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About Back Pain Unknowns and Approach TreatmentBack pain unknowns or the regular nuisance backpain that is not concentrated to one type or area. Read more on back pains unknown causes below...
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About Back Pain Unknowns and Approach Treatment Deciding
on the Best Health Care for you
All About Back Pain
Unknowns and How to Approach Treatment
Your sore back can be a nuisance, or worse. It may prevent you from doing what you need to do. IE: work or what you want to do, and even enjoyable pastimes. You may have reached the point of wondering: "Will I be able to keep my mind off the aching pain today? Will my back pain ever go away? When can I get better and become more active again without this back pain?" If you're like millions of other people who deal with chronic nonspecific back pain, you're more than familiar with these questions.
Nonspecific but chronic back pain is different from the occasional sore back you might have for a day or two after too much gardening or painting the ceiling. Unlike instances of acute back pain, chronic nonspecific back pain is:
Long lasting. To be termed
chronic, back pain usually has been present for three months at a time.
Recurring. Even after resolution of one long episode of back pain, pain tends
to return. However, the recurrence is highly variable among people and unpredictable.
Chronic nonspecific back pain is the kind of back pain that, by definition,
is "nonspecific." In other words, in most cases the cause is unknown
or difficult to pin down. If this kind of back pain describes your pain, then
this is the place for info. If you need information about back pain that's associated
with a herniated disk, especially back
pain that involves radiating leg pain or leg muscle weakness, see the information
in that topic.
Back pain is one of the most common complaints treated by physicians. Nearly 4 out of 5 people will experience back pain at some time in their life. The vast majority of these cases do not have a definable cause for their pain. This is an important, common problem and the annual cost of treating this pain runs in the tens of billions of dollars.
Back pain can develop in association with a number of causes such as
muscle
strain or sprain
back injury
overuse
muscle disorders
sciatica
poor posture
Pregnant women, smokers, construction workers, and people who perform repetitive lifting all have increased risk of back pain.
When the cause is
unknown
For roughly four out of five people walking into their doctors' offices with
low back pain, the cause is unknown. That is, four times out of five the cause
of low back pain is deemed "nonspecific." The doctor isn't able to
identify a cause of back pain based on:
-What someone tells him
or her
-A physical examination of the individual
In most cases of back pain, if you have no history of prior cancer or systemic
disease and no apparent nerve problems, your doctor may not recommend diagnostic
tests. Instead he or she may suggest an initial conservative approach to treatment.
That's because the reason for your back pain is likely some sort of nonspecific
musculoskeletal cause that may respond well to conservative treatment.
Diagnosis
To rule out specific causes of back pain, or to confirm a possible cause, your
doctor may recommend one or more of the listed diagnostic tests.
X-rays
- X-rays can reveal bone problems, tumors or degenerative changes (wear and
tear, or aging) in your spine.
Computerized tomography (CT Scan) - Using computers and X-rays,
CT scanners produce a series of images that can define disk and bone problems.
Myelography - This test involves the injection of a special
dye into your spinal canal. After the injection, X-rays of your spine can reveal
a herniated disk or other lesions.
Magnetic Resonance Imaging (MRI) - This test combines a strong magnetic force
with radio waves. The result is computer-generated images of bones, muscles,
cartilage, ligaments, tendons and blood vessels. MRI testing can identify herniated
disks or other problems with your back.
Electrical Nerve Conduction Test (electromyography, or EMG)
- This diagnostic approach measures the electrical impulses produced by nerves
as they connect from your spinal cord, through your spine and on down to your
muscles. Studies of your nerve pathways can confirm nerve injury caused by herniated
disks or spinal stenosis.
Bone Scan - During a bone scan, a radiologist injects a radioactive
substance (tracer) into one of your veins. Doctors then use a special scanner
to locate bone tumors or compression fractures caused by osteoporosis.
A good mattress will protect the back for the many hours that you are in bed. A mattress that properly supports the body will also be a very important element in helping relieve stress on the muscles and joints of the back. The most important information needed for finding a correct mattress to support the back involves knowing what position you sleep in. You spend a third of your life in bed, it makes sense to have a good one.
