Whiplash is the rapid bending forward and extension backward of the spine, usually the cervical spine, by an abrupt change in the speed and direction in which you are in is obviously traveling faster that yours. When the collision occurs, your car is projected forward, forcing your head backward. Then you car rapidly decelerates, hits another car ahead of you, or you slam on the brakes to avoid it, and your head is thrown forward. All this may occur within seconds and cause damage to the facets and their coverings, discs, and the muscles around and the ligaments supporting the spine.

Whiplash Injury

The whiplash may also cause the brain to bounce back and forth inside the skull. The brain is a mass of nerve and other cells and blood vessels. It has the consistency of moderately firm butter and is supported by leatherlike sheets (dura) and surrounded by a leatherlike sac filled with spinal fluid. At the base of the brain, delicate nerves, a fraction of an inch in diameter, leave the buttery mass, enter holes in the skull, then can travel to your nose, eyes, ears, and other structures. You can readily understand that as a result of severe whiplash, in which the brain is thrown back and forth inside the dural sac inside the skull, damage to it and the nerves leaving it may occur. A whiplash injury may cause a mild concussion, which can affect thinking and mood. Double vision, ringing in the ears, and headaches are common. If the speed at which this accident occurs is high enough, broken vertebrae, a damaged spinal cord, and severe concussion or even a contusion or bruise of the brain, resulting in bleeding within it, can result. There are usually no broken bones, disc herniations, large blood clots, ripped muscle, or torn skin. The result of a whiplash injury is obviously painful, and the painful aftereffects, for unclear reasons, last varying times in different people.

Acute whiplash pain may cause local or widespread muscle spasm. For those with chronic pain, the facets are the usual culprits, although muscle spasm may still exist. The top three segments of facets, C2-3, C3-4, and C4-5, are responsible for head and upper neck pain. Lower facets may cause mid-to-lower neck, thoracic, and lumbar pain.

Whiplash injury may also cause what we call discogenic pain. Even when not herniated, discs may have a torn covering (annulus) and internal tears within the nucleus. The torn annulus can be  seen on MRIs. Not all discs with a torn annulus are painful. The C2-3 and C3-4 discs may cause headache and these and the C4-5 discs may also cause upper neck pain. Like facets, lower discs may cause lower neck, thoracic, or lumbar pain. Discogenic and facet pain may coexist.

Symptoms of Whiplash

Symptoms may occur right after the injury or may be delayed for several days. They include:

  • neck pain and stiffness
  • headaches
  • pain in the shoulder or between the shoulder blades
  • pain, numbness, or tingling (paresthesia) in he arm and/or hand
  • less commonly, low-back pain, with possible radiation into the buttocks, groin, hips, and thighs

Treating Cervical Whiplash Pain

Most whiplash-caused head and neck pain goes away in a few weeks to a few months. In the past, whiplash was often treated by immobilising the neck in a cervical collar; today, we encourage early movement rather than keeping the neck rigid. The collar is the best used intermittently for short periods.

In the first twenty-four hours after injury, apply heat and keep moving the neck slowly and gently. No single treatment has proven effective, but exercises, physiotherapy, cervical collars, medication, and injections have all helped some people some of the time.

Key Points about Whiplash

  • Whiplash is one of the most controversial conditions in medicine.
  • It is most frequently caused by a rear-end auto accident.
  • Most whiplash heals in a matter of weeks, but 20 percent to 40 percent persist for years.
  • It can lead to chronic neck, back, and head pain.
  • Cervical facets and muscle spasm cause the pain.
  • Whiplash can also cause discogenic pain.
  • Because it is test-negative, others frequently don’t believe that you have it.
  • Diagnosis must be done by ruling out all other possibilities.
  • It is treated with medication, physiotherapy and injection.

Call +65 64712674 for an appointment to treat Whiplash Pain today. Same day appointment.

