spinal

Low Back Pain

Low back pain (LBP) describes

Low back pain (LBP) describes pain between the lower edge of the ribs and the buttock. Highest prevalence among musculoskeletal pain and leading cause of disability.

Most common causes:

  • Intervertebral Disc problem
  • Muscle strain
  • Lumbar facet joint pain
ddd2-illustration

Disc Problem

Back pain is strongly associated with degeneration of the intervertebral disc. Disc degeneration, is asymptomatic in general but can cause back pain pain on herniation and prolapse. It can cause sciatica when the prolapsed disc compresses the nerve roots. Disc degeneration alters disc height and the mechanics of the rest of the spinal column, affecting other spinal structures such as muscles and ligaments. In the long term, it can lead to spinal canal stenosis, where the canal diameter is reduced, being a major cause of pain and disability in the elderly.
Pain caused by a herniated disc classically increases by bending forward, sitting, coughing, or (excessive) stress on the lumbar discs and can be avoided by lying down or sometimes by walking. Conversely, pain from a lumbar spinal canal stenosis can typically increase when walking and relieve immediately upon bending forward.

Treatment

  • Epidural administration of local anaesthetics with corticosteroids, Muscle Relaxants, Physical therapy

Facet Joint Pain

Each vertebrae in the spinal column articulate with the adjacent vertebrae via Intervertebral disc and two facet joints present at the back of the vertebrae. hese facet joints provide stability to the spine by preventing the spine bending excessively and help in distributing the load evenly.
The prevalence of facet arthritis is the highest at L4-L5, followed by L5-S1 level. 
Causes:
  • Degeneration and osteoarthritis (due to Obesity, poor posture)
  • The prevalence of facet arthritis is the highest at L4-L5, followed by L5-S1 level.
  • Trauma
  • Inflammation (Spondyloarthropathy)
Symptoms
Lumbar facet pain can be single sided or both sided with or without radiation to the buttocks, hips, or legs. Upper lumbar facet pain is referred to the sides, hip, and outside of thigh whereas lower lumbar facet pain is referred to the posterior thigh It is dull aching type. It is aggravated by backward bending, side bending and rotation. The pain is relieved by forward flexion which unload the stress on the facet joint. Rising in the morning is difficult due to pain and stiffness of the back.
Conservative:
Ergonomics, Physical therapy, Oral anti-inflammatory drugs for a short duration Interventional Management:
  • Intra-articular Lumbar facet joint injection
  • Lumbar Medial Branch Block and Radiofrequency Ablation
Facet-Joint-Syndrome-Treatment-Doctor-Spine-Specialist-NYC
Quadratus-lumborum-insertion

Muscle Strain

Paraspinal muscles and ligaments spasm can contribute to low back pain.

Causes: Strenuous or Sudden non-strenuous activities (heavy weight lifting, repetitive spinal movements, trauma). Pain often is felt 1 or 2 days after the activity. Myofascial pain may be an important contributor, where trigger points may be present in skeletal muscles such as Iliopsoas, Quadratus lumborum, erector spinae muscles.

Treatment:

  • Pharmacological treatment
  • Physiotherapy
  • Myofascial trigger point injections

Sacroiliac Joint Pain

The SI joint is a diarthrodial synovial joint. Only the anterior part is a true synovial joint. The posterior part is a syndesmosis consisting of the sacroiliac ligament, gluteus midius, minimus and piriformis muscles. Risk factors include leg length discrepancy, abnormal gait pattern, trauma, scoliosis, lumbar fusion surgery with fixation of the sacrum, heavy physical exertion, and pregnancy.


Treatment of SI joint pain best consists of a multidisciplinary approach and must include conservative (pharmacological treatment, cognitive–behavioral therapy, manual medicine, exercise therapy and rehabilitation treatment) as well as interventional pain management techniques.
Sacroiliac joint pain