INJURY AND BACK PAIN

Management of Back Pain

There can be many causes of back pain including accidents, strains, and injuries. Two types of back injury are spondylolisthesis and cervical radiculopathy. Both have their own set of symptoms, causes, and treatments.

The spine, or backbone, is made up of a column of 33 bones and tissue extending from the skull to the pelvis. These bones, or vertebrae, enclose and protect a cylinder of nerve tissues known as the spinal cord. Between each one of the vertebra is an intervertebral disk, or band of cartilage serving as a shock absorber between the vertebrae. The types of vertebrae are:

• Cervical vertebrae: the seven vertebrae forming the upper part of the spine
• Thoracic vertebrae: the 12 bones between the neck and the lower back
• Lumbar vertebrae: the five largest and strongest vertebrae located in the lower back between the chest and hips
• The sacrum and coccyx are the bones at the base of the spine. The sacrum is made up of five vertebrae fused together, while the coccyx (tailbone) is formed from four fused vertebrae.

What Causes Back Pain?

The causes of back pain can be complex. Some causes of back pain include accidents, muscle strains, and sports injuries.

How Is Back Pain Diagnosed?

In addition to performing a complete history and physical exam for your back pain, your doctor may suggest one of the following diagnostic studies:

• X-rays, which can be used to provide detail of the bone structures in the spine and to check for instability (such as spondylolisthesis, see below), tumors, andfractures.
• CT scans, which can identify specific conditions, such as a herniated disc or spinal stenosis.
• MRI scans, which can provide details about the backs' discs and nerve roots. MRI scans are most commonly used for pre-surgical planning.
• CT scans, which can identify specific conditions, such as a herniated disc or spinal stenosis.

A number of other imaging and electrical studies may also be used to identify back problems, and some injections are used for diagnostic purposes as well as for pain relief.

Types of Back Injury

Two main types of back injury include:

• Spondylolisthesis: This is a slipping of vertebra that occurs, in most cases, at the base of the spine. Spondylolysis, which is a defect or fracture of one or both wing-shaped parts of a vertebra, can result in vertebrae slipping backward, forward, or over a bone below.
• Cervical Radiculopathy: Cervical radiculopathy is the damage or disturbance of nerve function that results if one of the nerve roots near the cervical vertebrae is compressed. Damage to nerve roots in the cervical area can cause pain and the loss of sensation in various upper extremities, depending on where the damaged roots are located.

Causes of Spondylolithesis

There are many causes for spondylolithesis. A vertebra might be defective from the time a person is born, or a vertebra may be broken by trauma or a stress fracture. In addition, vertebrae can be broken down by infection or disease. Most commonly, this disorder occurs in children and adolescents who are active in sports.

Symptoms of Spondylolithesis

Symptoms of spondylolithesis include:

• Lower back pain
• Muscle tightness and stiffness
• Pain in the buttocks
• Pain radiating down the legs (due to pressure on nerve roots)

Spondylolithesis Treatments

Spondylolisthesis is treated with the strengthening of supportive abdominal and back muscles through physical therapy. For patients who continue to have severe pain and disability after physical therapy, there is the option of surgical fusion (arthrodesis) of the vertebra to the bone below.

Causes of Cervical Radiculopathy

In cervical radiculopathy, damage can occur as a result of pressure from material from a ruptured disc, degenerative changes in bones, arthritis, or other injuries that put pressure on the nerve roots. In older people, normal degenerative changes in the discs can cause pressure on nerve roots. In younger people, cervical radiculopathy tends to be the result of a ruptured disc. This disc material then compresses the nerve root, causing pain.

Symptoms of Cervical Radiculopathy

The main symptom of cervical radiculopathy is pain that spreads into the arm, neck, chest, and/or shoulders. A person with radiculopathy may experience muscle weakness and/or numbness or tingling in fingers or hands. Other symptoms may include lack of coordination, especially in the hands.

Cervical Radiculopathy Treatment

Cervical radiculopathy may be treated with a combination of pain medications such as corticosteroids (powerful anti-inflammatory drugs) or non-steroidal pain medication (Motrin or Aleve) and physical therapy. Steroids may be prescribed either orally or injected epidurally (into the dura, which is the membrane that surrounds the spinal cord). 

Physical therapy might include gentle cervical traction and mobilization, exercises, and other modalities to reduce pain.

