Thursday, November 23, 2017

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Lumbar Pain: Signs and Symptoms

Are you suffering from back pain? Why live with it?..... Instead lets try and find out the ways and means of relieving the discomfort associated with back pain

However, the thing that you need to know is to learn more about the main causes. Any problem that you may have in moving your back has a specific cause behind it. While your back pain can develop slowly over days, you may often experience an intense shooting pain, tingling, and even numbness in your low back or down either lower extremity when you try to move, walk or sit.  The reasons behind each kind of pain may differ as well.

 The Lumbar spine is comprised of five bones (vertebrae) in the lumbar spine, although it is not unusual to have six. Each vertebra is stacked on top of the other and between each vertebra is a gel-like cushion called an intervertebral disc. This disc functions to help absorb pressure, distribute stress, and help the vertebrae from rubbing /grinding against each other. The vertebrae and disc are held together by groups of ligaments. Ligaments connect bone to bone, whereas tendons connect muscle to bone. In the spine, tendons connect muscles to the vertebrae. The ligaments and tendons help to stabilize the spine and guard against excessive movement in any one direction.

The spine it very similar to all our joints in our body as the knee, shoulder, and other joints. The spinal joints are called (facet joints). The facet joints link the vertebrae together. They are located at the posterior area of the spinal column (on the back side of the vertebrae). The facet joints functions to make the spine more flexible and enable you to bend forward, backwards as well as side to side.

In the center of the spinal column is a vertical hole called the spinal canal. This canal contains the spinal cord. The bones of the vertebrae serve as armor to help protect the spinal cord from injury.

The spinal cord descends from the brain, through the cervical, thoracic and lumbar vertebrae in the spinal canal. It ends, usually in between the first and second lumbar vertebrae. Below this level a group of nerves called the (cauda equine) which translates to (the horse’s tail) travels through the rest of the spinal canal and branches off to various parts in the lower half of your body.

The spinal cord and the nerves are part of the central nervous system that includes the brain. The nerves are the body’s message board (system). Without this we would not be able to move, feel and experience sensations such as temperature.

Let us now take a look at some of the most common causes of Low back (lumbar spinal) pain:

Lumbago or Low back pain: This is the most common disorder involving the muscles and bones of the back. Lumbago affects approximately 80% of people at some point in their lives. In the United States low back pain is the most common cause of job related disability and a leading contributor to missed work. Low back pain which could be classified as one of the below classifications Sprain or Strain. Can also be classified by duration as Acute pain: (pain lasting less than 6 weeks), Sub-chronic pain: (pain lasting between 6 weeks to 12 weeks) or Chronic pain: (pain lasting more than 12 weeks). Low back pain can be further classified by the underlying cause as either Mechanical, Non-mechanical, or Referred pain.

Mechanical low back: is the general term that refers to any type of back pain caused by improper movement, activities as lifting a heavy object, bending forward, or static loading of the spine via prolonged sitting or prolonged standing activities. Examples:

  • Sprain / Strain
  • Degenerative Disc
  • Degenerative Facet
  • Disc Herniation
  • Spinal Stenosis
  • Compression Fracture
  • Spondylolisthesis
  • Spondylolysis
  • Bulging Disc

If your low back pain is diagnosed to be mechanical in nature then Physical Therapy is a great treatment option for you. This is because in Physical Therapy we are treating the cause of your symptoms and not masking them with Medications or injections. However, there are times when pain medications and or injections are needed for treatment of mechanical symptoms. Sometimes taking medications or injections for low back symptoms will mask or cover up symptoms and patient will return to mechanical cause as poor posture, poor lifting technique, or poor body mechanics with work duties and make injury / symptoms worse.

Non- Mechanical low back: is the general term that refers to any type of back pain caused by inactive life styles. Meaning not caused by activity, movements, posture related stresses to the spine. Example:

  • Neoplasia
  • Infection
  • Inflammatory arthritis
  • Ankylosing spondylitis
  • Psoriatic spondylitis
  • Reiter
  • Paget
  • Scheuermann disease

Referred Low Back Pain: Referred pain is pain that is perceived at a location other than the site of the painful stimulus. Referred pain from the back for example would be. If someone had symptoms as pain, tingling and numbness or any combination of these in one or both lower extremities, however, painful stimulus is from lumbar disc or discs. Example:

  • Bulging Disc
  • Herniated Disc
  • Slipped Disc

Back Strain: Strain is an injury to the area that attaches the muscle to a bone. Now a strain of the low back can be caused by over stretching or over working the muscles by either a physical activity or poor imbalanced posture. Strains will result in pain and or stiffness within the muscles that are being worked/stressed in the low back.Contracting the affected muscle can aggravate the involved tendon that is strained.

