Common back injuries include strains and sprains, fractured vertebrae and herniated disks. These can occur as a result of sports injuries, working in the garden, or around the house, or as a trauma due to an accident. Back injuries can be quite painful and can restrict a person’s everyday mobility.
The human backbone (spine) extends from the skull to the pelvis and is made up of a neatly stacked column of 33 bones (vertebrae) and tissues. A band of cartilage, serving as a shock absorber, is found between each vertebrae which form a protection around the spinal cord. The vertebrae may be classified as follows:
Cervical vertebrae-forming the upper part of the spine, seven in number Thoracic vertebrae-found between the neck and the lower back, twelve in number Lumbar vertebrae-located in the lower back between the chest and hips; contains five of the largest and strongest vertebraeSacrum and coccyx-group of bones fused and located at the base of the spine
Types of Back Injuries
There are two types of back injuries - spondylolisthesis and cervical radiculopathy. Both are specific conditions with its own set of causes, symptoms and treatments.
Spondylolisthesis occurs when a vertebra, mostly from the base of the spine, slips from its position. It can occur as a result of Spondylolysis too, which is a defect in one or both of wing-shaped parts of a vertebra. Symptoms include pain in the lower back and buttocks that radiates down to legs, and overall muscular weakness.
Cervical Radiculopathy- Cervical radiculopathy is a condition that results from impaired nerve function and occurs when the nerve roots, in the proximity of the cervical vertebrae, are compressed. The pressure is brought on by arthritis, degenerative changes in the bone or a damage in the surrounding bones. Any damage to these nerve roots can give rise to pain, loss of sensation in the regions of the neck, shoulders and arms. Cervical Radiculopathy- Cervical radiculopathy is a condition that results from impaired nerve function and occurs when the nerve roots, in the proximity of the cervical vertebrae, are compressed. The pressure is brought on by arthritis, degenerative changes in the bone or a damage in the surrounding bones. Any damage to these nerve roots can give rise to pain, loss of sensation in the regions of the neck, shoulders and arms.Diagnosis & Treatment of Back Injuries
If the back pain is significant, consult an osteopath.
The root cause of pain can be diagnosed with the help of a simple X-ray. CT scans or MRI scans are usually taken before planning a surgery.
The mainstay of Spondylolisthesis treatment is physical therapy, to strengthen abdominal and back muscles.
Cervical radiculopathy on the other hand is treated with a combination of pain killers and physical exercises. The pain medications used are acetaminophen (paracetamol), ibuprofen, ketoprofen and naproxen. Steroids may also be given either orally or injected epidurally. Physical therapy includes traction and other mobilization exercises.
Surgery is usually the last option and is usually considered when the compression on the nerve is significantly high and results in motor weakness.
It may be a good idea to take bed rest for some time. Applying ice compression will bring relief. Once treatment begins and the pain settles, it might be a good idea to take up gentle exercises such as stretching, yoga or pilates.
Computer Related Injuries
Computer related injury (CRI) is a cluster of work-related symptoms in computer users such as Repetitive Strain Injury (RSI), Work Related Upper Limb Disorder (WRULD), Musculoskeletal Disorder (MSD), fatigue, migraine headaches and eye strain.
With newer gadgets and facilities come newer health challenges. The computer maybe the modern marvel that has increased the pace and productivity of work, but the human body is not designed to be sedentary. Reports from PC users all over the world, point to serious health issues posed by the monotony and stress of being tied to a computer for most part of the day.
"We pray with our hands and often communicate with them. We use them to eat, work, and make love. We employ them as marvelously sophisticated instruments of flexibility and strength, and when they are damaged, we anguish." - Keith L. Moore
A few of the health problems that the computer has brought in its wake include Repetitive Strain Injury (RSI), Work Related Upper Limb Disorder (WRULD), Musculoskeletal Disorder (MSD), fatigue, migraine headaches and eye strain. These symptoms could just be the beginning of serious health concerns because computer usage is relatively new and we are yet to understand the long- term health consequences of a lifetime of working at a computer desk.