Whether you sit for minutes or hours, you can't underestimate the value of proper posture while sitting. It has been demonstrated that at times there can be as much as six times the amount of stress on your back when you sit than while lying down. Fortunately you can lower the amount of stress placed on the spine with proper back support. To accomplish this, first you must decide whether the chair you use presently is adequate for your needs. A good chair will be able to provide your lower back with proper lumbar pressure. This pressure will keep the curve of the spine in this area supported in the normal position. When a proper lumbar support is not provided with your chair, an insert lumbar cushion can accomplish this. The size of the cushion is very important, as too much lumbar support can compress and irritate the spine. A good working ergonomic type of chair can be adjusted to allow tilting and height control of the seat and chair back. Here are some tips for adjusting your chair properly: Adjust the height of the chair to allow your feet to rest comfortably on the floor. Adjusting the tilt angle of the seat will change the position of your pelvis, thereby shifting the back towards or away from the seat back. Tilting the front of the seat downward will bring your lower back into extension and thus increase the lower lumbar curve. Tilting the front of the seat upward will bring your lower back into flexion and thus decrease your lumbar curve. Combine the seat angle tilt with the seat back tilt for optimal support of the back. If the seat back height can be adjusted, make sure the small of your back fits with the part of the seat back which curves outward to support the lower back. If these adjustments still do not support the spine properly, you will definitely need a lumbar insert cushion or more ergonomically correct chair. Insert cushions will need to have height adjustability to fit correctly. This is usually achieved with a strap that allows you to set the height of the cushion to the thickest part against the small of your back. Each person's spine curves differently, so another important feature that some back support cushions provide is the ability to adjust the size of the lumbar thickness to customize the fit.
Soft Back Braces
Back braces can be necessary when an injury creates instability to the spinal column, as it will protect the back from further injury. Soft back braces can be useful for support of fatigued muscles and allow temporary relief to the irritated tissue in the initial stage of injury. However, wearing a back brace for prolonged periods after the area has finished with the initial healing stage can also weaken the back musculature over time, as the muscles will rely on the brace to keep good posture. While too much movement of the back may cause exacerbation of the Arthritic Joints, completely preventing movement of the area has been shown to hinder the healing process. The best solution is to find a brace that puts pressure directly over the irritated area only, thereby protecting the tissue, but also allowing the rest of the back muscles to still be used. Short term use of a back brace will not cause any weakening of the back muscles. If the muscles are completely not used for prolonged periods they will weaken over time. To avoid this, once the injury has healed sufficiently enough, use a back brace only to support the back during any activity that requires protection for the spine. It can be noted that the use of a brace while sleeping should not cause the muscles to weaken, but many patients find that overusing the brace can become irritating to the skin underneath. Most of the patients we survey tell us that using a back brace which puts direct pressure over the irritated area provides instant relief.
Traction Devices
Caution should be taken when applying traction to any newly injured area, and should not be performed in these cases unless specifically recommended by your doctor. Lumbar (low back) traction can be accomplished through various products which keep the pelvis stationary while using gravity to force separation of the vertebrae and thereby open the spinal canals that the nerves exit through. However, the multifidous muscle which attaches to the lumbar vertebrae may not allow the separation of the vertebrae if the muscle is in too much spasm. Some types of traction allow for better separation when the multifidous muscle is in spasm. One such type of traction is performed by doctors of chiropractic through applying pressure manually to the spine while a flexing table tractions the spine in a downward motion. In the earlier stages, light traction can provide an unloading of the spine, thereby releasing the nerve pressure between each segment created from a decrease in circulation and an increase of inflammation within the joint space. In later stages, traction combined with body movement may also help to break up scar tissue build up between the joints. When the muscles are in too much spasm to allow for this type of traction, upright types of traction units can enable a person to move their body during the therapy to avoid further muscle spasm, while providing a relieving therapy to the spine. Home traction units may be beneficial, but caution should be taken not to apply too much traction too quickly to the back, as this may initiate a spasm to the surrounding musculature. Therefore, only traction units which can gradually increase the separating of the vertebrae and allow unloading of the spine without reaching too much drastic pull would be recommended.
Electric Stimulation Devices
Electric stimulation is an effective way to reduce pain. This is accomplished though blocking the same pain receptors that cause the nerves to irritate due to Arthritic Joints. Micro-current is a specific type of electric stimulation which has been shown to stimulate healing to the injured tissue. Some electric stimulation units can charge the muscles to contract when the intensity is raised or it is placed over a motor point of the muscle. At times, this contraction causes the muscles of the back to loosen up by fatiguing them, while other times it may cause further irritation to the tissue. Home electric stimulation devices may not always be as effective as the more costly type usually found in a health practitioner's office but as technology increases the home units become more and more advanced..
