There are many types of back pain and I will go through them now to help clear up any confusion you might have. Establishing the cause of your pain is an important first step in finding the solution, as an incorrect diagnosis can send you in the wrong direction wasting a lot of your time and money.
Sprains and strains are seen to be the most common source of back pain, accounting for around 85% of cases. But that is a very generalised description and rather than being the cause of the back pain, these strains or sprains are the back pain you feel and the symptom of a deeper problem that exists.
Imbalances in the muscles, caused by such things as bad posture, an injury or accident, overuse, stress or simply lifestyle factors that raise your stress levels, are what cause the sprains and strains to happen in the first place.
For the relatively inactive person acute back sprain or strain can often be settled down quite simply with rest and heat on the tight muscles (not the point you feel the pain) and perhaps a short course of anti-inflammatory drugs. However for the active person it becomes a great deal more complicated because, without having the muscles rebalanced and the 'cause' of the strain eliminated, it can often be some time or in some cases never, before a sufferer can return to their active lifestyle without pain.
In my opinion, the major underlying cause of sprain and strain injuries occurring in relatively inactive people is poor posture or a physically stressful activity they are not use to. This can include such things as a day of gardening, house painting or moving furniture. Combine the over activity with an inadequate diet and you have a recipe for pain.
As part of sprains and strains I would have to include the chronic pain that comes after a fall or accident. Often the injured area does not get the correct treatment and after a while, because of the trauma that is left in certain muscles, they become weak causing pressure to build up on a nerve or joint causing inflammation and pain.
When it is the back that's affected, this weakness can eventually set up more long term damage to the disks or vertebrae and any one of the following conditions could be the result.
Disc problems, although seen as a localised structural problem, these are often a product of muscle imbalances whereby the twisting or tilting pressure generated by the pelvis and exerted on the vertebrae, exposes the disk to damage or injury.
This includes a bulging disc at L4/ L5 or L5/ S1 (the last two joints of the lumbar vertebrae) that presses on the sciatic nerve causing a pain that goes into the buttock or down the leg called sciatica. A more serious problem is a ruptured disc where the outside casing of the disc called the annulus breaks and the leaking fluid from inside irritates the nerve.
Often the reason why a disc is injured in the first place is because of a muscle imbalance. This exposes the disc to pressure it isn't designed to take. By successfully treating the muscle imbalances I have found that this pressure can be released giving the bulging or ruptured disc a chance to recover, eliminating the pain and the need for surgery. Of course the ruptured disc takes a lot longer to come right and requires patience and persistence on the part of the sufferer.
I can think of one particular case I worked on recently where a ruptured disc in a 26 year old was treated successfully and he was taken out of pain even though the MRI scan still showed the fluid spreading around the vertebrae and nerves. A specialist looking at the scan would not believe the person had no pain at that point, but the reality was, once the pressure had been taken away from the spine and the imbalance in his pelvis removed he felt fine.
When performing surgery on an injured disc, as is regularly done, the specialist often chooses to perform a discectomy with a laser or what they call a 'classic discectomy' , which is the more commonly used method. It is carried out under a general anaesthetic and is quite invasive.
Firstly the skin on the back is cut; the muscles of the spine are separated from the vertebra and retracted laterally to allow access for the surgical instruments. A hole is then cut through the vertebrae to provide a way of getting to the nerve and disk and through this opening the nerve root is identified and retracted aside, the annulus is cut and the nucleus is removed in fragments with forceps.
After surgery the normal procedure is for the patient to be put on analgesic medication and taken out of bed to start walking the day after surgery. Discharge from hospital is usually after a couple of days and the patient can often return to work, depending on the job, usually is in 4 to 8 weeks, unless there are any complications, like an infection or the operation doesn't succeed at getting rid of the pain.
With the laser discectomy the procedure is done under local anesthesia, with a slight sedation. A needle is passed through the skin from the back, slightly laterally, into the herniated disk as its position is constantly monitored with X-rays.
Once the needle is in position, a fibre optics endoscope is passed through it to the centre of the disc. This device allows the surgeon to see the nucleus while, with another fibre, they use the laser beam to evaporate the disc material. Once the surgeon is happy with the amount of space he has produced in the centre of the disc, the endoscope and needle are removed.
After surgery the patient is taken directly to their room and under normal circumstances is discharged the same day, walking.
Returning to work will normally be between 2 to 6 weeks depending on the occupation.
Although the laser discectomy surgery seems like a much simpler way to go it is not suitable for all patients. For example, if the disk has already ruptured the annulus, the external ring and outer ligaments, or there is a detached fragment of disk, then the classic discectomy will have to be undertaken.
One question that comes up when a discectomy is being discussed is should it be accompanied by a spinal fusion? Research that was carried out in 1994 with this question in mind found the following:
'Chhabra MS. Hussein AA. Eisenstein SM. Clinical Orthopaedics & Related Research. (301):177-80, 1994 Apr. The results of lumbar diskectomy for a sciatic syndrome in 90 patients were reviewed at an average of 8.5 years after operation. The best results were achieved in those patients who had their diskectomy within 12 months of the onset of their symptoms and through minimal approaches. Eighty-six percent of patients returned to gainful employment. Sixteen patients (18%) returned with low back pain attributable to the loss of intervertebral disk, of whom eight (9%) required secondary spinal fusion for control of pain. Seven of these latter patients obtained gratifying clinical and functional results. The findings suggest there is insufficient indication for routine spinal arthrodesis combined with lumbar disk excision. Those eight patients (9%) who developed a disabling postdiskectomy/ postlaminectomy instability syndrome did so usually as a consequence of excessive bone and ligament excision and benefited significantly from subsequent spinal arthrodesis. '
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