Lower Back Pain

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 or slipped disc.

You can Ease the pain with:

  • Medication
  • Physiotherapy
  • Injection

What is Muscle Spasm?

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: bending the back for long hours. Or it can be caused by misuse and muscle injury during sports. 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.

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.

Muscle Spasm and Back Pain Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

Book Appointment Online for Muscle Spasm & Back Pain Treatment

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.

Back Pain Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

Book Appointment Online for Back Pain Treatment

When you think about your ribs, you tend to concentrate on the ones at the front of your chest. But, of course, they’re connected to your spine, too, at the back. Which is why many problems that develop in your ribs affect your back as well. Unfortunately, the precise cause can be difficult to diagnose because the pain they cause can be linked to a variety of factors.

Symptoms

The symptoms of rib problems are pain, either localised over part of the chest, and pain on breathing deeply, coughing, sneezing, and laughing. Several things can be responsible, including strains, sprains, and fractures. Other conditions can also cause similar types of pain.

What Causes Pain in the Rib Cage?

Costovertebral Joint

Rib problems that cause back pain fall into two main groups:

Costovertebral Joint Strains

Each rib is attached to the spine, and the joint is termed the costovertebral joint. It is supported by cartilage and ligaments. Causes of costovertebral joint strain include:

  • Muscle imbalances
    Tight chest muscles and weak back muscles.
  • Working overhead
    As in painting ceilings, hanging curtains, or lifting objects up and down from high shelves.
  • Poor posture
    While working at a computer or in a car.
  • Conditions
    Bronchitis, asthma, or other problems that cause you to cough and sneeze a lot.
  • A poor sleeping position
    Possibly caused by an unsupportive mattress or by falling asleep in an armchair

Ligament Sprains

Ligaments bind and surround the costovertebral joints at the spine and also where the ribs attach to the sternum (breastbone) at the front – the costochondral joints. The ligaments and cartilage surrounding these joints can be sprained – pulled or torn suddenly, especially in areas that are carrying the most load and strain – which tires the surrounding muscles.

Possible causes include:

  • Chest trauma
    This may be caused by a car accident or a fall. Such accidents are also often associated with rib fractures.
  • Excessive movements
    Including bending, lifting, arching, or twisting.
  • Sports
    Especially if you’re not in good shape. Contact sports such as football and ice hockey carry a particular task.
  • Falls
    These may result from an accident in the home or at work, or from participation in sports such as skiing, gymnastics, or horseback riding.
  • Carrying heavy loads
    For prolonged periods.

Figuring out What’s Wrong with the Ribs

First, the doctor will want to rule out a prolapsed or bulging disc in your neck or mid-back because the pain that these cause can be similar to that of a rib problem. Then your doctor will touch and manipulate the joints and ligaments involved before diagnosing the problem.

If a rib fracture is suspected, X-rays may be needed to confirm the diagnosis; if multiple rib problems are suspected, a CT or MRI scan may also be necessary.

Fixing Pain in the Rib Cage

In the case of both costovertebral joint strains and ligament sprains, the first port of call is oral medications. Next comes the an anti-inflammatory injection. Physiotherapy may be recommended to complement the treatment which aims to reduce inflammation, increase joint mobility, and relax any possible muscle spasm.

Rib Cage Specialist

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore

DR KEVIN YIP

Book Appointment Online for Rib Cage Pain Treatment

A variety of conditions can cause pressure on one or more nerves as they leave your vertebral column in the middle and lower back. And, depending on the cause, the severity of symptoms, also known as “radiculopathies,” can vary.

Symptoms for Nerve Root Impingement

Pressure on the nerve roots often causes what is known as “radicular pain” – that is, pain that seems to come from some distance away from the site of the original problem. This is because the nerves that emerge from your spine form the link between your brain and you outlying tissues: if they are pinched or damaged, you’ll feel pain in the areas that they supply.

The symptoms of nerve root trouble in the middle and lower back can vary from back pain and numbness to nerve pain. Bending forward or sitting tends to relieve the pain of spinal stenosis because this flexed position enlarges the space available for the spinal cord or cauda equina, a bundle of nerves at the end of the cord. There may no symptoms until the condition has been present for some time. In other cases, there’s an immediate onset of pain.

What Causes Impingement on the Nerve Roots?

There are a number of ways a nerve root can become compressed in this area:

Spinal Stenosis

Spine Anatomy
Spine Anatomy

A narrowing of the canal and bony openings (foramina) through which the spinal cord travels and the nerve roots emerge, spinal stenosis can cause a number of nerve root problems in the lumbar spine. The lower part of the lumbar region is more often affected than the upper part.

Spinal stenosis is usually the result of the aging process, when osteoarthritis sets in and your discs become drier and shrink. The growth of bony projections – spurs, called osteophytes, that protrude into the canal and foramina can also contribute to nerve root problems.

