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Return to activity | Diagnostics | Pain
relief | Time | Limiting rest | Physical
therapy | Exercise | Injection
therapy | Types of Medication | Massage | Biofeedback | Acupuncture
The primary goal of treatment is to get you back to your job, and back to your recreational activities.
During the first visit with the physician, a medical history will be taken. The physician then reviews the history, and collects more specific information during the patient exam. In the exam, the physician may move certain joints and limbs in ways that reveal diagnostic information about the back or neck problem. Be sure to answer all the physician's questions honestly because certain movements are intended to produce, or not produce, discomfort. What you feel helps the physician diagnose your problem correctly. Consequently, it is crucial to answer questions honestly.
For simple muscle-related back pain, X-rays are of limited value because they do not show muscles and discs, only bones. A physician may use X-rays to determine if there are any fractured vertebrae after a fall, or if there is a narrowing of the disc space which may imply a disc problem.
In some cases, the physician may use MRI or CT to determine what may
be causing the person's pain. These tests are painless, and function
simply as a medical photograph of your body.
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- X-rays show bones and the spaces between the bones. MRI (Magnetic Resonance Imaging) and CT Scans provide the physician with images of the soft tissues and nerves in the spine, including discs and joints.
- Pain relieving injections can relieve back pain and give the physician important information about the problem.
- Myelograms can reveal the extent of damage in the spine. This procedure is used to determine if surgery is necessary and to provide the surgeon with additional information to make sure back or neck surgery is successful.
In addition to function, relief of pain
is important. However, it is important for the patient to understand
that pain is a signal from the body to the brain that something is wrong.
Either the back is too weak, too inflexible, something lifted was too
heavy, or the wrong body mechanics were used.
Those doctors who focus exclusively on pain symptoms often recommend
a course of treatment that is the exact opposite of what the individual
needs to recover from the back problem.
Years ago, for example, doctors treated back pain with bed rest and heavy
drugs to mask the discomfort. It was found, however, that this type of
treatment was actually damaging to the back, because it caused muscles
in the back to get weaker which, in turn, caused more strain and pain.
Patients became more dependent on drugs and grew more inactive and disabled.
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Believe
it or not, for back pain that recently started, and where it is limited
to the low back area, and where there are NO
RED FLAG SYMPTOMS, time is your best asset. Check out
the home
remedy section of this site for ways to help your back
or neck pain to resolve itself.
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In 1986,
the New England Journal of Medicine reported that for
most back pain, rest and inactivity should be limited to two days at
most. After that time, patients should be encouraged to start moving
and exercising to strengthen the back muscles and increase flexibility.
In turn, part of the rehabilitative process requires a commitment on
the part of the patient to work closely with the therapist during those
first few weeks to ensure a successful long-term recovery.
While drugs and manipulation may relieve initial pain, neither of these
changes the musculature of the back which is necessary for long-term
recovery. Only exercise can strengthen the back muscles and make them
more flexible and resistant to future strain.
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Physical therapy
Physical therapy helps to strengthen muscles that support the spine,
and increase flexibility. This new strength and flexibility will help
prevent future back strain. A therapist may use ultrasound, electrical
stimulation, heat or ice, mobilization and exercises to reduce pain and
the likelihood of future injury. Click here to learn more about physical
therapy.
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Exercise
In the old days, the prescription for pain was often bed rest. Now, however,
it is known that more than a few days of bed rest after an injury can
be counterproductive to rehabilitation. One of the best cures for back
pain is increasing strength and flexibility through exercise. Activity
acts as a lubricant to the joints and muscles in the back and is as necessary
to recovery as oil is to the hinge in a squeaky door.
It is important to work with a therapist to make sure exercises are done
properly. Never do any exercise that increases the pain.
Exercise and movement can help, tissues in the back become stronger and
better able to support the back and resist the impact of additional injury.
Specific exercises can be used to target particular types of back pain
help to make the back stronger.
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For years, spine physicians have used cortisone injections, epidural
steroid injections, trigger point injections and nerve blocks to relieve
pain in the spine. The injections are really intended as a means to an
end. The theory is that by injecting pain-relieving medication directly
into the site of injury or the pain generator, a patient can bridge from
inactivity to the physical therapy gym. Once there, and able to move,
the patient is ready for therapists to begin to work their wonders.
