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.
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.
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.
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.
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.
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.
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.
If you suspect your pain is caused by acute lumbar dysfunction, you should:
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.
If an MRI shows a tear in the annulus or disc covering, usually coupled with other signs of disc degeneration.
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.
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.
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.
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
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