Other causes of the spinal stenosis are a herniated or bulging disc, inflamed facet joints, a vertebra that has slipped forward (spondylolisthesis), trauma (such as road accident or fall from a ladder), scoliosis, bone disease, a tumour of the spine, or a congenital defect of the spine, such as a narrower that usual spinal column that has been present from birth.

Slipped Disc and Disc Bulges

Herniated Disc

Unfortunately poor movement patterns, such as bending with your back rather than your legs o pick up things, can damage the innermost rings of your vertebral discs. The damage gradually spreads to the outer rings, allowing the gel-like fluid in the center to leak out. If the outermost rings are still mainly intact, the fluid causes a bulge, which can press into the central spinal canal or into the space where the nerves leave your spine, and pinch them – causing, for example, problems such as sciatica. If all the rings are damaged, and the fluid seeps out of it, the disc ruptures and “slips” – what doctors call a “prolapse” or “herniation.”

Facet Joint Problems

These tiny joints are located at the back of the vertebrae. They are the joints at which the upper part of each vertebra joins the lower part of one above it, and the lower part joins the upper part of the one below. But if, for example, the lumbar spine loses stability, as a result, say, of poor lifting technique, the fibrous tissue surrounding the facet joints can thicken in an effort to regain stability and protect the area. This can not only pinch nerves as they leave the vertebral column, it can encourage the growth of bony spurs called osteophytes that will also pinch the nerves.

Proper Posture in Lifting Heavy Load

Figuring Out Nerve Root Impingement

Back pain should always be investigated by your doctor. In particular, if you experience bowel and bladder incontinence, severe numbness down the legs, muscle weakness, poor balance, or paralysis, seek immediate medical attention. Following a physical examination, and listening to an account of your symptoms, your doctor will probably be able to make a preliminary diagnosis. An X-ray, CT scan, or MRI of the spine may confirm the precise cause.

Fixing Nerve Root Impingement

Many cases of nerve root inflammation get better without treatment. If this doesn’t happen, the treatment options your doctor may consider include:

  • Physiotherapy
    This usually involves stretching and strengthening exercises. Posture and movement training are also likely to be included.
  • Medication
    NSAIDs, and injections may be helpful.
  • Surgery
    May be an option to relieve pressure on your spinal cord and/or nerve roots.

Nerve Root Impingement Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

Book Appointment Online for Nerve Root Impingement Treatment

Minor neck injuries may result from tripping, falling a short distance, or excessive twisting of the spine. Severe neck injuries may result from whiplash in a car accident, or sports-related injuries.

“Burners” and “Stingers”

If you’ve played contact sports and suffered a burner or a stinger, you remember it. The pain shoots from the shoulder to the hand “like an electric shock or lightning bolt down the arm”. A burner or stinger is an injury to the nerve supply to the upper arm, either at the neck or shoulder, often following a fall onto the head – for example, following a tackle in football.

What Happens?

When the head is forced sideways and downward, it bends the neck and pinches the surrounding nerves. As a result, you may feel numbness or weakness in the arm and possibly a feeling of warmth.

Usually the symptoms subside quickly – within seconds or minutes – but in up to 10 percent of cases, the unpleasant sensations can last hours, days, or longer.

What Should be Done?

You should immediately get checked by a doctor. An examination will confirm the type of injury. If the symptoms pass, you will probably need no treatment. But you may need further medical attention if you experience weakness lasting more than a few days, neck pain, symptoms in both arms, or if you have a history of recurrent stingers or burners. Having a narrow spinal canal – spinal stenosis – may make you more prone to burners and stingers.

Whiplash

When your head is jerked violently and unexpectedly backward or forward – typically in a car accident or during contact sports – the resulting injury is known as whiplash. It can also be called cervical sprain (or strain) or hyperextension injury.

Whiplash Injury
Whiplash Injury

What Happens in a Whiplash Injury?

The pain is caused by the soft tissues (muscles, tendons, and ligaments) of the neck being forced to the very limit of their range of motion. If the ligaments are torn, there will be internal bleeding bleeding between them and the vertebrae. You may start to feel pain and experience stiffness in the neck within minutes or it make take several hours for symptoms to be felt. Further symptoms that result from whiplash may include neck spasms, dizziness, and headache.

What Should be Done?

It’s important to seek medical help as soon as possible. Modern surgical treatment with internal fixation (screws, plates, rods) has eliminated the need for cast treatment in all but the most unusual circumstances. A plastic collar may be used for a short period.

Subject to your doctor’s advice, anti-inflammatories and physiotherapy may help relieve discomfort in the early stages the recovery process.

You can expect a full recovery within a couple of weeks, although some people have problems for longer.

Neck Injury Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

Book Appointment Online for neck injury specialist Treatment