Neck and Back Pain
The most common causes of neck and back pain are muscle, ligament, and nerve abnormalities due to injury or prolonged wear and tear. Pain may also be caused by cumulative strain to an area due to faulty posture, poor habits or improper use.
The most important part of the healing process is determining exactly where the source of the pain is. The NeuroCenter has developed an individualized approach for treating pain. First, a comprehensive examination is used to reach an understanding of the neurophysiology of the patient’s movements and posture. This information is then utilized to diagnose and create a therapeutic program designed to best meet the specific needs of the individual patient.
Diagnostic testing, including an electromyogram (EMG)is performed to evaluate nerve and muscle function. This test is performed at our facility. Treatment of your pain depends on your diagnosis. Most patients are treated successfully with rest, medication, immobilization, physical therapy, exercise, activity modification or a combination of these methods. Treatment may involve both medication and physical therapy. At times the use of conservative surgical interventions, such as injections and nerve blocks, may be needed.
Our team works together to eliminate the pain as quickly as possible. We understand that persistent pain can cause anxiety, depression, hostility, irritability, fatigue, social withdrawal, and loss of productivity.
Some common neck and back disorders include:
Neck strain is caused by overuse of the neck muscles and ligaments or an acute event that causes trauma to the neck muscles and ligaments. An example of neck strain caused by overuse is individuals whose employment requires extended periods of neck flexion, such as one who works on an assembly line, using an airgun for a large part of the day or office personnel who may strain their neck to see the computer screen better. An example of an acute event causing a neck strain is a whiplash injury in which the neck is forcefully bent backward then forward then back again during an automobile accident. In the event of an acute, traumatic event causing neck pain, a fracture or dislocation needs to be ruled out immediately by neck x-rays and other studies as needed.
"Whiplash" is a non-medical term to describe hyperextension injury to the neck resulting from an indirect force, usually a rear-end automobile collision. The injury is usually sustained by the driver or passenger of a stationary car that is hit from behind by a fast-moving vehicle. Because the victim is completely relaxed and unaware of an impending collision, the sudden acceleration of the struck vehicle throws his head backward, causing violent hyperextension of the neck. This is followed by a recoil, projecting the head forward into extreme flexion, and finally by a return to the neutral position. Damage to the structures of the neck occurs when the head is thrown back and the neck hyper-extends. The neck muscles may be severely stretched, and some of the fibers torn. The movement of the neck is limited by the chin striking the chest or the steering wheel of the car that prevents more severe spinal injuries.
Immediately after a whiplash accident, the victim is often unaware that he has been injured. He experiences only slight discomfort and stiffness in his neck. The next day, about 12 to 24 hours after the accident, he realizes something is wrong. Injury at the base of the neck increases in severity and is aggravated by neck movements, which become restricted.
Radiculopathy is pain that is caused by damage to the origin of a nerve in the spine (nerve root). The pain is usually severe in the spine and often extends to the entire length of the nerve. If the nerve originates in the cervical spine, the pain spreads to either of the upper extremities or both. The patient will experience weakness, numbness or tingling in the shoulder, arms, or hands. This is called cervical radiculopathy. Sometimes when the nerve roots in the upper part of the cervical spine are affected, the pain extends to the back of the head or behind the ears. This upper cervical radiculopathy can cause sharp intermittent pain that is called occipital neuralgia or a constant pain that is referred to as cervicogenic headaches.
If the origin of the nerve is the upper or middle back (thoracic spine), then the pain may extend around the chest, like a brazier or around the belly, like a belt. The pain could be located on one side or both. This condition is called thoracic radiculopathy In the lower back (lumbosacral spine), the pain may radiate to either or both gluteal areas and lower extremities. This is called a lumbosacral radiculopathy and is commonly referred to as sciatica once it reaches the legs. Sciatica is characterized by pain in the lower back and gluteal region radiating down one or both legs into the thigh, calf, ankle and foot. Genuine sciatica occurs when pain travels below the knee.
Sciatic pain results when the base of the spine is compressed or when injury or pressure have compressed the spinal roots of the sciatic nerve. The sciatic nerve systems are located in the lumbar and the sacral regions of the spine. Sciatic pain can be described as sharp, dull, burning, tingly, numb, continuous or intermittent and usually only affects one side of the body. It can radiate the entire length of the nerve, in some cases all the way down to the toes.
The usual causes of radiculopathy are disc herniation or spondylosis (osteoarthritis of the spine).
