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Don’t let chronic back pain go untreated

Our back is a fine tuned machine that is made up of many small joints, muscles, ligaments and tendons. When working at its best, it can accomplish some amazing stuff. When one component goes awry it can result in severe pain and total disability, so it is important to stay ahead of the problem by getting proper treatment early.

Chronic Low Back pain

Most back pain is localized and caused by a simple muscle strain or injury. It tends to resolve quickly. Unfortunately, in some pain lasts six months or more and is classified as “chronic.” It can be felt as bone, nerve or muscle pain. It can be localized or radiating. Pain can continue past acute injury because of sensitization (the original injury heals but the pain remains because the nervous system now considers it normal to have pain) or ineffective treatment.

Symptoms:
• Mild to severe pain that exists anywhere along the back
• Radiating pain into the arms or legs
• weakness, numbness or tingling

Other conditions that can mimic chronic back pain include:
• Disc degeneration
• Osteoarthritis
• Myofascial pain
• Fracture
• Scoliosis
• Radiculopathy

Your problem will be evaluated by gathering information with a complete and detailed medical history followed by a focused physical examination. Diagnostic studies confirm your diagnosis. These specialized tests may include x-ray, CT, electrodiagnostic (EMG) studies, ultrasonography, or MRI. Treatment will depend on the source of pain. Options include different oral medications, physical therapies and targeted injections.

Degenerative disc disease

Degenerative disc disease happens to all of us as we age. The water in the disc begins to break down and effects the bone, muscle, ligaments and joints in the area. Up to 50-70% of this process is secondary to genetics. Repetitive stress to that back as well as smoking are thought to play a role as well. Many are lucky, and although they have the condition they never experience pain. Others are debilitated by the process. Intervertebral disc injuries never fully heal, so continued inflammation has the potential to cause increasing pain.

Symptoms:
• Painless progression to severe back pain
• Loss of flexibility
• Muscle spasms

Your problem will be evaluated by gathering information with a complete and detailed medical history followed by a focused physical examination. Diagnostic studies confirm your diagnosis. These specialized tests may include x-ray, CT, electrodiagnostic (EMG) studies, ultrasonography, or MRI. Treatment will depend on the source of pain. Options include different oral medications, physical therapies and targeted injections.

Disc Herniation

Herniated discs often happen as we age and most never experience pain. Others are unlucky, and the herniation results in severe debilitating pain. It is most common in individuals aged 30 to 50 years. A herniated disc can be exacerbated by poor mechanics, repetitive strain, or mechanical overloading. While large disc herniations are more likely to cause leg or arm symptoms, they are also more likely to shrink compared with smaller disc herniations. The pain associated with a disc herniation is related to the compression or irritation of nerves.
Symptoms vary:
• Pain radiating down the arm or leg
• Pain with leg extension
• Arm or leg weakness
• Arm or leg numbness

Other diseases that can mimic a disc herniation include:
• Fracture
• Infection
• Neoplasm
• Stenosis
• Shoulder osteoarthritis
• Hip osteoarthritis
• Sacroiliac joint dysfunction
• Spinal stenosis
• Spondylosis

Your problem will be evaluated by gathering information with a complete and detailed medical history followed by a focused physical examination. Diagnostic studies confirm your diagnosis. These specialized tests may include x-ray, CT, electrodiagnostic (EMG) studies, ultrasonography, or MRI. Treatment will depend on the source of pain. Options include different oral medications, physical therapies and targeted injections. Long term studies have shown that treatment should be geared to returning you back to your normal functional status as 2 years later there is no difference in the surgery and non-surgical groups.

Sacroiliac Pain

The sacroiliac joint links the spine to the lower extremities. The joint is stabilized by the ligaments that surround the joint. It is thought to be the cause of up to 30% of chronic low back pain cases but it is often not considered in the assessment. Unfortunately, one third of lumbosacral spinal fusion patients also develop sacroiliac joint pain.

Symptoms:
• Pain may be felt in the buttocks, lower back, groin, abdomen, lower leg and foot
• The pain is often on one side.
• The pain is often worsened with entering or exiting a car
• Often a pop is heard that results in pain relief

Other diseases that can mimic [diagnosis] include:
• Ankylosing spondylitis
• Lumbar disc pain
• Hip osteoarthritis
• Malignancy
• Myofascial pain
• Radiculopathy
• Referred visceral pain
• Rheumatoid arthritis
• Trochanteric bursitis
• Facet joint pain

Your problem will be evaluated by gathering information with a complete and detailed medical history followed by a focused physical examination. Diagnostic studies confirm your diagnosis. These specialized tests may include x-ray, CT, electrodiagnostic (EMG) studies, ultrasonography, or MRI. Treatment will depend on the source of pain. Options include different oral medications, physical therapies and targeted injections.

Spinal stenosis

Spinal stenosis is a narrowing of the central spinal canal. It often presents with radiating pain and little back pain. It can be due to arthritic degenerative changes or family history. Its prevalence can increase with age, often presenting after age 50. The natural course of stenosis is often stable symptoms with no deterioration based on a 4 year prospective trial. Unfortunately, exacerbations can be very painful. The symptoms of stenosis are thought to be related to mechanical compression of the neural fibers or reduced blood flow to the nerves.

Symptoms:
• Progressive weakness
• Progressive numbness and tingling
• Pseudoclaudication describes buttock, thigh, and leg pain that is worsened with walking or standing and improved with sitting

Other conditions that mimic stenosis
• Lateral recess stenosis
• Radiculopathy
• Malignancy
• Traumatic

Your problem will be evaluated by gathering information with a complete and detailed medical history followed by a focused physical examination. Diagnostic studies confirm your diagnosis. These specialized tests may include x-ray, CT, electrodiagnostic (EMG) studies, ultrasonography, or MRI. Treatment will depend on the source of pain. Options include different oral medications, physical therapies and targeted injections.

Piriformis syndrome

Piriformis syndrome is sciatica-like pain due to impingement of the sciatic nerve as it courses through the piriformis muscle. The incidence is thought to be 6% to 8% of all low back pain cases and is most often noted in the 30 to 40 year old age group. The piriformis muscle is the largest of the short external rotators of the hip. The piriformis muscle originates from the second to fourth sacral vertebrae, exiting the pelvis through the sciatic notch and inserting on the upper portion of the greater trochanter with variations in the course of the sciatic nerve through the piriformis muscle. Activities that can worsen the pain include arising from a chair, walking up stairs or standing for a long period of time. Any activity that increases hip external rotation can increase the pain.

Symptoms
Pain in the buttock or entire leg

Other diseases that can mimic piriformis syndrome include:
• Endometriosis
• Herniated disc
• Hip joint pain
• Pelvic tumors
• Sacroiliac joint dysfunction
• Spinal stenosis
• Spondylosis

Your problem will be evaluated by gathering information with a complete and detailed medical history followed by a focused physical examination. Diagnostic studies confirm your diagnosis. These specialized tests may include x-ray, CT, electrodiagnostic (EMG) studies, ultrasonography, or MRI. Treatment will depend on the source of pain. Options include different oral medications, physical therapies and targeted injections. The symptoms of piriformis syndrome can respond quite well to non-surgical treatments. Simple measures such as oral anti-inflammatory medications, muscle relaxants, physical therapy, and a strengthening exercise programs. Ultrasound guided trigger point injections can be very precise in accurately diagnosing and treating the underlying problem

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