Stress And Back Pain

Is stress contributing to your back pain? It’s becoming recognized that your state of mind has an effect upon your level of back pain and whether it eventually becomes chronic.. People who are unhappy, worried depressed, or miserable at work are more likely to develop chronic back pain, according to the latest findings. Several recent studies have shown that psychological distress has increased the risk of developing back pain and of experiencing a slow recovery. A study in Sweden found that anxiety and the practice of ‘catastrophizing’ – assuming that the worst will happen- increased the risk of back pain. In another study in the US, people who reported higher levels of anger and distress also reported higher levels of chronic back pain. These studies show that we must review the complete picture with back pain and recognize that it involves much more than just muscles and bones.

In citing the major causes of back pain, in addition to physiological and skeletal problems, the Mayo Clinic cites three Risk Factors:
• Stressful Job
• Depression
• Anxiety

The stresses that are experienced everyday by people are usually easily identified and can be dealt with. Some examples of stress causing situations are:
• Worry about being on time
• Missing a train or plane
• Worry about a job interview
These situations, while upsetting and tension causing, can be handled and, once dealt with, usually do not result in long-lasting problems.

Repressed Emotional Stress
The type of stress that can lead to troublesome back pain is called repressed emotional stress. The process is not logical but, then, many subconscious emotions are not logical or rational. Repressed emotional stress might be caused by:
• An unhappy relationship
• Hidden anger and resentment towards a spouse, children or parents
• Dissatisfaction with a job or career choice, or disillusionment and a poor self image.
• A rift in family relations
• Loss of a loved one
• Financial problems or disaster such as an impending foreclosure
• Physical abuse or threats

Repressed emotional stress may not be easily recognized as the subconscious mind may hide it, creating a smokescreen of back pain symptoms to keep your mind focused on the pain instead of looking for the underlying causes. Repressing (hiding) the real causes blocks any true healing and an effort must be made to recognize and deal with the factors behind the symptoms.

No one should ever discount the powerful effect of stress on the body and the mind.
Stress puts the body into a sustained ‘fight or flight’ mode. When confronted by a threat, whether physical or emotional, real or imagined, a gland in the brain, called the hypothalamus, releases noradrenaline and adrenaline. These hormones trigger a complex set of actions which lead to a physiological and psychological state of hyper-alertness. Problems arise when this hyper-alert state becomes the norm.

The fight or flight mechanism causes muscles to tense in preparation for action, and if this response is not deactivated, the muscles can go into painful spasms, causing severe back pain. As the muscles of the neck and back tighten and squeeze the blood vessels, just like a kink in a garden hose, the supply of nutrients and oxygen are decreased. This leads to pain and eventual weakening of the muscles, making them more susceptible to strain and injury.

Stress is a part of every day life but studies have shown that if we exist in a daily state of hyperawareness, due to all the stresses that confront us, that we are predisposed to develop a number of disorders including heart disease, hypertension, and depression.

Experts at Johns Hopkins Hospital say that a growing number of studies confirm that the mind-body connection plays a role in back pain, both in setting off an initial attack and in contributing to ongoing chronic back pain. These studies have also led to the development of stress-relaxation techniques that can be learned to help break this vicious cycle.

(Brought to you by Jupiter Chiropractor)

Sciatica During Pregnancy

Imagine the surprise a woman must feel while dealing with the physical symptoms and discomforts of pregnancy, to suddenly develop severe back pain. This is not the usual low back pain that is often experienced during pregnancy; it is sciatica. This sharp, shooting pain usually starts in the buttocks and radiates down the back or side of the thigh to the calf and possibly the heel. There may be paralyzing numbness, in addition to the pain, which can be severe enough to limit mobility.

Sciatica can occur at any time in a normal pregnancy but it is most common during the second and third trimester, when the baby is larger and carried lower in the abdomen. Known as Pregnancy-Related Sciatica, it is caused by the pressure of the baby on the sciatic nerve. This is the largest nerve in the body, about the diameter of a finger. Its fibers branch off the spinal cord at the 4^th and 5^th lumbar vertebra (L4, L5) and the first few segments of the sacrum.

As the pregnancy develops, the abdominal tendons and ligaments become looser to prepare for childbirth. The backs of some women become quite unstable and prone to injury. Medical evaluation should always be sought. In some cases, sciatic pain is due to pressure on the nerve that is caused by damage to the disc between the vertebrae of the spine. This creates inflammation and pain and requires specific treatment.

Most physicians avoid prescribing medications for pregnant patients suffering from sciatica but there are several steps that can be taken to relieve or decrease the discomfort. This includes:

• Massage to reduce muscle tension. Some experts believe that tightness in the gluteus and psosas muscles contribute to sciatic pain. Treatment once or twice a week can help relieve stress on weight-bearing joints.
• Moist heat alternated with ice packs
• Chiropractic treatments may be helpful. Be sure to select a practitioner experienced in treating prenatal patients.