Often spine injections are provided in a series of three or four injections
spanned over a couple weeks. The theory is that a series works better
at knocking down pain and inflammation than a single injection.
There has been some conflicting research about the value of various injections.
Some studies have questioned the benefit of epidural steroid injections.
Another authority, Britain's Royal College of General Practitioners,
noted in their back care guidelines released in 1997 that epidural steroid
injections relieve low back pain with sciatica (leg pain) better than
some other treatments. The Royal College is less supportive about facet
joint injections and trigger point injections. According to the College,
there is little supporting evidence that these injections improve clinical
outcomes. With that said, many spine specialty centers believe in the
benefit of injections and continue to use them.
There are many treatments, including spine injections, that need more
study to come to a definitive conclusion as to their proven benefit.
Some experts theorize that there may be some placebo effect associated
with the relief that accompanies an injection. In any event, when a patient
gains relief after an injection, it reinforces a physician's desire to
use that treatment again.
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Medication
Medicine, in some cases, may lessen swelling and reduce pain, providing
symptom relief. The type of medication your physician recommends depends
on your symptoms and your level of pain.
At home, symptoms may be relieved by Non-Steroidal Anti-Inflammatory
Drugs (NSAID) such as ibuprofen products like Motrin or Advil. Aspirin
might also be recommended to ease pain.
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Massage
Not only does it feel relaxing, massage has notable health benefits
that are an important part of back pain rehabilitation. Massage helps
the back pain sufferer by releasing toxins in muscles, increasing circulation,
releasing endorphins, reducing inflammation, alleviating muscle cramps,
breaking down scar tissue and calming the nervous system.
Aside from the physical health benefits, massage has a psychological
impact in helping the patient learn to feel relaxed. For the chronic
back pain sufferer, even the simple luxury of drifting off effortlessly
to sleep has usually not been a reality for months, sometimes even years.
Massage can bring back that feeling of calm - a concept that has become
foreign to them.
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Biofeedback
For hundreds, even thousands, of years, Eastern medicine has asserted
the importance of the role the mind plays in controlling physical health.
In the West these ideas were touted as mystical and scientifically unfounded.
Recently, however, as more scientific connections are made between mind-body
healing, Western science is beginning to appreciate and incorporate this
type of therapy into pain rehabilitation.
Due to its objective means for tracking progress, biofeedback is one
of the more popular of these mind-body therapies in pain rehabilitation.
During sessions, electrodes are attached to the body to monitor body
temperature, heart rate, muscle tension, skin resistance and perspiration.
Through biofeedback, the patient is taught to recognize the way in which
stress and relaxation chemically alter the body's function. For instance,
the patient will learn to lower heart rate and muscle tension. The biofeedback
equipment will record statistics and gauge progress as the patient learns
to control the body thus controlling pain.
By recognizing these signals in biofeedback sessions, the patient is
able to recognize them in his or her daily life and arrest the onset
of muscle spasms or high blood pressure from the start. This keeps pain
at a minimum or away altogether.
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Traditional acupuncture is based on the ancient Chinese
theory that there are energy pathways that run throughout the body.
These pathways, called meridians,carry the body's vital force or energy,
called chi (pronounced "chee").
The principle behind acupuncture is that disease and pain are caused
by the body's energy flow (chi) being out of balance.
Through the insertion of thin needles at specific points along the meridians,
the flow of energy is controlled and rebalanced in the body.
Acupuncture dates back in China to the first century B.C., during the
era of the Han dynasty (206 B.C. -220 A.D.). Because Western physicians
in the United States have difficulty understanding the correlation between
acupuncture philosophies and traditional physiology, acupuncture has
not been accepted readily in the United States.
Modern science has taken a shot at explaining how acupuncture can relieve
pain. Some observe that the traditional Chinese "meridians" overlap
with some of the pathways of the central nervous system. By using needles,
the acupuncturist can stimulate the nervous system to release endorphins
(morphinelike chemicals) in the muscles, spinal cord and brain. These
chemicals either relieve the pain symptoms or trigger other chain reactions
that relieve pain symptoms.
Because acupuncture is nonsurgical and does not involve drugs and it,
has no real negative side effects or permanent complications, it may
be worth exploring when you have exhausted the traditional remedies of
Western medicine and you still want a nonsurgical option.
Need
more information on back and neck pain?
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