A common deteriorating condition of the spine as you get older is that age-old problem known as arthritis. It is so common in the spine that to some degree over 95 percent of individuals who are 50 and older have osteoarthritis which is a general wear and tear or degenerative changes to the bones of the spine. The most common spot for arthritis to first rear its ugly head is in the lower back. This is because it is the lower spine that takes the most abuse due to its position on the “totem pole”. Being at the bottom means the vertebrae in the lumber spine suffer from the wearing effects of gravity.
When arthritis occurs in the lumbar spine and as the vertebra deform and as the spinal canal shrinks there are a myriad of painful problems that can occur including the irritation of nerve roots such as the sciatic nerve which can lead to sciatica.
Arthritis back pain is a very common type of back pain affecting older people. In fact, if you take an X-ray to look for spinal arthritis, 95 percent of people over age 50 will have some degenerative or "wear and tear" changes in their spines. This type of arthritis is classified as osteoarthritis.
Arthritis can affect any joint, and that includes the joints in the back. And the most common area is the lower back.
Symptoms of arthritis of the spine are caused when the bones or other structures of the back put pressure on or pinch the spinal cord or the nerve roots that emerge from the spinal cord. When the spinal canal — the bony canal in which the spinal cord is located — is significantly narrowed by arthritis, it is called spinal stenosis, and wear and tear over time is the most common cause. Spinal stenosis typically causes back pain accompanied by pain or numbness in the legs.
Causes and Risk Factors for Spinal Arthritis
You have 26 bones in your back, stacked on top of each other and separated by disk “cushions”. Your back bones allow you to stand up, and they also protect your spinal cord and spinal nerves.
Osteoarthritis occurs when the bands of tissue that support your spine thicken, the bones and joints change shape, and the surfaces of the bones bulge out as spurs. Any of these changes can put pressure on other structures and cause pain.
Although the majority of spinal arthritis is caused by wear-and-tear arthritis, it can also be from inflammatory types of arthritis, such as rheumatoid arthritis. However, rheumatoid spinal arthritis usually affects younger people and it is not a common cause of arthritis back pain.
Risk factors for osteoarthritis back pain include:
Age. Arthritis back pain is most common in people over age 50, but symptoms may start by age 30. Some people will not experience back pain until they are in their 70s. The luckiest of us, although rare, will never experience back pain.
Being too heavy. It’s logical. The more weight you are carrying the more abuse you are putting on your back.
Injuring your back. A history of trauma to your spine or a history of spinal surgery can increase your risk for developing spinal arthritis.
Symptoms of Arthritis in the Back
Arthritis back pain symptoms can occur anywhere along the spine. They usually come on slowly and get worse over time. "People who have spinal stenosis from arthritis in their back usually get some relief by leaning forward, and their symptoms get worse while standing. They may need to lean forward and rest on their shopping cart in the store," says Kovacs.
Other symptoms of arthritis of the spine may include:
Neck pain that radiates into the shoulders and arms
Back pain that radiates into the buttocks and legs
Numbness, cramping, or weakness in the arms or legs
Loss of bladder or bowel control
Diagnosis and Treatment for Arthritis of the Spine
Doctors can usually diagnose spinal arthritis by taking your medical history and doing a physical exam. A good old plain X-ray is sometimes the only other diagnostic exam needed. If symptoms persist over time, the next step is usually an MRI.
Treatment of arthritis back pain usually starts with rest, but may require medications, physical therapy, and surgery as a last resort. In the past doctors used to advise rest for a longer periods of time for back pain, but it has been since learned that returning to activity sooner is usually better. This is because keeping blood flowing to the muscles in the back thereby keeping nutrients flowing keeps the muscles loose and in shape and prevents atrophy and spasms.
Common approaches to ease arthritis back pain may include:
Physical therapy to strengthen the muscles that support the back
Medications to relieve pain and reduce swelling
Weight loss and regular exercise
Alternative treatments such as chiropractic manipulation or acupuncture
Surgical treatment to relieve pressure on the spine or the spinal nerves
Back braces such as the DDS 500 decompression brace
If you have arthritis back pain or neck pain that radiates into your arms or legs, work with your doctor to find the best treatment. You should always tell your doctor about spinal arthritis symptoms of numbness and weakness. Loss of bladder or bowel control may be a symptom of spinal arthritis which is causing dangerous pressure on the nerves of the lower back. This is an emergency symptom and requires immediate attention.
Arthritis back pain is very common, especially if you are over age 50. Although there is no cure for arthritis of the spine, in most cases symptoms of arthritis back pain can be relieved by conservative treatment and lifestyle changes. A decompression back brace such as the DDS 500 can offset the effects of gravity and help minimize or eliminate pain.
