LOW BACK PAIN

1. LOW BACK PAIN Unfortunatelly pain in the low back is perceived as something trivial and can be mistakenly dismissed as a self limiting conditions by patients and doctors alike. LOW BACK PAIN (LBP) is a pain felt in the lower area of the spine. The pain in the lumbar spine can have multiple anatomical location. Pain from hip or pelvis as well is from thoracic spine can project to the area of lumbar vertebrae and is perceived as pain in the low back. SYMPTOMS Symptoms will be dependent on which structures are irritated. Usually pain in the low back which changes location is functional in origin. Low back pain with radiation into the leg, burning sensation ,numbness and tingling should always be taken very seriously and requires immediate medical attention. CAUSES Low back pain can be caused by structural pathology such as: herniated or protruded disc, arthritis of the lumbar joints. It can also be caused by pinched nerve within or around the structures of spinal canal or spinal foramens. It could also be functional such as muscular or ligsmentous pain. - poor posture - developmental aberrations - muscular or ligamentous strain - poor motor control of the lumbar spine - poor function of the lumbopelvic-hip complex

2. - trauma - bulging or herniated disc - sacroiliac joint restriction or hypermobility - poor function of the core (deep spinal stability mechanisms) - poor breathing mechanism CHRONIC LBP Chronic LBP is usual a result of combination of following factors: Poor, inadequate and untimely treatment, poor beliefs, poor copping strategies, overuse of structural diagnosis as well as emotional stress. DIAGNOSIS Diagnosis of LBP is almost always clinical with exception of very severe pain with numbness, tingling, radiation and loss of strength. DIFFERENTIAL DIAGNOSIS Rarely low back pain can arise from structures inside the viscera (organs), however dysfunction of motility of visceral organs as well as breathing can be an important causative factor in LBP. Most often differential diagnosis requires the differentiation of anatomical areas below or above the lowback as well as carefully examination of the whole locomotor system. TREATMENT OF LOW BACK PAIN Since low back pain is so multifactorial individual approach is paramount. The successful treatment of low back pain is one that addresses the cause rather then the symptoms. In order to attack the cause two factors must be identified: 1) movement dysfunction;

3. 2) pain generator- structure irritated during specific movement (ligament, muscle, joint, nerve,disc and etc...) Since multiple structures can refer pain to low back, primary load transfer failure must be identified. The spinal stability system has to be addressed from perspective of dynamic stability rather then the core strength. At NYDN we provide very individual and comprehensive approach based on our meticulous examination skills and most integrative treatment . We combine most advanced scientifically proven low back treatment methods such as: DNS (dynamic neuromuscular stabilization), ISM (integrated system model approach), clinical Pilates, structural integration, postural retraining, myofascial release and acupuncture just to name a few. Low Back Pain: Causes, Symptoms, Diagnosis and Treatment What is Low Back Pain? Lower back pain is a condition that affects all human beings at one point of their lives. It mainly occurs in the lumbar region, which is the area below the ribcage. The discomfort associated with this medical condition is often intense. It may end on its own, or may require specialized treatment, more so if it persists. What Causes of Low Back Pain? This condition is usually caused by various conditions. Problems occurring in the spinal nerves, muscles, discs, tendons and bones often result in lower back pain. The condition may be caused by the irritation of large nerve roots, which run from the back down to the legs. Smaller nerves, which are spread throughout the lumbar region may sometimes get overworked, thus causing intense pain in the region.