Computer - related injuries are mainly a physical problem and not a psychosomatic one. Prolonged hours of sitting and working at a particular place can increase stiffness in joints and muscles. Stress may aggravate symptoms. It has been proved easier to prevent computer -related injuries than to cure them.
Ergonomics is the science that focuses on equipment design at workplaces with a view to reduce fatigue and discomfort in workers by improving working conditions. The overall aim of ergonomics is to increase workers’ efficiency and thereby maximize productivity.
Ergonomic furniture and ergonomic accessories are becoming increasingly popular in markets all over the world. For instance, ergonomic keyboards designed with a view to reduce muscle strain and repetitive stress injuries such as carpal tunnel syndrome, are hitting the market offering different features. Some ergonomic keyboards are a single board with keys arranged in 2 or 3 groups at different angles rather than a straight keyboard. Some have the keyboard split into separate independent pieces with elevated sections at different angles. Some ergonomic keyboards have keys fixed at a vertical elevated level so that the user’s hands can be unbent and perpendicular to the ground.
Employers and workers need to be informed of the health hazards of constant computer use, successful prevention techniques and useful remedies if injuries do occur.
In India, CRI is not treated as an occupational hazard, unlike developed countries such as the US, Canada, Australia and UK where computer-related injuries are compensated.
Startling Facts
A 2007 cross- sectional study conducted on a sample of 136 users comprising of university students and office staff in Malaysia, where many were using standard keyboard and mouse without any ergonomic modification whatsoever, reported the following findings:
• About 50% of those with some degree of low back pain did not use an adjustable backrest.
• Many users had high incidence of Rapid Upper Limb Assessment (RULA) of the wrist and neck that suggested an increased risk of developing Occupational Overuse Syndrome (OOS).
• As many as 64% were using refractive corrections and yet had showed high incidence of Computer Vision syndrome (CVS) that generally included eye fatigue, headache and burning sensation.
• An increase in CVS scores corresponded with increased hours of computer usage.
A study conducted in India on a sample of 650 people in computer-dependent careers, (average age was 27 years and ratio of males to females was 4:1) revealed that:
• 55% developed CRI symptoms within a year of beginning computer-dependent careers.
• 76% reported at least 1 symptom.
• 60% of those with severe injuries reported neck and shoulder pain and stiffness.
• 6 software engineers between 25 and 35 years with CRI symptoms had to give up their career.
• Recent studies have shown that using computers for three hours a day at a stretch can prompt health risks such as Occupational Overuse Syndrome OUS, Computer Vision syndrome CVS, tension headaches, low back pains and psychosocial stress. Intensive studies are being conducted to explore ways and means of coping with computer -related injuries that are gradually increasing, as reports from all over the world seem to suggest.
• Back injuries account for one third of all workplace injuries.
• 10 years ago back injuries were associated with heavy lifting. Today they are caused by people sitting in front of computers.
• A 1998 survey showed RSI has increased by 22% in a couple of years.
• In the early 1990s the average age of workers reporting carpal tunnel syndrome was late 30s to early 40s. Now it has dropped to mid-20s and even younger.
• In Bangalore, India, results of a study among more than 1,200 IT professionals (2001-2003) suggest that over 75 percent of those studied reported CRI symptoms of varying severity.
• The US Bureau of Labor Statistics says CRI accounted for 66% of work- related illnesses in the US in 1999.
• Estimated costs to companies due to loss of productivity and compensation due to CRI is 60-100 billion dollars in the US alone
Computer related injury (CRI) is a cluster of work-related symptoms in computer users such as Repetitive Strain Injury (RSI), Work Related Upper Limb Disorder (WRULD), Musculoskeletal Disorder (MSD), fatigue, migraine headaches and eye strain.
With newer gadgets and facilities come newer health challenges. The computer maybe the modern marvel that has increased the pace and productivity of work, but the human body is not designed to be sedentary. Reports from PC users all over the world, point to serious health issues posed by the monotony and stress of being tied to a computer for most part of the day.
