What is an Annular Tear?
Annular Tear Definition:
An annular tear is a hole or rip somewhere in the interwoven layers of the annulus fibrosus, the tough ligament that forms the exterior capsule of an intervertebral disc.
Intervertebral discs are pressurized cushions found between each bone of the spine. These discs act as shock absorbers and allow the spine to bend in several directions. Each one consists of the annulus fibrosus and, inside the capsule, the nucleus polposus, which consists of a soft, gel-like substance. The nucleus and the inner layers of the annulus have no blood supply or nerve fibers. It is only the outer layers of the annulus that are supplied with many nerve fibers and so are sensitive to pain. Annular tears, therefore, are often asymptomatic, which means that their existence does not necessarily produce any symptoms.
The peripheral layer of the annulus consists of the outer layers. Damage to this layer is usually caused by an injury, and can lead to disc degeneration. The concentric, or central, layer is found between the outer and inner layers. Tears to this layer are also usually as a result of trauma. The inner, radial, layer begins at the center of the disc and extends to the peripheral layer.
Annular tears can happen in any layer, and symptoms, if present, can therefore be felt anywhere along the spine and sometimes in the limbs as well.
Annular Tear Causes:
The normal aging process is commonly responsible for annular tears. With time and usage the annulus becomes thinner, losing elasticity and becoming vulnerable to damage. Small holes gradually get larger and, if large enough, the material of the nucleus can start to leak out of the capsule.
Contact sports, with the vigorous bending, twisting and collisions that take place, also often lead to annular tears. Any strenuous activity or occupation involving heavy lifting or lots of bending may cause tiny injuries that may, over time, escalate into a larger tear.
Another common cause for such injury is being overweight. As the spine supports most of the weight of the body, excessive load can compress the discs and increase the risk of tears appearing in the annulus.
Annular Tear Symptoms:
When enzymes contained in the gel-like substance of the nucleus leak out through the annulus and reach the peripheral layer with its many nerve endings, there is a strong inflammatory chemical reaction. This is when pain begins to be felt as a result of having a tear.
If the disc is herniated (the disc is bulging out between the vertebrae, or has actually ruptured), the pain may be experienced as a sharp stabbing sensation, tingling similar to pins and needles, numbness of the skin, or weakness in the limbs, depending on the location of the damaged disc. Pain is typically felt in the back, but can also be felt in one or both legs. There may be some swelling due to inflammation.
Increasing the pressure on the disc will make the pain worse, as will sitting, coughing, sneezing, bending or lifting. Standing will make the pain better.
Annular Tear Diagnosis:
Your medical history will be taken by your health care provider, and a physical examination performed. You will be asked questions relating to the onset and severity of your symptoms. An x-ray may be taken to rule out any fracture of the bones.
The best test for diagnosing an annular tear is a CT (computed tomography) scan. Dye can be injected into the nucleus of the disc, which then shows up clearly on the scan. An MRI scan is not as good at showing a tear, but may be useful in identifying the location of the damaged disc. A nerve conduction study may be performed.
Annular tears are classified according to severity and extent, ranging from 0 for a perfectly normal disc, to 6 for the worst tear and leakage of the nucleus.
Annular Tear Treatment:
Most tears heal by themselves, with some self-treatment, and never need surgery. Scar tissue forms in the outer layers of the annulus, forming a plug through which the nucleus material cannot leak. Unfortunately, the plug does not extend through all the layers, probably because of the lack of a blood supply to the central and inner layers, which leaves the disc vulnerable to future tears.
Your doctor will provide stronger pain medication if necessary. You might also be given an epidural injection of a corticosteroid to relieve pain and reduce inflammation. These injections can provide relief for many weeks, but because of possible side effects, can only be given a limited number of times.
A physiotherapist will have a variety of treatment options available, and will tailor the treatment to your particular needs. Such options might include massage, electrical stimulation, ultrasound, hydrotherapy and spinal realignment. You will also begin supervised low impact exercises, and be given advice on exercises to perform at home, leading to a gradual resumption of your normal activities.
Surgery is rarely needed, but if required will probably be one of three procedures. One would seal a leaking tear, another would be performed to shrink the disc enough that the size of the tear was reduced, and the third would be the removal of the damaged disc and fusion of the two vertebrae.
Annular Tear Prevention:
- Cold compresses, applied for 15 minutes at a time, several times a day, are helpful during the first day or two, followed by hot compresses.
- Acetaminophen (Tylenol), NSAIDs such as ibuprofen (Advil) or naproxen (Aleve) will provide pain relief and the reduction of inflammation.
- Try to avoid staying in bed. Prolonged inactivity will lead to weaker muscles and more pain.
Nothing can be done to stop aging, and many annular tears do not produce any painful symptoms. However, staying as healthy and active as possible will reduce the risk of damage to the spine.
- Exercise to build muscle strength and improve flexibility.
- If you smoke, stop. Nicotine reduces the ability of the disc to absorb nutrients and will therefore hasten degeneration.
- Maintain a healthy weight.
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What is a Herniated Disc?
Herniated Disc / Slipped Disc Definition:
A herniated disc occurs when the spongy, gel-filled cushion between two bones of the spine bulges or slips out of place. The spine is made from 33 bones, stacked to form a tunnel, within which lie the spinal cord and nerves. The vertebrae are separated by discs which acts as shock absorbers, and allow the spine to be flexible. These discs are made up of a hard outer capsule (annulus fibrosus) and a soft, spongy middle (nucleus polposus).
Herniated discs are sometimes called ruptured discs, although there is a difference. When a disc bulges out between the vertebrae, it is termed herniated. If the nucleus inside the disc breaks through the capsule, it is known as a ruptured disc. Sometimes pieces of a ruptured disc, called free fragments, become detached and get lodged in the spinal canal. These are often reabsorbed by the body and cause no problems.
