcare provider to create a plan to reduce this risk.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points about osteoarthritis

  • Osteoarthritis is a chronic joint disease. It affects mostly middle-aged and older adults.

  • It starts with the breakdown of joint cartilage.

  • Risk factors include heredity, obesity, injury, and overuse.

  • Common symptoms include pain, stiffness, and limited movement of joints.

  • Treatment may include medicines, exercise, heat, and joint injections. Surgery may be needed to repair or replace a severely damaged joint.

  • Lumbar Strain
  • Sacroiliac Joint Dysfunction
  • Scoliosis
  • Kyphosis
  • Spinal Stenosis

Lumbar Strain

anatomy-spineWhat is a lumbar strain?

A lumbar strain is an injury to the lower back. This leads to damaged tendons and muscles that can spasm and feel sore. The lumbar vertebra make up the section of the spine in your lower back.

 

What causes lumbar strain?

Injury can damage the tendons and muscles in the lower back. Pushing and pulling sports, such as weight lifting or football, can lead to a lumbar strain. In addition, sports that require sudden twisting of the lower back, such as in tennis, basketball, baseball, and golf, can lead to this injury.

Certain risk factors can increase the risk for this injury. The risk factors are:

  • Severe lower back curvature

  • Forward-tilted pelvis

  • Weak back or abdominal muscles

  • Tight hamstrings

What are the symptoms of lumbar strain?

The following are the most common symptoms of a lumbar strain. However, each person may experience symptoms differently. Symptoms may include:

  • Sudden lower back pain

  • Spasms in the lower back that result in more severe pain

  • Lower back feels sore to the touch

The symptoms of a lumbar strain may look like other conditions and medical problems. Always talk with your healthcare provider for a diagnosis.

CT scanHow is lumbar strain diagnosed?

In addition to a complete medical history and physical exam, diagnosing low back pain may include the following. However, specialized tests aren't usually required.

  • X-ray. A diagnostic test that produces images of internal tissues, bones, and organs onto film.

  • CT scan. This is an imaging test that uses X-rays and a computer to make detailed images of the body. It shows details of the bones, muscles, fat, and organs.

  • MRI. This test uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

  • Radionuclide bone scan. A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into your bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.

  • Electromyogram (EMG). A test to evaluate nerve and muscle function.

How is lumbar strain treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include:

  • Rest

  • Ice packs and/or heat and compression applied to the back

  • Exercises (to strengthen the abdominal muscles)

  • Stretching and strengthening exercises (for the lower back as it heals)

  • Learning how to use and wear appropriate protective equipment

Medicines, such as anti-inflammatories and spinal injections, may also be used to relieve pain and inflammation.

When should I call my healthcare provider?

Call your healthcare provider if any of the following happen:

  • You’re unable to stand or walk.

  • You have a temperature over 101.0°F (38.3°C).

  • You have frequent, painful, or bloody urination.

  • You have severe abdominal pain.

  • You have a sharp, stabbing pain.

  • Your pain is constant.

  • You have pain or numbness in your leg.

  • You feel pain in a new area of your back.

  • You notice that the pain isn’t decreasing after more than a week.

Call your healthcare provider immediately for the following:

  • Pain radiating down the leg

  • Pain that is accompanied by fever, weakness in the leg, or loss of control of the bladder or bowels

Living with lumbar strain

Cold reduces swelling. Both cold and heat can reduce pain. Protect your skin by placing a towel between your body and the ice or heat source.

  • For the first few days, apply an ice pack for 15 to 20 minutes.

  • After the first few days, try heat for 15 minutes at a time to ease pain. Never sleep on a heating pad.

  • Over-the-counter medicines can help control pain and swelling. Try aspirin or ibuprofen.

Exercise

Exercise can help your back heal. It also helps your back get stronger and more flexible, helping prevent reinjury. Ask your healthcare provider about specific exercises for your back.

Use good posture to prevent reinjury

  • When moving, bend at the hips and knees. Don’t bend at the waist or twist around.

  • When lifting, keep the object close to your body. Don’t try to lift more than you can handle.

  • When sitting, keep your lower back supported. Use a rolled-up towel as needed.

Key points about lumbar strain

  • Lumbar refers to your lower back.

  • Strain can cause damage to the tendons and muscles causing pain and soreness.

  • Nonsurgical methods can cure most low back pain.

  • Call your healthcare provider if symptoms don’t get better over the next several days or if symptoms get worse.

Sacroiliac Joint Dysfunction

The Sacroiliac Joint is located in the pelvis.  It links the iliac bone (the pelvis) to the sacrum (the lowest part of the spine above the tailbone).  The purpose of this joint is to help the body transfer weight and other forces between your upper body and your legs. Pain emanating from the lower back could be caused by Sacroiliac Joint Dysfunction.

  • Pain from the SI Joint can start in the lower back and travel through the lower buttocks and upper legs
  • Often times patients will say it hurts to stand and it hurts to sit

Scoliosis

What is scoliosis?

