Lumbar Sprains & Low Back Pain: Treatment Options

November 11, 2013June 24, 2014 / Thomas Cohn, MD

Lumbar sprains are often considered a generic term to explain low back pain that originates from the muscles or ligaments. It is usually just in the low back and buttock area, and does not spread into the legs. Lumbar strains and sprains are not serious injuries, they do not involve damage to lumbar discs, lumbar nerves, the vertebrae, or joints. Pain is localized to the back and will resolve with conservative treatment.

What is a Lumbar Sprain?

Technically, sprains are tears of ligaments. In the lumbar area, these ligaments hold the bones in alignment with the help of muscles. Strains occur to muscles when they are overstretched. Most lumbar pain is related to injuries to the muscles, and thus are more correctly considered strains.

Mobility of the lumbar region is dependent on the action of both very large and very small muscles along the spine. The lumbar spine can bend forward and back, rotate and twist. Lifting and twisting can put excessive forces through the spine and muscles causing a strain. Pain usually appears after doing any of the following:

Performing too much lifting
Staying in a bent position
Performing repetitive lifting and twisting

Performing activities without the proper body mechanics, obesity, and poor conditioning are all contributing factors.

Treatment Options

Treatment of lumbar strains is typically conservative. Ice initially for a day or two and then heat is often helpful. Ice reduces initial swelling and pain, while heat facilitates muscle rest, blood flow, and healing. Nonprescription medications including anti-inflammatories like ibuprofen and aspirin as well as analgesics like acetaminophen are helpful. Rest should be limited to no more than two days. Over 90% of these will resolve readily in less than a month. Chiropractic therapy, massage, and physical therapy may all help improve function and diminish pain.

Full medical evaluation may be necessary if the pain continues longer than several weeks, or there are more serious problems like:

actual leg weakness,
numbness,
loss of control of the bowels or bladder,

Rarely will an injury to the spine, discs or nerves be present. Even in cases of more severe back injuries, most of these also heal with conservative care. Only in cases of neurologic compromise causing leg weakness or loss of control of the bowel or bladder would surgery be a definite consideration.

Low back pain is usually due to a muscle strain. Learning proper body mechanics and maintaining good core strength helps prevent injury. Almost everyone strains his or her back at some point. Conservative care and time will heal almost everyone.

5 Tips for Sleeping Through Pain

October 24, 2013June 24, 2014 / Thomas Cohn, MD

When you’re in pain as the result of an injury or other condition, oftentimes the best remedy is to get plenty of rest and sleep. But sleeping through pain is easier said than done. Rolling over onto a painful back, leg, or arm can wake you up (and keep you up) in the middle of the night. More pain equals less sleep, and less sleep slows your recovery. It’s a vicious (dare I say painful) cycle.

But there are a steps you can take to help sleep soundly through the pain. Here are a few tips:

Take your pain relief medications as directed, and right before bed if possible.
Reduce your caffeine intake. Coffee, soda, and energy drinks are jam packed with caffeine. They are designed to keep you awake and alert. This is great if you need a pick me up at work, but not when you’re trying to sleep. If you can’t cut out the caffeine completely, try to only drink it in the morning.
Cut down alcohol consumption. Many people find that a “nightcap” helps put them to sleep. While it’s true that alcohol can induce drowsiness, the sugars in alcohol are more likely to wake your body up later in the night.
Get into a sleep cycle. Try to go to bed and wake up at the same times every day. This will help your body get into an internal rhythm or groove.
Relax and avoid physical activity before bed. Exercising is a great way to reduce your pain, but exercising too late in the evening can keep you up and make it difficult to fall asleep.

Whether you’re dealing with chronic pain from an illness, or acute pain following an injury or surgery, getting a good night’s sleep is essential for your overall health. Follow these tips and you’ll be off to dreamland in no time.

Spine Surgery Often Unnecessary in Treating Back Pain

October 16, 2013June 24, 2014 / Thomas Cohn, MD

A recent presentation at the North American Spine Society (NASS) meeting, points to the fact that a third of spine surgery patients are still using narcotic/opioid medications one year after surgery.

Further, the study indicates that of those patients using opioids before surgery, 51% continued a to use them a year later. The article goes on to discuss the concern that too much opioid prescribing is occurring. This is the wrong concern. The real concern should be whether spine surgery should have been done in the first place.

Reasons for Spine Surgery

The United States has one of the highest rates of spine surgery. Compared to most other countries, the spine surgery being done is mostly unnecessary. There are appropriate reasons for spine surgery, such as:

Trauma
Scoliosis
Changes in the spine causing nerve damage with loss of muscle or organ function

Pain alone is a poor reason for spine surgery. Most spine pain is caused by degenerative discs and joints. Treating this surgically most often only changes the location of pain, and does not resolve pain. Nonsurgical management of most spine conditions has been shown to be much more successful in numerous studies. Ask a group of surgeons, the answer of course is that the surgery works.

Pain management experts will usually have a more conservative view with regards to surgery. Spinal fusion surgery has at most a 30% success rate for helping with pain. Spinal surgery in general also has a 20% rate of significant surgical complication. The above statistics highlight the real issues with spine surgery – that it often causes more problems than solutions.