Herniated discs are a very common spinal abnormality, and often bulge away from the spinal cord, causing no problems at all. Herniated disc symptoms such as pain and numbness are only experienced when the herniated disc presses on a nerve in the spinal canal. Most occurrences of this condition are in the lower back (lumbar spine), between the 4th and 5th lumbar vertebrae. They can also happen in the neck (cervical spine) and, rarely, in the upper back (thoracic spine).
Herniated Disc / Slipped Disc Causes:
The normal aging process is responsible for many herniated discs. This is termed disc degeneration. As the body ages, the outer capsule of the disc starts to dry out and become less flexible. This loss of elasticity causes tiny cracks or tears to appear, and the nucleus (the spongy gel) can form a bulge in the capsule or even break through.
Another, less common, cause is injury. A sudden strain on the lower back might cause a disc to herniate. Repetitive actions such as pulling, lifting with poor posture, playing some sports, or even constant exposure to vibration when driving can also be causes of this condition.
Slipped Disc Risk factors:
- A history of back injuries or surgery.
- Being male.
- Being overweight.
- Being between the ages of 35-45.
Herniated Disc Symptoms:
The main symptoms are pain, numbness, pins-and-needles, or weakness.
If the affected disc is in the lumbar spine (lower back), symptoms will be felt anywhere from the buttocks to the foot, but will only affect one leg. If the disc is in the cervical spine (neck), the symptoms will be similar, but felt in the shoulders, arm or chest.
A sufferer of a herniated disc in the lumbar spine might well feel 'shooting' pains, sometimes radiating from the buttocks, sometimes from behind the knee, down one leg and possibly reaching the ankle or foot. This is known as sciatica, and is the most common herniated disc symptom that people experience. It has been described as feeling like an electric shock and can be triggered by coughing or sneezing. Sometimes the pain might be more of a dull, burning, feeling, or even pins-and-needles. The pain might happen suddenly, or come on gradually. It may be intermittent or constant. Sitting or standing for long periods, or bending or twisting might make the pain worse, whereas walking, lying down, or being in any position that relieves pressure on the spine may make it better.
If the nerve being compressed is in the upper part of the lumbar spine, pain might be felt near the ends of the lowest ribs, or perhaps in the front of the thigh.
Weakness or numbness might be felt in particular muscles, depending on the destination of the affected nerve.
Deep muscle pain or muscle spasms might be experienced.
There is a rare, but very serious, condition called cauda equine syndrome, which happens when the entire bundle of nerves in the spinal canal is compressed. In this instance, both limbs will be affected. There may be weakness or numbness and the symptoms may get progressively worse, with a loss of sensation in the inner thighs, buttocks and rectal region. There may be loss of bladder and bowel control, and possibly even paralysis. If you suspect you may have this condition, you should seek immediate medical help.
A condition called spinal stenosis, which is when the spinal canal narrows and therefore compresses the spinal cord and its nerves, can cause similar symptoms to a herniated disc.
Herniated Disc / Slipped Disc Diagnosis:
Your doctor will take your medical history, and perform an examination that will include testing your reflexes, muscle strength and ability to walk. Your sensitivity to light touch, pinpricks and vibration will probably be assessed. One diagnostic test is called the Leségue test. This involves you lying or sitting down and raising one straight leg. If this elicits a painful or strange sensation in the foot or leg, your doctor will probably consider this a positive diagnosis of a herniated disc and will not order further tests, unless they are needed to pinpoint which nerves are being affected, or another condition is suspected. Such further tests might include an X-ray, CT (computed tomography) or MRI (magnetic resonance imaging). Very occasionally a myelogram, electromyogram or a nerve conduction study might be required.
Herniated Disc / Slipped Disc Treatment:
The tiny tears and cracks in the annulus of a disc will not repair themselves, but the pain caused by the herniation will usually lessen with time. Half of all sufferers will be better within one month, and most within six months.
Self-help options, if the pain is severe:
- Rest. Try relaxing either on the floor or on a medium-firm bed, with a small pillow under your head and another under your knees. Be careful not to stay in any one position for too long.
- Apply an ice pack to the affected area, for 20 minutes, several times per day. After any spasms have ceased, try applying heat, again for about 20 minutes, every 2-3 hours.
- Take pain-reducing medications such as Tylenol, Advil, Motrin or Aleve.
- Avoid painful positions, or activities that make the pain worse.
Self-help options, if the pain is mild:
- Keep active if possible.
- Walk on a level surface for 10-20 minutes, every 2-3 hours, but only do this if you are not experiencing any pain. It is important to maintain muscle strength.
If your symptoms do not improve after a week or two, contact your doctor. You may be referred to a physiotherapist for further exercises, heat treatment, ultrasound or electrical stimulation. Your doctor may prescribe stronger pain medication, such as codeine or Vicodin, or muscle relaxants such as Valium. Another possible treatment is a corticosteroid injection into the site of the herniated disc.
Alternative medicine such as chiropractic, massage and acupuncture might help. There is also a treatment called modern decompression, which involves lying on a machine and having your spine very gently stretched to relieve the pressure.
Surgery for a herniated disc is only occasionally called for as most cases resolve themselves, given time.What to look for in a brace to help a herniated disc:
There are two types of brace available, rigid or corset. Which one is best for you depends on your particular need and which is the best fit.
Although rigid braces used to be heavy and tended to make wearers feel too hot, modern materials have lessened the weight and improved ventilation, making them more comfortable to wear.
Corset-style back braces allow for a bit more flexibility.
Herniated Disc / Slipped Disc Prevention:
Unfortunately, once a back has been weakened through injury or age, it tends to remain weak and therefore vulnerable to further problems. The most important things to remember are:
- When lifting, use your legs. Do not bend at the waist, but squat down instead.
- Maintain good posture at all times.
- Exercise in order to keep your muscles strong and your spine flexible.
