Category Archives: Low back pain

Second only to the common cold as a reason for patients to see a doctor

Patients over 70 do well after minimally invasive spinal stenosis surgery

Rosemary Frei writing in Pain Management News reported on a study led by Raja Rampersand, MD at the Spinal Program of the Toronto Western Hospital and the University of Toronto. Analysis of data from 2008 to 2011 compared patients aged 40 to 69 with patients past the age of 70 who underwent surgical decompression for lumbar spinal stenosis.  There were no differences in adverse events between the two groups, although patients in both groups took longer to recover if a fusion accompanied the decompression. lumbar-spinal-stenosis-old-man

Comment: Spinal stenosis is one of the most common low back syndromes seen in rheumatology practice.  Although epidural steroid injections and physical therapy can be effective for many patients, many people with this malady go on to have surgery. This study provides encouraging news for patients with spinal stenosis.

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How to protect your back when you lift… another lesson in arthritis treatment

While arthritis is a frequent cause of low back pain and can be treated medically, most low back pain comes from simple daily activities such as lifting. In this case, prevention is the best treatment.low-back-pain-2

Lifting things the wrong way can cause severe low back problems including sprain, strain, and disc herniation.

Here are nine tips to help you prevent a problem:

  1. Plan ahead. Avoid sudden movements by clearing the path and ensuring you have a plan in mind.
  2. Stand with your feet shoulder width apart.
  3. Bend from your hips and knees, keeping your back straight.
  4. Use your core. Focus on trying to make your belly button meet your spine.
  5. Bring what you’re lifting as close to your body as possible both before and during lifting.
  6. Lift using your legs.  Push up from the heels.
  7. Ask for assistance if the object is heavy.
  8. Avoid twisting at the waist.  Keep the nose aligned with the toes. Move the feet.
  9. If pain does follow lifting and continues for more than 24 hours, see a physician.

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Don’t be a victim of arthritis myths… Arthritis treatment is effective!

Ashley Macha, writing in Health online, reported on four arthritis myths.  This was done as part of a May is Arthritis Awareness Month campaign, featuring Joe Montana, Hall of Fame quarterback.

1. Myth: Arthritis only affects the aging.  Reality: This is the most common misconception. Anyone, at any age can be affected, according to the Arthritis Foundation. The most common type is osteoarthritis, the kind due to wear and tear on the joints over time (which is what Montana has), but also rheumatoid arthritis, an autoimmune disease that can occur at any age, juvenile arthritis, an autoimmune disease in children, and other types.

2. Myth: Joint health is not a serious issue. Reality: The population of those with arthritis in the United States is increasing, with approximately 70 million Americans predicted to have arthritis by 2030. It is the number one cause of disability in the United States.

3. Myth: Patients with arthritis should avoid exercise. Reality: The Arthritis Foundation recommends starting out walking or doing water workouts. Montana lifts weights to keep his muscles in shape. “When muscles are strong, it takes pressure off them [joints].” Patience White, MD, and vice president of public health for the Arthritis Foundation says resistance training can provide numerous benefits for those who suffer from arthritis. Dr. White recommends simple exercises, including hamstring and calf stretches, or weightlifting with something as simple as 16-ounce soup cans.

4. Myth: There is no treatment for arthritis. Reality: “I always thought initially that there was nothing you could do to help to ease your everyday life,” Montana said. There are medication and treatments, as well yoga moves to help ease pain, natural remedies, and new treatments are in the pipeline. Treatment also varies with the type of arthritis. There are more than 100 different kinds of arthritis and each is treated differently.

There are many other myths but the key points to remember are that arthritis, when diagnosed early is very treatable and that newer treatments such as stem cell therapy for osteoarthritis look extremely promising.

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What’s the cause of my back pain?

There are four categories of low back pain.  The first is mechanical back pain low-back-painwhich is the most common category.  This pain is made worse with movement and made better with rest.  It gets worse with prolonged sitting or standing.  It generally doesn’t radiate into the legs and there is no evidence of a neurologic problem.  The most common causes are ligament dysfunction, postural abnormalities, and osteoarthritis.

The second category is inflammatory spine pain.  The pain is worse in the morning and there is extended morning stiffness.  Movement and exercise make the pain better.  Examples of this type of pain are conditions such as ankylosing spondylitis.

Neurogenic back pain is the third category.  This is a mechanical type pain that radiates down the leg, often to the foot. Numbness and tingling are common.  The pain can be intense.  Neurologic exam shows evidence of reflex change and muscle weakness.  Maneuvers designed to stretch the sciatic nerve on exam make the pain worse.  The most common causes are disc herniation, osteoarthritis, fractures, and malignancy.

Systemic back pain comes from more serious causes such as infection, malignancy, or diseases affecting internal organs.  Pain is constant and unrelieved by rest.  Symptoms such as fever, chills, appetite loss, weight loss, and abdominal pain may provide clues to diagnosis.

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Epidural steroid injections for arthritis… another risk

One of the most common problems seen in clinical rheumatology practice is low back pain related to osteoarthritis.  Many of us rheumatologists do epidural injections for patients with spinal arthritis, particularly when patients have spinal stenosis.

As you can imagine there has been a furor over recent reported of fungal, meningitis related to tainted steroid preparations.  The New York Times reported “that more people may be at risk from contaminated drugs” produced by the “company linked to a growing meningitis outbreak.” The FDA also said that products from the New England Compounding Center in Framingham, Massachusetts, “may have also caused other types of infections in patients who have had eye operations or open-heart surgery.”

Fortunately, our practice does not use a compounding pharmacy as a source for injectable steroids.

This is a terrible occurrence, and is one that should remind us all about the risks of medical therapies.

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Lumbar spinal stenosis: the masquerader

One of the most common problems encountered by rheumatologists is lumbar spinal-stenosisspinal stenosis.  This is a condition where arthritis and disc disease in the low back narrows the central canal that the spinal cord occupies.  As a result there is pressure placed on the spinal cord leading to many confusing symptoms.

Typically occurring in people past the age of 65, most will have back pain that radiates into the buttocks and upper thighs. The pain is worse with standing and walking and relieved by sitting.  Patients will often exhibit a waddling gait and have an abnormal sensory exam during the physical.

MRI scanning can help confirm the diagnosis.  Typically, the exam will show mri-spinal-stenosisarthritis in the facet joints, bulging of the intervertebral discs, and enlargement of the ligamentum flavum, the thick ligament that runs lengthwise down the spinal canal.

Other conditions can make the diagnosis difficult.  These include osteoarthritis of the hip, mechanical back pain, hip bursitis, and vascular narrowing.  The latter also causes aching in the legs with walking. The difference can be made by having the patient ride a bike.  With vascular claudication, the pain will return.  With spinal stenosis, the pain will not.

Treatment is highly dependent on the individual patient. While exercise and non-steroidal anti-inflammatory drugs may relieve some symptoms, they are difficult for many older patients with spinal stenosis to tolerate.  Epidural injections of steroids sometimes are helpful.  Many patients will require decompression surgery.

For more information on lumbar spinal stenosis and other arthritis problems go to:

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