A normal spine, when viewed from behind, looks straight. But a spine affected by scoliosis shows a side-to-side curvature, with the spine looking like an "S" or "C." The back bones (vertebrae) may also be rotated. This makes it look like the person is leaning to one side. Scoliosis is defined as a curvature of the spine measuring 10° or greater.

Scoliosis is not due to poor posture.

Spinal curvature from scoliosis may occur on the right, left, or both sides of the spine. Both the middle (thoracic) and lower (lumbar) spine may be affected by scoliosis.

What causes scoliosis?

In most cases, the cause of scoliosis is not known. This is called idiopathic scoliosis. In other cases, scoliosis may be caused by a breakdown of the spinal discs. This can occur with arthritis or osteoporosis. Or it may be a hereditary condition that runs in families.

The abnormal curves of the spine are defined according to their cause:

  • Nonstructural scoliosis. This is also called functional scoliosis. In this condition, a normal spine is curved due to one or more problems. For example, the leg lengths may be different. Or there may be an inflammatory problem. This type of scoliosis is often short-term. It goes away when the underlying problem is treated.

  • Structural scoliosis. The possible causes of structural scoliosis include:

    • Unknown (idiopathic scoliosis)

    • Disease that is neuromuscular, metabolic, rheumatoid, or other type

    • Birth defect

    • Injury

    • Infection

    • Abnormal growth

What are the symptoms of scoliosis?

These are the most common symptoms of scoliosis:

  • Difference in shoulder height

  • Head is off-center from the rest of the body

  • Difference in hip height or position

  • Difference in shoulder blade height or position

  • When standing straight, difference in the way the arms hang beside the body

  • When bending forward, the sides of the back look different in height

Get medical care right away if you have back pain, leg pain, or changes in bowel and bladder habits. These are not often seen with idiopathic scoliosis.

The symptoms of scoliosis may look like other health problems. Always see your healthcare provider for a diagnosis.

How is scoliosis diagnosed?

A healthcare provider will ask about your health history. He or she will give you a physical exam. You will have X-rays. These are the main tool for diagnosing scoliosis. The healthcare provider measures the degree of spinal curvature on the X-ray.

Other tests may be done for nonidiopathic curvatures, abnormal curve patterns, or congenital scoliosis. These include:

  • MRI. MRI uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body.

  • CT scan. A CT scan uses X-rays and computer technology to make detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Early detection of scoliosis is most important for successful treatment.

How is scoliosis treated?

The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include:

  • Observation and repeated exams. This may be needed to determine if the spine is continuing to curve. It's used when a person has a curve less than 25° that is still growing.

  • Bracing. Bracing may be used when the curve measures more than 25° to 30° on an X-ray, but skeletal growth remains. It may also be needed if a person is growing and has a curve between 20° and 29° that isn't improving or that is advancing. The type of brace and the amount of time spent in the brace will depend on the severity of the condition.

  • Surgery. Surgery may be recommended when the curve measures 45° or more on an X-ray and bracing isn't successful in slowing down the progression of the curve when a person is still growing. Certain symptoms, such as loss of bladder or bowel control, may also require surgery.

There's no scientific evidence to show that other methods for treating scoliosis (for example, chiropractic manipulation, electrical stimulation, nutritional supplementation, or exercise) prevent the progression of the disease. Talk with your healthcare provider before starting, or paying for, a nontraditional treatment for scoliosis.

Key points about scoliosis

  • Scoliosis is a sideways curvature of the spine measuring 10° or greater.

  • In most cases, the cause of scoliosis is not known. In some cases, scoliosis may be caused by a breakdown of the spinal discs. This can occur with arthritis, osteoporosis, or as a hereditary condition that runs in families.

  • Symptoms include a difference in shoulder height, difference in hip height or position, and the head being off-center from the rest of the body.

  • In addition to a full health history and physical exam, X-rays are the main tool for diagnosing scoliosis.

  • Treatment may include observation and repeated exams, bracing, and surgery.

Kyphosis

What is kyphosis?

A normal spine, when viewed from behind appears straight. However, a spine affected by kyphosis has a forward curvature of the back bones (vertebrae) in the upper back area, giving an abnormally rounded or "humpback" appearance. This is sometimes known as roundback or a dowager's hump.

Kyphosis is a curvature of the spine measuring 50 degrees or greater on an X-ray. The normal spine can bend from 20 to 45 degrees of curvature in the upper back area. Kyphosis is a type of spinal deformity.

What causes kyphosis?

A child can be born with kyphosis (congenital) or it can be caused by the following conditions:

  • Metabolic problems

  • Neuromuscular conditions

  • Brittle bone disease (osteogenesis imperfecta). A condition that causes bones to fracture with minimal force.

  • Spina bifida. A neural tube defect.

  • Scheuermann disease. A condition that causes the vertebrae to curve forward in the upper back area. The cause of Scheuermann disease is unknown and is commonly seen in males.

  • Postural kyphosis. The most common type of kyphosis. It generally becomes noticeable in adolescence and can be associated with slouching versus a spinal abnormality. Exercise is used to help correct posture.