- Maintain a healthy weight.
- Don't smoke. Nicotine damages discs and increases one's sensitivity to pain.
- Back (or neck) braces may be helpful, mostly to remind you to maintain correct posture, and to provide support if you are recovering from surgery or a particular back injury.
- Avoid positions or activities that are known to cause you problems.
Low Back Pain
Most people will experience some sort of back pain during their life, usually in the lower back (lumbar spine), as this area of the spine bears most of the weight.
The spine has 33 bones, each separated by an intervertebral disc. Attached to the spine are muscles, ligaments, tendons and blood vessels, and running through the tunnel formed by the spine are nerves and the spinal cord. Bearing in mind how much lifting, straining, twisting and other movements we perform throughout the day, it is hardly surprising that occasionally some part of the lower back will be injured.
Low Back Pain Causes:
The aging body is responsible for many instances of low back pain. The intervertebral discs begin to deteriorate and lose the ability to adequately cushion the vertebral bones. They can become herniated or ruptured. Ligaments attaching bone to bone thicken and lose elasticity, increasing the risk of strain or sprain.
Daily life contains many possibilities for injury to the lower back. One of the most common is failing to maintain correct posture when lifting heavy objects. Standing incorrectly, or sitting in a poor position for a long time, or even sleeping in a bad position will increase strain on the back. Normal activities such as gardening or playing golf, especially after a long period of inactivity, place a huge strain on weakened muscles. A person's job may also be a factor. Driving a jackhammer or heavy industrial machinery which cause a lot of vibration will again put the lower back at risk of strains or tears to the muscles and ligaments.
Fractures, either through accident or a condition such as osteoporosis, are likely to cause low back pain. Pregnancy, with the associated increase in weight and strain on the body, can be a cause, as can various female reproductive disorders. Many diseases or conditions, especially arthritic conditions, can trigger low back pain, as can some skeletal abnormalities such as scoliosis or kyphosis.
Being middle-aged or older, smoking, being overweight, and performing heavy work or exercise after extended inactivity all increase the risk of developing low back pain.
Low Back Pain Symptoms:
Low back pain is what it says it is: pain in the lower back. The ways the pain is experienced are many and varied. It might feel dull or be sharp and 'shooting'. It could be constant, or come and go. It might feel like burning or pins-and-needles. It could range from mild to severe and the severity could change. You might experience muscle spasms, cramping or stiffness, or possibly weakness or numbness.
When low back pain is the result of a nerve being pinched, as happens when you have suffered a herniated disc, the pain will radiate down one leg, anywhere from the buttock to the foot. It will feel worse when sneezing, coughing or straining to pass a stool.
Pain resulting from an arthritic condition will most likely feel worse in the back and hip. It probably starts gradually, becomes increasingly painful and generally lasts a few months. It will feel worse after rest and first thing in the morning, and better after moving around.
Diseases of the spine cause low back pain that tends to be worse in the affected area. The pain might be accompanied by fever and sensitivity of the spine to touch.
Low Back Pain Diagnosis:
It is necessary to determine the particular cause of the low back pain in order to decide upon the correct course of treatment.
Your doctor will ask for your medical history, including any previous back problems. You will be asked about your current symptoms; what makes the pain better or worse; the type of pain you are experiencing, and the site of the pain and whether it radiates to any other part of the body. You will probably be asked about any remedies that you have already tried.
You will have a physical assessment, including your posture, spinal alignment, reflexes, muscle strength and range of motion. You may be asked to sit or lie down and raise one straight leg into the air, to see if you might have a herniated disc.
Other diagnostic tests, depending on what the doctor thinks might be the problem, might include X-ray, CT (computed tomography) or MRI (magnetic resonance imaging) scans. Occasionally a bone scan might be ordered, as might a discogram or myelogram.
Low Back Pain Treatment:
Time usually solves most low back pain.
- Avoid overexerting yourself for a few days. Rest your back, but do not spend too long in bed as this has been shown to make matters worse. Unless the pain is so severe that you really can't get up, try to stay reasonably active.
- Apply ice to the area for 20 minutes at a time, several times a day. After any muscle spasms have eased, apply gentle heat in the same manner.
- Over the counter pain medication such as acetaminophen (Tylenol) could be tried, as well as NSAIDs such as ibuprofen (Advil), aspirin or Aleve if there is also inflammation.
- When sleeping, put a small pillow between your knees if you lie on your side, or under your knees if you are a back sleeper.
- Gradually return to your normal routine and activities, avoiding any heavy lifting or anything else that might aggravate your back.
- Walk, ride a stationary bike, or swim.
- Gentle exercises such as those listed below will improve muscle strength and flexibility.
- Chiropractic medicine may be useful if your range of motion is limited.
- Massage provides relief from tension in the muscles, and is very popular.
- Be sure to check with your doctor first, but capsaicin cream, devil's claw or white willow bark may help.
Your doctor might prescribe stronger pain medication such as morphine or codeine, if needed, or perhaps a muscle relaxant. Sometimes an anti-depressant can work as they block messages to the brain and can increase mood-improving endorphins. You may also be given an epidural steroid, a nerve blocker or a facet joint injection.
Physiotherapy might include:
- Heat and cold treatment
- TENS, to reduce muscle spasms
- Ultrasound, to increase the blood supply to the area
- Exercises for strength, posture and flexibility
- Using a brace to restrict motion and improve posture while the injured or weak part of your back recovers.
What to look for in a brace to help with low back pain:
The exact brace you might find helpful will vary according to your particular needs, but you should look for good support for the lumbar region. Compression of the abdomen will lessen the pressure on your spine and provide relief, allowing healing to take place.
Low Back Pain Rehabilitation Exercises:
Avoid toe touches, sit ups and leg lifts, all of which will put strain on your back.
Lie on your back with feet flat on the floor and knees bent.