According to research, approximately eight out of 10 adults will back pain as a result of muscle spasms at least once during their lives. As a general rule, muscle spasms are caused by overuse such as when doing manual labor or working out or from participating in a strenuous sporting event. They can, however, also be caused by minor and often undetected injuries in the lumbar spine. And, once you get muscle spasms, you are likely to get them again.
The muscles in your lower back work in conjunction with the abdominal musculature. Without them, movement and stability of the spinal column would be impossible.
Technically speaking, back spasms are involuntary, spontaneous contractions of a muscle. And although they may seem to come out of nowhere, they are actually triggered by micro strains and injuries in the spine, usually incurred unknowingly over time. Your body’s natural reaction to these injuries is inflammation which irritates nearby nerves which in turn causes muscles to contract and spasm.
Another potential cause of muscle spasms is herniated, bulging or degenerated discs. If a damaged or degenerated disc touches or pinches a nearby nerve root, the result is pain and your body may attempt to immobilize the area by involuntarily tightening the surrounding muscles and as a result painful muscle spasms are likely to occur.
Other causes of muscle spasms include structural imbalances, lack of exercise, too much exercise, or dehydration.
If you suddenly find yourself suffering from back spasms, treat the affected area with ice packs for 20 minutes every 2 or 3 hours. If the spasms do not subside within the first 72 ours, start applying heat to the area. The ice helps decrease inflammation/swelling and the heat encourages blood flow which carries nutrients to help the area heal.
If the spasms persist, decompression of the spine may be your best option. Decompression works to reverse the process that created the damage that leads to the spasms in the first place. If the spasms are in your lower back, the DDS 300 or DDS 500 decompression back brace is an affordable and highly effective way of achieving decompression.
Anti-inflammatory drugs such as ibuprofen or aspirin can help as well. Also, don’t hesitate to combine the suggested therapies. A multi-therapy approach generally gets better and faster results.
Of course the best treatment for muscle spasms is to not get them in the first place. An ounce of prevention is worth a pound of cure. The best way to prevent is to stay in good shape by exercising, stretching and strengthening your muscles. If you have not exercised in a while start slow to avoid the very problem you are trying to prevent. Using a fitness coach is highly recommended as well.
Average cost of Spinal Fusion: $46,429*
Average cost of Discetomy: $13,210*
Average cost of Epidural: $1000/shot with a minimum of 3 shots needed to achieve relief for a grand total average cost of $3000.**
Average cost of physical therapy: $200 per visit with an average of 8 visits needed to achieve acceptable results for an average total cost of $1600.*
Cost of DDS 300: $299
Acute Back Pain: Back pain that occurs for less than six months.
Analgesics: Any member of the group of drugs uses to achieve relief from pain (analgesia). Includes over-the-counter drugs such as Ibuprofen or acetaminophen or prescription drugs such as Percocet or Lortabs.
Block: A permanent or temporary targeted injection of pain medication that prevents a nerve from continuing to send pain signals to given area of the body.
Cervical Vertebrae: Consists of seven vertebrae in the neck. They are individually numbered: C1, C2, C3, C4, C5, C6, and C7.
Chronic Back Pain: Back pain that persists for more than six months.
Decompression: The elimination of pressure on a nerve or the spinal cord via back surgery or exterior manipulation such as with a decompression brace or a chiropractic adjustment.
Disc: Sometimes spelled with a “k” (Disk). It is a circular soft tissue grouping found between each vertebrae. It consists of a fibrous shell and a jelly-like nucleus. Its primary function is to cushion the vertebra allowing the spine to be flexible.
Disc Replacement: Removal and replacement of a damaged disc via surgery.
Epidural: The word “epidural" is commonly used to describe an injection of pain medication into the epidural space which is the area between the bone and the membrane which encloses the brain and spinal cord.
Facet Joints: Also known as Zygapophyseal or “Z” joints are joints between adjacent vertebra.
Fusion: The joining of two vertebrae together for greater stability via surgery. Fusions usually achieved using cages which are the prosthesis that holds/fuses the two vertebrae together.
Ligaments: Strong bands of tissue that connect bones to other bones in joints including the spine.
Lumbar Vertebrae: Five vertebrae in the lower back numbered L1, L2, L3, L4 and L5.
Muscle Relaxants: Drugs which help relax the muscles which can be beneficial to those suffering from muscle spasms.
Opioids or Opiates: Prescription pain medications such as morphine that decrease the perception of pain by binding to receptors in the central nervous system.