4. Whenever muscles that are located on the lower back get strained during intense activities, you are likely to experience pain. In rare cases, damage to the joints and ligaments, or the regeneration of the intervertebral disc causes slight pains in the lower back region. Every so often, the occurrence of the condition depends with age. Younger adults aged between 30 to 50 years have a higher chance of experiencing the condition due to the degeneration of the intervertebral disc, or from back muscle strains. Those who are 60 years and above often experience discomfort due to the degeneration of the joints, or from compression fractures. This occurs due to their advanced age. Over-activity has been proven to be a major cause of this medical condition. When you overwork yourself, your muscles tend to get sore. This results from overstretched or injured ligament fibers. Spinal Stenosis is another major cause of low back pain. This condition comes about when space that surrounds the spinal cord gets smaller. This exerts excess pressure on the spinal nerves and the cord itself. In the event that the intervertebral discs collapse, osteoarthritis often starts developing. When this occurs, the human body responds by allowing a new born to grow in the facet joints to offer extra support to the vertebrae. This bone causes discomfort with time, which explains why you might start experiencing low back pain. What is Low Back Pain Symptoms? Most patients report varying symptoms. The intensity of the pain experienced also differs from one patient to another. Some patients complain about a piercing, stabbing sensation while others experience a dull cramp. This variation is influenced by the causal factor of the back pain. Generally, individuals who are affected by this disorder complain about back pains, which worsen whenever they bend or lift up objects. These activities strain muscles fund on the back. There are some who complain about a sharp discomfort, more so when they sit down. Standing or walking for prolonged periods worsens the pain in some cases. Normally, the soreness may recede or disappear altogether, only to return a few days later. The pain is often experienced on the lumbar region but may extend to the buttocks. Sometimes, there is numbness or tingling sensations. Diagnosis The first step that physicians take when diagnosing low back pain is discussing the symptoms with patients. Thereafter, they evaluate a patient’s medical history before the back is examined. The examination process involves massaging the back to

5. pinpoint areas where the pain is more intense. In severe cases, physicians often measure the level of nerve function in the leg region. This may involve testing reflexes, more so at the knees and ankles. A patient’s level of reflex greatly determines the extent to which he or she is affected by the condition. Low back pain is sometimes diagnosed by imaging tests. X-ray imaging, magnetic resonance imaging, computerized axial topography scans, bone scans and bone density scans can be used to diagnose the condition. X-ray imaging is used to determine whether the cause of back pains is broken bones or any bone deformity. Magnetic resonance imaging is used to highlight the condition of intricate muscle and nerve tissues. It establishes the presence of medical conditions like herniated disks, or tissue infection. CAT scans come in handy in the event that a physician thinks you have a bone disorder. Bone scans are recommended if your physician needs to have a better understanding of the bone structure in your lower back region. Data garnered from the scan will tell the exact cause of the discomfort that you are experiencing. Bone scans are also used to pinpoint the presence of bone cancer, which sometimes causes lower back pain. Treatment Options The main challenge that faces physicians is how to treat low back pain in an effective manner. The intervention used on each individual case greatly depends on his or her medical history, and the severity of the condition. In as much as lower back pain is a largely self-remedying condition, there is need for medical intervention if the pain recurs. The treatment offered may either be surgical or nonsurgical. 1. Surgical Treatment This intervention is often considered after the failure of nonsurgical interventions. The latter should be tried for at least six months before surgical treatment is considered. Besides this, surgery ought to be an option only after the exact source of pain has been pinpointed. There are several surgical procedures used in the treatment of lower back pain. These include spinal fusion and disk replacement. Spinal fusion involves fusing together the vertebrae to enhance healing. Movements between segments of the vertebrae is painful. Fusing the components together eliminates such movements, and the pain that comes along. The procedure is used on patients who have extensive degeneration of the disks. Spinal fusion has been proven to be quite effective in the elimination of lower back pain.

6. Disk replacement is a surgical intervention, which entails the removal of the disk so that it can be replaced by an artificial one. This procedure is often carried out to maintain flexibility and restore normal motion, which is usually hampered by back pain. Disk replacement is carried out through the abdomen. 2. Nonsurgical Treatment This involves the use of therapies to alleviate pain. Medications have been offered for years to relieve back pain. Anti-inflammatory medications such as brufen can eliminate pain and inflammation. Aspirin, codeine and steroids have similarly been used successfully to treat the condition. However, the three medications have different side effects. Owing to the fact that severe back pain is incapacitating, a combination of medical and therapeutic interventions is preferred. Physical therapy, which entails the use of inactive modalities such as massages, electric simulations and ultrasound, is often combined with exercises to increase lower back strength. Chiropractic therapy, traction and the use of braces have all been found to have the ability of substantially reducing lower back pain. Prevention of Lower Back Pain It is quite difficult to prevent lower back pain due to the typical wear and tear that occurs on the back. Certain practices can however be used to minimize the occurrence of the condition. Regular exercises, including swimming and jogging keep back muscles strong and agile. This makes them more resistance to wear and tear. Another effective way of preventing back pain is lifting items using the legs as the center of support, not the back. When picking heavy items, avoid bending your back. Maintaining a manageable body weight also goes a long way in preventing lower back pain. Standing and sitting using the right posture is helpful too. Most people tend to ignore discomfort in the lower back region because they think the condition is not serious. With time however, it might cause further problems. You need to understand where is low back pain mostly occurs so that you can seek medical attention promptly. Living a healthy lifestyle, and avoiding strenuous activities helps avert back inflammation. You also need to consult your physician regularly so that conditions, which cause low-back pain can be detected early. Acupuncture May Help Reduce Low Back Pain

