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Ankylosing Spondylitis

Ankylosing spondylitis is a type of arthritis that affects the spine. Ankylosing spondylitis symptoms include pain and stiffness from the neck down to the lower back. The spine’s bones (vertebrae) may grow or fuse together, resulting in a rigid spine. These changes may be mild or severe, and may lead to a stooped-over posture. Early diagnosis and treatment helps control pain and stiffness and may reduce or prevent significant deformity.

Who Is Affected by Ankylosing Spondylitis?

Ankylosing spondylitis affects about 0.1% to 0.5% of the adult population. Although it can occur at any age, spondylitis most often strikes men in their teens and 20s. It is less common and generally milder in women.

What Are the Symptoms of Ankylosing Spondylitis?

The most common early symptoms of ankylosing spondylitis include:

  • Pain and stiffness. Constant pain and stiffness in the low back, buttocks, and hips that continue for more than three months. Spondylitis often starts around the sacroiliac joints, where the sacrum (the lowest major part of the spine) joins the ilium bone of the pelvis in the lower back region.
  • Bony fusion. Ankylosing spondylitis can cause an overgrowth of the bones, which may lead to abnormal joining of bones, called “bony fusion.” Fusion affecting bones of the neck, back, or hips may impair a person’s ability to perform routine activities. Fusion of the ribs to the spine or breastbone may limit a person’s ability to expand his or her chest when taking a deep breath.
  • Pain in ligaments and tendons. Spondylitis also may affect some of the ligaments and tendons that attach to bones. Tendonitis (inflammation of the tendon) may cause pain and stiffness in the area behind or beneath the heel, such as the Achilles tendon at the back of the ankle.

Ankylosing spondylitis is a systemic disease, which means symptoms may not be limited to the joints. People with the condition also may have fever, fatigue, and loss of appetite. Eye inflammation (redness and pain) occurs in some people with spondylitis. In rare cases, lung and heart problems also may develop.

What Causes Ankylosing Spondylitis?

Although the cause of ankylosing spondylitis is unknown, there is a strong genetic or family link. Most, but not all, people with spondylitis carry a gene called HLA-B27. Although people carrying this gene are more likely to develop spondylitis, it is also found in up to 10% of people who have no signs of the condition.

How Is Ankylosing Spondylitis Diagnosed?

The diagnosis of ankylosing spondylitis is based on several factors, including:

  • Symptoms
  • Findings of an physical exam
  • X-rays of the back and pelvis
  • Measurements of the chest when breathing
  • Results of lab tests

How Is Ankylosing Spondylitis Treated?

There is no cure for ankylosing spondylitis, but there are treatments that can reduce discomfort and improve function. The goals of treatment are to reduce pain and stiffness, maintain a good posture, prevent deformity, and preserve the ability to perform normal activities. When properly treated, people with ankylosing spondylitis may lead fairly normal lives. Under ideal circumstances, a team approach to treat spondylitis is recommended. Members of the treatment team typically include the patient, doctor, physical therapist, and occupational therapist. In patients with severe deformities, osteotomy and fusion can be done.

  • Physical and occupational therapy.Early intervention with physical and occupational therapy is important to maintain function and minimize deformity.
  • Exercise.A program of daily exercise helps reduce stiffness, strengthen the muscles around the joints and prevent or minimize the risk of disability. Deep breathing exercises may help keep the chest cage flexible. Swimming is an excellent form of exercise for people with ankylosing spondylitis.
  • Medications. Certain drugs help provide relief from pain and stiffness, and allow patients to perform their exercises with minimal discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs)– such as ibuprofen, naproxen, and aspirin — are the most commonly used drugs for spondylitis treatment. In moderate to severe cases, other drugs may be added to the treatment regimen. Disease-modifying anitrheumatic drugs, can be used when NSAIDs alone are not enough to reduce the inflammation, stiffness, and pain.
  • Surgery. Artificial joint replacement surgery may be a treatment option for some people with advanced joint disease affecting the hips or knees.

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Back Pain

Back pain usually affects the lower back. It can be a short-term problem, lasting a few days or weeks, or continue for many months or even years. Most people will have some form of back pain at some stage in their lives.

If your back pain is non-specific, your doctor will recommend you try self-help measures. Alternatively, he or she may prescribe medicines or refer you for physical therapy if your pain is severe or chronic. If, however, your doctor suspects you have a specific underlying cause, he or she may refer you to have spinal injections. These are used to find out the exact source of, and also to treat, your back pain but aren’t suitable for everyone.

Self-help

There are a number of things you can do to help relieve low back pain.