Many people are unaware that they have joints in their spine. There are two tiny facets one on each side of each vertebra to keep the spine stable. As do the shoulder and the knee, spinal facets joint two bones: the vertebra above and below. Spinal facets are true synovial joints. They have a capsule (synovium) that is lubricated by fluid and are filled by a network of pain-sensitive nerve fibres. These small, delicate joints are prone to injury, deterioration, and, in some diseases, inflammation, and they sometimes become sources of chronic neck and back pain independent of the discs and spinal nerves. After muscle pain, facet pain is probably the most common cause of low-back pain.

Facet Joint

Lumbar-facet Pain

Lumbar-facet pain is the most common (though facet pain can occur in any part of the back). The telling sign of lumbar-facet pain is black and possibly buttock, groin, and thigh pain, especially while sitting or arching your back, which increases the pressure on the facets in the back of the spine. Bending forward or lying down usually relieves lumbar-facet pain.

Cervical-facet Pain

Cervical-facet pain is the second most common facet problem and may cause headaches, shoulder, and occasionally arm pain. These facets are often more painful when the neck is bent backward or to the sides, which increases pressure on the facets. Headache from facet pain (cervicogenic headache) occurs in the morning after a night tossing and turning, which also increases pressure on these joints.

Thoracic-facet Pain

Thoracic-facet pain is less common. These joints become injured when excessive amounts of rotation and extension cause a sharp pain anywhere between the upper shoulder blade and the area over the lower ribs. Pain from thoracic facets doesn’t usually travel to the side or front of the chest. Thoracic vertebrae form a relatively immobile segment of the spine compared to the highly mobile neck and lumbar area. Therefore, the thoracic discs and facets are less likely to wear out.

How Facet Pain Develops

The vertebral bodies, separated by the discs, make up the front of the spine and carry the weight of the structure. As the discs degenerate, the facets end up carrying more weight than they should, leading them to wear down and become painful. When facets wear out they can become arthritic, just as occurs in other joints, such as the knees, hips, or fingers.

Osteoarthritis usually develops in the facets of the neck and lower back. The synovium wears out, bone surfaces rub together, and the facets become painful. With time, calcified outgrowths, called osteophytes, develop around the facets, degenerated discs, and supporting ligaments of the spine. The result is loss of flexibility and possibly pain.

Being overweight is an increasingly common cause of problems with lumbar facets. Heavy people wear down their discs earlier and therefore may develop chronic facet pain – among other spinal problems – early in their lives.

Facets can be injured from trauma, such as whiplash from a rear-end auto collision. They can also be injured in sports, such as by being tackled in football or falling off a horse. Golfers are prime candidates for lumbar and thoracic facet injury because of the repetitive twisting motions as they swing the club. A sudden excessive movement – especially backward or to the side – can traumatise the joint and cause pain that can last several days. Sometimes this pain becomes chronic, for reasons that are poorly understood

Spondylolisthesis or slippage of one vertebra over another can also cause low back pain from the facets and other structures. Pain can be controlled by treating the facets only if the slippage is of a low degree and the spine is relatively stable. If the vertebrae wiggle significantly, facet treatment won’t be enough. Medication and lifestyle modification may help you to tolerate your back pain; if they don’t, surgery – fusion – is needed to stabilise your spine.

Diagnosing Facet Pain

Facet problems are identified by the pattern of referred pain, local tenderness over the site, and pain in certain body positions. Your doctor will try to find the pain by poking or moving the suspected painful areas during a physical exam. Physical examination should reveal tenderness over the affected facets and possibly painful trigger points in overlying or nearby muscles and in one-sided lumbar pain, possibly pain in the sacroiliac joint and bursa overlying the hip on the same side as the painful facets.

To make the diagnosis of the facet pain and accompanying myofascial or other test-negative pain and to exclude other possible anatomically based causes of pain, it may be necessary to have a MRI of the painful areas of the spine, and possibly, of the painful pelvis and hip.

Chronic facet pain may come from long-term changes in the joint, detectable by radiological studies, even though facet pain itself is not. Normal appearing facets may hurt, and those that appear arthritic may not. Therefore, facet pain is a test-negative condition, one whose diagnosis is made clinically (using history and examination), not by radiological or other conventional studies.