If significant compression on the nerve exists to the extent that motor weakness results, surgery may be necessary to relieve the pressure.

Can You Prevent Back Pain?

Prevention

The prevention of back pain is, itself, somewhat controversial. It has long been thought that exercise and an all-around healthy lifestyle would prevent back pain. This is not necessarily true. In fact, several studies have found that the wrong type of exercise such as high-impact activities may increase the chance of suffering back pain. Nonetheless, exercise is important for overall health and should not be avoided. Low-impact activities such as swimming, walking, and bicycling can increase overall fitness without straining the low back.

 prone to injury or strain.
• Specific exercises: Talk to your doctor about how to perform these exercises.
  
  
  • Abdominal crunches, when performed properly, strengthen abdominal muscles and may decrease tendency to suffer back pain.
    
    
  • Although not useful to treat back pain, stretching exercises are helpful in alleviating tight back muscles.
    
    
  • The pelvic tilt also helps alleviate tight back muscles.
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• Lumbar support belts: Workers who frequently perform heavy lifting are often required to wear these belts. There is no proof that these belts prevent back injury. One study even indicated that these belts increased the likelihood of injury.
  
  
• Standing: While standing, keep your head up and stomach pulled in. If you are required to stand for long periods of time, you should have a small stool on which to rest one foot at a time. Do not wear high heels.
  
  
• Sitting: Chairs of appropriate height for the task at hand with good lumbar support are preferable. To avoid putting stress on the back, chairs should swivel. Automobile seats should also have adequate low-back support. If not, a small pillow or rolled towel behind the lumbar area will provide adequate support.
  
  
• Sleeping: Individual tastes vary. If the mattress is too soft, many people will experience backaches. The same is true for sleeping on a hard mattress. Trial and error may be required. A piece of plywood between the box spring and mattress will stiffen a soft bed. A thick mattress pad will help soften a mattress that is too hard.
  
  
• Lifting: Don't lift objects that are too heavy for you. If you attempt to lift something, keep your back straight up and down, head up, and lift with your knees. Keep the object close to you, don't stoop over to lift. Tighten your stomach muscles to Most low back pain is caused by a combination of overuse, muscular strain, and some form of injury to the muscles, ligaments, and discs that support the spine.  Muscle strain over time, according to some experts, can result in an overall imbalance in the spinal structure, creating a constant tension on the muscles, ligaments, and discs, creating a situation where the back is more
  The most common causes of lower back pain are:
  Overuse or injury of muscles, ligaments, and joints.
  Pressure on the nerve roots in the spinal canal from herniated discs, joint degeneration ( osteoarthritis),  or vertebral defects (Spondylolysis)
  Spinal stenosis, or a narrowing of the spinal canal.  This usually develops with age.
  Fractures of the vertebrae caused by significant force such as an auto accident, a direct impact to the spine, or compression of the spine by falling on the buttocks or head.
  Scoliosis or other spinal deformities may also be a culprit in lower back pain.
  While there is no clear evidence that low back pain can be prevented, you can take steps to minimize its effect on you and your life.  Exercise to keep your back healthy and strong.  Learn how to lift heavy objects correctly, without undue stress on your back.  Try to work on maintaining good posture at all times, whether standing, sitting, or sleeping.
  You should also maintain a healthy weight, and if you are a smoker, quit now, as smoking increases the chance for bone loss (Osteoporosis) as well as your sensitivity to pain.
  A healthy diet and good stress management never hurts either.
  For proper back pain treatment, contact a local back pain specialist.  They can treat and manage your pain and have you enjoying life to the fullest again in no time.
  keep your back in balance.

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Back and neck injuries are often referred to as "soft tissue injuries." Insurance companies in particular like to refer to neck and back injuries as such so that they canundervalue the victims' injury claims and undermine the injured person, so that the victims simply 'need to go on' with their lives.

The severity of back and neck injuries are difficult to evaluate without an MRI (magnetic resonance imaging). It is unusual for medical providers to authorize this treatment because of cost, as well as if the MRI shows the victim has a small fracture, a bulging disc, orherniated disc; the insurance company will probably have to pay more money.

If you, as an injured person has a herniated disc, a small fracture or a bulging disc, you may not be able to resume a normal lifestyle. You may also suffer chronic pain. An injured worker with a neck or back injury also may not be able to continue as before at a manual labor job or even sitting in a chair in an office of eight-hour days.

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