  • Stay active and continue your daily activities as normally as you can. Bed rest may actually make low back pain worse, so try to limit the time you spend resting to a minimum.
  • Apply hot or cold packs to the affected area. You can buy specially designed hot and cold packs from most pharmacies. If you prefer, you can apply a cold compress, such as ice or a bag of frozen peas, wrapped in a towel. Don’t apply ice directly to your skin as it can damage your skin.

Medicines

Taking an over-the-counter painkiller such as aspirin or paracetamol, or anti-inflammatory medicine is often enough to relieve acute low back pain. You can also use creams, lotions and gels that contain painkillers or anti-inflammatory ingredients. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If your pain is severe or chronic, your doctor may prescribe stronger medicines such as diazepam, morphine or tramadol. However, these aren’t suitable for everyone because they can be addictive and cause side-effects. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Physical therapies

A physiotherapist (physical therapist – a health professional who specialises in maintaining and improving movement and mobility) may be able to help you design a programme to help you exercise and stretch.

Alternatively, your doctor may refer you for physical therapy such as chiropractic treatment or osteopathy (therapies that are given alongside conventional treatments) to help with your back pain. Treatment can involve exercises, posture advice, massage, and techniques known as spinal mobilisation and spinal manipulation.

Surgery

Back pain, even if it’s chronic, can usually be treated or managed successfully, but about one in 10 people have ongoing problems. Back surgery is really only considered as a last resort if the pain is related to a specific cause.

Complementary therapies

Some people find acupuncture can help relieve low back pain.
Alternatively, you could try a pain-management programme to help you better deal with and manage your symptoms.

You should always talk to a doctor before trying any complementary therapy.
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention of back pain

Good back care can greatly reduce your risk of getting low back pain. To look after your back, make sure you:

  • take regular exercise – walking and swimming are particularly beneficial
  • try to keep your stress levels to a minimum
  • bend from your knees and hips, not your back
  • maintain good posture – keep your shoulders back and don’t slouch

Stop the pain and get your back checked! Call +65 6471 2744 for appointment / Email: info@boneclinic.com.sg

Back Problems

Back pain is a common problem that affects most people at some stage in their lifetime. The back is prone to a range of problems including postural stress, muscle strains, ligament sprains, disc problems, sciatica, arthritis, structural defects, disease and fracture.

Structures of the back

The back is an intricate structure of interlocking components. Vertebrae are the bones that stack on top of each other to make up the spinal column and protect the spinal cord. Between each vertebra are the discs that act as shock absorbers and give the spine its flexibility. Facet joints and strong ligaments hold the vertebrae together, while the muscles control and produce the movements of your back.

Causes of back pain

There are many possible causes of back pain. Any structure in the back has the potential to cause pain if affected by injury or disease. Pain may result from:

  • A sprain or strain of the joints or muscles of the back
  • Doing an activity such as lifting something too heavy or lifting too often
  • Bad posture over a long period of time
  • Lack of exercise.

Degeneration of the spine such as that seen in arthritis, disc disease, osteoporosis and some congenital abnormalities can also result in back injury and increase the risk of back pain.

Types of back conditions

There are many different back conditions, all of which can cause back pain. These include:

  • Soft tissue injuries – like sprains and strains
  • Disc problems
  • Postural stress
  • Sciatica
  • Structural problems
  • Disease
  • Fracture.

Soft tissue injuries – sprains and strains

An out-of-condition back or one with pre-existing problems is more susceptible to soft tissue injuries like sprains and strains.

  • Sprain – a joint injury that involves stretching or tearing of the ligaments.
  • Strain – an injury to muscle or tendons.

Stretching a ligament or muscle too far or too quickly could result in a tear of the tissue. Excessive force and repetitive use may also damage muscles.

Disc problems

The intervertebral discs are the spongy cushions between the vertebrae. As we age, these discs dry out and harden, making them prone to injury. The term ‘slipped disc’ is misleading. The disc doesn’t actually move out of place, but can bulge (prolapse), herniate or even rupture.

Most disc problems arise from prolonged stress or injury and may be caused by straining the back (such as when lifting).

Postural stress

Poor posture for an extended period of time places stress on all of the structures of the spine. Ligaments and joint are overstretched and muscles are overworked and may spasm.

Sciatica

Sciatica is nerve pain arising from the sciatic nerve that runs from the spine into the buttock and down the back of the leg. The cause is usually a disc bulge or prolapse pressing on the spinal (intervertebral) nerve. Other causes include narrowing of the nerve tunnel between discs due to osteoarthritis.