Treating Facet Pain

An acute episode of facet pain can be treated with rest, medicines or physiotherapist.

You may need injections of local anaesthetics and corticosteroids into any especially painful muscles with trigger points (myofascial pain) associated with the facet problem. If relevant, the bursa overlying the hip may also be injected before starting to exercise. This needed exercise may be painful for the first few weeks.

Treatment of Chronic Facet Pain with Injections

Diagnosis and preliminary treatment of chronic facet-related pain can be done by injections into the facets or the nerves supplying these joints. Just as epidural injections are used to treat root pain within the spinal column, facet-joint injections are sometimes used to diagnose and, for the short term, treat pain from the facet joints. If the facets are in fact the sole or a major cause of pain, injections of anti-inflammatory corticosteroids and local anaesthetics directly into the joints or over the nerves transmitting pain impulses from the facets to the spinal cord may reduce pain and facilitate the rehabilitative therapy.

The injection of anaesthetic briefly blocks the pain signals emanating from the joint, and the corticosteroid reduces any inflammation of the joint and surrounding structures.

Key Points about Facet Pain

  • Facet are small joints, one on each side in the back of the spine, that connect two vertebrae.
  • Facets keep your spine stable but are not made to bear considerable weight.
  • Facets forced to bear weight as the discs degenerate are prone to degeneration.
  • After muscle spasm, facet pain is probably the most common cause of low-back pain.
  • Facet pain can occur anywhere in the spine.
    It is most common in the lower back.
  • Facets that appear normal on radiologic studies may hurt, while those that appear arthritis may not.
  • Osteoarthritis can develop in the facets of the neck and lower back.
  • Being overweight causes problems with lumbar facets sooner rather than later.

Call +65 64712674 for an appointment to treat Facet Pain today. Same day appointment.

Lower Back Pain
Lower Back Pain

Gluteus Maximus Syndrome

This is an example of a myofascial pain problem that may result in buttock pain and perhaps mimic sciatica. The gluteus maximus is the powerful muscle of the buttock that helps you stand erect, walk, run, climb stairs, and rise from a seated position. It is attached to the coccyx at the base of your spine and the back of your pelvis. A spasm or tightness of this muscle can cause local buttock and even sciatica-like pain when you try to walk uphill in a bent-over position, pain on prolonged sitting, and in swimming the crawl. Normally, the spasm and pain are on only one side. Manual manipulation of the muscle often relieves this type of spasm, when combined with physical therapy and, if needed, trigger-point injections.

Piriformis Syndrome

Deep inside the buttock is a muscle called the piriformis that originates on the sacral vertebrae and stretches to the thighbone. This muscle rotates your thigh outward when your upper leg is brought back behind you. The sciatic nerve runs under the piriformis muscle as it leaves the spinal canal and travels down the leg.

The piriformis can cause pain if it is overused, such as by repeatedly lifting things from the ground and throwing them over one shoulder – loading a with with hay or firewood – or from running. Myofascial pain affecting the piriformis muscle will cause pain to radiate down the back of the thigh. The pain is made worse when the muscle is stretched, as in bringing the leg, bent at the knee, across the center of the body.

Sometimes piriformis syndrome is associated with low back pain or pain around the coccyx, groin, or other the hip. It is often associated with sacroiliac-joint-related pain, which must be recognised and treated apart from the piriformis syndrome. One-sided facet pain may also coexist with either piriformis syndrome or sacroiliac-joint pain, as may bursitis of the hip. They all have to be recognised and treated separately, and they can be, with good, lasting results.