In addition, these helpful habits may decrease the chances of developing sciatica:

• Avoid hours of sitting slumped at a computer or standing with a baby on one hip. Both can contribute to lower back pain.
• Maintain proper posture and try to stand straight.
• Wear flat shoes or ones with a very low heel. Avoid shoes that throw your weight backwards.
• Williams Exercises have been developed specifically for use during pregnancy. They may temporarily relieve sciatica pain as they help strengthen the muscles of the pelvic floor, the back and abdomen.
• Swimming and walking are excellent exercises if not contra-indicated by the physician.
• Avoid walking on an incline as this can cause joint irritation and lead to problems.
• Try to avoid significant weight gain.
• Try sleeping on a firm mattress, lying on one side. A pillow rolled up under the knees may be helpful.
• When getting out of bed, try rolling onto your side first, letting the weight of your feet and legs dangling over the edge of the bed, pull your body into a sitting position. This puts less stress on the lower back, helping you to avoid triggering a painful muscle spasm.
• Bedrest may be necessary at times.
• See your physician if the pain becomes unmanageable.

Sciatica is unique to a pregnancy and may gradually disappear on its own. Just because you had sciatica in one pregnancy does not mean it will appear in a subsequent one.

(Brought to you by Deerfield Beach Spinal Decompression)

Coccydynia And Low Back Pain

Back pain due to coccydynia can be quite miserable – just ask anyone who has ever developed it after a fall on a slippery floor, a skid on the ice, or a bumpy landing while skiing or snowboarding.

Coccydynia is pain in the coccyx, or tailbone, the boney area at the end of the spine between the buttocks. Sometimes referred to in layman’s terms as a ‘butt ache’, it is a nagging pain, which can become excruciating, and increase with pressure from sitting or moving to stand up. It has been described as a pain similar to sitting on a sharp knife or a marble that rolls around or a feeling of being impaled on a cane or broomstick. The pain and discomfort may persist for months to eventually become chronic.

Causes
Falls On The Buttocks.
• This is the most common cause, often diagnosed as a fractured coccyx.

Unstable or Dislocating Coccyx
• The most common cause of pain is due to a coccyx which dislocates or moves more than normal when you sit down. This may develope after a fall, from childbirth or injury in a car accident. The actual cause is often unknown but this disorder is responsible for 55% of cases of coccyx pain.

Childbirth
• If the joints around the pelvis become more flexible in preparation for childbirth, sometimes the coccyx can be pushed out of position easily.

Repetitive Strain
• This is common after a great deal of rowing or bicycle riding

Misaligned Or Long Coccyx
• In this condition, the coccyx bone points forward or is angled forward about 70°, which is greater than normal and causes pain.

Boney Spur Or Spicule On Coccyx
• This has been the cause of pain in 14% of patients.

Muscle Spasms In The Gluteus Maximus Muscle Of The Buttocks
• These muscles help lower the body from a standing to a sitting position. Muscle spasms cause pressure where the glutueus is attached to the coccyx.

Piriformis Syndrome
• The piriformis muscle runs horizontally from the lower spine to the top of each femur (hip bone). It crosses the sciatic nerve and spasms in the muscle cause pain in the hips and down the leg. Sitting may aggravate it.

Pilonidal Cyst
• This is a birth defect in which an abscess develops at the end of the tailbone, causing pressure, swelling, inflammation, and pain in the coccyx area. The cyst is usually removed surgically.

Symptoms Of Coccydynia
• Pain during or after sitting
• Acute pain when moving to standing after sitting
• Deep ache around coccyx
• Shooting pains down both legs
• Pain during bowel movements
• Pain during intercourse
• Pain during menstruation

Coccydnia may clear up after a few months but in the case of persistent pain, it is wise to have a medical evaluation to determine the cause.

(Brought to you by Fort Lauderdale Chiropractic)

Causes of Back Strain and Back Sprain

Lumbar sprains and muscle strains of the lower back are common causes of back pain. When the muscle fibers are abnormally stretched or torn in the lower back, the result is a strained low back muscle, called a lumbar strain. When the tough bands of tissue, the ligaments, that hold bones together, are stretched or torn from their attachments, the painful result is a lumbar sprain. Both injuries have similar symptoms so the two types of injuries are often grouped together by physicians under the term, musculoligamentous injuries of the lumbar spine.

The ligaments in your back, which can be injured, are similar to those in your ankle, which can be damaged by a sprain. Surprisingly, despite the discomfort from a sprained back, people are much more likely to continue walking around than they are with a sprained ankle. This is mainly due to the difficulty encountered in trying to support injured back ligaments with a firm binding as can be done with an ankle. This is important as the danger of damage to the ligament is much greater in the back than in any other part of the body.

