Most people have back and neck pain from time to time. Some people have ongoing pain that affect their daily activities. Find out how our spine specialist can treat, manage, and avoid back and neck pain.
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.
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.
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
- If you suspect your pain is caused by acute lumbar dysfunction, you should:
- take painkillers for the first few days of pain
- If after 3 days, you are still unable to move, you should:
- seek medical attention.
- If after 7-10 days you are not able to resume normal activities, you should:
- consult a doctor for further treatment.
- If after 6-8 weeks you are not recovering as expected, your doctor may:
Treatment – Disc Herniation and Sciatica
- If you suspect your pain is caused by sciatica, you should:
- consult a doctor for examination and diagnosis
- If the pain increases when you are upright, you should:
- lie flat for short periods.
- If after 7-10 days you are unable to resume normal activities, consult a doctor, who may:
- refer you for an epidural steroid injection or a nerve-root block.
- also refer you for physiotherapy.
- 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:
- your doctor may refer you to a orthopaedic surgeon to consider removing disc protrusions that may be causing pain.
Treatment – Sacroiliac Strain
If you suspect your pain is caused by acute lumbar dysfunction, you should:
- take painkillers for the first few days of pain
- If, after 3 days, the pain has not settled, you should:
- consult a doctor
- If, after several weeks, you are still unable to resume normal activities, you should:
- consult your doctor for further examination, advice, or treatment.
- If, after 6-8 months, you still have recurring pain, you should:
- seek further advice from a orthopaedic surgeon who may give you epidural injection.
Low Back Pain Specialist
When the annulus – the cover around the disc – tears, pain may occur. The annulus has nerve fibres, unlike the nucleus. When a tear occurs in the annulus, you may feel pain in the neck or lower back and areas overlying and around the tear. Pain may also travel down the arm or leg as with a true disc herniation.
Although an annular tear may produce pain that is referred or travels from the neck to an arm or from the lower back to a leg, it can never produce weakness or numbness. Only compression of the root can do that. Annular tears usually heal inn two to three months. However, they can tear again and cause pain again. This phenomenon is part of chronic discogenic pain. Discogenic pain, to the extent it is understood arises from abnormalities within the disc itself and has nothing to do with pain from a herniation, which occurs as a result of root compression by herniated disc.
Diagnosing Discogenic Pain
If an MRI shows a tear in the annulus or disc covering, usually coupled with other signs of disc degeneration.
Conservative Treatment of Discogenic Pain
Most people with annular tears recover with rest, pain medications, and a gradual resumption of normal activity. NSAIDs, muscle relaxants for spasm, and narcotics should be used as needed. Sometimes physiotherapy or epidural steroid injections may be used.
Most discogenic pain comes from an annular tear, although that may not be the whole story. Although there is no pressure on a spinal root in this condition, it does hurt. Activity reduction and lifestyle modification so as not to bear down – risking a further tear or a disc herniation through the tear – is important.
The vast majority of annular tears causing discogenic pain heal without difficulty. For those that don’t, there are several minimally interventional treatments presented below.
Epidural Steroid Injections
Besides acting on the swollen, inflamed nerves, the liquid in the steroid epidural injection also flushes away the chemicals produced by the annular tears that cause root inflammation and pain. Studies on epidurals show that they work well for a very small specific group of people, such as those under forty who have not previously has surgery or those with pain lasting less than three months. If used at all, epidural injections are most appropriate as a short-term treatment for those whose spine-related pain also travels or radiates down a leg or arm.
Key Points about Discogenic Back Pain
- Discogenic back pain arises from abnormalities within the disc itself. It has nothing to do with pain from a herniation, which occurs as a result of root decompression by the herniated disc.
- Most people with discogenic back pain recover with rest, pain-relieving medications, and other conservative treatment.
- Epidural injections work well for short-term relief on some people with this type of pain.
- There is no need surgery for most discogenic back pain.
Discogenic Back Pain Specialist
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.
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.
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.
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
- 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.
Myofascial Pain Specialist
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:
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.
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.
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.