Diagnosis and Treatment

Piriformis syndrome is diagnosed from the history and physical examination. Whether the symptoms are from myofascial pain or entrapment, they cannot in the office be completely differentiated from lower lumbar nerve pain from disc herniation or stenosis. Spinal root compression must be excluded before the diagnosis of piriformis syndrome can become a prime target of treatment (root compression can coexist with myofascial pain of various muscles). Obviously, a disc herniation, which may be the underlying cause of myofascial pain and require surgery as the best treatment, should be recognised and dealt with before embarking on a host of trigger-point injections and physical therapeutic measures for focal muscle spasm.

Treatment of this disorder is the same as for any myofascial pain – stretching exercises, analgesics, anti-inflammatory medications, and muscle relaxants. For persistent pain, trigger-point injections of local anaesthetics and corticosteroids in the muscles followed by stretching exercises may be used with good result.

Sciatic-Nerve Entrapment

A separate issue from the problem of myofascial pain is sciatic-nerve entrapment by the piriformis. Some contend that in some patients the piriformis muscle and underlying sciatic and some other nerves and blood vessels are so positioned that the muscle irritates or compresses these nerves, causing sciatic, groin, and hip pain. People with this problem will have symptoms sciatic-nerve irritation, including tingling, which is at times painful, involving the affected sciatic nerve, not just pain in the buttock or thigh (they may have that, too). This diagnosis accounts for at most a small percentage of patients with buttock, hip, and sciatic pain usually from other causes.

Diagnosis

In entrapment, electrodiagnostic tests may document nerve compression in the area of the buttock, and an MRI scan may detect an enlarged muscle inside the pelvis. The recommended treatment could be

  • oral medications
  • physiotherapy
  • injections
  • surgery if all the above treatment shows no improvement

Key Points to Treating Muscle Spasm and Myofascial Pain

  • Never ignore muscle pain accompanied by weakness, numbness, and bowel or bladder problems.
  • Heat dilates the blood vessels to increase the flow of oxygen to muscles, helping them heal.
  • After you have strained a back muscle, that muscle is more vulnerable to another such injury.
  • Low-back pain is a common symptom of myofascial pain syndrome.
  • Pain from spinal discs and facets often causes spasm and myofascial pain in the muscles overlying those structures.

Call +65 64712674 for an appointment to treat Myofascial Back Pain today. Same day appointment.

Lower Back Pain

Muscle spasm is a common cause of acute back and neck pain. Many backs go into spasm following overuse, playing sports without warming up first may strain their backs. Others lift or pull heavy objects using their backs rather than their legs for leverage and cause a spasm. There are many ways to hurt the muscle around the spine as there are people who put themselves out of action with this type of acute back pain. Muscles in any part of the spine can go into spasm, as it is for disc herniations.

Herniated Disc

A muscle spasm is an involuntary local muscle contraction. It can be acute or chronic. It can be caused by repetitive overuse: raking and picking up autumn leaves. Or it can be caused by misuse and muscle injury, such as a sudden, poorly coordinated lunge to hit a tennis ball. It can also occur in response to an underlying painful problem, such as an acute disc herniation or chronic pain following failed spinal surgery.

Any awkward movement – misuse or injury – can lead to a severe , painful muscle spasm and even cause the back to lock in place. Not only exertion; ordinary things like sneezing, coughing, bending to tie your shoe, or turning to face a different direction can cause a spasm. Finally, many of you who have had disc herniation know how some of the muscles in the back or neck, occasionally in the leg or shoulder, go into painful spasm.

Acutely damaged muscles become painful because acid and other toxic chemicals are produced within the muscle after overuse: a reaction to misuse or injury. Any spasm, regardless of cause, can turn the muscles of the back into a hard, painful knot. You have likely has a severe back or neck spasm or know of someone who has; it literally keeps you from moving, as if you were in painful, muscular cast.

Not only do injured muscles often go into spasm but chronically painful underlying spinal conditions, such as disc herniation, can cause chronic spasm, worsening the underlying pain. Here the spasm is mediated by the nervous system; it is not due to muscle injury. Such a reflexive spasm is caused by excessive pain impulses travelling up the root compressed by the disc to the cord. Then, through a reflex mechanism there, other nerve impulses are sent back to the root, which results in spasm of the muscles supplied by it.