"We pray with our hands and often communicate with them. We use them to eat, work, and make love. We employ them as marvelously sophisticated instruments of flexibility and strength, and when they are damaged, we anguish." - Keith L. Moore
A few of the health problems that the computer has brought in its wake include Repetitive Strain Injury (RSI), Work Related Upper Limb Disorder (WRULD), Musculoskeletal Disorder (MSD), fatigue, migraine headaches and eye strain. These symptoms could just be the beginning of serious health concerns because computer usage is relatively new and we are yet to understand the long- term health consequences of a lifetime of working at a computer desk.
Computer - related injuries are mainly a physical problem and not a psychosomatic one. Prolonged hours of sitting and working at a particular place can increase stiffness in joints and muscles. Stress may aggravate symptoms. It has been proved easier to prevent computer -related injuries than to cure them.
Ergonomics is the science that focuses on equipment design at workplaces with a view to reduce fatigue and discomfort in workers by improving working conditions. The overall aim of ergonomics is to increase workers’ efficiency and thereby maximize productivity.
Ergonomic furniture and ergonomic accessories are becoming increasingly popular in markets all over the world. For instance, ergonomic keyboards designed with a view to reduce muscle strain and repetitive stress injuries such as carpal tunnel syndrome, are hitting the market offering different features. Some ergonomic keyboards are a single board with keys arranged in 2 or 3 groups at different angles rather than a straight keyboard. Some have the keyboard split into separate independent pieces with elevated sections at different angles. Some ergonomic keyboards have keys fixed at a vertical elevated level so that the user’s hands can be unbent and perpendicular to the ground.
Employers and workers need to be informed of the health hazards of constant computer use, successful prevention techniques and useful remedies if injuries do occur.
In India, CRI is not treated as an occupational hazard, unlike developed countries such as the US, Canada, Australia and UK where computer-related injuries are compensated.
Startling Facts
| A 2007 cross- sectional study conducted on a sample of 136 users comprising of university students and office staff in Malaysia, where many were using standard keyboard and mouse without any ergonomic modification whatsoever, reported the following findings: • About 50% of those with some degree of low back pain did not use an adjustable backrest. • Many users had high incidence of Rapid Upper Limb Assessment (RULA) of the wrist and neck that suggested an increased risk of developing Occupational Overuse Syndrome (OOS). • As many as 64% were using refractive corrections and yet had showed high incidence of Computer Vision syndrome (CVS) that generally included eye fatigue, headache and burning sensation. • An increase in CVS scores corresponded with increased hours of computer usage. A study conducted in India on a sample of 650 people in computer-dependent careers, (average age was 27 years and ratio of males to females was 4:1) revealed that: • 55% developed CRI symptoms within a year of beginning computer-dependent careers. • 76% reported at least 1 symptom. • 60% of those with severe injuries reported neck and shoulder pain and stiffness. • 6 software engineers between 25 and 35 years with CRI symptoms had to give up their career. • Recent studies have shown that using computers for three hours a day at a stretch can prompt health risks such as Occupational Overuse Syndrome OUS, Computer Vision syndrome CVS, tension headaches, low back pains and psychosocial stress. Intensive studies are being conducted to explore ways and means of coping with computer -related injuries that are gradually increasing, as reports from all over the world seem to suggest. • Back injuries account for one third of all workplace injuries. • 10 years ago back injuries were associated with heavy lifting. Today they are caused by people sitting in front of computers. • A 1998 survey showed RSI has increased by 22% in a couple of years. • In the early 1990s the average age of workers reporting carpal tunnel syndrome was late 30s to early 40s. Now it has dropped to mid-20s and even younger. • In Bangalore, India, results of a study among more than 1,200 IT professionals (2001-2003) suggest that over 75 percent of those studied reported CRI symptoms of varying severity. • The US Bureau of Labor Statistics says CRI accounted for 66% of work- related illnesses in the US in 1999. • Estimated costs to companies due to loss of productivity and compensation due to CRI is 60-100 billion dollars in the US alone |
Back Pain
Back pain is ranked second to headaches as the most frequent location of pain. Four out of five adults will experience at least one bout of back pain at some time in their lives. It is almost next to common colds in the list of common diseases.