Sciatica: The term used to describe the condition of pain caused by the irritation of the sciatic nerve which is the main nerve stemming from the lower spine and running down either leg. An irritated sciatic nerve can manifest pain in the buttocks, upper or lower leg and/or foot. It can also manifest as numbness or tingling.
Spinal Cord Stimulators: Battery powered units such as TENS (Transcutaneous Electrical Nerve Stimulation) units that help manage pain signals by occupying the nerve channels overriding the pain.
Spinal fluid: The fluid that surrounds the spinal cord and brain.
Spinal manipulation: The most common form of spinal manipulation is chiropractic manipulation performed by a trained doctor of chiropractor. However, any adjustment, even those using a device such as a decompression table, rigid back brace or decompression back brace, also fall under this definition.
Spine: The main structure of the back made up of bones called vertebrae and of ligaments, discs, and nerves.
Tendons: Tough bands of tissue holding muscle to bone.
Thoracic Vertebrae: The 12 vertebrae located between the neck (cervical) vertebrae and the lower back (lumbar) vertebrae. They are numbered T1, T2, T3, T4, T5, T6, T7, T8, T9, T10, T11 and T12.
Traction: Use of a brace, harness or table to stretch the back in order achieve decompression with the goal of relieving pain.
Vertebra: One of 33 bones comprising the spine. They stacked in a column one upon each other, with discs in between.
Vertebral Compression Fracture: A fracture within a vertebra, which causes the vertebra to collapse.
Spinal fusion is a complex surgery that involves the combining or “fusing” two or or more vertebrae into one solid, non-flexing unit. The first spinal fusion surgeries were performed in the early 1900’s, but were primarily done to limit deformities created by tuberculosis infections. Many patients who underwent the surgery in those early days reported that their low back pain had subsided to some degree as an unexpected side effect of the surgery. Since then, spinal fusion surgery has grown in scope and popularity.
Though the basic principles and goals are the same, modern spinal fusion is quite a bit more complex and often involves cages which “cage” two vertebrae together secured by screws or pins which are usually threaded and are either square or cylindrical shaped. Most cage models and screws are made of titanium with a few made of carbon fiber.
While spinal fusion is still a very viable option for many back pain sufferers, especially those with deformities, its use has proliferated exponentially in the last decade. According to a CBS News report, the number of spinal fusions rose by 70 percent from 2001 to 2011, rising to an astounding level of 490,000 spinal fusions performed each year. Today there are more spinal fusions performed than hip replacements according to the report. But unlike hip replacements that have an impressive success rate, spinal fusions are peppered with controversy.
Proponents for spinal fusion surgery tout its success with little mention of any shortcomings or negative side effects. In fact, so many patients who have had the procedure done are still in pain that this category of spinal surgery accounts for a significant part the failed back surgery tally….a count so large that the medical industry at large has a name for it: FBSS (Failed Back Surgery Syndrome).
Dr. Sohail Mirza, Chair of Orthopaedics at Dartmouth-Hitchcock Medical Center, has issued reports warning people against spinal fusions. In the CBS New report he offer the brutal advice to any candidate for spinal fusion surgery: “The benefits are limited and short lived.” He goes on to say that commonly in as little as a year to two years later, the pain is back and in many cases increased.
The challenge of spinal fusion are many. For starters the fact that foreign objects are being introduced into the body and directly drilled/inserted into bone can lead to problems down the road, including life-threatening problems for 1 in 20 spinal fusion patients. Nerve damage is also common, leading to more pain or nerve death. Another problem is an increase in stress on the remaining “healthy” disc and vertebrae. Because two vertebrae that were once flexible are now melded into one nonmoving unit, the disc and vertebra just above the fusion now receives twice the stress and therefore wears down at an increasing rate. This phenomenon is exacerbated when more than two vertebrae are fused. And as a disturbing trend, multiple-vertebrae fusions are becoming more common with some surgeons fusing as many as 5 vertebra at a time.
Answering why this trend is happening can be as easy as following the money. According to the same CBS News report, “A spinal implant maker can earn tens of thousands of dollars from a single fusion.
Many of these companies also pay surgeons to promote and develop new products. Those involved say the arrangements fuel innovation. Medical ethicists contend that they can also create conflicts of interest and influence a doctor to use a certain company's products.”
Spinal fusion certainly has its place. But with so many leading to FBSS and increased stress on the remaining mobile discs and vertebrae, one has to ask, “Is it worth the risk, and the cost?”
This question becomes more relevant in light of the fact that other, significantly-less expensive options are available that address the core reason so many modern fusion take place—to decompress and remove stress from a severely damaged or diseases disc.