Structural problems

Structural problems of the back can cause pain by putting added stress on the structures of the spinal column:

  • Kyphosis – an excessive outward curve of the upper back, which is sometimes referred to as ‘hunchback’.
  • Scoliosis – an excessive sideways curve that can affect either the upper or lower regions of the spine.

Causes of kyphosis and scoliosis include birth defects, lifelong bad posture and certain diseases that affect the integrity of the bones, such as osteoporosis.

Disease

Back problems are more likely to be caused by lifestyle factors such as inactivity than by serious disease. However, some of the diseases that can affect the spine include:

  • Ankylosing spondylitis – a disease that causes inflammation and pain in spinal joints and limb joints.
  • Arthritis – especially osteoarthritis, a condition in which cartilage that normally cushions two joints breaks down.
  • Cancer – bone cancer either originates in bone tissue (quite rare) or is caused by the spread of cancer cells from an original tumour somewhere else in the body.
  • Osteoporosis – a disease that involves thinning of the bones. It commonly occurs in women after the menopause but also affects men with increasing age.

Fracture

A broken bone (fracture) occurs when a force exerted against bone is stronger than the bone can structurally withstand. Some diseases, such as cancer or osteoporosis, make fractures more likely.

Prevention of back pain

If you reduce the stress and strain on your back, it could help to reduce the risk of injury. You can help to reduce pressure on your back by staying active.

You can also help prevent back pain if you avoid:

  • Slouching in chairs or in the car
  • Sitting for long periods without a break
  • Lifting incorrectly
  • Being unfit or out of shape.

Treatment

Treatment for back problems depends on the specific condition. In many cases of back pain, the first and most important treatment is to keep active and resume normal activities – work, sport and recreation – as soon as possible. The majority of back injuries will improve by themselves.
Other treatment options may include:

  • Physiotherapy – this can provide mobilisation and manipulation, specific stabilisation exercises, ergonomic advice, postural advice and taping and bracing.
  • Medication – including painkillers and anti-inflammatory drugs. There are also specific treatments for osteoporosis.
  • Low impact exercise – aerobic activities that do not jolt the spine are helpful for many people. Some of these activities include walking, swimming or cycling.
  • Strength training – developing and maintaining a tight ‘girdle’ of muscle can reduce back pain and the risk of future injury.
  • Weight loss – being overweight or obese can load the back with unnecessary strain.
  • Surgery – in severe cases, when the condition does not respond to other treatments, it may be necessary to undergo surgery. The techniques used depend on the condition. For example, surgery for a ruptured disc involves removing the fragments that may be pressing on nerves.

Things to remember

  • Back pain is common and is usually not associated with a serious disease or problem.
  • You can help to reduce pressure on your back by staying active.
  • Treatment for back problems depends on the specific condition – always see a registered health professional.

Back Pain

Back pain is extremely common – about four in five people are affected at some point in their lifetime. Anyone can get back pain at any age, but it’s most common in people between the ages of 35 and 55, or over.

Your back has many interconnecting structures, including bones, joints, muscles, ligaments and tendons. Its main support structure is the spine, which is made up of 24 separate bones called vertebrae, plus the bones of the sacrum and coccyx. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord threads down through the central canal of each vertebra, carrying nerves from your brain to the rest of your body.

It’s often very difficult to know exactly what causes back pain, but it’s usually thought to be related to a strain in one of the interconnecting structures in your back, rather than a nerve problem. Back pain caused by a more serious, underlying condition is rare and you’re unlikely to be affected unless you are very old or very young.

If you have low back pain, you may have tension, soreness or stiffness in your lower back area. This pain is often referred to as ‘non-specific’ back pain and usually improves on its own within a few days.

Back pain may be called either ‘acute’ or ‘chronic’ depending on how long your symptoms last. You may have:

  • acute back pain – lasting less than six weeks
  • sub-acute back pain – lasting six weeks to three months
  • chronic back pain – lasting longer than three months

You should see a doctor as soon as possible if, as well as back pain, you have:

  • a fever (high temperature)
  • redness or swelling on your back
  • pain down your legs and below your knees
  • numbness or weakness in one or both legs or around your buttocks
  • loss of bladder or bowel control (incontinence)
  • constant pain, particularly at night
  • pain that is getting much worse and is spreading up your spine

These symptoms are known as red flags. It’s important to seek medical help for these symptoms to ensure you don’t have a more serious, underlying cause for your back pain.