Ultrasound
Ultrasound is an extremely effective way to stimulate proper tissue healing. Sound waves are generated from a crystal vibrating inside the head of the ultrasound wand and then transmitted through sound conducting gel to the tissue. This allows the sound waves to break down unwanted scar tissue, increase circulation to the area, and help relax the musculature. This can be extremely beneficial in the case where Degenerative Arthritis has caused soft tissue irritation to the back. Ultrasound can only be used in the presence of a licensed health practitioner.
Ice Packs
Ice should be used in the initial 72 hours of an injury to reduce inflammation and numb the pain associated with Degenerative Arthritis. Ice is not usually recommended for use in cases of Inflammatory Arthritis. One potential problem with ice is that temporarily it will tighten the musculature even more. Also it should be recommended that ice should not be used for longer than 20 minutes to an area, as it will cause a reversal reaction which will allow the tissue to become more inflamed. For low back inflammation we recommend using a combined brace and ice gel pad to put a more firm pressure over the irritated area. This will also provide support over the injured area while providing ice therapy.
Hot Packs
Hot packs are useful for increasing circulation and thereby loosening up the muscle tissue. Waiting to use heat therapy until three days after the onset of when the initial irritation to the Degenerative Joints first occurred will give the swelling a chance to go down, as heat increases the inflammation to the area. Use of heat therapy in cases of Inflammatory Arthritis is contraindicated as it will further increase swelling to the area. It is believed that moist heat is better than dry, as there is less possibility for dehydration to the musculature. We found a simple to use moist heat pack (depicted below) which contains beads that activate upon being heated up in a microwave to give off moist steam without adding water. This occurs from a natural process by which the beads retain moisture from the air. The ease of use, combined with the comfort of this product, make it a very popular therapy for patients.
Whirlpool and Jacuzzi Water Therapy
As previously mentioned, moist heat therapy for Degenerative Joints is useful for increasing circulation and thereby loosening up the muscle tissue. Use of heat therapy in cases of Inflammatory Arthritis is contraindicated as it will further increase swelling to the area. In the case of a heated whirlpool, the heat will completely surround the area. Add to this the jet massaging action of a Jacuzzi and you have a great way to relax the muscles of the back. Waiting to use heat therapy until three days after the onset the Arthritis first occurred will give the swelling a chance to go down, as heat increases the inflammation to the muscles.
Mechanical Massage Devices
Many of the same benefits seen with regular massage can be accomplished with mechanical massage devices that penetrate deeply through a tapping action called percussion, and thereby disperse lactic acid in the soft tissue and increase circulation, giving an overall relaxing effect to the musculature. This can be very effective for the "knotted up" type of musculature. More superficial massage devices that just vibrate may serve to increase circulation to the tissue, but lack the other aforementioned benefits. It should be noted that the stretching of the muscular fibers will not occur like it does in manual massage. Percussive massagers should be used on slower speeds when the soft tissue is very inflamed, as it is less irritating to the area.
Topical Analgesics for Pain Relief
Over-the-counter sprays, sports creams and ointments that have analgesic properties can be useful for pain control of the Arthritic joints, without any intestinal side-effects. Menthol is the active ingredient which works to block pain receptors and help relieve pain in the soft tissue and joints. The higher the menthol percentage, the stronger the formula. Some companies use as much as 16 percent menthol, but that much is not necessary to achieve results and can cause burning side effects. Menthol can be derived naturally from peppermint or be synthetically produced. Natural menthol penetrates the skin more effectively. Other ingredients such as capsaicin, peppermint and eucalyptus can also help to block pain. Keep in mind that capsaicin or capsicum are responsible for the burning/tingling sensation that occurs in the same pepper spray that police use to stop attackers. Use of these Cayenne pepper derivatives can leave residual numbness and tingling in an area for days after each use. Some companies are also using other herbs believed to have natural healing, relaxing and mild anti-inflammatory properties such as MSM (methylsulfonylmethane) and Glucosamine, but most only add trivial amounts. Glucosamine and MSM are usually taken in oral pill form. Dosages usually range between 1,000-1,500 mg a day. Glucosamine is currently undergoing many trials to determine effectiveness for helping cartilage repair. Studies have demonstrated that patients with deterioration of joint cartilage halt and even regenerate the tissue after taking Glucosamine for at least six weeks.