Signs and Symptoms:

  • Pain
  •  Swelling
  • Bruising
  • weakness and stiffness
  • popping sensation
  • Immobility of area of strained muscle

Back Sprain: Sprain is an injury to the ligament that attaches a bone to a bone. Now a sprain of the low back can also be caused by over stretching or over working the ligament or ligaments by either a physical activity or poor imbalance posture. We must realize a sprain is a non- contracting injury because a ligament does not contract it is mainly a supporting structure between bones. Therefore sprains will result in pain and or stiffness within the ligaments that are stressed in the low back. Stress on the supporting low back ligaments can result in stretching, tearing or completely tearing the ligament between bone attachments causing lack of stability at that bone to bone attachment.

Signs and Symptoms:

  • Pain
  • Swelling
  • Bruising
  • Stiffness
  • Instability at joint

Degenerative Disc Disease:  Degenerative disc disease is really not a disease at all, but rather a set of circumstances that leads to the breaking down of the vertebral disc or loss of fluid in the disc. This reduces the ability of the disc to act as shock absorbers and make them less flexible. Degenerative disc disease usually starts to show itself as we age and the stresses we put on our low back over the years start to break down the structures of the disc and its surrounding structures.

Signs and Symptoms:

  • Low back Pain “Worse” with sitting
  • Increased Low Back pain with bending, lifting and twisting activities
  • Better with changing positions frequently as in walking and even running
  • Best with lying down

Degenerative Facet: The Facet joints are the joints structures that connect the vertebrae to one another. The facet is like any other joint in the body. They have cartilage that line the joint allowing the bone to glide smoothly over one another. The function of the facet is to provide support, stability and mobility to the vertebrae spine. A degenerative facet mostly occurs when the thin layer of cartilage covering the joints break down, causing inflammation and pain, which maybe slight, moderate to severe.

Signs and Symptoms:

  • Stiffness low back after standing in one place too long
  • Difficulty with twisting and stretching low back
  • Dull pain moving into thigh and buttocks
  • Tenderness around the inflamed joints
  • More discomfort when leaning backwards the forward

Herniated Disc: Is when the disc has weakness in the outer wall in the spine. This allows the soft tissue that makes up the inside of the disk called nucleus propulsus to push against the weakened wall. This results in a bulge forming in the side of the disc wall. This bulge becomes under more stress, during activities as twisting, lifting, bending forward of the spine. When this bulging disc becomes too stressed it can herniate. Herniation is when the disc fluid call nucleus propulsus comes through the disc wall and places pressure on the nerves in the spinal canal. A true herniated disc is when you have symptoms of pain, tingling, or numbness or any combination of these in the associated disc distribution area that does not stop, change no matter what you do with body positions.

Signs and Symptoms: vary greatly depending on the position of the herniated disc and the size of the herniation.

Not pressing on the nerve:

  •  Ache in the low back or no symptoms at all

Pressing on the nerve:

  • Pain, tingling, numbness, or weakness in the area of the body to which that nerve being compress travels.
  • These symptoms will not lessen once they start no matter what body positions you change to.
  • Gets more intense with sneezing, coughing, or straining to pass stools.
  • More intense symptoms with sitting, prolonged standing, and bending or twisting movements of the lumbar spine.
  • Weakness in both legs and or loss of bowel or bladder control are specific symptoms of nerve root compression called “Cauda Equina Syndome”. If you have any of these symptoms you should go to emergency room emediately.
  • When sciatica nerve is pinched or compressed you will get “Sciatica”.

Sciatica is pain that travels down lower back through buttocks and down usually one leg to the ankle. However, sciatica can be present in both legs.

Spinal Stenosis: Is the narrowing of space in the spine which causes pressure on the spinal cord or nerves exiting the spinal cord. Most commonly a result of wear and tear changes related to aging process of the disc, ligaments, bones and facet in the spinal canal.

