Pain often occurs when one of the facet joints that link the vertbrae in your spinal column is suddenly twisted or jerked. A joint that is damaged in this way may stick or “lock”, making movement difficult as well as painful. Facet joint strain can occur throughout your spine.

Facet Joint

Causes for Facet Joint Strain

Awkward twisting or bending of your neck or back can injure the ligaments, muscles, or the capsule of a facet joint. Whiplash from a car accident is a good example of this type of injury, but it can also result from failure to warm up before exercising or playing sport, or from lifting heavy objects. Even simply turning over in bed or sleeping awkwardly can have the same effect. Your muscles may then go into an uncontrollable spasm, making the joint stiff and immobile. Facet joints are more vulnerable to strains from middle age onwards, when osteoarthritis may flare up, the discs in your spine have degenerated significantly, and the ligaments that are supporting the joints become more slack.

Symptoms and Diagnosis of Facet Joint Strain

In the early stages, disabling pain in you neck or back is often accompanied by restricted movement. Pain from facet joint strain in your lower back may also radiate into your buttocks, hips, lower abdomen, and thighs. Movement may be limited for only a few weeks; however, it can last for months, and in some cases years, unless you receive appropriate treatment, which usually involves manipulation or, in chronic cases, an injection. Facet joint strain in your neck may extend down to your shoulders,  making it difficult to bend your neck or turn your head. Your doctor will make a diagnosis by giving you a physical examination.

Risks and Recovery for Facet Joint Strain

There is no serious risk from facet joint strain, but failure to relieve pain or inflammation can lead to permanently stiff joints. Joint strain in the middle of your back, although the least common, may cause pain to radiate around your chest, making it painful and difficult to breathe, especially if the joints between the ribs and thoracic vertebrae become “locked”.

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Weakening of the bones is fairly common in old age and may also occur in younger people who are in poor health. When this loss of structural strength affects the vertebrae of the spinal column, even a slight increase in pressure on them – perhaps due to a fall or sudden vigorous activity – can cause cracks and fractures, especially in the mid – and lower back.

Compression Fracture

Causes of Vertebral Compression Fracture

Osteoporosis is the most common cause of bones (including the vertebrae) becoming weaker and more susceptible to injury. The condition causes loss of minerals from the bones, making them less dense and more fragile. It mainly affects women after the menopause, due to hormonal changes, but men also develop osteoporosis to some degrees as they age. If you are a heavy smoker, alcoholic, do little exercise, or have suffered from an eating disorder (such as anorexia) and are still underweight and very thin, you have a high risk of developing osteoporosis.

Symptoms and Diagnosis for Vertebral Compression Fracture

If you fracture a vertebra, you will feel a sudden, severe pain in he area of your back where the injury has occurred. Damaged vertebra in your lower back may also cause pain around your pelvis and, if any nerves are irritated, numbness and tingling in your legs. In the upper part of your back, the pain may radiate around your chest and make breathing difficult. You may find it hard to move around, and even lying down can cause pain; coughing or sneezing may hurt too. This pain and lack of mobility is likely to take several weeks to subside. Your doctor may arrange for a CT or an MRI scan to assess the extent of the fracture.

Treatment of Compression Fractures

Treating the osteoporosis with medicines and calcium and treating the pain with analgesics. A brace or corset is sometimes recommended, to keep the back stable as the bones heal. Surgery may be needed if there is any loss of function because of bone pressing on the spinal cord or spinal nerves.

Risks and Recovery

Without treatment the shape of your spine and your posture may be permanently affected. While the pain lasts you are likely to find it difficult to perform everyday activities.

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These linked conditions generally affect your lower back but may occur in any part of your spine. Spondylolysis occurs when a defect or weakness in a vertebra is then at risk of slipping out of line with the vertebrae adjacent to it, leading to spondylolisthesis, which can be debilitating and painful, or may be painless and go unnoticed.

Causes

Spondylolysis may start with a minor crack across the narrow arch of bone in a vertebra, known as the neural arch. In some cases, this crack is present at birth, but usually it is the result of a fall or due to strain and overuse. Some sports, such as cricket and football, repeatedly put stress on the arches of the vertebrae, which can lead to minor cracks or breaks. Spondylisthesis generally develops from spondylolysis, with the crack widening to a complete break due to further stresses and strains. This break allows the damaged vertebra  to slip out of line, which can irritate the linked facet joints and ligaments and possibly trap a nerve.

Symptoms and Diagnosis

The pain from a displaced vertebra due to spondylolisthesis depends on the degree of slippage. A slight slip may cause little or no pain, while a greater degree of slippage can lead to more intense pain because of the irritation to the spinal joints and ligaments. If your nerve is trapped, there may be some pain, numbness, or “pins and needles” in one or both of your legs. Your doctor will make a diagnosis is through a physical examination and testing including an X-ray, MRI scan, and myelogram.

Spondylolisthesis

Risks and Recovery

Back-strengthening exercises can help stabilise your posture, but where vertebrae have severely slipped, nerve entrapment can develop that may require surgery. Young people diagnosed with spondylolisthesis should avoid contact sports and activities with a high risk of back injury. A young person who is still growing should be monitored every six months, using X-rays to detect further movements and shifts in the spinal column. Once growth stops, the vertebrae are unlikely to slip any further.