For a topical pain reliever to work effectively it needs to have a good transport mechanism (ability to let ingredients be able to pass through the first layer of skin down to the deeper tissues below). In theory, supplements such as Glucosamine Sulfate and MSM have small enough molecules to pass through the skin barrier and not just affect the top of the skin, but rather penetrate deeper down. Because Glucosamine and MSM absorb so well, they also make great skin conditioners. Where as taking Glucosamine and MSM will affect your whole body, placing it over an area can add 28 times more than a pill would provide over a specific area. Topical pain relievers with oils and waxy substances like glycerin, strearic acid and cetyl alcohol would make a poor transport mechanism for ingredients like Glucosamine and MSM, yet some companies continue to use this ingredient. While methyl and propyl paraben are preservatives that offer an indefinite shelf life, they also lessen the penetration of a topical pain reliever.
Therefore, the best type of topical analgesic is one that combines good powerful natural ingredients, with a good transport mechanism that has no preservatives, but also no oils to block penetration or eventually turn the formula rancid.
Vitamin, Mineral and Herb
Supplementation
Certain vitamins and herbs can be used as supplementation for the body's natural healing and defense system. The RDA recently increased some of its recommended daily values for certain vitamins, and has listed tolerability ranges (See RDA's website for further information). It has been a long standing debate as to how much extra supplementation can be utilized by the body, and many contributing factors may play a part in this process. These factors may include weight, smoking, exercise, stress, pregnancy, and quality/type of the supplementation. While the FDA does not approve any of the following vitamins and herbs for use of pain or inflammation, many doctors surveyed are currently using some or all of the following in their practice to target muscle and connective tissue:
Vitamin E, Vitamin C, Zinc , Calcium, Copper, Boswellin, Bromelain, Curcumin, Hops, Valerian Root, Kava Kava, MSM and Glucosamine Sulfate.
Nutritional Aid in the Healing
Process
While nutritional changes will not usually produce immediate results, there can be no better way to make long term changes in the body than eating right. Some foods have properties which have been shown to change inflammatory levels. Acidic fruits can mildly block the body's inflammation process, whereas red meat and shellfish increase arachidonic acid, which is known to increase inflammation levels. As new nutritional studies are performed new info will be added.
Medications
One of the most frequent questions our health experts encounter is whether medication should be taken, and which one would be right for them. It is important to remember that medications are aimed at temporarily reducing pain, inflammation, and relaxing the body, but have not been proven to increase healing to the area. Here are some of the most commonly mentioned medications:
For over-the-counter medication, Ibuprofen has been indicated for temporary pain relief. Studies have also shown that in higher amounts, Ibuprofen can act as an anti-inflammatory, but a medical doctor's prescription is needed for this dosage. Aspirin and acetaminophen are also indicated for muscle pain relief, but do not show anti-inflammatory properties in prescription dosages. Acetaminophen does not have warnings about adverse reactions for people with aspirin allergies, as it is not an aspirin derivative. It has also been demonstrated to be better tolerated by people with weak intestinal systems. While Aspirin is known to be more abrasive on the intestinal system, it may have other side benefits such as blood thinning that prevents the blood clots which can lead to strokes and myocardial infarctions.
As these medications work to block pain and inflammation temporarily, it stands to reason that the need for these medications can occur when a person can no longer function due to the pain or when it hinders sleep and thereby impedes the body's natural healing process. A person on pain medication should consider that they may more easily overdo it during the temporary relief period, which could cause further injury to the muscles.
*As side effects can occur, we recommend that you always consult your medical doctor to determine if and what medication is appropriate for your situation.*
Exercises and Stretches for the
Back
All general exercises and stretches listed will can help to increase back stability and flexibility. However, as each Arthritis condition is different, always consult your doctor to determine what is right for your particular situation.
Yoga
and Meditation to Relax the Back
Regardless of the current situation your back is in, relaxing could be key to helping it heal. While meditation can always be useful for achieving this, Yoga can at times be irritating if caution is not taken. Yoga is a series of slow movements combined with stretches and meditation to allow for an increase in flexibility and relaxation to the muscles and joints, as well as to help optimally integrate the connection between the mind and body. However, what might seem to be easy maneuvers should still be treated cautiously, as your individual situation may prohibit certain Yoga moves. One simple meditation practice that is usually met with good success is to close your eyes and visualize yourself in the most happy and relaxing place you know of. Sometimes just taking the time to do this can be what you need to begin the healing process.