The most common site for pain is the lower back because it bears the brunt of our weight and hence is more prone to get affected.
Structurally backache is a condition that usually is caused when one or more structures of the back gets affected and these includes muscles, cartilage, bones or spinal cord.
Anatomy of our Back - The back region of our body is made of interconnecting structures like bones, joints, muscles, ligaments and tendons. The spine of the back itself is made up of 24 small bones (seven cervical, twelve thoracic and five lumbar) and is the major support structure of back. These small bones are called vertebrae and they are further attached to sacrum and coccyx as we go from top to down. The sacrum attaches itself in front to the bones of the pelvis.
Our Erect Posture and flexibility of our body-The erect human posture has made our back adapt to withstand the forces of gravity over our lifetime. It also has made this region more easily vulnerable to wear and tear, strains and fractures. To keep us mobile, the flexibility of our back is important. This is determined by various factors such as joint structure, muscle elasticity and connective tissue fiber material made up of collagen, elastin and titin. Disc that are interposed between the vertebra, acts as a shock absorber and gives joints their strength, stability and flexibility but limits movement. Vertebrae and discs provide a protective tunnel that allows the spinal cord and its spinal nerves to pass through. These nerves running down the center of the vertebrae, branch off to various parts of the body. The collagen fibers help the disc withstand the tension of the erect posture and our weight. Disc protects the spine and keeps it stable during strenuous activities that puts strong force on the spine, such as jumping, running, and lifting.
Back ache is more prevalent between the age of 35 and 55. The most frequently cause of our back pain are:
Heavy physical work
Frequent bending, twisting, lifting
pulling and pushing
Repetitive work
Static postures
Vibrations
Psychosocial risk factors for backache includes stress, distress, anxiety, depression, cognitive dysfunction, pain threshold, job dissatisfaction, and mental stress at work.
Back pain may be sudden and sharp or it may be dull and if persistent for more than a week it might result in tension, soreness or stiffness of back muscles. Pain may aggravate with slightest of movement or even with coughing and sneezing. It may also be accompanied with numbness and tingling in the arms or legs.
The pain if limited to the back can be treated by simple remedies at home but if radiating to the lower abdomen, groin, leg or foot, needs medical attention.
Back pain is ranked second to headaches as the most frequent location of pain. Four out of five adults will experience at least one bout of back pain at some time in their lives. It is almost next to common colds in the list of common diseases.
The most common site for pain is the lower back because it bears the brunt of our weight and hence is more prone to get affected. Structurally backache is a condition that usually is caused when one or more structures of the back gets affected and these includes muscles, cartilage, bones or spinal cord.
Anatomy of our Back - The back region of our body is made of interconnecting structures like bones, joints, muscles, ligaments and tendons. The spine of the back itself is made up of 24 small bones (seven cervical, twelve thoracic and five lumbar) and is the major support structure of back. These small bones are called vertebrae and they are further attached to sacrum and coccyx as we go from top to down. The sacrum attaches itself in front to the bones of the pelvis.
Our Erect Posture and flexibility of our body-The erect human posture has made our back adapt to withstand the forces of gravity over our lifetime. It also has made this region more easily vulnerable to wear and tear, strains and fractures. To keep us mobile, the flexibility of our back is important. This is determined by various factors such as joint structure, muscle elasticity and connective tissue fiber material made up of collagen, elastin and titin. Disc that are interposed between the vertebra, acts as a shock absorber and gives joints their strength, stability and flexibility but limits movement. Vertebrae and discs provide a protective tunnel that allows the spinal cord and its spinal nerves to pass through. These nerves running down the center of the vertebrae, branch off to various parts of the body. The collagen fibers help the disc withstand the tension of the erect posture and our weight. Disc protects the spine and keeps it stable during strenuous activities that puts strong force on the spine, such as jumping, running, and lifting.
Back ache is more prevalent between the age of 35 and 55. The most frequently cause of our back pain are:
Heavy physical work Frequent bending, twisting, lifting pulling and pushing Repetitive work Static postures VibrationsPsychosocial risk factors for backache includes stress, distress, anxiety, depression, cognitive dysfunction, pain threshold, job dissatisfaction, and mental stress at work.