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Tensing your muscles is a normal response to stress and heightened emotions, such as anger, nerves, or frustration. You may also get into the habit of holding certain sets of muscles in a tense, fixed position when performing basic everyday actions, such as moving around or sitting on your desk. This tension, however, is a major cause of neck and back pain.

Trapezius Muscle

Causes to Muscular Tension

Poor posture, injury, overexertion, differences in leg length, and conditions such as scoliosis can all cause you to tense specific sets of muscles, as the muscle compensate for any difficulties these problems create. Stress and emotional pressures are the main triggers for over-tense muscles, but difficulty sleeping or poor nutrition can also cause an increase in muscular tension. Holding your muscles for any length of time in a tense, contracted position limits blood flow to your muscles and restricts the supplies of nutrients and oxygen that they need to work properly.

All this can lead to pain and muscle spasms, which in turn put strain on the joints and ligaments so that they too become tender and sore.

Symptoms and Diagnosis

Pain from excess muscle tension may start with dull ache, but can become extremely painful. Muscles that are regularly held in a contracted and tense position for extended periods of time may also develops “knots”, or “trigger points”. These are particularly tender areas that are easily irritated, sending waves of pain out to other, often distant, parts of your body. Your doctor will make a diagnosis by performing a physical examination.

Risks and Recovery

You should always check that the pain is due solely to chronic muscular tension, rather than any illness or physical problem. If you hold your muscles in a tight, tense state for a very long time, they can become permanent shortened and stop functioning properly.

Treatments for Muscular Tension

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Acute attacks of low back pain commonly afflict young and middle-aged adults. They can occur with little warning, or can develop slowly over a number of days. In about half of these cases, no obvious trigger for he pain can be identified. The pain can be severe and temporarily disabling, and last for 10-14 days on average.

Lower Back Pain
Lower Back Pain

Causes

The causes of acute low back pain may include a fall or stumble, repeated heavy lifting, an awkward bend, prolonged bending and stooping, or a cough or sneeze. Occasionally it may occur suddenly, without any obvious cause, such as waking in the morning and finding it impossible to get out of bed. The actual physical causes of the pain are probably one of the following: acute dysfunction of a segment of the lumbar spine, lumbar disc internal disruption or herniation, irritation of a sciatic nerve, a sacroiliac strain, ligament strain or, very occasionally, a muscle strain. Accompanying muscle “spasm” is a common result of these strains, but is not the cause in itself.

Symptoms

The symptoms of acute low back pain are sharp pain, either centrally or to one side of your lower back, with an intense dull aching which can spread further into your buttocks, groin, and even thighs. Muscle spasm can grip your spine – known as “splinting” – causing immobility and stiffness; the pain may be worse with one or two particular movements such as bending forwards, backwards, or sideways, and you find it hard to sustain some positions, such as sitting, for long.

Risks and Complications

Normally, episodes of acute low back pain will resolve within a few weeks without the need for specific treatment, and the threat of any serious complications as a result of them is very small. The main risks are associated with resting for too long, which can cause stiffness. You may become fearful of any movement because of the memory of the initial pain or the idea that any pain caused by moving means further harm. Rarely, a disc strain can develop into cauda equina syndrome, when the disc prolapses or herniates fully into the spinal canal and damages the nerves that run into the legs, bladder, and bowels.

Treatment – Acute Lumbar Dysfunction

Immediate

  • If you suspect your pain is caused by acute lumbar dysfunction, you should:
    • take painkillers for the first few days of pain

Short Term

  • If after 3 days, you are still unable to move, you should:
    • seek medical attention.

Medium Term

  • If after 7-10 days you are not able to resume normal activities, you should:
    • consult a doctor for further treatment.

Long Term

  • If after 6-8 weeks you are not recovering as expected, your doctor may:
    • arrange investigations such as an X-ray, MRI or blood tests.

Treatment – Disc Herniation and Sciatica

Sciatica
Sciatica

Immediate

  • If you suspect your pain is caused by sciatica, you should:
    • consult a doctor for examination and diagnosis

Short Term

  • If the pain increases when you are upright, you should:
    • lie flat for short periods.

Medium Term

  • If after 7-10 days you are unable to resume normal activities, consult a doctor, who may:

Long Term

  • If after 6-8 weeks you are not recovering as expected, you should:
    • seek further advice from your doctor, who may arrange MRI.
  • If you have not responded to physiotherapy within 3 months, then:

Treatment – Sacroiliac Strain

Immediate

If you suspect your pain is caused by acute lumbar dysfunction, you should:

  • take painkillers for the first few days of pain

Short Term

  • If, after 3 days, the pain has not settled, you should:
    • consult a doctor

Medium Term

  • If, after several weeks, you are still unable to resume normal activities, you should:
    • consult your doctor for further examination, advice, or treatment.

Long Term

  • If, after 6-8 months, you still have recurring pain, you should:

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