7. Low back pain has become a major global health concern with nearly 70% of the industrialized world’s population afflicted. The lack of adequate treatment for this chronic pain has caused severe comfort of life problems among the millions of individuals who combat it day and night. While physical therapy and pain medications are the standard care for most patients, many seek alternative treatments to either augment or entirely supplant the usual care methods. One such treatment is acupuncture, an ancient Chinese practice using thin needles to release pressure points on the body. Acupuncture for pain management has increased lately in popularity because of the lack of options patients face when combating the day to day struggle of a sometimes debilitating pain. Like most non-Western approaches to medicine, the academic community has relatively little to say about acupuncture’s effectiveness. However, a recent study by the Centre for Health, Activity and Rehabilitation at the University of Otago examines the effectiveness of acupuncture for the treatment of low back pain and reveals that the practice may be useful in relieving pain and increasing functionality when used in addition to physical therapy. The study, a survey of sixteen unique clinical trials, reveals that even in a scientific study, there are no clear cut answers that prove or disprove the effectiveness of acupuncture for low back pain. Often, these studies do little to separate acupuncture from the stigma that it is unscientific, but this overview reveals that some trials that have treated the practice as medicine and studied its effects in the same manner as more mainstream low back pain treatments. Ultimately, an open-mindedness of the medical community to study alternative treatment will be the key to understanding more about pain treatment, which can only bring positive results to the millions of individuals afflicted by this debilitating pain. Cultural bias or fear of the unknown should not deter scientific progress, a role which the public plays just as strong of a role to be willing to explore new treatments. However, the public cannot put its trust in new methods

8. of treatment unless their physicians can speak to the benefits and shortcomings of each method knowledgably. There are several conclusions we can make about acupuncture based on these trials. Though no study supports a recommendation of only acupuncture for low back pain, the use of acupuncture as an addition to a more standard pain management plan is either tolerated as “not harmful” or, in some cases, is encouraged due to positive results. There were many instances in which patients using true acupuncture versus those who were administered a kind of placebo (i.e. no penetration of the needles, incorrect points on the body) experienced very positive results while the placebo groups reported nothing. Though there were some cases that contradicted this, a general statement about the use of acupuncture for low back pain is that it can be helpful if used in addition to physical therapy but should not fully replace a more standard pain management program. Ultimately acupuncture is a personal choice for individuals open to exploring alternative possibilities to treating pain. According to the most modern science on the practice, patients may feel relief in the short term after acupuncture treatment- many have reported comfort and less pain. However, the disappointment that accompanies another failed pain treatment method may be too frustrating. Both instances have occurred as evidenced in these trials. It seems that currently, pain relief is far too personal for the scientific process to make a definitive statement on this particular method, which may a comfort more personal than a study can explain. Ultimately, what the recent study reveals is that there has not been enough clinical examination of acupuncture for low back pain. While the medical community’s support remains with the standard method of low back pain treatments, management of pain medication and physical therapy, there is an ever-growing community of individuals exploring new methods of treating their pain. In the case of acupuncture the “new” treatment is an ancient practice with a history rooted deeply in Chinese culture. Perhaps a little more relief can be found through acupuncture, time will tell if it should be a part of the long-term plan. https://nydnrehab.com/what-we-treat/back-pain-and-neck-pain/low-back-pain/