For most people with back pain, there isn’t any specific, underlying problem or condition that can be identified as the cause of the pain. However, there are a number of factors that can increase your risk of developing back pain, or aggravate it once you have it. These include:

  • standing, sitting or bending down for long periods
  • lifting, carrying, pushing or pulling loads that are too heavy, or going about these tasks in the wrong way
  • having a trip or a fall
  • being stressed or anxious
  • being overweight
  • having poor posture

There may be other, more serious underlying causes of your low back pain, but these are rare. They include:

  • fracture – a crack or break in one of the bones in your back
  • osteoporosis – a condition where bones lose density causing them to become weak, brittle and more likely to break
  • a slipped disc – this is when a disc bulges so far out that it puts pressure on your spinal nerves
  • spinal stenosis – a condition in which the spaces in your spine narrow
  • spondylolithesis – when one of your back bones slips forward and out of position
  • degenerative disc disease – when the discs in your spinal cord gradually become worn down
  • osteoarthritis – a wear-and-tear disease that can particularly affect the joints of your spine
  • rheumatoid arthritis – an inflammatory condition in which your immune system causes inflammation of the lining of your joints and surrounding structures

Low back pain may also be caused by an infection or cancer, but these two causes are very rare.

Diagnosis of back pain

A doctor will usually be able to diagnose low back pain from your symptoms and there will be no need for further tests. If, however, your symptoms don’t improve after a few weeks, or you have some red flag symptoms, he or she may refer you to have:

  • an X-ray
  • a CT scan (a test that uses X-ray equipment and computer software to create pictures of the inside of your body)
  • an MRI scan (a test that uses magnets and radiowaves to produce images of the inside of the body)
  • blood tests

These tests are used to find out if you have a more specific, underlying cause for your back pain.

Please note that availability and use of specific tests may vary from country to country.

Treatment of back pain

If your back pain is non-specific, your doctor will recommend you try self-help measures. Alternatively, he or she may prescribe medicines or refer you for physical therapy if your pain is severe or chronic. If, however, your doctor suspects you have a specific underlying cause, he or she may refer you to have spinal injections. These are used to find out the exact source of, and also to treat, your back pain but aren’t suitable for everyone.

Self-help

There are a number of things you can do to help relieve low back pain.

  • Stay active and continue your daily activities as normally as you can. Bed rest may actually make low back pain worse, so try to limit the time you spend resting to a minimum.
  • Apply hot or cold packs to the affected area. You can buy specially designed hot and cold packs from most pharmacies. If you prefer, you can apply a cold compress, such as ice or a bag of frozen peas, wrapped in a towel. Don’t apply ice directly to your skin as it can damage your skin.

Medicines

Taking an over-the-counter painkiller such as aspirin (acetylsalicylic acid) or paracetamol (acetaminophen), or anti-inflammatory medicine such as ibuprofen is often enough to relieve acute low back pain. You can also use creams, lotions and gels that contain painkillers or anti-inflammatory ingredients. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If your pain is severe or chronic, your doctor may prescribe stronger medicines such as diazepam, morphine or tramadol. However, these aren’t suitable for everyone because they can be addictive and cause side-effects. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Physical therapies

A physiotherapist (physical therapist – a health professional who specialises in maintaining and improving movement and mobility) may be able to help you design a programme to help you exercise and stretch.

Alternatively, your doctor may refer you for physical therapy such as chiropractic treatment or osteopathy (therapies that are given alongside conventional treatments) to help with your back pain. Treatment can involve exercises, posture advice, massage, and techniques known as spinal mobilisation and spinal manipulation.

Surgery

Back pain, even if it’s chronic, can usually be treated or managed successfully, but about one in 10 people have ongoing problems. Back surgery is really only considered as a last resort if the pain is related to a specific cause.

Complementary therapies

Some people find acupuncture can help relieve low back pain.
Alternatively, you could try a pain-management programme to help you better deal with and manage your symptoms.

You should always talk to a doctor before trying any complementary therapy.
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention of back pain

Good back care can greatly reduce your risk of getting low back pain. To look after your back, make sure you:

  • take regular exercise – walking and swimming are particularly beneficial
  • try to keep your stress levels to a minimum
  • bend from your knees and hips, not your back
  • maintain good posture – keep your shoulders back and don’t slouch