Breathe out, tighten abdominal muscles and 'pull' your belly button towards your spine to flatten the lower back. Hold 5 seconds. Repeat 10 times.
Knee to chest:
This will help if your pain is better when sitting.
Lie on your back and gently pull one knee towards your chest, using your hands to hold the stretch. Hold 10 seconds. Switch legs and repeat. Do 3-5 for each leg.
Repeat exercise but this time pulling both knees together to your chest. Hold for 10 seconds. Repeat 3-5 times.
This will help if your pain is better when standing or lying down.
Lie on your back with arms by your sides, feet flat on the floor and knees bent. Slowly raise your hips off the floor. Tighten your buttock muscles (gluteus maximus). Hold for 3-5 seconds. Release. Repeat 10 times.
- Avoid activities or positions that have caused lower back pain before, but if you must perform them, take extra care, warm up first and keep the sessions brief.
- Maintain good posture at all times, but especially when lifting.
- Exercise to promote strong muscles and flexibility.
- If you smoke, stop.
- Maintain a healthy weight.
Sacroiliac Joint Injury | SI Joint Injury
The sacroiliac joints are found where the sacrum meets the left and right iliac bones, below the lumbar (lower) spine and above the coccyx (tailbone). The sacrum is made from five bones fused together into a triangular shape. The iliac bones are the two large bones that form the pelvis. Between these bones are small, strong joints that act as shock absorbers and carry the entire weight of a standing person. Strong ligaments connect the bones and keep the joints in the correct position. The range of motion in the sacroiliac joints is very small, about 2-4 mm for men, and only slightly greater for women.
A sacroiliac (SI) joint injury can be called SI joint dysfunction, SI joint syndrome, SI joint strain, SI joint inflammation, or sometimes facet syndrome. They all mean that the joint has suffered some damage that is causing sacroiliac joint pain.
Sacroiliac Joint Injury Causes:
It is generally believed that an injury to this joint, and the resultant si joint pain, is caused by either too much motion in the joint, or too little.
The most common cause of injury is normal wear and tear due to aging. The ends of the bones that form the joint are covered with cartilage, a smooth and slippery connective tissue that allows the bones to slide over each other with minimal friction. As we age, the cartilage thins through usage, or becomes damaged, which results in the bones starting to rub against each other. This can lead to osteoarthritis, otherwise known as degenerative arthritis.
During pregnancy, in order to ready the body for childbirth, hormones are released that relax ligaments. Loose ligaments do not hold bones together tightly enough and can cause problems with the sacroiliac joint. After childbirth, the ligaments tighten up again, and in some cases tighten too much, again leading to pain in the joint. Also, the extra weight being carried by a pregnant woman, and the different way of walking involved, add stress to the joints and might cause difficulties.
In fact, any altered manner of walking, perhaps as a result of having a bad knee, or hip, increases stress on the SI joints. Poor posture can also be responsible for abnormal wear on the joints, as can lots of bending and twisting while playing sports, or lifting and twisting while holding a heavy weight.
Some disorders such as ankylosing spondylitis or rheumatoid arthritis are known to produce pain in the SI joints.
Sacroiliac Joint Injury Symptoms:
It can sometimes be difficult to pinpoint the exact location of the pain, but generally it is felt in the lower back or back of the hips, sometimes radiating out into the groin or down into the legs.
It is thought that if there is too much movement in the joint, the pain will be felt mostly in the lower back, hip and the groin.
If the problem is not enough movement in the joint, the pain will still be felt in the lower back, but also on one side of the buttocks, and down into the leg with a sensation similar to that of sciatica. There may also be a feeling of wanting to stretch the back at that point.
If the cause is inflammation or arthritis in the sacroiliac joint, stiffness or a cold, burning sensation in the pelvis might be felt.
Coughing, sneezing or bending may make the SI joint pain worse. Standing up and walking may also make it worse, while lying down will generally make it better.
If any nerves have been pinched or otherwise impaired, weakness in the legs might be experienced.
A fracture of any of the bones may produce a grinding feeling in the joint and the inability to bear any weight on the leg.
Sacroiliac Joint Injury Diagnosis:
One reliable and simple way of determining that your pain is caused by an injury to the sacroiliac joint is by pressing on the site of the pain. If that corresponds with the position of the joint, it is the source of your discomfort. Of course, any of a number of conditions might be responsible, and your health care provider will try to determine which it might be.
A medical history will be taken, and you will have a physical examination as well. Your doctor is likely to place your hips and legs in certain positions and then apply some pressure, in an attempt to reproduce the conditions that cause you pain.
An x-ray might be taken, and possibly a CT or MRI scan. CT and MRI scans are more detailed and show the soft tissues of muscles and ligaments as well as bones. It is also possible that a bone scan might be needed.
The only non-invasive test that will definitively confirm that the SI joint is the source of your pain is an injection of a numbing agent, such as lidocaine, into the area. If the SI joint is numbed, and your pain disappears, then the joint is responsible.
Sacroiliac Joint Injury Treatment:
Non-surgical options are usually successful.
- Avoid activities that provoke sacroiliac joint pain.
- Apply ice, crushed in a bag and wrapped in a towel, to the site of the pain for 15 minutes at a time, every 4 hours.
- Once the acute pain has eased, heat can be applied.
- Acetaminophen (Tylenol) or NSAIDs such as ibuprofen (Motrin, Advil) or naproxen.
Your doctor may prescribe Prednisone, which is an oral steroid. This can be taken for a short time to help reduce inflammation. If you have been given lidocaine during the diagnostic tests, this might have included a steroid. These injections can relieve pain for several months, and can be given up to 3 times a year.
A physiotherapist may want you to wear a sacroiliac belt, which stabilizes the joint while it heals. Use of this belt would be gradually reduced over time. You would probably also be taught exercises to build muscle strength and increase flexibility. Yoga and Pilates can be very helpful practices.