Alternative Treatment Options

Treatment for spine pain involves many different options, including a variety of medications and possibly opioids. Every person has different needs, and a Pain Medicine physician can evaluate you and help determine an appropriate treatment program. Surgery should only be considered if neurologic compromise is occurring and without intervention, loss of motor control or organ function may result.

Opioid medication use in the United States may be out of control, but so is spine surgery. Surgery and opioid use are truly independent problems. Pain and opioid use after surgery is not a surprising issue. The problem is too much surgery and not enough good pain management of spine problems by qualified experts.

Spinal Stenosis: Causes & Pain Management Options

October 14, 2013June 24, 2014 / Thomas Cohn, MD

Spinal stenosis is a narrowing in the spinal canal where the spinal cord and nerves of the spine travel and exit the bony spine structure. It most commonly occurs in the neck and low back regions. It can be caused by normal changes relating to aging, such as:

Bony overgrowth
Trauma
Congenital changes

The body is highly adaptive, and if changes that lead to stenosis are slow, often no symptoms are present until the body can no longer compensate.

Causes & Symptoms

The symptoms of stenosis are signs of nerve damage at the spinal level that include:

Pain
Numbness
Muscle weakness
Bowel or bladder problems

Symptoms are dependent on the cause and location of the spinal narrowing. Trauma, like car accidents, can cause sudden fracture of the spinal vertebrae. The bone pieces can damage the spinal cord causing immediate paralysis. Congenital abnormalities may cause curvatures of the spine (scoliosis) and pinching of the nerves as they exit the spine.

Stenosis most commonly develops as one ages. The bone can become overgrown where the vertebral discs and joints are causing central and lateral spine narrowing. In the neck, symptoms of pain, numbness, and weakness occur in the arms and head, but can also occur in the legs. Low back stenosis causes symptoms in the low back and legs, and sometimes bowel and bladder control. Symptoms in the low back may be very positional. Bending forward and sitting may significantly relieve the pain. The most common symptoms that send a person to a doctor are pain or muscle weakness.

Diagnosis

Diagnosis of spinal stenosis is made based on symptoms, history, and physical examination. Pain is often in the distribution of a particular spinal nerve level and muscle weakness corresponds to that level. An exam shows sensation changes, weakness of muscles, and reflex changes. If stenosis is suspected, CT or MRI scans of the spinal region can confirm the diagnosis. Electrodiagnostic studies may also be useful to determine the extent of nerve damage, and are performed by Physical Medicine doctors or Neurologists.

Pain Management Options

Treatment for spinal stenosis needs to be individualized for every patient. Conservative care centers on physical therapy to strengthen spinal muscles and maintain proper posture, to medications for pain and spinal injections. Many people can control symptoms for years with a variety of conservative care techniques. If the conservative path is not controlling symptoms, then surgical care may be necessary to relieve spinal narrowing.

Spinal stenosis is a complex condition. A good Physical Medicine pain specialist can lead one through the maze of diagnosis and treatment. Most people do respond to conservative care. Narrowing of the spine does occur in many people and often can be treated with PT, medications and other types of care. Find a physician who can lead you through conservative care before you consider surgery.

4 Types of Pain after a Car Accident (and Treatment Options)

September 3, 2013June 24, 2014 / Thomas Cohn, MD

Car accidents nearly always result in injury. These injuries can be mild to severe, but most often cause some form of pain. Here are some of the most common forms of pain that occur after a car accident and pain management options for each:

Neck pain from whiplash. Whiplash is perhaps the most common injuries sustained as a result of a car accident. It can result from the most catastrophic wreck, or the smallest parking lot fender bender. It occurs during accidents when the vehicle impact jerks the head around so much so that the neck over or hyper extends. Whiplash can cause neck pain, stiffness, and headaches. Often, people with whiplash do not feel symptoms until well after the accident.
Back pain from a herniated or bulging disc. Similar to neck injuries and whiplash, the spinal cord can sustain injury due to the violent jerking motions associated with many car collisions. The bones in your spine are cushioned by discs. During a car crash, these discs can slip out of place and cause pain. Read more about herniated discs.
Head pain due to Concussion. It is common for people in car accidents to hit their head on the steering wheel, headrest, or vehicle interior. If the head is hit hard enough it can become concussed – resulting in headaches, confusion, and loss of consciousness.
Leg, ankle, foot pain. In more severe car collisions, when there is substantial structural damage to the vehicle, injuries to the lower extremities can occur. These can range from slight sprains, to broken bones. Pain from these injuries also ranges greatly depending on the extend of the damage.

Pain Management Options

Whiplash. Treatment options can include a judicial use of NSAIDs, physical therapy, and use of a neck brace.
Spine injuries. Back pain from spinal injuries can be managed with medications, physical therapy, and injections.
Concussion. If you think you may have a concussion it is important to seek medical help immediately. Concussion severity can range greatly. Slighter concussions should be treated with simple rest. More severe concussions can have a negative impact on your memory and reflexes. In the most extreme cases hospitalization may be required.
Leg pain. Again, treatment options largely depend on the injury sustained, but generally the RICE method is the first option for treatment. Physical therapy or surgery may be required with more severe injuries.

Car accidents are common occurrences that can result in a number of painful injuries. If you are still dealing with pain from a previous car accident, talk to your physician about a pain management plan that can help you back to a pain free life.