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Back Pain

What is Back Pain?

Back pain or backache is the pain felt in the back that may originate from damage to the muscles, nerves, bones, joints or other structures in the spine. Back pain is one of the most common medical problems experienced by most people at some time in their life. It can be acute, usually lasting from a few days to a few weeks, or chronic, lasting for more than three months.

Characteristics of Back Pain

Back pain can occur as a dull constant pain or a sudden sharp pain. It may be confined to one area or radiate to other areas such as the arm and hand, upper or lower back, and leg or foot.

Related Symptoms

Other than pain you may experience weakness, numbness or tingling in your arms or legs caused by damage to the spinal cord.

Risk Factors for Back Pain

Athletes participating in sports such as skiing, basketball, football, ice skating, soccer, running, golf or tennis are at a greater risk of developing back pain. During these sports activities, the spine needs to bear more stress, take up more pressure, undergo twisting and turning, as well as bodily impact. This may cause strain on the back that can result in back pain. Athletes are at a high risk of back pain both from trauma and from overuse injuries, especially in sports requiring hyperextension.

Causes of Back Pain

The common causes of back pain in athletes include:

  • Musculoligamentous strain: It is the most common sports injury caused by injury to the soft tissues around the spine.
  • Spondylolysis: It is most commonly found in athletes who participate in sports such as gymnastics, pole-vaulting, and football. All these activities require frequent hyperextension of the lumbar spine.
  • Spondylolisthesis: It is a condition of the spine that occurs when one vertebra is displaced or has slipped forward over the other below it.
  • Herniated nucleus pulposus: When an injury occurs, the central core of the disc is pushed through a tear in the outer hard layer of the disc, causing a bulge and pressure on nearby nerves. If the herniated disc presses on a spinal nerve, it can cause back pain.

Other causes include growth-related problems such as scoliosis and Scheuermann's kyphosis.

Diagnosis of Back Pain

Your physician will diagnose back pain by reviewing your history and symptoms and examining your spine. A complete examination includes the examination of the signs of unusual curves of the spine, rib hump, tilted pelvis and tilting of the shoulders, and a test of your sensations. Other diagnostic tests may be needed to confirm the diagnosis.

Treatment for Back Pain

The treatment for back pain is usually non-surgical and includes:

  • Anti-inflammatory medications or NSAIDs are recommended to provide relief from pain.
  • Cold packs, heat packs or both, applied to your back will help ease much of the discomfort and relieve stiffness as well the pain.
  • Sleeping with the pillow between the knees while lying on one side or placing the pillow under your knees when lying on your back may help relieve back pain.
  • Exercises to strengthen your trunk and back muscles may be recommended.

These measures help to relieve your back pain; however, in certain conditions, the pain may not be resolved and may require surgical treatment. Your physician will decide on the appropriate surgery based on several factors.

If conservative treatment fails, we can consider:

  • Injections
  • Ablative therapy
  • Minimal Invasive Decompression
  • Spinal Cord Stimulation/Peripheral Nerve Stimulation

Neck Pain

Cervical Anatomy

The first 7 vertebral bones of the spinal column form the cervical spine in the neck region. The neck bears the weight of the head, allows a significant amount of movement, and is less protected than other parts of the spine. All these factors make the neck more susceptible to injury or other painful disorders. 

What is Neck Pain?

Common neck pain may occur from muscle strain or tension from everyday activities including poor posture, prolonged use of a computer and sleeping in an uncomfortable position.

Causes of Neck Pain

The most common cause of neck pain is injury to the soft tissues (muscles, ligaments or nerves) or prolonged wear and tear. Traumatic accidents or falls and contact sports can cause severe neck injuries and pain. Neck pain can also occur from infections, tumours or congenital abnormalities of the vertebrae. The common conditions producing neck pain include:

  • Rheumatoid arthritis: It is an autoimmune disease in which the body's immune system attacks healthy joints, tissues, and organs. The condition occurs most often in the upper neck area, causing inflammation of the lining (or synovium) of joints, and resulting in neck pain, stiffness, swelling, and loss of function.
  • Cervical disc herniation: disc herniation is the bulging or rupture of the soft fibrous disc that cushions the vertebrae. The soft central portion called nucleus pulposus bulges out through the tear in the capsule. Cervical disc herniation refers to the herniation of the discs in the cervical spine region or neck region. The condition can be caused by normal ageing or by traumatic injury to the spine. The condition results in painful, burning, tingling or numbing sensations in the neck. 
  • Cervical spondylosis: Cervical spondylosis refers to the abnormal degeneration of the cartilage and bones in the neck region. The condition results in neck pain radiating to arms or shoulder and neck stiffness that gets worse over time.
  • Cervical stenosis: Cervical stenosis refers to the narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to your arms and hands. 
  • Degenerative disc disease: Degenerative disc disease refers to the gradual deterioration of the disc between the vertebrae and is caused due to ageing. As people age, intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics, resulting in neck pain. 

Diagnosis of Neck Pain

The diagnosis of neck pain is made with a review of your history, physical examination and other imaging techniques including electromyography (EMG), X-ray, MRI scan, CT scan, blood tests, and bone density assessment. 

Treatment Options for Neck Pain

The treatment options for neck pain may include rest, ice application, use of a soft neck collar and neck immobilization using a splint, cast or sling. Medications such as anti-inflammatory drugs, analgesics, and muscle relaxants may be prescribed to reduce pain and inflammation. Certain stretching and strengthening exercises may be recommended to strengthen the neck muscles. 

Surgical treatment by anterior cervical discectomy with spinal fusion is typically recommended only after non-surgical treatment methods fail to relieve the pain. An anterior cervical discectomy is a surgical procedure performed to remove a herniated or degenerative disc in the cervical (neck) spine. Spinal fusion may be performed to provide stability to the spine. 

If conservative treatment fails, we can consider:

  • Injections
  • Ablative therapy
  • Spinal Cord Stimulation

Prevention of Neck Pain

The following steps may help you prevent or improve your neck pain:

  • Practice relaxation exercises to prevent undesirable stress and tension to the neck muscles.
  • Perform stretching exercises for your neck before and after exercise.
  • Maintain good posture if you work at a computer and adjust the monitor to your eye level. Stretch your neck frequently. 
  • If you use the telephone a lot, use a headset. 
  • Use a pillow that keeps your neck straight.
  • Wear seat belts and use bike helmets to reduce injuries.