Signs and Symptoms:

  • Pain in legs, feet, buttocks.
  • Weakness in legs, feet, buttocks.
  • Numbness in legs, feet, buttocks.
  • Cramping in the legs, feet, buttocks.
  • Stiffness in Legs, feet, buttocks.
  • All above symptoms are when Standing or walking for long periods of time.
  • Above symptoms worsen with stretching or extending your low back.
  • Above symptoms worsens with Walking (especially downhill)
  • Above symptoms worsen with standing straight or leaning backwards
  • Symptom Relief with bending forward low back, or sitting down.
  • Symptoms Relief with leaning over grocery cart.
  • Symptom relief with walking Up-hill.
  • Worse cases – loss of bladder and bowel control

Compression Fracture: Is when the normal vertebral body of the spine is squished, or compressed, to a smaller height. This is usually seen in two groups of people. First group are people that were involved in traumatic accidents. What happens in a traumatic accident is a load is placed on the vertebrae that exceeds its ability to maintain stability and the vertebrae collapses causing a compression fracture. Most commonly seen after a fall. The second group are people with Osteoporosis. Osteoporosis is a condition that causes a thinning of the bones or what is called brittle bones. In this condition the bones thin out and are less able to support a load. These people may develop compression fractures without severe injuries as in their daily activities.

Signs and Symptoms:

  • Back Pain that comes on sudden.
  • Back Pain that is severe and comes on gradually and worsens over time.
  • Worsening of pain with Standing or Walking.
  • Pain relief with Lying down
  • Difficulty with bending or twisting activities.
  • Pain with bending or twisting activities.
  • Loss of Height
  • Deformity of the spine (Kyphosis)
  • Constipation
  • Loss of appetite
  • Weight loss
  • Hip pain
  • Breathing difficulties

Spondylolisthesis: Is the displacement of a vertebrae or the vertebral column in relation to vertebrae below. The term “spondylolisthesis” was coined in 1854, from Greek “spondylo” for vertebrae and “olisthesis” for slip. These “slips” occur most commonly in the lumbar spine L5 on S1.

Signs and Symptoms:

  • General stiffening of the low back musculature.
  • Tightening of Hamstring musculature.
  • Changes in Posture (leaning forward slightly when standing).
  • Changes in Gait more of a “waddle” then a walk appearance due to decreased mobility of hamstrings.
  • Atrophy of Gluteal musculature.
  • Generalized Pain in lower back L5-S1.
  • Intermittent shocks of shooting pain beginning in buttocks traveling downwards into back of thigh and lower leg.
  • Sciatica extending below knee into feet
  • Sometimes including tingling and numbness.
  • Sitting and trying to stand up may be very painful and difficult.
  • Complaints of “slipping sensation” when moving into upright position.

Spondylolysis: Is a defect of a vertebra. More specifically it is defined as a defect in the “pars interarticularis of the vertebral arch”. Mostly seen in the lower lumbar spine (L5) vertebrae but can occur in any lumbar or thoracic vertebrae though less common.

Signs and Symptoms:

  • Pain in Low back: leads to reduced mobility and inactivity.
  • Weight Gain
  • Loss of Bone Density
  • Loss of Muscle Strength (core, hips, quadriceps, Hamstrings)
  • Loss of Flexibility of (trunk, hips, quadriceps, hamstrings)
  • Can Progress until one vertebrae slips out of place leading to “spondylolisthesis”

Bulging Disc: A disc bulge (commonly referred to as slipped disc) can potentially press against or irritate the nerve where it exits from the spine. This occurs when the ligament surrounding the disc is injuried to such an extent that the disc loses its ability to absorb and its outer wall called “annulus” becomes weakened. This allows the soft inside of the disc called “Nucleus Propulsis” to bulge outwards and compresses on the nerve root. Depending on how much bulging occurs will result in pain or other symptoms as numbness, sensations of pins and needles, weakness in the area or areas associated with that nerve level. Thus, some of the symptoms may be felt far away from the source of the trouble, for example in the lower leg or foot. Remember that in a bulging disc the Nucleus propulsis stays inside the annulus at all times, unlike in a herniated disc where the Nuleus propulsis breaks through the annulus wall.

Signs and Symptoms:

  • Pain, spasm, cramping, numbness, pins and needles, and or a combination of any of the above.
  • Location depends on at what level the compression, pinching or irritation occurs from L1 to L5.
  • Severity of the above symptoms or combination of symptoms depends on how much the disc (nucleus propulsis) pushes out and puts press on the nerve or nerve root.