If the pain persists, despite treatment, surgery is an option. The joints would be surgically fused together to prohibit any movement in them at all.
What to look for in a sacroiliac belt:
The most important function the belt has is to prevent movement of the joint, so you need to look for one that stays in position. Good cushioning is important for comfort.
Sacroiliac Joint Injury Prevention:
It is not possible to completely prevent damage to the SI joint due to aging, but there are some things that will help to minimize the risk.
- Maintaining a healthy weight and staying fit will reduce stress on the joints.
- Always warm up properly before exercise.
- Do exercises to strengthen muscles and improve flexibility.
- Develop and keep good posture.
- Take care to use proper techniques when lifting.
- Avoid activities that are known to provoke sacroiliac joint pain.
Sciatica: What is Sciatica? What is Sciatic Nerve Pain?
Sciatica is not an injury or a disorder, but a symptom of an underlying problem involving the sciatic nerve. It is the term used to describe the pain that is felt as a result of damage to, or compression of, the sciatic nerve.
The sciatic nerve is the longest nerve in the body and is actually two nerves, the tibial and common peroneal, held together in a sheath of connective tissue. Nerve roots leave the side of the lumbar (lower) spine at intervals, eventually joining to form one large nerve that travels through the buttock and down the back of the thigh, dividing back into the tibial and common peroneal nerves at about knee level.
- A herniated disc is the most common cause of sciatica. The bulging or rupture of an intervertebral disc can compress the nerve, triggering pain.
- Spinal stenosis, which is the narrowing of the spinal cord, can also compress the sciatic nerve.
- Spondylolisthesis, a condition where one vertebra slips out of position and over the one beneath, can result in the nerve being pinched.
- A disorder, known as piriformis syndrome, causes the muscle that connects the lumbar spine to the thighbone to spasm or get tight, placing pressure on the nerve.
- A tumor on the spine can also press on the sciatic nerve.
- An accident or some trauma to the nerve root, such as a hip dislocation, can trigger sciatica.
- Osteoarthritis, or wear and tear on the vertebral joints, is another possible cause.
- Sometimes pressure from the uterus during pregnancy can compress the nerve and cause pain.
- An injection into the buttock muscle, improperly administered, can also be a cause.
Sciatica Risk factors:
- Aging. Being over 40 increases the risk.
- A job that involves prolonged sitting, heavy lifting or twisting.
- Diabetes increases the risk of damage to nerves.
- A sedentary lifestyle.
Sciatica can be felt anywhere along the path of the sciatic nerve, but typically it is felt as pain radiating from the lumbar spine into the buttock and down the back of one leg.
The type of pain varies. It can be constant or just from time to time. It can be felt as a mild ache, a burning sensation, or even as an electric shock. A tingling, pins-and-needles feeling is common. Numbness and/or weakness felt anywhere in the leg is also possible.
Pain from sciatica tends to be worse when sitting for a long time, coughing, sneezing or straining to pass a stool.
If very severe pain is accompanied by a loss of bladder or bowel control, or if such symptoms are experienced after an accident, call for immediate medical help. You may have cauda equine syndrome, a serious condition where the entire bundle of nerves has been damaged.
It is rare for sciatica to cause any permanent damage, and most symptoms disappear with time and self-treatment.
Your health care provider will take your medical history, ask questions concerning the onset and severity of your symptoms, and perform a physical examination. This will include testing muscles for strength and also testing your reflexes.
For very severe or long lasting pain, an x-ray or a CT or MRI scan might be needed.
Most cases of sciatica are resolved within a few days to a few weeks, and nearly all cases within 6 to 12 weeks. Time and self-treatment are usually all that are needed.
- Do not stay in bed unless the pain is so severe that you are really unable to get up. It has been found that bed rest tends to make the pain worse, and also leads to weaker muscles. Instead, reduce your activity for the first few days and start with some very gentle exercises as soon as you are able. Exercise is known to stimulate the production of endorphins, which are our natural painkillers.
- When the pain is acute, apply ice, crushed in a bag and wrapped in a towel, to the site of the pain. Keep it there for 15 minutes and repeat several times a day. After 2 or 3 days, when the pain has eased, you can apply heat.
- Over the counter medication will ease pain and reduce inflammation. You can take acetaminophen (Tylenol) or NSAIDs such as ibuprofen (Advil).
A physiotherapist can supervise a gentle and gradual return to exercise, and teach specific exercises to improve posture, build muscle strength and increase flexibility.
Acupuncture, chiropractic, osteopathy and massage are other treatment options that might help with sciatica.
Your doctor may prescribe stronger medication if needed. Such medication might be an anti-inflammatory combined with a muscle relaxant, or perhaps antidepressants, which block pain messages to the brain and also produce endorphins. An epidural steroid injection is also a possibility. These reduce inflammation around the nerve, thereby relieving pain. Such injections can produce unwanted side effects, however, so they can only be given a limited number of times.
Be guided by your health care provider who will be able to give you information and supervision as you begin rehabilitation. You will probably be able to start with low impact exercises in water, and using a stationary bicycle. As the pain eases, you should add in aerobic exercise and muscle and core strengthening exercises.
Most of us have tight hamstrings, and stretching them nearly always improves sciatic pain.
Lying down on your back, raise the affected leg into the air. Using your hands, a towel or exercise belt, hold it behind the knee. Slowly start to straighten the knee until a stretch is felt. The aim is to eventually straighten the knee enough so the sole of the foot is facing the ceiling, but it may take some time to achieve this. Hold the stretch for 10 seconds to begin with, gradually working up to 30 seconds.
This exercise is helpful if your sciatica is due to a herniated disc.
Lying on your stomach on the floor, gently prop yourself up on your elbows. Go carefully as this can cause some discomfort at the beginning. Hold for 5 seconds, working up to 30 seconds. Repeat the exercise 10 times.
