Back and leg pain

BACK PAIN

Spinal pain in the lumbar region (lower back) and cervical region (neck) are highly prevalent. Lumbarmuscle strains and sprains are the most common causes of lower back pain. The thoracic spine can also be a site of spinal pain, but because it is much more rigid, the thoracic spinal area is much less frequently injured than the lumbar and cervical spine.

The lumbar and cervical spine are prone to strain because of its weight-bearing function and involvement in moving, twisting and bending. Lumbar muscle strain is caused when muscle fibers are abnormally stretched or torn. Lumbar sprain is caused when ligaments, the tough bands of tissue that hold bones together, are unusually stretched. Both of these can result from a sudden injury or from gradual overuse.

When the lumbar spine is strained or sprained, the soft tissues become inflamed. This inflammation causes pain and may cause muscle spasms. Even though lumbar strain or sprain can be very debilitating, neither usually requires neurosurgical attention.

Spinal pain can be caused by things more severe that might require surgical consideration. These usually involve spinal pain that radiates into to arms, legs, or around the rib cage from the anterior chest.

Three types of muscles support the spine:

Extensors (back muscles and gluteal muscles)
Flexors (abdominal muscles and iliopsoas muscles)
Oblique or rotators (side muscles)

Symptoms

Non-surgical lower back, cervical, and thoracic pain usually affect the central or para-spinal soft tissue without radiating into the arms, around the chest, or down the legs. On the contrary, pain radiating from the spine into the extremities or chest wall implies structural pinching of the nerves in the spine that might require a surgical opinion if it fails to improve within days to weeks with non-surgical symptomatic treatment.

Other symptoms include:

• Stiffness in the lower back area that restricts range of motion
• Inability to maintain normal posture due to stiffness and/or pain
• Muscle spasms either with activity, or at rest
• Pain that persists for a maximum of 10-14 days
• Notable loss of motor function such as the ability to tiptoe or heel walk.

Diagnostic Testing

Diagnostic testing is usually necessary only when the pain has been present for more than two weeks and has not improved as expected. Likewise, if pain radiates into the extremities or around the chest well past the spinal epicenter of the pain focus, it is important to rule out underlying causes such as an undetected spinal disc injury. If symptoms are persistent, the following tests may be ordered by your doctor. If the improvement fails to reach a satisfactory stable point, additional diagnostic efforts should be pursued. Likewise, if clinical symptoms deteriorate, the diagnostic evaluation needs to be extended.

X-ray — Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are obtained to search for other potential causes of pain; i.e. spinal mal-alignment, tumors, infections, fractures, etc.

Magnetic Resonance Imaging (MRI) — A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology. MRI’s can show the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumors. Add contrast to the study and it can be made sensitive enough to detect inflammatory processes such as infections and new compression fractures without spinal mal-alignment.

Cat Scan with 3-D reconstruction —Shows boney detail better than any other imaging test and can still show soft tissue and nerves.

Electromyography or Nerve Conduction Velocity Testing — EMG / NCV neurophysiologic testing of nerves to help localize site of compression or other neural pathology.

Treatment

Non-surgical

Strains, sprains and even structural neural compression from disc herniations can be treated with diminished activity and even bed rest for a short period of time; usually from one to three days.

This should be as brief as possible, as prolonged bed rest can lead to a loss of muscle strength, and may increase muscle stiffness, adding to pain and discomfort. Initial medical treatment is commonly comprised of nonsteroidal anti-inflammatory (NSAIDs) medication if the pain is mild to moderate. Muscle relaxants and narcotic medication can be added or substituted for cases of more severe pain symptoms.

Your doctor may recommend physical therapy. The therapist will perform an in-depth evaluation; which combined with the doctor’s diagnosis, will dictate a treatment specifically designed for patients with spinal pain. Therapy may include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation and stretching exercises.