This reflex mechanism may be active even if the root is not compressed or irritated. For example, the pain from a broken vetebra or one damaged by a tumour may cause spasm of the muscles around it. In this case, both the vertebra and the affected muscles are supplied by the same roots. In these cases of reflex spasm, our muscles have formed a sort of splint to protect the underlying spine. Unfortunately, the splint may be as painful the underlying problem.

Ongoing spasm, regardless of the cause, injures the muscle to some extent. However, once the underlying cause is removed, the spasm should diminish in at most a few days.

Straining Your Back

The difference between a strain and spasm may be academic when it comes to sore back muscles, since the treatment is similar. Strain is caused by predominantly by overuse: repetitive, forceful movements that result in muscle soreness without spasm. Muscle is made up of individual and segmental strands of tissue. When any muscle, including those around the spine, encounter excessive pulling force, individual strands can stretch or tear – become strained – while the rest of the muscle remains intact. If you do lots of bending, lifting, and twisting, you are probably no stranger to this type of back pain. On the opposite side of the coin are people who rarely exercise. Muscles and ligaments become weak. When an inactive person suddenly becomes active, injuries are common.

The major symptom of back strain is pain when you stretch the muscle and you feel it tighten. If the strain is more severe, the symptoms are abrupt and immediately disabling. They are often accompanied by what patients describe as an audible snap or pop. After the initial  burst of pain, symptoms of severe strains may subside, making them sometimes less painful than minor strains. Lumbar muscle strains may cause a broad, aching pain across the lower back or pain may be limited to one side. You may have trouble bending down or stranding up straight. You may also feel an occasional spasm when you move around or even while sleeping.

Diagnosing and Treating Back Muscle Injuries

If in addition to pain, you have weakness, bowel or bladder problems, numbness, or tingling in your arms or legs, these suggest that you have more than a muscle problem and indeed suggest a disc herniation, broken vertebra, or spinal instability, resulting in the compression of the cord or nerve roots. For moderate-to-severe pain, see your doctor immediately. For what you interpret as just muscle pain, see your doctor if it persists for a month or so.

We can’t see a spasm on X-ray or MRI, and it may not be detectable by many sophisticated diagnostic tests, but your doctor can diagnose it by touching the muscle in question and feeling the tightness.

High-quality tests like an MRI is referred to see if there is damage to a spinal disc, a fracture, slippage, or an unsuspected cancer.

You can Ease the pain with:

  • Medication
  • Heat or stretching
  • Physiotherapy
  • Spinal injection

Prevention

After you have sprained a back muscle, it is more vulnerable to another injury.

  • Exercise regularly to strengthen your back and abdominal muscles, which support your spine.
  • Good posture.
  • Use ergonomics.

Call +65 64712674 for an appointment to treat Muscle Spasm and Back Pain today. Same day appointment.

Spine Anatomy

Our spine is a complex anatomy, due to the complexity, there are different kinds of pain cause by different parts of the spine, such as:

  • Pain from Facets
  • Pain from Discs
  • Pain at the End of the Spine
  • Pain due to Wear and Tear

Pain from Facets

As we age, we lose height, primarily because the discs that separate the vertebra dry out and shrink. The vertebrae become more closely opposed, and the facets take on undue weight. Facets are designed more to create stability than to bear weight. This excess wear causes them to degenerate, and some arthritic and hurt, at times chronically. As they become arthritic, they may also calcify (harden with deposits of calcium from the body) and become deformed. The excess calcification of these joints may bulge into the spinal canal and foramen, pressing on the nerves there. This may contribute to spinal stenosis, the narrowing of spinal canal.

Spinal Stenosis

Pain from Discs

Discogenic pain comes from a tear in the annulus, with no disc material oozing out onto a spinal nerve. This kind of pain usually is described as deeper than facet pain, but the two frequently coexist. Discs are deeper in the spinal structure than the facets and pain from them cannot easily be provoked by poking the area around the spine. Both facet and discogenic pain may be one-sided but often affect both sides of the back.