Decompression therapy costs just 1 to 3 percent what spinal fusion can cost, and its success rate is quite remarkable. The most affordable form of decompression therapy is a decompression back brace or traction belt such as the DDS 300 or DDS 500. Another decompression option includes decompression tables usually found at chiropractor’s offices.
Before you consent to spinal fusion surgery…or any spine surgery for that matter, do your research and give alternative approaches a try. You may just find the relief you are looking for at a fraction of the price.
According to studies, at some point in our lives back pain will affect around 80 percent of. Often times it will be due to some repeated behavior that we can change.
If you are suffering from back pain or if you wish to do the right things to avoid back pain in the future, avoid these ten bad habits:
1. Not exercising. Your back, particularly your lower back, are very reliant on the thousands (yes thousands) of muscles that help keep you vertical, allow you to bend over and twist and all of the other movements you put your torso through on a daily basis. The failure to do any exercise, particularly abdominal strengthening exercises, can lead to bad posture and increased stress on your spine which can lead to premature wear and eventually low back pain.
2. Poor posture. Remember all those times your mother lectured you to sit up straight? Turns out her admonitions were rooted in more than just in her desire to see you look more proper at the family dinner table. Poor posture can add strain to muscles and put stress on the spine that over time can actually change its anatomical characteristics. Slouching while sitting in a chair is the worst but even standing the wrong way can put undue stress on your lower back.
3. Lifting Incorrectly. Here’s advice you’ve likely heard more than a few times. Bend your knees and use the power of your legs when you lift. Keep the weight of the object you are lifting close to your body and avoid twisting while lifting. If the object is heavy or awkward or both, get help from a lifting buddy or use a machine to do the work.
4. Being overweight. It should come as no surprise that being overweight can, over time, wear your back down. Having a large belly shifts the entire center of your gravity forward and puts additional strain on your back muscles.
5. Smoking. Degenerative disc disease is one of the top causes of low back pain, and the restriction of blood flow as a result of nicotine from cigarette smoking is one of the top promoters for disc disease. Cigarette smoking also inhibits calcium absorption and prevents new bone growth.
6. Lacking Nutrients. Nutrients such as vitamin D and calcium are essential for bone strength. Other nutrients can help with good blood flow and cell health. Be sure to eat well and if necessary take supplemental vitamins.
7. Being Lazy. Excessive lying around, being a couch potato, taking the elevator when you could take the stairs: These are all indirect ways of hurting your back via losing strength. And a weak spine is a spine that is more susceptible to damage and disease.
8. Staying Sedentary. Your thought after back pain first manifests itself may be to stay inactive. But staying down for tool long can actually do more harm than good. Activity increases blood flow to the affected area which will help the inflammation to decrease and muscle tension to loosen.
9. Over Exertion: Just as too much inactivity is bad for your back, so too is too much activity all at once. While the most common result of suddenly working a muscle group or area of the body to vigorously is sore muscles, there is a risk of muscle tearing and or pulling. The best advice is to stay active and in shape at all times.
10. Having Surgery. While back or spine surgery may very well be necessary in some cases, back surgery has such a low success rate that there is such a thing as FBSS (Failed Back Surgery Syndrome). Before consenting to a discectomy, lamectomy, a cage or any other type of back surgery, be sure to exhaust all your natural and non-evasive options such as decompression via a decompression back brace such as the DDS 300, DDS 500, DDS Double or DDS Double Lite.
Four out of five adults will experience an episode of significant back pain sometime during their life. Not surprisingly, back pain is one of the problems most often seen by health care providers. Fortunately, the majority of patients with back pain will successfully recover and return to normal social and work activities within 2-4 months, often without treatment.
In 1979, the major professional organization specializing in pain—the International Association for the study of Pain—introduced the most widely used definition of pain: “an unpleasant sensory and emotional experience associated with actual or potential damage, or described in terms of such damage.” This pain is a complex experience that includes both physical and psychological factors.
It is quite normal to have emotional reactions to acute back pain. These reactions can include fear, anxiety and worry about what the pain means, how long it will last and how much it will interfere with activities of daily living. Though it’s normal to avoid activity that causes pain, complete inactivity is ill-advised. Rather, it is important to take an active role in managing pain by participating in physician-guided activities. There are now accepted clinical guidelines for management of acute back pain (by definition, within the first 10 weeks of pain) and its associated stress. These guidelines emphasize:
Questions You Need to Ask
In order to minimize emotional distress, it is important to ask your health care provider questions about your back pain so you do not leave the office uncertain or anxious. Understanding your pain will help decrease your anxiety. Keep in mind that, if your pain lasts more than 2-4 months (which is usually considered a normal healing time for most back problems), your condition may become chronic. Chronic pain can be associated with even greater psychological distress. During the acute period, feelings of helplessness, stress and even anger towards your health care provider (for not relieving your pain) may occur.