Back pain may be sudden and sharp or it may be dull and if persistent for more than a week it might result in tension, soreness or stiffness of back muscles. Pain may aggravate with slightest of movement or even with coughing and sneezing. It may also be accompanied with numbness and tingling in the arms or legs.
The pain if limited to the back can be treated by simple remedies at home but if radiating to the lower abdomen, groin, leg or foot, needs medical attention.
Yoga For Back Pain
Back pain, one of the common problems of present day, is caused due to stress and tension in the muscles that support the spine. Sedentary lifestyle, stress, o
veruse or under use of the back, postural mistakes are unconscious triggers to the widespread problem of back pain. Regular exercise is a redeeming feature that brings relief to back pain.
Backache strikes when the muscles are under fatigue, commonly at the neck or lumbar region (where most twisting, turning or bending occurs). Frequent backaches occur due to overstrained or over stretched muscles, improper sitting positions, stress, lumbar scoliosis and earlier injuries. Many conditions cause back pain and they can be treated with conscious and gentle yoga practice. It has proven to be a safe and effective way to alleviate many forms of back pain and prevent its recurring bouts. However, all cases of back pain need to be evaluated by a medical expert for diagnosis and treatment.
Yoga for Upper and Lower Back Pain
Lower back pain is caused due to excess sitting that can weaken the back muscle and results pain in your lower back. It may also be due to some other reasons like poor postural habit and sudden lifting of heavy objects, whereas upper back pain usually occurs between the neck and top of the lumbar spine. It is caused due stress, anxiety, shoulder pain and neck pain. These symptoms can leads to stiffness and aching in your lower back and upper back of the body. Yoga is another form of exercise that will help relieve you from both lower and upper back pain. Practicing yoga poses and exercise movements will help to increase joint flexibility. It also helps to maintain and improves strength and flexibility in the hips, shoulder and neck movements.
Healing Benefits of Yoga
- Yoga strengthens muscle groups. Many postures in yoga strengthen the back and abdominal muscles and help the body maintain a proper upright posture and movement. Stretching and relaxation reduces tension in stress carrying muscles. When these muscles are well conditioned, it helps to offset back pain.
- Yoga eases lower back pain, by stretching and strengthening the muscles of the lower back. It increases blood circulation, which brings healing nutrients to the injured tissues. Yoga also helps maintain a natural curvature of the spine that is crucial in avoiding lower back pain.
- Thus, Yoga is an excellent therapy for healing injured and sore back muscles, speeding time to recover from an injury and preventing re injury. It also reduces the risk of disability due to back pain. In short, Yoga increases awareness of the body and keeps the body healthy and supple.
Back pain, one of the common problems of present day, is caused due to stress and tension in the muscles that support the spine. Sedentary lifestyle, stress, o
veruse or under use of the back, postural mistakes are unconscious triggers to the widespread problem of back pain. Regular exercise is a redeeming feature that brings relief to back pain.
Backache strikes when the muscles are under fatigue, commonly at the neck or lumbar region (where most twisting, turning or bending occurs). Frequent backaches occur due to overstrained or over stretched muscles, improper sitting positions, stress, lumbar scoliosis and earlier injuries. Many conditions cause back pain and they can be treated with conscious and gentle yoga practice. It has proven to be a safe and effective way to alleviate many forms of back pain and prevent its recurring bouts. However, all cases of back pain need to be evaluated by a medical expert for diagnosis and treatment.
Yoga for Upper and Lower Back Pain
Lower back pain is caused due to excess sitting that can weaken the back muscle and results pain in your lower back. It may also be due to some other reasons like poor postural habit and sudden lifting of heavy objects, whereas upper back pain usually occurs between the neck and top of the lumbar spine. It is caused due stress, anxiety, shoulder pain and neck pain. These symptoms can leads to stiffness and aching in your lower back and upper back of the body. Yoga is another form of exercise that will help relieve you from both lower and upper back pain. Practicing yoga poses and exercise movements will help to increase joint flexibility. It also helps to maintain and improves strength and flexibility in the hips, shoulder and neck movements.