Lumbar-disc-related pain (either discogenic pain or pain from disc herniation) is usually worse during the day. It may exist at night and impair sleep. Many postures and activities make it worse: standing, walking, sitting, rising from a bent position, and bending down. Less commonly, lying in bed, with the spine curving into the mattress, may irritate the torn disc or a lumbar nerve compromised by a herniated disc. Anything that puts vertical or bending-related stress of a degenerated, painful disc may worsen the pain.

Cervical-disc-related pain is worse at night because you turn your head while you sleep. It may also cause pain during the day when you turn your head to look around. When your head bounces around on your neck, such as when you are riding in a car over a rough road, it may also cause pain if you have cervical disc problems.

Thoracic-disc-related pain is rare. When it does not occur, it may cause pain in he back or even travel partway around the chest along a rib. Thoracic disc herniation sometimes results in pain that may be confused with other ailments, like heart disease or reflux of the oesophagus.

Pain at the End of the Spine

The sacrum itself is rarely a cause of pain unless it is fractured or its connection to the lumbar spine is altered. In people with normal bones, sacral fracture may occur from a severe fall. People with severe osteoporosis can fracture the sacrum even fro minor trauma. Various types of sacral tumours can cause local pain and damage to the nearby nerves that control bowel and bladder.

Pain in the area of the sacrum also occurs after fusion surgery in which the lumbar spine is surgically fused to the sacrum at L5-S1. Sacral pain following this type of fusion is perhaps the most common cause of severe chronic sacral pain in the noncancer patient population. Occasionally, sacral pain is due to sore or tight muscles. It may exist while walking, standing, or sitting.

Chronic, severe tailbone – coccyx – pain is rare. This is fortunate, since it is often difficult to treat. Most people with such pain – coccydynia – complain of pain in the tailbone while sitting. It usually develops following a fall on their rear end, usually squarely backward, as on an icy sidewalk. The tailbone can also be invaded by tumours, which cause pain and often bowel dysfunction.

Pain due to Wear and Tear

The spine wears out from stress. The lumbar spine (lower back) supports the most weight and is the most common area for spine-related pain. The are of greatest spinal degeneration is the lower lumbar spine, attached to the fixed pelvis. The lower cervical spine, just above the shoulders, is the second most likely area to degenerate over time. Consequently, the lumbar and cervical areas have the greatest propensity for disc herniations. (The thoracic spine is least likely to cause chronic pain).

The vertebrae themselves may cause pain if fractured by day-to-day trauma, suffer an osteoporotic collapse, are weakened by a blood vessel malformation, or invaded by a tumour. If a piece of fractured vertebra presses on the nerves in the spine or spinal cord, serious, possibly permanent pain, weakness, and numbness or bowel and bladder disturbance may result.

Another problem occasionally seen is a birth defect involving a hole in the bone in the back of the L5 vertebra that disconnects the stabilising facet joint on the side of the defect from the rest of the vertebrae. Over time, this may destabilise the spine, allowing slippage. This type of defect is called spondylolysis. Spondylolisthesis occurs when a vertebral body slips out of place with respect to the one above or below it, causing spinal instability. Think of that gooseneck lamp is no longer in line with the others. This may result in narrowing of the spinal canal and foramen underlying the area of slippage, resulting in pressure on the nerve roots there. This pressure may become a source of chronic pain, weakness, and numbness unless the spinal instability is surgically corrected.

Key Points to Understand Your Back Pain

  • The spine is a mechanical masterpiece with many components that can be damaged by injury or aging.
  • The lumbar back is the most common site for spinal pain, followed by the cervical area just above the shoulders.
  • Most back pain is muscular and improves with time, rest and, at most, conservative treatment.
  • Much spine-related pain can be prevented by some lifestyle modifications, such as controlling weight.
  • Back pain can also be caused by medical diseases.

Call +65 64712674 for an appointment to investigate and treat your Back Pain today. Same day appointment.