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Back pain
Overview | Causes | Symptoms | Diagnosis | Treatment | FAQ
Overview
Back pain is a fairly broad category called “soft tissue
injury,” which covers muscles, tendons and ligaments. About 80%
of back and neck pain is muscle-related.
The stomach muscles, or abdominals, enable the back to
bend forward. They also assist in lifting. The abdominals work with the
buttock muscles to support the spine. The oblique muscles go around the
side of the body to provide additional support to the spine.
Another type of strain relates to spinal ligaments that
run in front and in back of the vertebral bodies. Tendons, which also
connect muscles in the spine, can develop inflammation, or tendonitis.
Some people believe that part of what makes the back muscles
more prone to strain is that they are shorter than other big muscles
in the body. The muscles in our thighs that enable us to walk, run and
jump are longer and less prone to strain. It’s very unusual to
strain a thigh muscle.
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Causes
Muscles in the back can strain or spasm and form a hard lump, like a
charley horse in the leg. Back muscle spasms can be caused by injury
and pain, whether the source is muscle strain or a disc problem. A
spasm, defined as an involuntary convulsive contraction of muscle fibers,
can be excruciating. The muscle spasm can be steady or come in waves. Your muscle is sending you a signal that it has been
pushed beyond its ability.
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Symptoms
A symptom of muscle strain may be an excruciatingly painful spasm in the back.
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Diagnosis
Outlined below are some of the diagnostic tools that your physician may
use to gain insight into your condition and determine the best treatment
plan.
- Medical history: Conducting a detailed medical history
helps the doctor better understand the possible causes of your back
and neck pain, which can help outline the most appropriate treatment.
- Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
- X-rays are usually the first step in diagnostic testing
methods. X-rays show bones and the space between bones. They are of
limited value, however, since they do not show muscles and ligaments.
- MRI (magnetic resonance imaging) uses a magnetic field
and radio waves to generate highly detailed pictures of the inside
of your body. Since X-rays only show bones, MRIs are needed to visualize
soft tissues like discs in the spine. This type of imaging is very
safe and usually pain-free.
- CT scan/myelogram: A CT scan is similar to an MRI in
that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves. A local
anesthetic is injected into the low back to numb the area. A lumbar
puncture (spinal tap) is then performed. A dye is injected into the
spinal canal to reveal where problems lie.
- Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup. These
tests, called electromyography (EMG) or somatosensory evoked potentials
(SSEP), assist your doctor in understanding how your nerves or spinal
cord are affected by your condition.
- Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton. Bone
scans are also used for finding lesions for biopsy or excision.
- Discography - Discography is used to determine the internal
structure of your disc. It is performed with a local anesthetic by injecting
dye into the disc under X-ray guidance. An X-ray or CT scan is performed
to determine if the disc’s structure is normal or abnormal and
if the injection causes pain. A benefit of a discogram is that it enables
the spine surgeon to determine the disc level that is causing pain.
And if surgery is necessary, discography helps ensure a successful surgery and reduces the risk
of operating on the wrong disc.
- Injections: These can relieve back
pain and give the physician important information about your problem,
as well as provide a bridge therapy.
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Treatment
Surgery is never appropriate for muscle strain. 
As with any muscle injury, it’s natural for an individual
to stop moving the injured area and wait for it to heal. Ironically,
this is counter productive. Restricting movement causes the muscle to
weaken, become less flexible, and receive less circulation. In fact,
gentle stretching and exercise is the best way to resolve the injury
by getting it moving and increasing circulation.
Recommendations
- Rest.
- Apply ice for five minutes at a time for the first 48
hours, then switch to heat.
- Take anti-inflammatories, preferably ibuprofen like
Advil or Nuprin as directed on the bottle. Acetaminophen (Tylenol)
may be taken for pain if you are allergic to ibuprofen.
- Try our home remedy exercises. But remember: no exercise
should be painful. Stop if they cause an increase in pain or symptoms.
- An appointment with a non-surgical spine specialist is
most appropriate for muscle-related back pain.
- Call us immediately if you experience any emergency,
red flag symptoms.
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FAQ
What's the difference between a sprain and
a strain?
While someone may argue that the two words are different, that a sprain
is a more serious injury than a strain, in reality, sprain and strain
have evolved to mean essentially the same things to doctors and lawyers.
Both words relate to an overworked muscle, ligament or tendon that is
overstretched.
Some may argue that strain relates to stretching or tearing
of muscles or tendons, while sprain relates to tearing of ligaments or
tissues in a joint area. For example, if bones in a joint are forced
beyond a comfortable range of motion, the joint may be sprained.
Another word that you may hear is “muscle spasm,” when
a muscle locks up in an excruciating, hard lump.
What’s the difference between
a simple strain and a more serious herniated disc?
Most people erroneously think that the more excruciating the pain, the
more likely it is that you herniated a disc. That is not the case at all. In
some cases a back spasm can be very painful. If the pain is mostly in the low back, it’s
probably not a herniated disc. Typically, a herniated disc in your back
will radiate pain down into your leg, or pain will radiate down your
arm if you have a blown disc in your neck.
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