Kyphosis is more common in females than males.

What are the symptoms of kyphosis?

The following are the most common symptoms of kyphosis. However, each person may experience symptoms differently. Symptoms may include:

  • Difference in shoulder height

  • The head bends forward compared to the rest of the body

  • Difference in shoulder blade height or position

  • When bending forward, the height of the upper back appears higher than normal

  • Tight hamstrings (back thigh) muscles

Back pain, pain down the legs, and changes in bowel and bladder habits are not commonly seen in people with kyphosis. If you have these types of symptoms, see your healthcare provider.

The symptoms of kyphosis may look like other spinal conditions or deformities, or may happen because of an injury or infection. Always talk with your healthcare provider for a diagnosis.

How is kyphosis diagnosed?

The healthcare provider makes the diagnosis of kyphosis with a complete medical history, physical exam, and diagnostic tests. For a child, the healthcare provider will want to have a prenatal and birth history of the child. They will also ask if other family members are known to have kyphosis. The healthcare provider also will ask about developmental milestones since some types of kyphosis can be associated with other neuromuscular disorders. Developmental delays may require further medical evaluation.

Diagnostic procedures may include the following:

  • Blood tests

  • X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. This test is used to measure and evaluate the curve. With the use of a full-spine X-ray, the healthcare provider measures the angle of the spinal curve. A treatment plan can often be made based on this measurement.

  • Radionuclide bone scan. A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.

  • MRI. A diagnostic procedure that uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.

  • CT scan. This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

XTiss_20140225_v1_001

Early detection of kyphosis is important for successful treatment. Healthcare providers, and even some school programs, regularly look for signs of kyphosis in children.

How is kyphosis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

The goal of treatment is to stop the progression of the curve and minimize deformity. Treatment may include:

  • Observation and repeated exams. The child will need observation and repeated exams. Progression of the curve depends on the child's skeletal growth and maturity. Curve progression often slows down or stops after the child reaches puberty.

  • Bracing. If the child is still growing, the healthcare provider may prescribe a brace. The type of brace and the amount of time spent in the brace will be discussed with you by your healthcare provider.

  • Surgery. In rare instances, surgery is recommended when the curve measures 75 degrees or more on X-ray, and bracing is not successful in slowing down the progression of the curve.

What are possible complications of kyphosis?

Possible complications of kyphosis depend on the type of kyphosis your child has. With Scheuermann kyphosis, there may be pain with activity or with long periods of sitting or standing. Severe kyphosis can harm how the lungs work.

What Is Spinal Stenosis?

Spinal stenosis is a condition in which the spinal canal narrows and pinches the nerves. This results in back and leg pain.

In adults 50 years of age and older, the risk of developing spinal stenosis increases. Younger people who are born with a small spinal canal may also develop symptoms. Aging can cause the tissues that connect the spine and bones (ligaments) to become thicker and calcified. The disks between vertebrae break down. Growths called bone spurs may happen on bones and into the spinal canal. All of these conditions tighten the spinal canal. This causes spinal stenosis.

Symptoms of spinal stenosis include pain and trouble walking, as well as numbness, tingling, a sensation of hot or cold, weakness or a heavy, tired feeling in the legs. A person may also experience clumsiness or frequent falls. Often, bending forward will lessen the pain, such as by leaning onto a shopping cart at the grocery store. If you notice any of these symptoms, talk with your healthcare provider. He or she may recommend pain medicine or corticosteroid injections to reduce swelling and pain, posture changes, physical therapy, or weight loss. Surgery may also be a choice.

Surgical treatment for spinal stenosis is considered after nonsurgical remedies have not improved symptoms, and when the benefits of surgery are greater than the potential risks. In some cases, surgery may be an urgent matter due to the development of severe weakness or loss of bowel and bladder function.

Surgical procedure

Common surgical procedures used to treat spinal stenosis:

  • Decompression. This is surgery that involves removing the bone and soft tissues of the spine that are pinching the nerves. This procedure is also referred to as a laminectomy.

  • Spinal fusion. This surgery is done when there is a contributing deformity of the vertebra or curvature of the spine and involves permanently fusing two or more vertebrae together. A piece of bone, usually taken from the hip, is used to complete the fusion. Screws and rods may be used to hold the bones together while they mend, and can also speed recovery time.

While there is treatment for spinal stenosis, prevention should be a primary focus. Staying physically fit and getting regular exercise can contribute to a healthier spine by improving endurance and strengthening the back muscles. Maintaining a healthy weight can also help. It reduces the load placed on the spine. Don't smoke because it can cause  the spine to break down faster than the normal aging process.

EVERYDAY CARE FOR BACK PAIN

  • Exercise: The Right Program and the Right Preparation
  • Smoking Hurts Your Back
  • Watch That Backpack Load

Exercise: The Right Program and the Right Preparation

You don’t have to exercise intensely for long periods of time to be physically fit. Experts agree that physical activity doesn’t necessarily have to be vigorous. They recommend at least 30 minutes of moderate, uninterrupted physical activity daily, or on most days of the week.