Prognosis

The prognosis is excellent for a complete recovery from a lumbar strain or sprain injury. More than 90 percent of patients completely recover from an episode of lumbar muscle strain or sprain within one month. Heat and ice treatment are indicated on an “as needed” basis at home to treat sudden flare-ups of lower back pain, along with anti-inflammatory medications. However, lower back strain may develop into a chronic condition unless efforts are made to change habits that contribute to the problem.

Prevention Tips

The following tips may be helpful in preventing low back pain associated with strain and sprain:

• Do crunches and other abdominal-muscle strengthening exercises to provide more spine stability. Swimming, stationary bicycling and brisk walking are good aerobic exercises that generally do not put extra stress on your back;
• Use correct lifting and moving techniques, such as squatting to lift a heavy object (don’t bend and lift), and get help if an object is too heavy or awkward;
• Maintain correct posture when you’re sitting and standing;
• If you smoke, quit. Smoking is a risk factor for arthrosclerosis (hardening of the arteries), which can cause lower back pain and degenerative disc disorders;
• Avoid stressful situations if possible, as this can cause muscle tension;
• Maintain a healthy weight. Extra weight, especially around the midsection, can put strain on your lower back.

Surgical

Causes of surgically significant spine pain are often single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as you age, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.

Certain individuals may be more vulnerable to disc problems and, as a result, may suffer herniated discs in several places along the spine. Research has shown that a predisposition for herniated discs may exist in families, with several members affected. This does not necessarily mean that disc disease is a hereditary condition, but it can run in families.

 

LEG PAIN

Possible Causes of Leg Pain:

Pain in the legs can be caused by a variety of things. Leg pain if not the result of direct injury to the area or repetitive use, can be due to damage to the peripheral nervous system or of a neurological disorder that causes weakening of muscles. It is best to consult a Neurologist for an accurate diagnosis.

Peripheral Neuropathy

Peripheral Neuropathy results from damage to the peripheral nervous system. Symptoms can range from numbness or tingling, to pricking sensations (paresthesia), or muscle weakness. Areas of the body may become abnormally sensitive leading to an exaggeratedly intense or distorted experience of touch (allodynia). In such cases, pain may occur in response to a stimulus that does not normally provoke pain. Severe symptoms may include burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction.

Causes: Common causes of peripheral Neuropathy are injury or sudden trauma, repetitive stress to the area, metobollic or endocrine disorders, small vessel/ autoimmune diseases, and infections

In diabetic neuropathy, one of the most common forms of peripheral neuropathy, nerve damage occurs in an ascending pattern. The first nerve fibers to malfunction are the ones that travel the furthest from the brain and the spinal cord. Pain and numbness often are felt symmetrically in both feet followed by a gradual progression up both legs. Later, the fingers, hands, and arms may become affected.

Restless Leg Syndrome

Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them for relief. Individuals affected with the disorder often describe the sensations as throbbing, polling, or creeping. The sensations range in severity from uncomfortable to irritating to painful.

Is there any treatment? For those with mild to moderate symptoms, many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Decreased use of caffeine, alcohol, and tobacco may provide some relief. Physicians may suggest that certain individuals take supplements to correct deficiencies in iron, folate, and magnesium. Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients.

Physicians also may suggest a variety of medications to treat RLS, including dopaminergics, benzodiazepines (central nervous system depressants), opioids, and anticonvulsants. The drugs ropinirole, pramipexole, gabapentin enacarbil, and rotigotine have been approved by the U.S. Food and Drug Administration for treating moderate to severe RLS. The Relaxis pad, which the person can place at the site of discomfort when in bed and provides 30 minutes of vibrations (counterstimulation) that ramp off after 30 minutes, also has been approved by the FDA.

What is the prognosis? RLS is generally a life-long condition for which there is no cure. Symptoms may gradually worsen with age. Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep. In addition, some individuals have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear.

 

Information courtesy of the National Institute of Neurological Disorders and Stroke