Healing Benefits of Yoga
Backache strikes when the muscles are under fatigue, commonly at the neck or lumbar region (where most twisting, turning or bending occurs). Frequent backaches occur due to overstrained or over stretched muscles, improper sitting positions, stress, lumbar scoliosis and earlier injuries. Many conditions cause back pain and they can be treated with conscious and gentle yoga practice. It has proven to be a safe and effective way to alleviate many forms of back pain and prevent its recurring bouts. However, all cases of back pain need to be evaluated by a medical expert for diagnosis and treatment.
Yoga for Upper and Lower Back Pain
Lower back pain is caused due to excess sitting that can weaken the back muscle and results pain in your lower back. It may also be due to some other reasons like poor postural habit and sudden lifting of heavy objects, whereas upper back pain usually occurs between the neck and top of the lumbar spine. It is caused due stress, anxiety, shoulder pain and neck pain. These symptoms can leads to stiffness and aching in your lower back and upper back of the body. Yoga is another form of exercise that will help relieve you from both lower and upper back pain. Practicing yoga poses and exercise movements will help to increase joint flexibility. It also helps to maintain and improves strength and flexibility in the hips, shoulder and neck movements.
Healing Benefits of Yoga
- Yoga strengthens muscle groups. Many postures in yoga strengthen the back and abdominal muscles and help the body maintain a proper upright posture and movement. Stretching and relaxation reduces tension in stress carrying muscles. When these muscles are well conditioned, it helps to offset back pain.
- Yoga eases lower back pain, by stretching and strengthening the muscles of the lower back. It increases blood circulation, which brings healing nutrients to the injured tissues. Yoga also helps maintain a natural curvature of the spine that is crucial in avoiding lower back pain.
- Thus, Yoga is an excellent therapy for healing injured and sore back muscles, speeding time to recover from an injury and preventing re injury. It also reduces the risk of disability due to back pain. In short, Yoga increases awareness of the body and keeps the body healthy and supple.
Low Back Pain
Important Clinical Distinctions Spinal Stenosis and Disc pain
Spinal stenosis usually presents with pain radiating beyond the back to the buttocks, thighs or lower legs. The pain is worsened with extension of the lumbar spine (eg, standing or walking) and improves with flexion of the spine (eg, sitting or stooping forward). This is in contrast to pain originating from a disc which is typically worsened by lumbar flexionMyofascial pain The features of myofascial low back pain include diffuse low back pain of gradual onset which worsens after resting or sitting. The pain is aggravated by cold and relieved by warmth and movement. There is often associated stiffness and limited range of motion, with a sensation of tightness in the back. Bilateral leg pain and paresthesia may occur, but limping and listing are unusual. Tenderness is present within the affected muscle and soft tissues, and often the sacroiliac joints. Fibromyalgia may also present as back pain with these features.