Swimming and Lower Back Pain

In many cases, swimming can be a very helpful exercise for back pain sufferers. Athletes commonly become injured, and swimming is a great way to keep active since it usually does not put excess strain on a swimmer’s back. However, that’s not to say that swimming can’t cause back pain or injuries as well. Sometimes lower back pain can be caused from swimming when the muscles in the lower back become hyper extended, or over stretched, during the breaststroke or other forward stokes. In addition to hyper extension of the lower back, the cervical spine, or upper spine and neck, can also become injured while swimming. Repetitive jerking motions of the head during frontward stokes could also seriously injure the area.The neck and cervical spine are particularly prone to injury while swimming. The anatomy of this area of the spine is very complex and is composed of seven vertebrae surrounding the spinal cord, which extends downward from the brain. Stretching outward from the spinal cord are nerves which travel to muscles and other tissue throughout the body.To prevent back pain while swimming, it’s crucial that you use proper form and techniques. Unnatural or awkward movements while swimming can easily damage tissue through the back, so it’s important to maintain the correct stokes and movements. In addition, swimming with sidestrokes or backstrokes can also minimize stress on the back when compared with frontward strokes. When doing the front crawl or other forward strokes, make sure to roll your body when taking a breath and avoid jerking the head backwards so that you can reduce strain on the neck. Using a snorkel can also help reduce the awkward movement of the neck by reducing the need to adjust the head when taking breaths. Wearing a mask or goggles can also reduce unintentionally jerky head movements while trying to get water out of the eyes. Boards, life vests, or other types of floatation devices can also help maintain proper form while swimming.

If you are actively involved with swimming and are experiencing neck or back pain, seek the advice of a coach or more experienced swimmer. If they spot you while swimming, they may be able to determine if something is wrong with your strokes and can advise you on proper technique.

Specific strokes can cause their own unique problems. The next page discusses some items to be aware of when doing certain strokes and several methods to help relieve back discomfort.

In many cases, swimming can be a very helpful exercise for back pain sufferers. Athletes commonly become injured, and swimming is a great way to keep active since it usually does not put excess strain on a swimmer’s back. However, that’s not to say that swimming can’t cause back pain or injuries as well.Specific swimming strokes can cause their own unique back injury problems. Here are some items to be aware of when doing certain strokes:

  • For the freestyle, make sure you do not rotate your head too much when taking breaths. In addition, do not let your head move up too much or deviate from the axis along the length of the body. Deviating from this axis, or over rotating the head, can easily lead to neck and back injury while swimming. Also, when you’re not going up for breathes make sure you keep your head looking downwards. As already mentioned, rolling too much can easily lead to damage.
  • With the backstroke, muscles along the front of the neck tend to become fatigued if you have not done that stoke in a long time. Make sure to ease into this stoke and avoid over doing it.
  • When doing any flipturns, tuck your head in and don’t have it extended outward from your body.
  • For the breaststroke, keep your head and neck still, while gently raising the head and back to take breathes.

When back pain becomes a problem there are several methods to help relieve discomfort:

  • Stretching, icing, and using over the counter medications such as ibuprofen are also very conservative ways to help reduce discomfort with mild cases of back pain.
  • However, with more serious pain, more serious forms of treatment may be required and seeking the help of a chiropractor or physical therapist may be more beneficial. With chiropractic manipulations, pain can often be relieved in many instances, but not necessarily for everyone.
  • Physical therapy is a common treatment for back pain ailments. Physical therapists design specific exercises and routines that are intended to both strengthen the tissue in the back while increasing flexibility, helping to minimize back pain.
  • Back braces are also a common way to treat back pain since they help to limit awkward movements and aid in the treatment of injured tissue.

If swimming continues to be painful it’s important to stop and seek the advice of a physician in order to stop back pain. By continuing to swim despite continual or worsening pain, the condition affecting the back may become worse and more serious forms of treatment may be required to reverse discomfort. Only in rare cases is surgery required to reverse ailments that affect the back. However, there are still instances where surgery may not be enough to completely reverse back pain conditions.

In many cases, swimming can actually help back pain. Swimming is an activity that is good for you, and it also does not usually strain or add significant weight to the back. This makes it a great alternative for those looking for an exercise that won’t aggravate their neck or back, as well as any other conditions that may be affecting their bodies. However, repetitive or awkward movements in the pool can lead to injury, so it’s important to learn the proper safety methods and techniques to avoid injury to the back.

About Back Pain

Most back pain, especially lower back pain, is caused by simple muscle strains.

Most back pain is caused by simple strains and the main focus of this site is how to prevent recurring back pain by strengthening the muscles that support the spine with back exercises, along with correcting posture, using proper lifting techniques, and understanding the physical limitations of the back. There is also information on a wide range of back pain treatments, including complementary treatments, for the relief of both acute and chronic back pain.

Back Pain, especially in the lower back (lumbar spine), is a problem that most people experience at some time in their lives. The muscles that support the spine are in constant use; even while simply sitting, the muscles are in use to keep one from falling over. The spine also bends, straightens and twists. This constant stress on the back can result in back strain and pain.