In order to help allay this distress, you need to be sure that your health care provider is attending to all of your important physical and psychological needs. You and your health care provider should do the following:
All of these recommendations are intended to reduce the emotional concerns and stress most patients experience with pain. If you are not satisfied with the treatment and explanations you receive, consider getting a second opinion from another health care provider. Anxiety and stress can actually increase your pain and reduce your pain coping skills.
Relationship between Stress and Pain
It is important to remember that there is a dynamic relationship between your state of mind (eg, stress level) and your physical condition (eg, pain). Pain can cause stress, which causes more pain, which causes more stress, and so on. The more chronic this vicious cycle becomes, the more likely your emotional distress will increase.
This cycle can be very difficult to break. Emotional suffering can lead to loss of sleep, inability to work as well as feeling irritable and helpless about what can be done. You may feel desperate and attempt to relieve the pain at any cost including the use of invasive medical procedures. Although invasive approaches may be beneficial for some conditions (such as a herniated disc), often they can be avoided if stress and pain are managed at an early point in time.
Education and reassurance from your health care provider goes a long way in preventing or relieving a great deal of stress and anxiety. You also need to be proactive about your condition and treatment. These naturally occurring feelings of anxiety and stress may cloud your judgment.
Your goal is to avoid getting into a chronic pain cycle. Reassurance from your health care provider that the pain is only temporary can go a long way to help you avoid becoming preoccupied with pain, and prevent unnecessary worry about the symptoms.
Psychological Interventions for Back Pain
Fortunately, there are a number of psychological therapies that have been successfully used in the management of pain and anxiety. These include stress management, relaxation training, biofeedback, hypnosis and cognitive-behavioral therapy (a method to reduce feelings of doom and helplessness). There are also medications available to help with sleep problems, anxiety and depression. Such comprehensive pain management programs, when integrated with your medical care, have proven to be quite successful.
Your health care provider can refer you to a psychological management program if it is appropriate. Participation in such a program does not mean the pain is “all in your head” - it is meant to teach you methods to cope with and control the pain. Remember, pain is a complex experience that includes a close interaction of physical and psychological factors! But together, you and your health care provider can help you manage and overcome your pain.
© 2004-2009 North American Spine Society
Acute low back pain with or without sciatica is one of the most common health problems in the United States and is the leading cause of disability for folks under 45 years old. The cost of evaluating and treating acute back pain runs into billions of dollars annually, not including time lost from work.
Due to the prevalence and ever increasing costs of low back pain, many studies have been conducted by the US Department of Health and Human Services as well as many individual states that have seen their worker comp claims skyrocket in recent years.
One result from these studies is that the majority of low back pain incidents are temporary and benign and do not warrant any extreme action such as MRI’s or surgery. Most such patient are back to their normal routines and activities within 30 days.
However, there are still many whose acute (short term) low back pain persists and becomes chronic (long term). It is the job of your doctor to determine which of the two categories you fall under and there are some common indications they look for to help them make the determination, even if you are still in the acute stage (before 30 days). They include the following:
X-rays are recommended when any of the above red flags are present. If there is a suspicion of cancer or infection is present in the X-rays, then further imaging may be required.
The challenge for doctors is to decide when to order the X-rays and furthermore, when to order CT or MRI scans. The general consensus has been developed over the last couple of decades is that MRIs and CTs have been overused and that low back pain can and often does go away on its own within 6 weeks or so of it first onset. They need to be sure that the low back pain is not a serious issue such as cancer or infection without causing undue/unjust expenses to the patient. If, however, the low back pain does not subside in 6 weeks then X-rays, MRIs or CT scans are likely to be
To further complicate the issue, it has been observed that MRIs and CTs can show signs of slight disc and spine abnormalities even if there is no pain present or other red flag symptoms. In the past two decades this has led to many unnecessary treatments, particularly surgery such as discectomy.
If you are suffering from newly onset back pain the best thing you can do is see a doctor to rule out any serious issues such as infection or cancer, and then rest and wait. If the pain persists beyond 4 to 6 weeks you and your doctor should investigate further using and MRI and other tools. Also consider nontraditional remedies such as stretching, yoga, mild exercise and decompression via decompression back brace such as the DDS 300 or DDS 500 or an inversion table.