To achieve and keep physical and cardiovascular fitness, health professionals advise following a balanced fitness program. This program should include the following:

  • Talk with your healthcare provider. If you have an existing health condition, or are just starting an exercise program, be sure to talk with your provider before beginning the program. This is to make sure the exercise program that you choose is designed with your health and wellness in mind.

  • Start slow. If you are just starting an exercise program, take it slowly. Gradually build up to 30 minutes a day.

  • Do what you love. Choose an activity you’ll enjoy. You are more likely to continue exercising if you are doing something that you like.

  • Change it up. In the beginning, follow a program that includes medium, not vigorous, physical activity. Start off with 30 minutes a day. Add some variety to your fitness routine. Try different types of activities. But also try to vary when and where you exercise. This will help keep you from getting bored with any one activity or location.

  • Warm up first. Be sure to start off any workout or exercise session with proper warm-up and stretching exercises. This will help to avoid injury or soreness after exercising.

  • Dress right. Wear the right clothing for exercising. This includes shoes with proper support for the activity. Also, be sure to dress appropriately for the weather.

  • Cool down after. Just as warming up and stretching are important as you begin each exercise session, so is a cool-down period at the end of your exercise activity. This should include at least several minutes of stretching or walking to allow your heart rate to come down slowly.

Experts now recommend participating in 2 types of physical activity each week to achieve aerobic health and muscle strengthening. Muscle strengthening activities include lifting weights, using resistance bands, yoga, or Pilates. Such exercises should be done twice a week. They should include the major muscle groups. These are legs, hips, back, chest, arms, shoulders, and stomach.

Smoking Hurts Your Back

Numerous studies show a link between cigarette smoking and back pain. Smoking damages your arteries, and it’s thought that the damaged arteries in the discs and joints in your back may lead to pain and injury. Smoking increases your risk for osteoporosis, a bone-thinning disease that can lead to back pain. Smoking also increases your risk of hip fracture as you get older. Fractures can take longer to heal due to nicotine's harmful effects on bone-forming cells.

Quitting smoking takes effort, but you may find it easier if you ask yourself the following questions:

  • Do I have a quit day? A key step in quitting is selecting the day that you will stop smoking. Mark this day on your calendar and make a commitment to quit on that day.

  • Have I prepared my environment? Throw away all the cigarettes, ashtrays, and lighters in your house. Ask people not to smoke in your home. Avoid places where other smokers gather, such as outside your office.

  • How will I deal with smoking triggers? Identify the things that trigger you to smoke. Then come up with a list of things you can do to deal with your smoking triggers. Ask friends who have quit smoking for advice.

  • How will I handle withdrawal? You may want to consider nicotine-replacement therapy. Nicotine medicines contain smaller, safer amounts of nicotine and none of the other harmful chemicals found in cigarettes. Talk with your healthcare provider about what medicine may be right for you.

  • Do I have a plan for lapses? It’s common for many people to relapse, particularly during the first 3 months after quitting smoking. Before you quit, make a plan to handle lapses, including seeking support from friends, family and healthcare providers.

No matter how long you’ve been smoking, you can quit for good.

Learn more at BeTobaccoFree.gov or Smokefree.gov.

Watch That Backpack Load

Most children rely on backpacks to carry books and supplies to and from school and activities. But a backpack that’s too heavy or doesn’t fit right can cause harm.

Children can hurt themselves by using poor posture to carry a heavy bag. They may arch their back, bend forward, twist, or lean to one side. These positions can change the spine’s alignment so its discs can’t absorb shock as they should. It can injure muscles and joints in the back, neck, and shoulders. It can cause problems with posture. Rarely, it may cause nerve damage.

Choosing the right backpack

Pick a backpack for your children that has the following traits:

  • Lightweight, but strong

  • 2 wide, padded shoulder straps (not just 1 strap)

  • A padded back to protect against sharp objects inside the bag

  • A waist strap to help keep the bag stable

Rolling backpacks

A rolling backpack can be useful if your child needs to carry heavy items. But a rolling pack can be hard to carry upstairs. It may be hard to roll over bumpy ground or in snow. Think about how your child will need to use the bag. In some cases, it may not be the best choice.

Wearing a backpack safely

Talk with your children about how to safely use a backpack. Help them adjust it. Teach them to:

  • Pack light. The backpack should be at a comfortable weight. Weigh it on a scale. When full, it shouldn’t be more than 10% to 20% of your child’s body weight.

  • Only carry what’s needed. Make sure your children know not to carry a whole day’s worth of books and supplies at once. Tell them to make trips to their locker during the day.

  • Use care when putting on and taking off their backpacks. Children should avoid twisting too much. When picking up a heavy backpack, bend with both knees—not at the waist.

  • Use both straps on both shoulders. This will help spread the weight and promote good posture. Tell your children not to sling both straps over 1 shoulder. This makes posture off-balance. 

  • Place the backpack evenly in the middle of the back. The backpack should sit about 2 inches above the waist. This will help prevent awkward postures.