Severe, constant back pain, persisting at night, suggests the presence of neoplasm, infection, or lateral recess nerve root compression. Thoracolumbar fractures present with back pain and segmental radiation in the distribution of the contiguous nerve roots. Sitting often aggravates the pain and muscle spasm may disturb sleep. Dorsal kyphosis, "dowager hump", and loss of height may be noted. Compression fracture may be the first symptom of osteoporosis. Sciatica Sciatica, which refers to pain radiating in a dermatomal distribution is highly suggestive of a herniated disc. The classic features are aching pain in the buttock and paresthesias radiating into the posterior thigh and calf or into the posterior lateral thigh and lateral foreleg. In most nerve root syndromes, a precise description of radiating pain will help localize to a nerve root level. Over 95 percent of herniated discs affect the L4-5 or L5-S1 interspace. The sensitivity of sciatica (the proportion of patients with a herniated disc who have sciatica) was 0.95 in one report, indicating that its absence makes lumbar disc herniation unlikely. The specificity of sciatica (the percentage of patients without a herniated disc who do not have sciatica) is also high at approximately 0.88. However the diagnosis should not be based solely on the presence or absence of sciatica. Irritation of non-neural structures in the lumbar spine, such as the facet joints and numerous ligaments and other supporting structures, can produce radiating pain in the lower extremities which can cause diagnostic confusion in some patients. Furthermore, radicular pain ("sciatica") can be caused by such diverse entities as neoplasms, spinal stenosis, entrapment neuropathy, myofascial pain syndromes, trochanteric bursitis, vascular malformations, endometriosis, diabetic radiculoneuropathy, herpes zoster (shingles), idiopathic lumbosacral plexitis, and entrapment of the sciatic nerve by the pyriformis muscle. Table 3: Differences between the pain of a herniated disc and spinal stenosis Characteristic Spinal stenosis Disc-pain Aggravating factor Lumbar extension Lumbar flexion (standing, sitting) Relieving factor Lumbar flexion (sitting Lumbar extension (lying or stooping over) down) Table- 4 Nerve Root Pain worst in Radiation Sensory Motor Reflexes of pain loss weakness S1 Leg>>Back Buttock, Fifth toe flexors, Absent ankle
posterior lateral foot gastrocne- thigh , mius PL calf and PL calf and rarely jerk heel PL thigh hamstrings L5 Back >>Leg PL thigh, great toe externsor no reflex groin, medial foot hallucis loss lateral Calf and DM AL calf longus, foot, first (less often) Tibialis anterior Two toes and peronii- foot drop L4 or L3 Back >> Leg AM thigh AM thigh Quadriceps Absent knee and knee and knee and jerk iliopsoas
Important Clinical Distinctions Spinal Stenosis and Disc pain
Spinal stenosis usually presents with pain radiating beyond the back to the buttocks, thighs or lower legs. The pain is worsened with extension of the lumbar spine (eg, standing or walking) and improves with flexion of the spine (eg, sitting or stooping forward). This is in contrast to pain originating from a disc which is typically worsened by lumbar flexionMyofascial pain The features of myofascial low back pain include diffuse low back pain of gradual onset which worsens after resting or sitting. The pain is aggravated by cold and relieved by warmth and movement. There is often associated stiffness and limited range of motion, with a sensation of tightness in the back. Bilateral leg pain and paresthesia may occur, but limping and listing are unusual. Tenderness is present within the affected muscle and soft tissues, and often the sacroiliac joints. Fibromyalgia may also present as back pain with these features.
Severe, constant back pain, persisting at night, suggests the presence of neoplasm, infection, or lateral recess nerve root compression. Thoracolumbar fractures present with back pain and segmental radiation in the distribution of the contiguous nerve roots. Sitting often aggravates the pain and muscle spasm may disturb sleep. Dorsal kyphosis, "dowager hump", and loss of height may be noted. Compression fracture may be the first symptom of osteoporosis. Sciatica Sciatica, which refers to pain radiating in a dermatomal distribution is highly suggestive of a herniated disc. The classic features are aching pain in the buttock and paresthesias radiating into the posterior thigh and calf or into the posterior lateral thigh and lateral foreleg. In most nerve root syndromes, a precise description of radiating pain will help localize to a nerve root level. Over 95 percent of herniated discs affect the L4-5 or L5-S1 interspace. The sensitivity of sciatica (the proportion of patients with a herniated disc who have sciatica) was 0.95 in one report, indicating that its absence makes lumbar disc herniation unlikely. The specificity of sciatica (the percentage of patients without a