The lower back supports most of the weight of the body and is subject to the most mechanical stress. As a result, the lower back is commonly injured. Lower back pain caused by strained muscles or ligaments is the most common type of back pain (sometimes referred to as lumbago).

Though most back pain is caused by muscle or ligament strain, there are other causes such as damage or injury to spinal nerves, bones, or discs. Sciatica, which is not a disease in itself but radiating pain and other symptoms caused by inflammation or compression of the sciatic nerve, can be caused by many conditions. Osteoarthritis of the spine is a common cause of back pain in people over 65 years of age. The incidence of some other back conditions also increases with age. Back pain is sometimes caused by a problem with the kidneys.

If back pain persists for over 3 months, it is considered chronic back pain. That doesn’t mean wait 3 months to see a doctor – an aching back can be a symptom of something that requires immediate attention such as a kidney infection. Back pain that lasts several days should be diagnosed and treated by a physician. It the pain is severe or is accompanied by numbness or pain down the leg, a doctor should be seen immediately.

The severity of back pain does not always correlate with the severity of the injury or damage.

In many cases the cause of back pain is hard to pin down. A simple muscle strain often causes more pain that a herniated disc. Herniated discs can produce intense back pain but often do not produce any symptoms at all. Even in those with damaged discs and spinal joints, the source of the pain may be strained back muscles.

If a doctor recommends surgery to relieve back pain, a second opinion should be sought. If one has a herniated disc, for example, but the herniated disc is not actually the source of the pain, surgery will not help relieve it. (Most herniated discs improve without surgery)

Stress, anxiety, and depression are often linked to back pain. Stress causes muscles to contract, which reduces blood flow to the tissues and often leads to pain. Stress hormones also heighten the perception of pain. There are many ways to relieve stress, from exercising to learning relaxation techniques. For some people, relieving stress is the most effective way to reduce pain.

Back pain can occur suddenly, but more often develops gradually.

For example, when the muscles supporting the back are held in one position (contracted) too long, the back muscles get fatigued and strained. Byproducts of muscular activity (such as lactic acid) build up in the back muscles. High levels of these acidic waste products in the muscles cause muscle irritation and pain.

Recurring back pain is frequently the result of inadequate muscle strength, shortened muscles; poor posture, being overweight, poor bending and lifting techniques. These are all factors that can be controlled .

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Microdiscectomy or microdecompression Spine Surgery

In a microdiscectomy or microdecompression spine surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to relieve neural impingement and provide more room for the nerve to heal.

A microdiscectomy is typically performed for a herniated lumbar disc and is actually more effective for treating leg pain (also known as radiculopathy) than lower back pain.

Impingement on the nerve root (compression) can cause substantial leg pain. While it may take weeks or months for the nerve root to fully heal and any numbness or weakness to get better, patients normally feel relief from leg pain almost immediately after a microdiscectomy spine surgery.

Microdiscectomy

Microdiscectomy

In general, if a patient’s leg pain due to a disc herniation is going to get better, it will do so in about six to twelve weeks. As long as the pain is tolerable and the patient can function adequately, it is usually advisable to postpone back surgery for a short period of time to see if the pain will resolve with non-surgical treatment alone.

If the leg pain does not get better with nonsurgical treatments, then a microdiscectomy surgery is a reasonable option to relieve pressure on the nerve root and speed the healing. Immediate spine surgery is only necessary in cases of bowel/bladder incontinence (cauda equina syndrome) or progressive neurological deficits. It may also be reasonable to consider back surgery acutely if the leg pain is severe.

A microdiscectomy is typically recommended for patients who have:

  • Experienced leg pain for at least six weeks
  • Not found sufficient pain relief with conservative treatment (such as oral steroids, NSAID’s, and physical therapy).

However, after three to six months, the results of the spine surgery are not quite as favorable, so it is not generally advisable to postpone microdiscectomy surgery for a prolonged period of time (more than three to six months).

Microdiscectomy Success Rates

The success rate for microdiscectomy spine surgery is approximately 90% to 95%, although 5% to 10% of patients will develop a recurrent disc herniation at some point in the future.

A recurrent disc herniation may occur directly after back surgery or many years later, although they are most common in the first three months after surgery. If the disc does herniate again, generally a revision microdiscectomy will be just as successful as the first operation. However, after a recurrence, the patient is at higher risk of further recurrences (15% to 20% chance).

 For appointment or enquiry, please call +65 6471 2744 or Email: info@boneclinic.com.sg

Low Back Pain: What can you do?