  • Organize the backpack well.P Place the heavy items low towards the center of the backpack.

  • Tighten and loosen the straps as needed. The straps should be snug while wearing the pack. This helps hold the pack firmly to the body. Tell your children to loosen the straps before removing the pack. This makes it easier to take off.

If your child has pain

Talk with your child about any discomfort from the backpack. Watch your child put on and take off the backpack. If your child has pain or numbness in the arm or legs from the bag, talk with the school about ways to lighten the load. Make sure the school allows trips to lockers as needed. If the pain continues, talk with your child’s healthcare provider.

SEEKING HELP FOR BACK PAIN

  • Chiropractic Medicine
  • Acupuncture
  • Chronic Pain

Chiropractic Medicine

Chiropractic medicine focuses on the link between the body's structure and function. A key part of chiropractic medicine is the belief that the body can heal itself with the right support.

Chiropractic medicine believes a person's health can be improved through hands-on treatments (called adjustments or manipulations) and tools. These are used to create better structure and alignment. Providers find structural and functional problems by doing a physical exam and taking X-rays. They may also do lab tests and other testing. Some chiropractors offer nutritional advice and do complementary medicine. They also often advise exercises to do at home.

Chiropractic treatments may help ease lower back pain, muscle pain, and other bone pain. During treatment, you may lie down on a special table. The provider then uses their hands and elbows to realign your spine.

Chiropractors have different training than licensed medical doctors. It's extensive and highly focused on the correct structure of the body. A Doctor of Chiropractic (DC) has had at least 3 years of college. There is a focus on biology or basic sciences. They also have at least 4 years of training at an accredited chiropractic college that includes classroom, lab, and clinical courses. To practice, they must also pass a comprehensive licensing exam. Many states require yearly continuing education credits to keep the license.

When considering chiropractic treatment:

  • Ask if chiropractic treatment could help your condition.

  • Ask how long treatments may take and how many treatments you may need.

  • Check your insurance coverage.

  • Find out if there are out-of-pocket costs.

  • As with any healthcare treatment, discuss the risks and benefits of the treatment with the chiropractor.

Tell the chiropractor about any medicines you take. If any vitamins or supplements are advised, ask about possible interactions with the medicines or supplements you are now taking.

Tell all of your healthcare providers (conventional or complementary) about the health approaches, supplements, and medicines you use. This will give them a full picture of your health. It will help ensure safe, effective, and coordinated care.

Acupuncture

What is acupuncture?

Acupuncture is the practice of putting thin needles into the skin on certain parts of the body. These are then activated by gentle and specific movements of the provider's hands. Or through electrical stimulation. 

Acupuncture is part of the ancient practice of Traditional Chinese medicine (TCM). TCM providers believe the human body has more than 2,000 acupuncture points. The points are linked by pathways called meridians. Meridians create an energy flow called Qi (pronounced "chee") all over the body. Qi is responsible for overall health. Disrupting the energy flow can cause disease. Using acupuncture on certain points is believed to improve the flow of blocked or nonmoving Qi. This restores energy movement and improves health.

Studies have shown that acupuncture works well for many conditions that are discussed below

Acupuncture is not for everyone. If you choose to see an acupuncturist, talk with your healthcare provider first. Find an acupuncturist who is licensed and has the right training and credentials.

What does acupuncture feel like?

Acupuncture is done using hair-thin needles. Most people report feeling little pain as the needle is put into certain points. Needles are only inserted to a point that gives a feeling of pressure or ache. Needles may be heated during the treatment. Mild electric current may also be applied to the needles. Some people say acupuncture makes them feel energized. Others say they feel relaxed.

Needles must be sterilized to prevent infection. And incorrect needle placement can cause pain during treatment. So it's important to find an experienced, well-trained provider who uses sterilized needles. The FDA regulates acupuncture needles just as it does other medical devices.

Sometimes other forms of stimulation are used over the acupuncture points instead of needles. These include:

  • Heat (moxibustion)

  • Pressure (acupressure)

  • Friction

  • Suction (cupping)

  • Electromagnetic energy impulses

How does acupuncture affect the body?

Acupuncture points are believed to stimulate the central nervous system. This releases chemicals into the muscles, spinal cord, and brain. These biochemical changes may stimulate the body's natural healing abilities. They may promote physical and emotional well-being.

Studies have shown that acupuncture is effective alone or used with conventional therapies to treat these conditions:

  • Upset stomach (nausea) caused by surgical anesthesia and cancer chemotherapy

  • Dental pain after surgery

  • Addiction

  • Headaches

  • Menstrual cramps

  • Tennis elbow

  • Fibromyalgia

  • Myofascial pain

  • Osteoarthritis

  • Low back pain

  • Carpal tunnel syndrome

  • Asthma

It may also help with stroke rehabilitation.

What conditions may be helped by acupuncture?