Spondylosis is arthritis of the spine. The condition is caused by the discs between the vertebral bodies losing water. Consequences include losing height and stability and degeneration of the small joints that connect the posterior part of the vertebra with the vertebra above or below. Very small movements occurring in this abnormal disc spaces cause excess bone and soft tissue to form, in its attempt to create stability. Nerve roots exit at each level of disk space and provide sensation and strength in the shoulders, elbows, and hands in the upper extremities and gluteal areas, thighs, legs, and feet in the lower extremities. Therefore, if the excess soft tissue is pinching the nerve roots, the patients can sense a combination of pain, numbness, and weakness in the arms following the specific distribution of the nerve root being pinched. This can also be called radiculopathy.
Back strain presents itself as your basic back pain that does not shoot into the legs. It is usually dull and can be felt in a variety of positions. Pain can also be felt into the posterior thigh and buttocks. Examination of the strained area may reveal muscle spasm and a limited range of motion. The painful area may be tender to touch and is usually not located directly in the midline of the back.
Stenosis means narrowing. In spinal stenosis, the spinal canal, which contains and protects the spinal cord and nerve roots, narrows and pinches the spinal cord and nerves. The result is low back pain as well as pain in the legs. Stenosis may pinch the nerves that control muscle power and sensation in the legs. Spinal stenosis may appear as you age or simply may have inherited it. It may also be caused by changes in blood flow to the lower back or lumbosacral spine. Patients with this condition experience pain and difficulties when walking. You may also experience numbness, tingling, and weakness in the legs.
Lumbar Disc Herniation
A common cause of low back and leg pain is a herniated or ruptured disc. Symptoms may include dull or sharp pain, muscle spasm or cramping, sciatica, and leg weakness or loss of leg function. Sneezing, coughing, or bending usually intensifies the pain.
Sciatica is a symptom frequently associated with a lumbar herniated disc. Pressure on one or several nerves that contribute to the sciatic nerve can cause pain, burning, tingling, and numbness that extends from the buttock into the leg and sometimes into the foot. Usually one side (left or right) is affected.
Nerve roots exit the spinal canal through small passageways between the vertebrae and discs. Pain and other symptoms can develop when the damaged disc pushes into the spinal canal or nerve roots. The disc may degenerate inside and lose its water content. This disc is prone to being compressed like a sandwich between two vertebrae causing an expansion of the entire disc (bulging disc) or may expand more into the local area of the annulus fibrosis causing a "nose-like" extension of the disc (disc protrusion). Finally, a disc herniation occurs when the annulus fibrous breaks open or cracks, allowing the nucleus pulposus to escape.
To read a brief example of what a treatment program will be like, please read the following CASE STUDY.
Sacroiliac Joint Dysfunction
Dysfunction in the sacroiliac joint, or SI joint, is thought to cause low back and/or leg pain. The leg pain can be particularly difficult, and may feel similar to sciatica or pain caused by a lumbar disc herniation.
The sacroiliac joint lies next to the bottom of the spine – below the lumbar spine and above the tailbone (coccyx). It connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest). The joint typically has the following characteristics:Small and very strong, reinforced by strong ligaments that surround it Does not have much motion Transmits all the forces of the upper body to the pelvis (hips) and legs Acts as a shock-absorbing structure
While it is not clear how the pain is caused, it is thought that an alteration in the normal joint motion may be the culprit that causes sacroiliac pain. This source of pain can be caused by either too much movement or too little movement. When it is due to too much movement or hypermobility or instability, the pain is typically felt in the lower back and/or hip and may radiate into groin area. When the pain is due to too little movement, or hypomobility or fixation, the pain is typically felt on one side of the low back or buttocks, and can radiate down the leg. The pain usually remains above the knee, but at times pain can extend to the ankle or foot. The pain is similar to sciatica, or pain that radiates down the sciatic nerve and is caused by a radiculopathy.
This condition can be treated with oral anti-inflammatory medications NSAIDs, ibuprofen [Motrin], naproxen [Naprosyn]) are often effective in pain relief as well. These can be taken long term if the patient does not have any other medical problems that prevent them from taking these medications. Oral steroids (Prednisone) are provided for short periods of time in some cases, as well to treat the inflammation.
In addition injections an SI joint injection can provide both diagnosis and treatment. Click here to read more about the SACROILIAC JOINT STEROID INJECTION.