- Develop a regular exercise regime.
- Maintain good posture.
- Take care when lifting heavy objects.
Spondylolysis and Spondylolisthesis: Definition, Symptoms & Treatment
Spondylolysis is the diagnostic term describing tiny fractures in the pars interarticularis bones of the spine. Spondylolysis is the most common cause of spondylolisthesis, the slippage of one vertebral bone over the one beneath. Although either of these disorders can be found anywhere in the spine, the lower back is predominantly affected, probably due to the increased weight that this area has to bear.
The vertebrae, or bones of the spine, are separated by discs which act as shock absorbers and allow movement of the spine in several directions. Part of the vertebrae include facet joints at the back of the spine and, attaching the joints, are small arched bones called the pars interarticularis.
If the pars become sufficiently damaged, they may no longer be able to hold the vertebrae in place, which can cause spondylolisthesis. Such damage also increases the stresses and forces that the intervertebral discs have to withstand, which may lead to conditions such as sciatica.
Spondylolysis is commonly found in young athletes whose particular sport necessitates regular hyperextension of the lumbar spine (lower back). Gymnasts are a good example, although the condition is found amongst athletes participating in many other sports. Spondylolysis can be diagnosed as active or inactive. The condition is not always dangerous, and does not necessarily lead to spondylolisthesis, but, if active, it does require careful treatment to avoid incorrect healing, which might lead to chronic or recurrent back problems.
Spondylolisthesis damage can occur on one or both sides of the spine. It is usually found between the fifth lumbar and the first sacral vertebrae, although it can also be found between the fourth and fifth lumbar vertebrae. It is rarely found higher in the spine. It is graded accordingly to severity, with 1 being the mildest, and 5 the most severe, in which instance the vertebra has completely slipped off the one below.
Spondylolysis and Spondylolisthesis Causes:
It is believed that 3-7% of the population has this condition, but it is not understood what will cause it in one person rather than another. Common causes are:
- Repeated overextension of the lumbar spine, resulting in degeneration and fractures of the pars interarticularis.
- Normal aging, leading to degeneration of the spine.
- Spondylolysis. As the facet joints are no longer held in correct position by the pars interarticularis, the slippage of one vertebra over another can occur.
- Congenital condition
- Tumor of the spine
- Past surgery
Spondylolysis and Spondylolisthesis Symptoms:
This condition can be present without any symptoms being felt, but there might be:
- Pain in the lower back following some sort of trauma, particularly when experienced by adolescents who engage in sports.
- Leg pain that prevents normal activity.
- Pain in the lower back that might radiate to the buttocks or back of thigh, or perhaps to below the knee, occasionally to the foot.
- Pain that is worse when standing, walking or bending backwards.
- Pain that is better when sitting or, particularly, reclining.
- Legs which feel very tired, especially after walking.
- Tight hamstrings.
If the spondylolisthesis is more severe, symptoms might include:
- Visible deformity of the back such as a short torso and large abdomen.
- Sway back (lordosis) and a pelvis that is tilted vertically.
- Such tight hamstrings that the gait is affected and a 'waddle' develops.
Rarely, a condition called cauda equina syndrome occurs when the nerve bundle in the spinal canal is compressed by the vertebral slippage. This is serious and, if suspected, immediate medical attention should be sought. The symptoms include:
- Numbness or weakness in the legs that becomes progressively worse.
- Unusual feeling in the 'saddle' area, the buttocks, inner thighs and rectal area.
- Sudden loss of control of the bladder and bowels.
Spondylolysis and Spondylolisthesis Diagnosis:
When any young athlete complains of pain in the lower back after some sort of trauma, spondylolysis must be suspected.
A particular test is known as Michelis' test. The patient stands on one leg in a position that hyperextends the lower (lumbar) spine. The position is repeated while standing on the other leg. If pain is experienced, the diagnosis might be active spondylolysis. An x-ray would probably be taken to confirm the diagnosis and to see if one or both sides of the spine are affected. To determine whether the condition is active or not, an MRI (magnetic resonance imaging) or SPECT (single photon emission computed tomography) scan will probably be taken. If it is active there will likely be pain in the low back; if inactive, any pain will probably be coming from a different source.
Spondylolysis and Spondylolisthesis Treatment:
Many people worry that continuing with sports or activities after treatment for spondylolysis will trigger spondylolisthesis, with danger of permanent damage or even paralysis. This has not been proved to be the case.
- Bracing of the back for about 4 months, to immobilize the lower spine and allow the pars interarticularis to heal, is considered an effective treatment. For the treatment of spondylolisthesis, the best success is experienced when bracing is used in the early stages.
- Cold and heat application to the area. Apply an ice pack for up to 20 minutes at a time, several times a day. When the pain has ceased, apply heat in the same manner.
- Pain medications such as acetaminophen (Tylenol) and/or NSAIDs such as ibuprofen (Advil), Aleve or aspirin to alleviate inflammation.
- Corticosteroid injections to the site can lessen pain and allow other therapies to take place.
Surgery is not usually needed, as time and non-surgical treatments are normally effective. However, if the back is not healing, or there are nerve-related complications, surgery might become necessary.
- Bracing is not needed. Often the disorder is discovered after fractures in the pars have already healed, in which case there might be recurrent or chronic low back pain.
- Any further slippage of the vertebrae is highly unlikely.
- Physiotherapy, chiropractic or osteopathy treatments will probably not help reduce the slippage, but may relieve pain caused by stresses on the facet joints.
- Exercise, beginning with gentle hamstring stretches and gradually including other stretches and strengthening positions.
What to look for in a brace to help with spondylolysis or spondylolisthesis:
A brace providing strong support will be useful. Gently compressing the abdomen with a brace lessens weight on the spine, thereby relieving pressure and allowing healing to take place. You may find a brace made with breathable fabric comfortable.