Many people in the U.S. get acupuncture treatment to ease long-term (chronic) pain. This includes arthritis and low back pain. But acupuncture has other uses around the world. Before getting acupuncture, talk with your healthcare provider. Conditions that may be helped by acupuncture include:

Digestive

Emotional

Gastritis

Irritable bowel syndrome

Hepatitis

Hemorrhoids

Anxiety

Depression

Insomnia

Nervousness

Neurosis

Eye-Ear-Throat

Gynecological

Rhinitis

Sinusitis

Sore throat

Menstrual pain

Infertility

Musculoskeletal

Neurological

Arthritis

Back pain

Muscle cramping

Muscle pain and weakness

Neck pain

Sciatica

Headaches

Migraines

Neurogenic bladder dysfunction

Parkinson's disease

Postoperative pain

Stroke

Respiratory

Miscellaneous

Allergic rhinitis

Sinusitis

Bronchitis

Irritable bladder

Prostatitis

Male infertility

Some forms of impotence

Addiction

Things to think about when choosing acupuncture

Scientific studies have not fully explained how acupuncture works in the framework of Western medicine. So acupuncture is still disputed. It's important to be safe when deciding about acupuncture.

  • Talk about acupuncture with your healthcare provider first. Acupuncture is not for everyone. Talk about all the treatments and medicines you are taking. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. If you have a pacemaker, are at risk for infection, have chronic skin problems, are pregnant, or have breast or other implants, tell your provider. Acupuncture may be risky to your health if you don't talk about these things.

  • Don't rely on a diagnosis of disease by an acupuncture provider. If you were given a diagnosis by a healthcare provider, ask him or her if acupuncture might help.

  • Choose a licensed acupuncture provider. Talk with your healthcare provider, friends, and family members. They may be able to refer you to a licensed or certified provider. You don't have to be a doctor to practice acupuncture or be a certified acupuncturist. About 30 states have set training standards for certification in acupuncture. But not all states require acupuncturists to get a license to practice. Not all certified acupuncturists are doctors. But the American Academy of Medical Acupuncture can give you a list of doctors who do acupuncture.

  • Think about costs and insurance coverage. Before starting treatment, ask the acupuncturist about the number of treatments needed. Find out how much they will cost. Some insurers cover the cost. But others don't. It's important to know before you start treatment if it is covered by your insurance.

Chronic Pain

What is pain?

Pain starts in receptor nerve cells found beneath the skin and in organs throughout the body. When you are sick, injured, or have other type of problems, these receptor cells send messages along nerve pathways to the spinal cord, which then carries the messages to the brain. Pain medicine may be needed to reduce or block these messages before they reach the brain.

Pain can be anything from slightly bothersome, such as a mild headache, to something excruciating and emergent, such as the chest pain that comes with a heart attack or the pain of kidney stones. 

What are the different types of pain?

Two major types of pain include the following:

  • Acute pain. This pain may come from inflammation, tissue damage, injury, illness, or recent surgery. It usually lasts less than a week or two. The pain usually ends after the underlying cause is treated or has been resolved.

  • Chronic pain. This is pain that lasts for months or even years.

What is chronic pain?

Chronic pain is long standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition, such as arthritis. Chronic pain may be “on” and “off” or continuous. It may affect people to the point that they can’t work, eat properly, take part in physical activity, or enjoy life.

Chronic pain is a major medical condition that can and should be treated.

Chronic pain is one of the most costly health problems in U.S. Increased medical expenses, lost income, lost productivity, compensation payments, and legal charges are some of the economic consequences of chronic pain. Consider the following:

  • Low back pain is one of the most significant health problems. Back pain is a common cause of activity limitation in adults.

  • Cancer pain affects most people with advanced cancer.

  • Arthritis pain affects more than 50 million Americans each year.

  • Headaches affect millions of U.S. adults. Some of the most common types of chronic headaches are migraines, cluster headaches, and tension headaches.

  • Other pain disorders such as the neuralgias and neuropathies that affect nerves throughout the body, pain due to central nervous system damage (to the brain and spinal cord), as well as pain where no physical cause can be found (psychogenic pain) increase the total number of reported cases.

What causes chronic pain?

There are many causes of chronic pain. It may start from an illness or injury, but remain long after recovery from other symptoms. Or there may be an ongoing cause of pain, such as arthritis or cancer. Many people suffer chronic pain in the absence of any past injury or evidence of illness.

What is the effect of chronic pain?

When pain becomes such a problem that it interferes with your life’s work and normal activities, you may become preoccupied with the pain, and feel depressed and irritable. Depression and irritability often lead to insomnia and weariness, leading to more irritability, depression, and pain. This state, in turn, can lead to suffering, sleeplessness, and sadness. The urge to stop the pain can lead some people to use multiple drugs and may drive others to have repeated surgeries, or resort to questionable treatments. The situation can often be as hard on the family as it is on the person suffering with the pain.

How is chronic pain treated?

