Neck And Low Back Pain
Neck pain is a very common complaint in patients. Often times neck pain is related to poor posture, excess stress, or working long hours. It can be caused by trauma, whiplash injuries, falls, degenerative arthritis, spinal stenosis, herniated disc syndrome or spinal cord injuries.
Symptoms of neck pain include pain in the distribution of the upper shoulders, base of the head and neck. There may be symptoms of weakness or tingling in the arms. Patients may have stiffness and decreased range of motion of the neck. In severe cases of cervical stenosis patients can lose their control of bowel and bladder.
Treatment for more conservative causes of neck pain includes physical therapy and trigger point injection therapy. If the neck pain is caused by facet arthritis and the pain is persistent failing treatment to therapy the patient may benefit from NSAIDs and facet joint steroid injections.
Neck pain caused by cervical radiculopathy is diagnosed via the EMG/NCV testing and cervical MRI. Treatment options for this condition include cervical traction therapy in conjunction with cervical epidural steroid injections.
Low back pain can originate from injuries of the soft tissue structures, muscles, ligaments, spinal joints, discs or vertebrae. Back pain may have a sudden onset and be acute or become chronic. It can change in its presentation from person to person based upon the anatomy and location of the injury. The pain can be localized or radiate into the legs, upper back or hips. Patients can feel the pain with certain activities or positions. It can be sharp, piercing, burning, or dull. The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain.
Risk factors (DON’TS) for developing low back pain include: poor posture, repetitive motion, prolonged sitting/ standing, smoking, poor nutrition, and incorrect bending, lifting, and twisting.
Treatment modalities are dependent upon the source of the pain. Dr. Desai offers many interventional techniques for the alleviation of the pain dependent upon the diagnoses.
Facet joints are paired joints located on the posterior aspect of the spine at each level. The joints help to provide spinal stability and limit excess motion. The facet joints are lined with cartilage and surrounded by a lubricating capsule with nerve endings within the capsule and just outside of the capsule. The facet joint can cause pain via irritation to the joint from degenerative arthritis, trauma, and misalignment.
Facet joints pain can cause local tenderness over the joint in both the cervical and the lumbar spine. In the low back, pain is often felt in the buttocks and can radiate into the posterior aspect of the thighs. In the neck, the pain can radiate into the trapezius muscles and upper shoulders and base of the neck. The pain is often made worse by bending backward or rotating. If facet joints are inflamed, they can cause the nearby muscles of the spine to go into spasm.
Various treatment options are available for facet joint pain. Conservative therapy for joint pain includes anti-inflammatory medications and physical therapy. Maintaining good posture is particularly important as is learning to modify ones activities to avoid further damage and alleviate pain. For persistent pain, X-ray guided injections facet joint injections can be performed to place medication directly into the joints at the source of the pain. If the patient responds to the facet nerve blocks then a procedure known as radio- frequency ablation can be performed to cause destruction of the small nerves of the joint offering up to 1 year of relief in symptoms.
Healthy discs act as shock absorbers of the spine, and improve the spine flexibility. They are located between the vertebral bodies in the spine. A disc is formed of an outer ring called the annulus, and inner gel which is known as the nucleous pulposus. If a disc outer ring or annulus is torn or damaged the inner nucleus pulposus can leak out which is called a disc herniation.
A herniated disc may be caused by either wear and tear of the disc or acute traumatic injury to the spine. If a herniated disc presses on nerve roots, it can cause pain, numbness, and weakness in the area of the body where the nerve travels. The disc itself has tiny nerve innervations which can be a source of pain. A chemical disc is caused by an inflammatory reaction to the nucleous pulposus leaking into the epidural space, which also leads to nerve and back pain.
Diagnosis of a herniated disc is made through MRI or CT scan imaging.
Treatment of an acute disc herniation with nerve pain can include physical therapy, medication management, and Interventional steroid injections. Dr. Desai will select the specific type of treatment based upon the patient presentation and case.
Radiculopathy is the inflammation of the nerve root in the spinal canal. Radiculopathy can occur in any portion of the spine: cervical, thoracic or lumbar. The inflammation of the nerve roots can be caused by a disc herniation which directly compresses the nerve root as it exits the spinal neuroforamina. It can also be caused by inflammatory cytokines from the nucleus pulposus being exposed to the epidural space known as a chemical disc. Any condition which narrows the bilateral neuroforamina such as spinal stenosis or neuroforaminal stenosis can lead to compression and inflammation of the nerve root.The symptoms of radiculopathy are pain, numbness, tingling, and burning sensation in the distribution of the nerve root which is inflamed. The symptoms can radiate into the distal extremities including fingers and toes. The symptoms often times follow into the distal extremities including fingers and toes. Treatment options include medication management, physical therapy and interventional procedures which directly deposit steroid into the inflamed area to calm the nerve pain and consequently the extremity pain.