Spondylolysis and Spondylolisthesis Prevention:
Unfortunately, once a back has suffered damage the likelihood of further problems is increased, so it is extremely important to take extra care. Lifestyle changes may have to be made in order to reduce the risk of trauma or excessive strain on the back.
- Exercise regularly to build up muscle strength and improve flexibility.
- Maintain good posture.
- Maintain a healthy weight.
- If you smoke, stop.
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The sternoclavicular joint (SCJ) is the joint between the clavicle (collarbone), and the sternum (chest bone). You might be able to feel the end of the clavicle as a bump to the side of the dip at the base of your throat. The actual joint is just below this bump. The end of each bone is covered with smooth, slippery, cartilage, which allows them to move against each other with minimal friction.
The SCJ supports the shoulder and is the only joint that connects the arm and shoulder to the main skeleton. It is an inherently unstable joint, but there are four different types of very strong ligaments, attaching bone to bone, which help to reinforce it and to keep the bones in their correct positions.
Types of sternoclavicular joint injury:
Sternoclavicular joint injuries are uncommon but not unknown, and are usually caused by a strong blow to the clavicle that tears or ruptures one or more ligaments, thereby damaging the joint to a greater or lesser degree.
- The ligaments of the joint can be sprained, which causes pain but does not destabilize the joint further.
- An injury to one or more of the ligaments is rare, but extremely painful. Most SCJ injuries are caused when something, a steering wheel, for example, or a tackling football player, hits the clavicle very hard. This can cause the ligaments to be torn or even ruptured, forcing the bones of the joint out of position. Fifty per cent of such dislocations are caused by car accidents and a further twenty per cent are the result of sports injuries, usually contact sports.
- Up until about the age of 25, part of the clavicle is still cartilage and not yet bone. This area is called the physis, or growth plate. A fracture to this area can look very similar to a dislocation.
- Degenerative arthritis, also known as osteoarthritis, tends to get worse with age and can cause pain and stiffness in the sternoclavicular joint. An old injury to the joint can also eventually cause problems.
Sternoclavicular joint injury risk factors:
- Being young and male. Young men tend to suffer more injuries of this type, probably because they play more contact sports and also are involved in more car accidents.
Sternoclavicular joint injury symptoms:
Pain and stiffness are the main symptoms of an injury to the sternoclavicular joint. A clicking, popping, or grating sensation might be felt in the event of a sprain. In the case of dislocation, the pain can be very severe, especially when attempting any movement of the arm. A dislocation can be termed anterior or posterior, depending on the direction in which the clavicle has been pushed. In the case of anterior dislocation, the clavicle has been pushed forward, in front of the sternum. The end of the clavicle can usually be felt, and often seen, as a hard lump in the middle of the upper chest.
A posterior dislocation is potentially very serious, as the clavicle has been forced backwards and may be endangering vital organs and blood vessels in the chest. Possible symptoms include having trouble breathing or swallowing, or a feeling of choking. Sometimes the voice becomes hoarse. Fortunately a posterior dislocation is extremely uncommon.
Sternoclavicular joint injury diagnosis:
Your health care provider will take a medical history from you and perform a careful and thorough physical examination, including assessing the range of motion of your arm. Any swelling, bruising or other signs of inflammation will be noted, and a comparison of both shoulders made. All of the joints in the shoulder will be gently pressed and felt. Muscle strength might be tested, and your pulse taken to ensure that blood flow is good.
X-rays from different angles will be taken, to look at the bones. You may have a CT (computed tomography) scan, as these show the soft tissues of ligaments and tendons as well as bones, and are therefore more informative.
Sternoclavicular joint injury treatment:
A sprain will be treated with ice and NSAIDs (non-steroidal anti-inflammatory drugs) such as Advil, Motrin or others, plus over-the-counter pain medications. A sling will be worn for between one and six weeks, depending on the severity of the sprain, to immobilize the joint and allow for healing.
Both anterior and posterior dislocations are treated by a procedure called closed reduction, unless the injury is so severe that surgery is required. As any movement of a dislocated sternoclavicular joint is extremely painful, sedation or a general anesthetic will be administered. The joint will then be manipulated back into its proper position. Following the procedure, the joint must be kept immobile, so a figure-of-eight strap, or clavicle harness, is worn, along with a secure sling, for about six weeks. Pain medication will be prescribed.
If surgery is considered necessary, because initial treatment has not worked, the clavicle will be attached to the ribs instead of the sternum. The joint remains unstable, but danger to the internal organs is minimized.
Growth plate fracture:
This usually heals without treatment, as bone growth tends to straighten out the clavicle, especially in younger children who have less bone in the physis at the time of injury.
Rest, ice, physiotherapy and anti-inflammatory medication are the usual treatments for arthritis-related pain of the SCJ. If these fail to resolve the problem, surgery might be considered.
Treatment for any injury to the SCJ will probably include physiotherapy. Ice treatment, electrical stimulation and perhaps massage, will help to reduce pain and swelling. Once the pain has lessened, an exercise regime will be developed with the initial aim of improving range of motion. Exercises to strengthen the muscles of the shoulder blade and rotator cuff will gradually be added.
What to look for in a sling, to help with a sternoclavicular joint injury:
You will need to wear a sling or shoulder support for at least one week and possibly up to six, so two main criteria are comfort and the required amount of immobilization. Some shoulder supports include a pocket for inserting cold or heat packs.
- If partaking in contact sports, wear proper padding and other protective gear.
- Do exercises to strengthen the muscles of the shoulder and rotator cuff.
Exercises to strengthen rotator cuff muscles:
Be sure to warm up carefully before doing any exercise, and do not exercise if there is any pain. Use light weights (2-3 pounds) and more repetitions for best results. Start with 15 repetitions for 1 set. Gradually increase number of sets and repetitions.
