Back Injury Guide
COMMON INJURIES
> Spondylolysis and Spondylolisthesis
General Information
Spondylolysis (spon-dee-low-lye-sis) and spondylolisthesis (spon-dee-low-lis-thee-sis) are common causes of low back pain in children and adolescents.
Spondylolysis is a weakness or stress fracture in one of the vertebrae, the small bones that make up the spinal column. A stress fracture can occur in adolescents who participate in sports that involve repeated stress on the lower back, such as gymnastics, football, and weightlifting. In some cases, the stress fracture weakens the bone so much that it is unable to maintain its proper position in the spine — and the vertebra starts to shift or slip out of place. This condition is called spondylolisthesis.
COMMON SYMPTOMS:
When symptoms do occur, the most common symptom is lower back pain. In patients with spondylolisthesis, muscle spasms may lead to additional signs and symptoms, including:
- Back stiffness
- Tight hamstrings (the muscles in the back of the thigh)
- Difficulty standing and walking
TREATMENT:
The goals of treatment for spondylolysis and spondylolisthesis are to:
- Reduce pain
- Allow a recent pars fracture to heal
- Return the patient to sports and other daily activities
Nonsurgical treatment may include:
- Rest. Avoiding sports and other activities that place excessive stress on the lower back for a period of time can often help improve back pain and other symptoms.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen and naproxen can help reduce swelling and relieve back pain.
- Physical therapy. Specific exercises can help improve flexibility, stretch tight hamstring muscles, and strengthen muscles in the back and abdomen.
- Bracing. Some patients may need to wear a back brace for a period of time to limit movement in the spine and allow a recent pars fracture the opportunity to heal.
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> Herniated Disk in the Lower Back
General Information
A herniated disk is a condition that can occur anywhere along the spine, but most often occurs in the lower back. It is sometimes called a bulging, protruding, or ruptured disk. It is one of the most common causes of lower back pain, as well as leg pain, or sciatica.
A disk begins to herniate when its jelly-like nucleus pushes against its outer ring due to wear and tear or a sudden injury. This pressure against the outer ring may cause lower back pain.
If the pressure continues, the jelly-like nucleus may push all the way through disk’s outer ring or cause the ring to bulge. This puts pressure on the spinal cord and nearby nerve roots. Not only is this a mechanical compression of the nerves, but the disk material also releases chemical irritants that contribute to nerve inflammation. When a nerve root is irritated, there may be pain, numbness, and weakness in one or both of your legs, a condition called sciatica.
A herniated disk is most often the result of natural, age-related wear and tear on the spine. This process is called disk degeneration. In children and young adults, disks have high water content. As people age, the water content in the disks decreases and the disks become less flexible. The disks begin to shrink and the spaces between the vertebrae get narrower. This normal aging process makes the disks more prone to herniation
COMMON SYMPTOMS:
In most cases, low back pain is the first symptom of a herniated disk. This pain may last for a few days, then improve. Other symptoms may include:
- Sciatica. This is a sharp, often shooting pain that extends from the buttock down the back of one leg. It is caused by pressure on the spinal nerve.
- Numbness or a tingling sensation in the leg and/or foot
- Weakness in the leg and/or foot
- Loss of bladder or bowel control.
TREATMENT:
Initial treatment for a herniated disk is usually nonsurgical in nature.
Nonsurgical treatment may include:
- Rest. One to 2 days of bed rest will usually help relieve back and leg pain. Do not stay off your feet for longer, however. When you resume activity, try to do the following:
- Take rest breaks throughout the day, but avoid sitting for long periods.
- Make all your physical activity slow and controlled, especially bending forward and lifting.
- Change your daily activities to avoid movements that can cause further pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory drugs such as ibuprofen or naproxen can help relieve pain.
- Physical therapy. Specific exercises will help strengthen your lower back and abdominal muscles.
- Epidural steroid injection. An injection of a cortisone-like medicine into the space around the nerve may provide short-term pain relief by reducing inflammation.