herniated disc who do not have sciatica) is also high at approximately 0.88. However the diagnosis should not be based solely on the presence or absence of sciatica. Irritation of non-neural structures in the lumbar spine, such as the facet joints and numerous ligaments and other supporting structures, can produce radiating pain in the lower extremities which can cause diagnostic confusion in some patients. Furthermore, radicular pain ("sciatica") can be caused by such diverse entities as neoplasms, spinal stenosis, entrapment neuropathy, myofascial pain syndromes, trochanteric bursitis, vascular malformations, endometriosis, diabetic radiculoneuropathy, herpes zoster (shingles), idiopathic lumbosacral plexitis, and entrapment of the sciatic nerve by the pyriformis muscle. Table 3: Differences between the pain of a herniated disc and spinal stenosis Characteristic Spinal stenosis Disc-pain Aggravating factor Lumbar extension Lumbar flexion (standing, sitting) Relieving factor Lumbar flexion (sitting Lumbar extension (lying or stooping over) down) Table- 4 Nerve Root Pain worst in Radiation Sensory Motor Reflexes of pain loss weakness S1 Leg>>Back Buttock, Fifth toe flexors, Absent ankle
posterior lateral foot gastrocne- thigh , mius PL calf and PL calf and rarely jerk heel PL thigh hamstrings L5 Back >>Leg PL thigh, great toe externsor no reflex groin, medial foot hallucis loss lateral Calf and DM AL calf longus, foot, first (less often) Tibialis anterior Two toes and peronii- foot drop L4 or L3 Back >> Leg AM thigh AM thigh Quadriceps Absent knee and knee and knee and jerk iliopsoas
Severe, constant back pain, persisting at night, suggests the presence of neoplasm, infection, or lateral recess nerve root compression. Thoracolumbar fractures present with back pain and segmental radiation in the distribution of the contiguous nerve roots. Sitting often aggravates the pain and muscle spasm may disturb sleep. Dorsal kyphosis, "dowager hump", and loss of height may be noted. Compression fracture may be the first symptom of osteoporosis. Sciatica Sciatica, which refers to pain radiating in a dermatomal distribution is highly suggestive of a herniated disc. The classic features are aching pain in the buttock and paresthesias radiating into the posterior thigh and calf or into the posterior lateral thigh and lateral foreleg. In most nerve root syndromes, a precise description of radiating pain will help localize to a nerve root level. Over 95 percent of herniated discs affect the L4-5 or L5-S1 interspace. The sensitivity of sciatica (the proportion of patients with a herniated disc who have sciatica) was 0.95 in one report, indicating that its absence makes lumbar disc herniation unlikely. The specificity of sciatica (the percentage of patients without a herniated disc who do not have sciatica) is also high at approximately 0.88. However the diagnosis should not be based solely on the presence or absence of sciatica. Irritation of non-neural structures in the lumbar spine, such as the facet joints and numerous ligaments and other supporting structures, can produce radiating pain in the lower extremities which can cause diagnostic confusion in some patients. Furthermore, radicular pain ("sciatica") can be caused by such diverse entities as neoplasms, spinal stenosis, entrapment neuropathy, myofascial pain syndromes, trochanteric bursitis, vascular malformations, endometriosis, diabetic radiculoneuropathy, herpes zoster (shingles), idiopathic lumbosacral plexitis, and entrapment of the sciatic nerve by the pyriformis muscle. Table 3: Differences between the pain of a herniated disc and spinal stenosis Characteristic Spinal stenosis Disc-pain Aggravating factor Lumbar extension Lumbar flexion (standing, sitting) Relieving factor Lumbar flexion (sitting Lumbar extension (lying or stooping over) down) Table- 4 Nerve Root Pain worst in Radiation Sensory Motor Reflexes of pain loss weakness S1 Leg>>Back Buttock, Fifth toe flexors, Absent ankle
posterior lateral foot gastrocne- thigh , mius PL calf and PL calf and rarely jerk heel PL thigh hamstrings L5 Back >>Leg PL thigh, great toe externsor no reflex groin, medial foot hallucis loss lateral Calf and DM AL calf longus, foot, first (less often) Tibialis anterior Two toes and peronii- foot drop L4 or L3 Back >> Leg AM thigh AM thigh Quadriceps Absent knee and knee and knee and jerk iliopsoas
Back Pain - Infographic
Back pain is ranked second to headaches as the most frequent location of pain. Four out of five adults will experience at least one bout of back pain at some time in their lives. It is almost next to common colds in the list of common diseases.
Back pain is ranked second to headaches as the most frequent location of pain. Four out of five adults will experience at least one bout of back pain at some time in their lives. It is almost next to common colds in the list of common diseases.
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