Lower Back Pain: How Exercise Helps

You may feel like resting, but moving is good for your back. Exercises for lower back pain can strengthen back, stomach, and leg muscles. They help support your spine, relieving back pain. Always ask your doctor before doing any exercise for back pain. Depending on the cause and intensity of your pain, some exercises may not be recommended and can be harmful.

Avoid: Toe Touches

Exercise is good for low back pain — but not all exercises are beneficial. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 minutes during exercise, patients should stop exercising and contact a doctor. Some exercises may aggravate pain. Standing toe touches, for example, put greater stress on the disks and ligaments in your spine. They can also overstretch lower back muscles and hamstrings.

Try: Partial Crunches

Some exercises can aggravate back pain and should be avoided when you have acute low back pain. Partial crunches can help strengthen your back and stomach muscles. Lie with knees bent and feet flat on the floor. Cross arms over your chest or put hands behind your neck. Tighten stomach muscles and raise your shoulders off the floor.  Breathe out as you raise your shoulders. Don’t lead with your elbows or use arms to pull your neck off the floor. Hold for a second, then slowly lower back down. Repeat 8 to 12 times. Proper form prevents excessive stress on your low back. Your feet, tailbone, and lower back should remain in contact with the mat at all times.

Avoid: Sit-ups

Although you might think sit-ups can strengthen your core or abdominal muscles, most people tend to use muscles in the hips when doing sit-ups. Sit-ups may also put a lot of pressure on the discs in your spine.

Try: Hamstring Stretches

Lie on your back and bend one knee. Loop a towel under the ball of your foot. Straighten your knee and slowly pull back on the towel. You should feel a gentle stretch down the back of your leg. Hold for at least 15 to 30 seconds. Do 2 to 4 times for each leg.

Avoid: Leg Lifts

Leg lifts are sometimes suggested as an exercise to “strengthen your core” or abdominal muscles. Exercising to restore strength to your lower back can be very helpful in relieving pain yet  lifting both legs together while lying on your back can make back pain worse. Instead, try lying on your back with one leg straight and the other  leg bent at the knee. Slowly lift the straight  leg up about 6 inches and hold briefly. Lower leg slowly. Repeat 10 times, then switch legs.

Try: Wall Sits

Stand 10 to 12 inches from the wall, then lean back until your back is flat against the wall. Slowly slide down until your knees are slightly bent, pressing your lower back into the wall. Hold for a count of 10, then carefully slide back up the wall. Repeat 8 to 12 times.

Try: Press-up Back Extensions

Lie on your stomach with your hands under your shoulders. Push with your hands so your shoulders begin to lift off the floor. If it’s comfortable for you, put your elbows on the floor directly under your shoulders and hold this position for several seconds.

Try: Bird Dog

Start on your hands and knees, and tighten your stomach muscles. Lift and extend one leg behind you. Keep hips level. Hold for 5 seconds, and then switch to the other leg. Repeat 8 to 12 times for each leg, and try to lengthen the time you hold each lift. Try lifting and extending your opposite arm for each repetition. This exercise is a great way to learn how to stabilize the low back during movement of the arms and legs. While doing this exercise don’t let the lower back muscles sag. Only raise the limbs to heights where the low back position can be maintained.

Try: Knee to Chest

Lie on your back with knees bent and feet flat on the floor. Bring one knee to your chest, keeping the other foot flat on the floor. Keep your lower back pressed to the floor, and hold for 15 to 30 seconds. Then lower your knee and repeat with the other leg. Do this 2 to 4 times for each leg.

Try: Pelvic Tilts

Lie on your back with knees bent, feet flat on floor. Tighten your stomach by pulling in and imagining your belly button moving toward your spine. You’ll feel your back pressing into the floor, and your hips and pelvis rocking back. Hold for 10 seconds while breathing in and out smoothly. Repeat 8 to 12 times.

Try: Bridging

Lie on your back with knees bent and just your heels on the floor. Push your heels into the floor, squeeze your buttocks, and lift your hips off the floor until shoulders, hips, and knees are in a straight line. Hold about 6 seconds, and then slowly lower hips to the floor and rest for 10 seconds. Repeat 8 to 12 times. Avoid arching your lower back as your hips move upward. Avoid overarching by tightening your abdominal muscles prior and throughout the lift.

Lifting Weights May Help

Done properly, lifting weights doesn’t usually hurt your back. In fact, it may help relieve chronic back pain. But when you have acute (sudden) back pain, putting extra stress on back muscles and ligaments could raise risk of further injury. Ask your doctor whether you should lift weights, and which exercises to avoid.