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> Low Back Strain (Back Strains and Sprains)
General Information
Muscle strains and lumbar sprains are the most common causes of low back pain. A low back muscle strain occurs when the muscles of the back are abnormally stretched too far. A lumbar sprain occurs when the ligaments, the tough bands of tissue that hold bones together, are torn from their attachments.
Differentiating a strain from a sprain can be difficult, as both injuries will have similar symptoms. Many doctors refer to both injuries as a category called "musculoligamentous injuries" of the lumbar spine. In general, it doesn't matter what you call the problem because the treatment and prognosis for both back strains and sprains is the same.
COMMON SYMPTOMS:
The most common symptoms of a lumbar strain or sprain are:
- Pain around the low back and upper buttocks
- Low back muscle spasm
- Pain associated with activities, and generally relieved with rest
TREATMENT:
Medications and therapeutic treatments combined often provide enough relieve pain enough to enable you to do all the things you want to do.
- Physical therapy can include passive modalities like heat, ice, massage, ultrasound, and electrical stimulation. Active therapy consists of stretching, weight lifting, and cardiovascular exercises. Exercising to restore motion and strength to the lower back can be very helpful in relieving pain.
- Braces are often used. Some people report feeling more comfortable and stable while wearing them.
- Chiropractic or manipulation therapy is available in many different forms. Some patients are able to get relief from their low back pain with these treatments.
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> Osteoporosis and Spinal Fractures
General Information
Osteoporosis is a natural phenomenon that occurs with aging. As we get older, our bones weaken. When the vertebrae in the spine weaken, they can narrow and become flatter. This can make elderly patients shorter and lead to a rounded back, a hump, or a bent-forward look to the spine.
The weakened vertebrae are at a high risk for fracture. A vertebral compression fracture occurs when too much pressure is placed on a weakened vertebra, and the front of it cracks and loses height. Vertebral compression fractures are often the result of a fall, but people with osteoporosis can suffer a fracture even when doing everyday things, such as reaching, twisting, coughing, and sneezing.
Fortunately, most people who suffer a vertebral compression fracture get better within 3 months without specific treatment to repair the fracture. Simple measures, such as a short period of rest and limited use of pain medications, are often all that is required. In some cases, patients are instructed to wear a brace to restrict movement and allow the vertebral compression fracture to heal.
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> Lumbar Spinal Stenosis
General Information
Lumbar spinal stenosis is a common cause of low back and leg pain, or sciatica.
As we age, the normal wear-and-tear effects of aging can lead to narrowing of the spinal canal, which houses the spinal nerves and spinal cord. This condition is called spinal stenosis.
Degenerative changes of the spine are seen in up to 95% of people by the age of 50. Spinal stenosis most often occurs in adults over 60. Pressure on the nerve roots is equally common in men and women.
Spinal stenosis occurs when the space around the spinal cord and spinal nerves narrows. This puts pressure on the spinal cord and the spinal nerve roots, and may cause pain, numbness, or weakness in the legs.
COMMON SYMPTOMS:
- Back pain.
- Burning pain in buttocks or legs (sciatica).
- Numbness or tingling in buttocks or legs.
- Weakness in the legs or foot drop (difficulty lifting the front part of the foot).
- Acute cauda equina syndrome.
TREATMENT:
Nonsurgical treatment options focus on restoring function and relieving pain:
- Physical therapy. Stretching exercises, massage, and lumbar and abdominal strengthening often help manage symptoms.
- Lumbar traction. Although it may be helpful in some patients, traction offers very limited results. There is no scientific evidence of its effectiveness.
- Anti-inflammatory medications.
- Steroid injections, also known as epidural steroid injections.
- Acupuncture.
- Chiropractic manipulation.
Surgery for lumbar spinal stenosis is generally reserved for peoplewho have poor quality of life due to pain and weakness, including difficulty walking for extended periods of time. This is often the reason that people consider surgery.
Your surgeon may give you a brace or corset to wear for comfort. They will likely encourage you to begin walking as soon as possible. Most people only need physical therapy to strengthen their backs.
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