Chronic pain affects all parts of your life. The most effective treatment includes symptom relief and support. A multidisciplinary approach to pain management is often required to provide the needed interventions to help manage the pain. Pain management programs are usually done on an outpatient basis. Many skilled professionals are part of the pain management rehabilitation team, including:

  • Neurologists and neurosurgeons

  • Primary care providers

  • Orthopedists and orthopedic surgeons

  • Anesthesiologists

  • Oncologists

  • Physiatrists

  • Nurses

  • Physical therapists

  • Occupational therapists

  • Psychologists/psychiatrists

  • Social workers

  • Case managers

  • Vocational counselors

Special pain programs are located in many hospitals, rehab facilities, and pain clinics.

The pain management rehab program

A pain management rehabilitation program is designed to meet your needs. The program will depend on the specific type of pain, disease, or condition. Active involvement by you and your family is vital to the success of the program.

The goal of a pain management program is to help you return to the highest level of function and independence possible, while improving your overall quality of life—physically, emotionally, and socially. Pain management techniques help reduce your suffering.

To help reach these goals, pain management programs may include:

  • Medical management of chronic pain, including medicine management:

    • Over-the-counter (OTC) medicines may include nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or acetaminophen.

    • Prescription pain medicines, including opioids, may be needed to provide stronger pain relief. However, these drugs are reserved for more severe types of pain, as they have some potential for abuse. They may also have unpleasant and potentially dangerous side effects.

    • Prescription antidepressants can help some people. These medicines increase the supply of the naturally produced neurotransmitters, serotonin and norepinephrine. Serotonin is an important part of a pain-controlling pathway in the brain.

    • Adjuvant medicines may be advised to help control the side effects or to help increase the pain-relieving effects of pain medicines.

  • Heat and cold treatments to reduce stiffness and pain, especially with joint problems such as arthritis

  • Physical and occupational therapy such as massage and whirlpool treatments

  • Exercise to prevent further problems and reduce spasticity, joint contractures, joint inflammation, spinal alignment problems, or muscle weakening and shrinking

  • Local electrical stimulation involving application(s) of brief pulses of electricity to nerve endings under the skin to provide pain relief

  • Injection therapies, such as epidural steroid injection

  • Emotional and psychological support, which may include:

    • Psychotherapy and group therapy

    • Stress management

    • Relaxation training

    • Meditation

    • Hypnosis

    • Biofeedback

    • Behavior changes

The philosophy common to all of the psychological approaches to pain management is the belief that you can do things on your own to control pain. This includes changing your attitudes, your perception of being a victim, your feelings, or your behaviors associated with pain. It also may include understanding how unconscious forces and past events have contributed to your pain. These goals may be accomplished with:

  • Patient and family education and counseling

  • Alternative medicine and therapy treatments, as appropriate

In addition, treatment may include the following:

  • Surgery may be considered. But although surgery can bring release from pain, it may also destroy other sensations or become the source of new pain. Relief is not necessarily permanent and pain may return. There are a variety of operations to relieve pain. Consult your doctor or more information.

  • Acupuncture, a 2,000-year-old Chinese technique of inserting fine needles under the skin at selected points in the body, has shown some promise in the treatment of chronic pain. Needles are manipulated by the practitioner to produce pain relief.

BACK PAIN AND PREGNANCY

  • Back Pain in Pregnancy
  • Exercise During Pregnancy
  • Work and Pregnancy

Back Pain in Pregnancy

Why is back pain so common in pregnancy?

One of the most common complaints during pregnancy is back pain. In fact, it's estimated that more than half of all pregnant women have some degree of back discomfort. Most back pain is related to the physical changes that happen during pregnancy, including hormones, changes in the center of gravity, and posture. Unfortunately, it typically gets worse as pregnancy progresses.

What causes back pain during pregnancy?

Throughout pregnancy, hormones affect a woman's muscles and joints. The hormones relaxin and progesterone relax muscles and loosen ligaments and joints, especially in the pelvic area. The extra weight and body changes in pregnancy along with these loosened joints and ligaments can cause discomfort and even lead to injury. 

As your uterus grows and becomes heavier, your center of gravity changes. This can lead to problems with balance and the potential for falls. The weight of your baby and weakening of belly muscles pulls your lower spine forward, adding strain to back muscles. Many women respond by leaning back in an awkward posture. This increases back strain and pain.  

What can you do?

Some back pain can be prevented: 

  • Try using correct body mechanics. For example, if you need to pick something up, squat down, bending at your knees and keeping your back straight. Try not to bend over from your waist. 

  • Use good posture when sitting or standing and do back-strengthening exercises. Ask your healthcare provider about back exercises that are right for you.

  • Don't do activities that strain the back, like lifting and moving heavy objects.   

  • Wear shoes that provide good support.

  • Sleep on your side with pillows between your knees for support.

  • Apply heat, cold, or massage to the painful area.

  • If you are having discomfort, talk with your healthcare provider. Back pain relief may need rest, supportive garments, or other types of treatment.

Prevention and treatment of back pain are important to avoid injury and to decrease the chance for long-term or chronic back pain. Because back pain in pregnancy can be a symptom of more serious problems, like preterm labor, always talk with your healthcare provider if symptoms are severe or last longer than 2 weeks. 

