Cause of Lower Back Pain: Spinal Stenosis

Spinal Stenosis is a common cause of lower back pain and sciatica. It is most often found in older patients in their 60’s and older.

Stenosis means a restriction or blockage of a hole or opening. When doctors refer to “spinal stenosis” they are most often talking about stenosis or blockage of the central spinal canal. The central, canal is the large opening in the spinal bones that provides a bony “tube” that houses and protects the spinal cord.

The Cause of Spinal Stenosis
The central canal may become reduced in size due to:

• Disc bulge or herniation
• Bone spur of vertebral body
• Bone spur from facet arthritis

Symptoms of Spinal Stenosis
No matter what the cause, the symptoms of central spinal stenosis are the same. The textbook example is back and/or leg pain that is aggravated by walking and is relieved by short periods of sitting, after which time the person can walk for a period of time before the pain increases again. Sufferers of spinal stenosis must take frequent breaks on a walk.

As the condition worsens the amount of time the patient is able to walk gets shorter and shorter. Eventually spinal stenosis sufferers stop going for walks, shopping, etc.

Diagnosing Spinal Stenosis
The history of pain while walking relieved by rest is a big clue. A physical exam is necessary to determine the extent of neurologic function.

Two things must be documented and monitored for treatment:

1. How long the patient can walk before he or she must sit
2. How far down the pain travels; buttocks, back of thighs, calves, etc

An MRI is the most conclusive test to accurately diagnose stenosis and to determine the severity and cause, i.e. bone spur versus disc herniation.

Spinal Stenosis Treatment depends on:

• The cause; disc vs. bone spur
• The severity

For more information on spinal stenosis and a possible treatment go to: http://www.spinediscrehab.com/drx9000.htm

Cause of Lower Back Pain: Facet Syndrome

Back Anatomy

The spine has 2 sets of joints: A large joint between the large weight bearing part of the spine which is held in place by the disc and a smaller pair of joints in the back of the spine that guide movement.

It’s the latter joints that this article will address.

The smaller paired joints in the spine are called “facet” (fuh-set) joints. These joints are designed to help guide movement within the spine.

Cause of Facet Syndrome
Facet syndrome is a cause of chronic back pain that results from prolonged stress on the facet joints. It is a form of osteoarthritis of a specific joint. Work injuries, accidents, subluxation, prolonged poor posture and disc disease all contribute to facet joint malfunction. Continued malfunction over time results in the breakdown of the cartilaginous facet joint linings. In time, the bones react by forming spurs in an attempt to fuse the joint shut.

Symptoms of Facet Syndrome
The hallmark of facet syndrome is a deep aching pain that is aggravated by sitting and leaning backwards or twisting at the waist. The pain is usually located within an inch or two of the midline of the spine. It may occur just on one side or it can be on both. Facet syndrome does not ordinarily cause radiating pain (sciatica).

Diagnosing Facet Syndrome
A thorough physical examination of the spine must be done. A simple maneuver where the patient’s back is extended over the doctor’s hand as a fulcrum (Kemp’s test) will usually cause reproduction of the pain. Oblique (angled) plain film x-rays will show characteristic signs of facet joint narrowing, irregularity and often spurs. A loss of disc height is often found at the same level. Advanced imaging like an MRI is not usually required.

For more detailed information and a video tutorial on facet syndrome follow this link.

Is Your Disc Bulge ‘Focal’ or ‘Diffuse’? and Why it Matters…

The spine is made of 26 interlocking bones held together and made flexible by “discs” between each spinal bone.

Disc Function:
The disc is a flexible, yet very strong structure that bears the brunt of our weight by absorbing shock. Discs allow movement between the vertebrae or spinal bones. The discs also act as spacers to allow enough room for sensitive and important nerves to pass from the spinal cord to the rest of the body so that your brain can control and communicate with distant organs and tissues.