Lie on one side with the upper arm resting on the stomach. Place a small towel under the elbow and upper forearm. Keeping the elbow on the towel, slowly rotate the arm until it is just above horizontal. Slowly lower again.
Lie on the stomach on a table or firm bed. With your arm hanging over the side and your thumb facing forwards, slowly raise the arm straight out to the side. Do not raise your arm higher than the level of your body.
Tailbone Injuries | Coccyx Bone Injury
Tailbone / Coccyx Bone Injury Definition:
The coccyx, or tailbone, is found at the very end of your spine. It is not, in fact, one bone as the name would suggest, but 3-5 small, not fully-formed, vertebral bones, held together by joints and ligaments to form a triangular shape which has a limited range of motion. Because of these attachments, and the number of nerves in the area, damage to the coccyx can cause problems in the rest of the spine, the pelvic floor and perhaps even the intestines.
The coccyx is normally well protected as it curves inward toward the front of the body. However, in women, it curves less and is therefore more vulnerable to injury. A fall or some other trauma to the tailbone can be extremely painful. It even has its own name - coccydynia. There can be extensive bruising, ligaments can be stretched or torn, and the bones can be dislocated or perhaps even fractured.
Tailbone / Coccyx Bone Injury Causes:
The most common cause of an injury to the coccyx is a fall onto a hard surface. Slipping on ice and landing hard on your backside frequently results in a fractured or broken tailbone.
Other causes might be:
- Trauma sustained during contact sports.
- Childbirth. The anatomical position of the coccyx means that sometimes a tailbone fracture can occur during childbirth.
- Bony growths (spurs), cancer or infection of the spine, although these are uncommon.
- Repetitive action involving friction, for example bicycling or rowing.
- Poor nutrition, especially lack of sufficient calcium and vitamin D, needed for strong bones.
Tailbone / Coccyx Bone Injury Symptoms:
- Pain, worse when sitting for a long time, upon standing up, or when walking.
- Increased pain when sitting leaning slightly backwards.
- Increased pain when sitting on a soft surface due to the coccyx being subject to more pressure.
- Increased pain during bowel movements.
- There may be tenderness to the area, and bruising.
- Constipation might become a problem.
- For women, pain during sexual intercourse.
- Low back pain, sciatica and headaches are all possible symptoms, but less common.
Tailbone / Coccyx Bone Injury Diagnosis:
See your health care provider to rule out any serious problems, but most injuries to the coccyx heal themselves in time. Definitely call 911 if you have sudden trouble breathing, moving your legs, or loss of feeling in your legs.
Your doctor will take a medical history from you, followed by a physical examination. You might have a rectal examination if a tailbone fracture or dislocation is suspected.
Although an x-ray might not show a coccyx bone injury, it could be useful to rule out any fracture of the tailbone. Further imaging tests such as a CT or MRI scan might be ordered if your doctor thinks it necessary.
Tailbone / Coccyx Bone Injury Treatment:
- Ice, applied to the tailbone area for 15 minutes at a time, four times a day for the first few days, will reduce inflammation. The ice should be crushed in a bag and covered with a towel before placing on the tender area.
- Pain medication such as acetaminophen (Tylenol) will help, and if there is inflammation as well, you might try NSAIDs such as ibuprofen (Advil), aspirin or Aleve.
- After any inflammation has reduced, heat can be applied, either via a hot compress or by taking a hot bath.
- When sitting, try to sit on a hard surface and lean slightly forward to relieve pressure on the tailbone. Shifting from buttock to buttock might also help. One of the best solutions is to use a specially designed cushion. These can be doughnut-shaped, or wedge-shaped with a cut out for the coccyx area.
- Sleep on your back with a pillow under the knees. This will lessen pressure on the spine.
- Eat a diet high in fiber to avoid constipation.
If these self-treatment measures do not provide relief, your doctor may prescribe stronger pain medication, stool softeners or a corticosteroid injection. Only very rarely is surgery required, and is not generally felt to be a satisfactory course to take. Occasionally the doctor might perform an intrarectal manipulation of a dislocated coccyx to realign it properly.
A physiotherapist might use electrical stimulation on the spinal cord to numb the painful area but, as stated above, tailbone injuries of this sort usually heal themselves in time. It may, however, take several weeks for all tenderness to disappear.
Osteopathy might be of some help if realignment of the spine is needed.
What to look for in a cushion for an injured coccyx:
Most coccyx cushions are now made in a wedge shape, although you can also find cushions in the shape of doughnuts. The important things to look for are:
- Firm foam construction. Some of the best have memory foam.
- A cut out for the tailbone area. This enables the tailbone to 'float' above the cushion, never coming into contact with any surface and so relieving pressure on the bones.
- A useful feature might be a removable, washable cover.
Tailbone / Coccyx Bone Injury Prevention:
Most injuries to the coccyx are caused by an accidental fall, or slipping and landing hard on the tailbone, so sometimes nothing can prevent such a trauma. However, in day-to-day life there are some things that can be done to minimize the risk.
- Wear slip-resistant soles on your shoes, especially when there is snow or ice on the ground.
- Don't run on slippery surfaces, such as around a swimming pool.
- Wear proper protection when taking part in contact sports.
- Do weight-bearing exercises to build strong bones.
- Do strengthening exercises to build strong muscles, which may help to prevent falls.
Most Common Back Injuries
MMAR Medical is proud to feature a comprehensive “Common Back Problems Library” as a free resource to sports medicine professionals, patients and individuals seeking a better understanding of a possible back injury. The following articles are written by professional medical copywriters, with the intent to be clear, easy to understand and genuinely useful to the reader. Each article focuses on explaining the possible back injury, the possible causes of issue, common symptoms of the ailment, as well as possible treatments for the back injury, including rehabilitation techniques and orthopedic back bracing options.