Try: Aerobic Exercise

Aerobic exercise strengthens your lungs, heart, and blood vessels and can help you lose weight. Walking, swimming, and biking may all help reduce back pain. Start with short sessions and build up over time. If your back is hurting, try swimming, where the water supports your body. Avoid any strokes that twist your body.

Try: Some Pilates Moves

Pilates combines stretching, strengthening, and core abdominal exercises. Under the instruction of an experienced teacher, it may help some people with back pain. Be sure to tell your teacher about your back pain, because you may need to skip some moves.

Guided Injection (Epidural) for Lower Back Pain

A lumbar epidural injection is a safe and effective minimally invasive treatment for the treatment of certain types of low back pain.  This type of spinal injection reduces nerve inflammation, calms symptoms, aids healing and, provides the physician with important diagnostic information.

The procedure involves injecting a corticosteroid into the epidural space.  A corticosteroid is a powerful, slow-releasing, and long-lasting anti-inflammatory medication effective at reducing inflammation. Sometimes a narcotic is injected to increase pain relief. The epidural space is between the protective membrane (dura mater) that covers the spinal cord and the bony spinal canal. After medication is injected, it flows and coats the nerve roots.

Diagnostically, when the patient’s symptoms are relieved, the injection provides evidence that a particular nerve root is a pain generator.

Many spinal problems cause low back and leg pain (sciatica).

Basics about Lumbar Spinal Nerves

There are 5 pair of spinal nerves In the lumbar spine. Each pair of nerves provides sensation and function to specific parts of the body. The spinal nerve pairs are numbered to correspond with the adjacent vertebral level. The nerve roots at L1 exit at the left and right between the first and second lumbar vertebrae (L1-L2).  L5 exits between the last lumbar vertebra and the sacrum (L5-S1).
Each pair of nerve roots exit the spinal column and branch out into the body forming the peripheral (outer) nervous system.  These nerves innervate the lower part (below the waist) of the body and enable movement (motor function) and feeling (sensory function). Dermatones are skin areas innervated by spinal nerve roots. Physicians use dermatomal patterns to help diagnose the location of certain spinal problems based on where the patient reports pain or weakness.
Based on symptoms, medical history, physical and neurological examination, and imaging study findings (x-ray, MRI), the physician can determine the spinal nerve root(s) associated with pain and other symptoms.

Patient Procedure Preparation

Some types of medications have to be stopped several days before the procedure.  Certain medications increase the risk for bleeding.  The physician may ask the patient to stop pain medication, including anti-inflammatory drugs to determine the full effectiveness of the lumbar epidural injection.

Possible Risks and Complications

Any medical procedure poses risks or possible complications. Although rare, possible risks or complications include bleeding, infection, nerve injury, and allergic reaction to medication.  Furthermore, the injection may increase pain and cause tenderness at the injection site.  The physician discusses all potential risks and complications with the patient well in advance of the procedure date.

What to Expect: The Procedure and After

The procedure is performed in a sterile setting.  After checking into the facility, the patient changes into a hospital gown and lies on the treatment bed, and an intravenous line is started through which medications are administered.  Relaxing medication is given; complete sedation is not necessary.

In the procedure room, the patient is positioned face down with a cushion placed under the abdomen.  This keeps the spine in a flexed position and the patient comfortable.  The skin area is cleansed using a sterile solution.  Local anesthetic is injected to numb the injection site.

Fluoroscopic imaging equipment called a C-arm is positioned over the patient.  During the procedure fluoroscopy captures x-rays in real time and displays the images on a monitor. Under fluoroscopic guidance, the physician inserts the needle and injects a small amount of contrast (dye) to verify needle placement.  Next, an anesthetic and corticosteroid is injected into the epidural space.  Pain may temporarily increase during the injection. The physician asks the patient for feedback during the procedure and makes the patient as comfortable as possible. When the injection is over, the injection site is covered with a small bandage.

A lumbar epidural injection treatment may involve one or more injections. The procedure takes about 15-minutes. After the procedure, the patient is moved into the recovery area where the nurse monitors vital signs.  Soon, the patient is discharged with written home care instructions.

Some patients experience discomfort after the procedure for two or three days. This is normal and does not necessarily mean the corticosteroid is not taking effect. Typically, the physician’s office will call the next day to follow up. Some physicians recommend that patients keep a daily record of pain levels and symptoms following a lumbar injection to provide the medical team with information that could guide further treatment.

Conclusion

Lumbar spinal injections have provided significant pain relief to many people with moderate to severe low back pain. Not everyone is an appropriate candidate for this procedure, and prospective patients should discuss risks and benefits with their physicians.

For more Information, please call +65 6471 2744 or Email to: info@boneclinic.com.sg

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