Exercise During Pregnancy

Getting regular exercise during pregnancy can often help reduce any physical discomforts. It can also help with recovery after your baby is born. But talk with your  healthcare provider or midwife before starting an exercise program.

Physical activity may be especially good for women with gestational diabetes. The American College of Obstetricians and Gynecologists says that women who exercise and are physically fit before pregnancy can safely continue exercising throughout the pregnancy. Women who weren't active before pregnancy or who have health or pregnancy complications should talk with their healthcare provider or midwife before starting any exercise during pregnancy.

Two mothers walking with jogging strollers

All women should be assessed by their healthcare provider or midwife before starting or continuing an exercise program in pregnancy.

Exercise may not be safe if you have any of these conditions:

  • Preterm labor in current or past pregnancies

  • Vaginal bleeding

  • Cervical problems

  • Leaking of amniotic fluid

  • Shortness of breath

  • Dizziness or fainting

  • Decreased fetal activity or other complications

  • Increased heart rate (tachycardia), although heart rate is often higher in pregnant women 

  • Certain health problems such as high blood pressure or heart disease

Don't do these types of exercise during pregnancy

Here are some exercises you should not do while pregnant:

  • Horseback riding

  • Water skiing

  • Scuba diving

  • High-altitude skiing

  • Contact sports

  • Any exercise that can cause a serious fall

  • Exercising on your back after the first trimester. This is because of reduced blood flow to the uterus.

  • Vigorous exercise in hot, humid weather. Pregnant women are less able to get rid of extra heat.

  • Exercise that makes you hold your breath. This can cause more pressure in your abdomen.

Work and Pregnancy

Congratulations on your pregnancy! If you work, you might be wondering if you can continue working throughout your pregnancy. Many women do so without any problems. Pregnancy causes many changes in your body. Your ability to keep working depends on your overall health, your unborn baby's health, and what sort of work you do. Many jobs are safe to continue through pregnancy. Other jobs may be OK at the beginning of pregnancy. But later in pregnancy, some duties may need to be changed or stopped. Sometimes your schedule or hours may need to be changed. If you keep working, the goal is to stay safe and comfortable.

Desk jobs

Most desk and computer jobs are safe during pregnancy. But because of fluid buildup during pregnancy, some women develop carpal tunnel syndrome. This can make keyboard work difficult. As your body and posture change, back, neck, and shoulder strain may also become an issue if you sit all day. If you are pregnant and work at a desk or on a computer, these tips may help:

  • Take frequent breaks. Get up and walk around to improve blood flow and reduce swelling.

  • Use a pillow or cushion for lower back support.

  • Use correct hand and arm positions when using a computer. Use a wrist rest if you use a keyboard and mouse.

  • Use a phone headset to ease neck and shoulder strain.

  • Don’t cross your legs or feet.

Standing work

Jobs that require standing for long periods can be hard on the pregnant body, causing back and leg pain. This is especially true late in pregnancy. Standing for long periods can also reduce blood flow to the baby, and may slow the baby’s growth. If you have to stand, try these tips:

  • Prop one foot on a short stool or box to help ease back pain.

  • Ask if you can sit on a tall stool rather than stand. 

  • Take breaks often. Sit down with your feet up if possible.

  • Wear good, comfortable, well-fitted and low-heeled shoes.

Heavy labor jobs

If you have a job that often requires heavy lifting, pulling, pushing, or other physical labor, talk with your healthcare provider about if it is safe to continue. Pregnancy symptoms, such as dizziness and extreme tiredness, can make some physical jobs dangerous. As your center of gravity changes, your sense of balance may suffer, making you more likely to fall. 

Environmental risks

If you work with chemicals, radiation, heavy metals, gases, or biological agents (virus, bacteria, fungus, or parasites) you may need to take extra safety measures during pregnancy. Some hazardous agents get into the mother’s blood and can pass to the fetus. Others can affect the mother’s health or harm the fetus directly. Talk with your healthcare provider about any specific concerns you may have. Ask if you should wear protective clothing. Always follow all safety procedures.

If you work in a very hot or cold environment, or are exposed to loud noise, you may need to adjust your work tasks to avoid these extremes.

Work-related travel

If your job requires travel, try to schedule it during the middle of your pregnancy (between 14 and 28 weeks). This is the safest time for travel and a time when early pregnancy symptoms have hopefully faded, but you are not yet too big and uncomfortable. Air travel is not advised after 36 weeks of pregnancy.  When traveling by air, consider these tips:

  • Try to book an aisle seat so you can get up and walk around and have easier access the bathroom.

  • Wear your seatbelt below your belly, across the hipbones.

  • Eat smaller meals.

  • If you are traveling out of the country, make sure you are up to date on the necessary vaccines. Don't travel to areas where there is a risk for malaria or a Zika outbreak.

When traveling by car, limit driving time to no more than 5 or 6 hours. Stop often to stretch your legs. Always wear your seat belt.

Talk with your healthcare provider if you have any questions or concerns about working while you are pregnant.