Pain in the lumbar spinal region (lower back) and cervical spinal region (neck) often cause the inability to go to work. Low back pain is often caused by lumbar muscle strains and sprains. The thoracic spine can lead to spinal pain but due to its rigidity, it is not as common to injure.
The lumbar and cervical spine are involved with many motions like twisting and bending and also is weight-bearing. Because of this, the lumbar and cervical spine are more easily injured. A lumbar muscle strain happens as muscle fibers get torn or stretched abnormally. A lumbar sprain is caused when ligaments are abnormally stretched. Ligaments are strong bands of tissue that hold bones together. Lumbar strains and sprains may be due to a single injury or can happen from overuse.
Inflammation of the soft tissues will occur after the lumbar spine suffers a strain or sprain. The inflammation leads to muscle spasms or pain. A lumbar strain or sprain may be a serious injury but often will not require surgery.
Other severe issues can cause surgical intervention in regards to spinal pain. This pain usually radiates from the spine to the arms, legs, or around the rib cage from the back to the anterior chest.
SYMPTOMS
Low back, cervical and thoracic pain that does not need surgery usually affect the paraspinal soft tissue and will not reach the arms, chest, or down the legs. Pain that reaches the extremities or chest wall may be due to pinches of the nerves in the spine and surgery may be an option.
Other symptoms include:
- Low back stiffness
- Restricted range of motion
- Muscle spasms
- Pain that lasts a maximum of 10-14 days
- Loss of motor function like walking on heels or tiptoeing.
DIAGNOSTIC TESTING
If pain has lasted longer than two weeks and has not improved, diagnostic testing is usually needed. If pain reaches the extremities or around the chest past the center of the spine, it is important to make sure there is not a damaged disc injury. Some diagnostic testing that may be ordered depending on symptoms are:
- X-ray
- MRI
- CT scan with 3-D reconstruction
- Electromyography or nerve conduction velocity testing
TREATMENT
Nonsurgical treatment
Many strains, sprains, or neural compression due to a herniated disc can be solved with low activity levels and bed rest for a couple of days.
Bed rest should be done for as short of a time as possible because bed rest can cause a decrease in muscle strength, an increase in muscle stiffness, and an increase in pain. The first treatment path is using nonsteroidal anti-inflammatory medications when the pain is moderate. Narcotic medication or muscle relaxants may also be used in a treatment plan.
Physical therapy will usually be recommended. After an evaluation, the doctor will create a treatment plan specific to the patient depending on their spinal pain. Some therapy treatments include pelvis traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation, or stretching.
Prognosis
There is a high chance of recovery from a lumbar strain or sprain injury. 9/10 patients will recover within a month of their lumbar strain or sprain injury. Heat and ice treatments at home can be used to decrease sudden swelling along with anti-inflammatory medication. Unless lifestyle habits are changed, a low back strain or sprain could become a chronic injury.
Prevention Tips
Here are some tips to prevent lower back pain due to a strain or sprain:
- Crunches and abdominal strength exercises to increase spine stability
- Swimming, stationary biking, walking are ways to exercise without putting stress on back
- Utilize proper lifting and moving techniques. Always squat when lifting a heavy object.
- Maintain good posture while sitting or standing
- Do not smoke as it can lead to atherosclerosis
- Avoid mental stress
- Maintain a healthy weight to put less stress on the low back
Surgical
Causes of spine pain that could lead to surgery:
A strain or injury of the spine can lead to a herniated disc. As people age, disc material will degenerate overtime and the ligaments holding it into place can weaken. As the disc material degenerates, a small strain or twisting motion can lead to a ruptured disc.
Herniated discs can occur in multiple spots along the spine as some individuals are more prone to disc problems. Research has shown that herniated disc issues can occur in families although it is not hereditary.
Herniated disc symptoms
Symptoms will vary depending on the size of herniation as well as the location of the herniated disc. If the disc does not press on a nerve, the patient may or may not experience spinal pain. If the disc is pressing on a nerve, there can be pain, numbness, or weakening in the areas of the body the nerve extends to. Usually a herniated disc is related to a period of spinal pain.
Lumbar spine (lower back) - Sciatica often results from a lower back herniated disc. Pressure on nerves that contribute to the sciatic nerve can lead to pain, burning, tingling, and numbness that radiates from the buttck into the leg and sometimes down to the foot. Typically only one side of the body will be affected. The pain is usually described as feeling sharp and like electric shocks. The pain may increase while standing, walking or sitting. Lower back pain may occur in addition to leg pain. The appropriate word to describe this is radiculopathy.
Cervical spine (neck) - Symptoms can be dull or sharp pains in the neck or between the shoulder blades that reach the arms, hands, or fingers. There can also be numbness or tingling in these areas. Pain can increase with different motions of the neck.
Thoracic spine - a thoracic disc herniated can cause posterior chest pain that reaches on or both sides of the rib cage. The pain typically arises from physical exertion or taking a deep breath. Numbness may also occur near the chest wall. Thoracic spine herniated discs are more rare than the lumbar or cervical spine herniated discs.
SURGICAL TERMS
Artificial disc surgery: Replacing a damaged or herniated lumbar or cervical disc with an artificial disc to keep spine stable. The artificial disc is composed of a plastic core with two metallic plates that fit into the spine.
Discectomy: Surgical removal or a partial removal of an intervertebral disc
Laminectomy: Using surgery to remove most of the lamina of a vertebra from general decompression of neural elements with or without discectomy.
Laminotomy: Opening will be made in the lamina to surgically access and decrease pressure on neural elements by removing bone spurs of herniated discs.
Spinal Fusion: Stabilizing surgical spine procedure. Bone can be grafted onto or into the spine to fuse vertebrae together. Instrumentation may be placed for additional support to the spine.
Spinal Compression fracture: With low calcium content, the vertebral body can collapse with daily activities. This can be treated with a back brace, pain medications, injection of the collapsed vertebrae with plastic, or open surgery.
POST SURGERY
The surgeon will instruct the patient on their post operative treatment. This may include a spinal brace. The surgeon will determine when to go back to daily activities. Sometimes rehab will be beneficial. There is expected discomfort after spinal surgery and pain is a warming sign to slow down. It is expected to have slow improvements for three or more months post surgery. Adverse trends to surgery include fever, chills, wound drainage, weakness, sensory or pain symptoms. There are no promises regarding the treatment of the spine as every patient and case is different. There is no best treatment plan but a surgeon can guide you your treatment options.