Disc Anatomy
A disc has 2 parts:
1. Annulus–outer fibrous tissue
2. Nucleus–inner gel substance

Disc Damage
When a disc is injured by acute trauma or by long-standing physical stresses, the outer fibers are weakened and allow the disc to bulge outward. The annulus may bulge or protrude in a small discreet area called a “focal” disc bulge or it may bulge across a wide portion of the disc, which would be called a “diffuse” bulge.

Focal bulges by their smaller and more localized nature cause more discreet neurologic symptoms like pain. Because the bulge is small or focused to only one area, the nerves involved are fewer.

Diffuse bulges however, take up more space and can cause more varied symptoms. You could one sided or both sided pain, you could have pain that appears to be coming from a different level altogether because of pressure on the spinal cord itself and not just a discreet nerve.

Obviously if you are going to pick and choose your bulge, you’d opt for a focal one. Unfortunately back pain sufferers have no choice. The “take away” point here though is if you know what type you have, it will help you to understand what your likely recovery is.

It’s also crucial for your doctor to take this into account to determine what treatment methods to use to cure your lower back pain and sciatica.

Learn what can be done to repair damaged discs and relieve the pain without surgery here:http://www.spinediscrehab.com/

Cause of Lower Back Pain: Bulging Disc Herniation

Intervertebral discs are “spacers” between the spinal bones. They provide room for the joints to move allowing flexbility of the spine. They also provide room for the nerves to exit from the spinal cord to the rest of the body.   

Discs are usually filled with water and are quite flexible, almost rubbery. Due to lifting injuries, repeated physical stress, automobile accidents, etc the outer disc fibers (annulus) become damaged allowing water to escape from the disc. In time, the disc become more and more dehydrated and beghins to weaken. Just like a car or bicycle tire that’s sidewall is weak, a bulge forms. The bulge may put pressure within the canal that nerves pass through causing not only back pian, but also butt, thigh, leg or foot pain (sciatica).

The disc bulge may worsen and the outer fibers may actually tear open and allow inner disc material (nucleus) to protrude outward (herniation) into the nerves or spinal cord. In most instances, a herniation like this will cause back pain and sciatica, but also serious physical signs such as loss of muscle strength in the legs, shrinking of leg muscles (atrophy) and/or loss of reflexes. See video tutorial of disc herniation here: http://www.CureForLowerBackPain.com

Diagnosis of disc bulge and herniation are by careful phsyical examination and confirmed conclusively on MRI scan. Plain x-rays will NOT show disc bulges or herniation. A seemingly normal x-ray may show up as a severe herniation on MRI.

Cause of Lower Back Pain: Degenerative Disc Disease

Degenerative disc disease refers to the breakdown and malfunction of one or more intervertebral discs. “Discs” are the spacers and shock absorbers between the spinal bones.

Discs are naturally about 75% water. With physical exertion, gravity, injuries and chronic postural stress the discs begin to lose their water content and become dehydrated. When this occurs the disc begins to shrink or contract. Rather than their usual “rubbery” consistency, they become dried out and leathery.

Under pressure of your body and gravity, the discs begin to thin. This allows the vertebrae (spinal bones) to crowd eachother causing pain in lower back. As the condition deteriorates, more pressure is built up around the spinal nerves passing between the spinal bones, which can cause back and leg pain otherwise known as sciatica. In time, the nerves become more irritated and begin to become damaged resulting in not only sciatica, but more seriously, muscle and reflex weakness.

See a flash video of degenerative disc disease here: http://www.secretdiscsolution.com/flash/HERN.swf

Diagnosing degenerative disc disease is straight forward. A thorough history, physical examination and plain film x-rays will detect this common cause of lower back pain.

Morning back pain and stiffness that improves after a hot shower or period of walking and/or stretching is a characteristic symptom of degenerative disc disease. Physical examination will usually show painful and reduced back mobility with tenderness over the affected joints. X-rays will show the characteristic signs of thinning disc space(s), and lipping or spurring on the vertebral bodies.

Degenerative disc disease is a slowly progressive condition that deteriorates over time. It begins as dehydration and then eventually leads to nerve damage.