Correct Shoes for Avoiding Back
Pain
While walking is one of the overall best exercises for your health, the shoes you choose to stroll in may just be the difference between hurting your back and helping to keep it strong and loose. High heel shoes put your spine in extension, which can impact the joints further when the vertebrae are already in a compressed state. Lack of shock absorption will further impact the joints with every step you take. Shoes that contain proper arch support can help take the pressure off those tired feet and add to increase overall shock absorption. Shoes with pressurized air or other cushioning chambers are necessary to protect the spine during the much harder impact a person will experience during exercise.
When to Use a Heel Lift
During standing a proper balance is
needed between both hips to keep the back in correct alignment. When one
leg is slightly longer, or the hip becomes fixated in a higher position, it
may be necessary to supplement the lower side of the hips with a heel lift worn
inside the shoe. When the spine is tilting to the lower hip side, a lift
may allow the spine to realign properly, and thus take pressure off the back.
If one leg actually grew shorter than the other, a lift may be needed on a permanent
basis to prevent the spine from moving back to its incorrect position.
A health practitioner should be the one to evaluate the situation and assess
the correct size heel lift needed.
Chiropractic Care
Chiropractors have the level of education befitting their title as doctors. Their focus is primarily on diagnosing and treating dysfunction of the muscles, nerves, and skeletal system without the use of drugs or surgery. As a particular back condition may at times warrant more aggressive forms of treatment, many chiropractors have developed good working relationships with medical doctors to enable a system of cooperative care to optimally benefit their patients. Chiropractic care helps increase the flexibility of the soft tissue of the spine and reduces the pressure that occurs from any restricted and minor misalignments of individual vertebral joint segments. This in turn helps to eliminate any nerve interference created from the dysfunctional area. This can be achieved by breaking down scar tissue through techniques which adjust the spine, re-aligning the attached vertebrae, as well as performing release techniques to the fibrous portion of the soft tissue. Many doctors of chiropractic also use therapeutic measures such as ultrasound, electric stimulation, and heat therapy. A doctor of chiropractic should take the time to diagnose your condition and help determine its cause.
Massage
Therapy
Many chiropractors have recognized the benefit of working in conjunction with massage therapists to loosen their patient's muscles as a precursor to treatment. This relationship works so well because the patient can be treated after becoming more relaxed and euphoric due to the natural release of endorphins, as well as the loosening of the musculature due to all the benefits of massage. Other benefits of massage depend on the type of massage being given.
Swedish massage is usually a more superficial, relaxing form, and therefore is less likely to break down scar tissue and trigger a release of spasmodic musculature as a deeper type of massage would accomplish. It should be noted that due to the increase in circulation and release of lactic acid (a natural chemical irritant that is a byproduct of muscle utilization without oxygenation) with massage, it is possible that the area can feel more inflamed and tender temporarily.
Acupuncture
Eastern philosophy proposes that acupuncture utilizes needles to stimulate energy points and are referred to as meridians. The Western scientific explanation is that the stimulation from the needle puncture triggers natural pain relieving chemicals from the brain, a reduction in inflammation to the area through an increase in circulation, and a relaxation response to the musculature. As no scar tissue is being broken down from the injured tissue, increase in flexibility will be less likely than with a manual tissue and joint mobilizing type of therapy.
Physical Therapy
Physical Therapy utilizes a variety of modalities such as ultrasound, electric stimulation, massage, and thermal therapy to help relieve muscular spasms. Manual tissue and joint mobilizing types of therapy can be used to help increase tissue flexibility. Physical Therapy excels in the use of muscular strengthening exercises to build stability to weaken tissue. It should be noted that irritated muscles can become further damaged with strengthening exercises that are premature to the healing of the area. A prescription from a doctor is often needed prior to treatment with a physical therapist for most health insurances to pay for any care rendered.
Medical Practitioners
A doctor of medicine can take the time to evaluate your condition and confirm your specific diagnosis. Medical doctors prescribe either over the counter or prescription only medication. They can prescribe medications that temporarily relieve inflammation, temporarily relax muscles, and temporarily relieve pain. Many medical doctors work with physical therapists and chiropractors to provide conservative management for the many back pain conditions a patient can experience. Orthopedic doctors have extended training in joint-related conditions such as this. While Orthopedic doctors can perform back surgery, this drastic step should only be used when all other treatment options have been exhausted, as back surgery carries many risks, and is not usually recommended for most conditions.