Causes Of Lumbar Sprains And Strains

Improper lifting or bending

• Work situations are often responsible when poor techniques in lifting, bending, twisting activities are used. Serious back conditions can be the result.

Sports injury

• Backs are particularly subject to strain with any kind of racquet sports or activities that require exaggerated movement of the spine.

Poor muscle conditioning

• Toned muscles that are in good condition are stronger and less prone to injury. Strong body core muscles help prevent back injury and support the spine.

Obesity

• Every extra pound that is carried around adds to the strain placed on the back. Abdominal weight can cause a sway back posture, making the body unbalanced and the back more prone to injury.

Poor Posture

• Standing slumped over or slouched causes the entire weight of the body to pull against the ligaments of the pelvis and lower back.. Years of this can cause these ligaments to become stretched and weakened so they can not properly control the joints. Years of poor posture can lead to back discomfort from the simple act of trying to stand erect!

Standing Incorrectly

• When forced to stand for long periods of time, most people unconsciously shift their weight to one side and usually favor standing on a certain side. This simple act causes spinal distortion and postural misalignment which can eventually result in a serious, sudden, back injury.

Smoking

• Experts have proven that nicotine blocks the distribution of oxygen and nutrients to the cells, including those of the muscles. Waste products build up in muscle tissue and a fatigued muscle, depleted of oxygen, is much more prone to injury.

Most back injuries are due to injuries of the muscles or ligaments and are the second most common cause of missed work days, only following the common cold. Most will heal within a month or so but any persistent back pain should be evaluated by a physician.

Breaking The Stress – Back Pain Cycle

One of the main causes of back pain is emotional stress and that back pain may be a signal that you are not coping well with stress. It’s common knowledge that people under stress are tense and that tension can settle in your back. Even if you are experiencing constant stress, your muscles may be tightening up so often that you become used to it. But those taut, tight muscles can send a strong pain signal to your brain. The discomfort may make you wary of normal activities and, as you limit your movement and activity, your muscles become weaker and gradually de-conditioned, and more painful. This vicious cycle continues and may end up as chronic back pain.

There are several things that you can do to ease stress induced back pain and break this
cycle.

Reducing Stress
Once you recognize the stress in your life and the effects it has, there may be some ways to deal with it.
• Try to identify people and situations that bother you. How can you deal with them? Some you might be able to avoid altogether.
• Say you hate driving home in rush hour traffic and become tied in knots. Can you adjust your work hours and leave a bit earlier or later? Could you go to the gym or library for an hour after work?
• If you hate standing in line at the grocery, consider shopping during off hours when the store is less crowded.
• Financial pressures, long work weeks, medical problems add to stress and can not always be changed. You have to recognize the stress these problems and situations create and attempt to develop ways to deal with it.
• Try to breakup your problems into small units that are not so overwhelming. Deal with one at a time, taking the easiest or most pressing first.
• Learn your limitations and don’t take on more than you can handle. Manage your time and learn to say ‘No’ to burdensome commitments.

Breathing Exercises

One breathing technique that is helpful is 2:1 breathing. Inhale to the count of three and then exhale while you count to six. Repeat this several times

Relaxation Techniques

These techniques invoke the relaxation response which is the opposite of the stress response. Using deep breathing techniques, muscles relax and blood pressure, heart rate and respiration decrease. Progressive muscle relaxation and self-hypnosis are also helpful.

Meditation And visualization

These methods have devoted followers who have calmed their busy minds by combining imagery with breathing exercises.
• One meditation technique is known as ‘taking the one chair’. Imagine yourself in a room in which there is a single chair. Sit down on the chair and let your thoughts and emotions pass in front of you. Remember that you are sitting in the only chair in the room and your thoughts have no place to rest. Watch them pass right on out of the room.

Body Scan

• Complete a body scan. Begin by lying or sitting down and do several cycles of 2:1 breathing. After you are fully relaxed, make a full mental sweep of your body as though you were undergoing a complete x-ray. Move slowly but steadily and note all areas of tightness or tension. After you’ve finished the scan, return to the tight, tense areas and consciously ‘ breathe’ into those spots for several breathing cycles. Imagine your muscles slowly relaxing.
• A body scan takes some time but if done on a regular basis, it can help you become aware of early warning signs of a looming back pain attack. You become aware of your individual signal spots, places that hurt when your back first starts acting up but before a full pain attack is under way. This helps you take early action to get the discomfort under control.

Consider talk therapy with a stress counselor, a support group or a psychologist. Talk to your health care provider about your stress. Most people think that the mind and body are separate and function independently. Instead, they usually work together in shaping experiences. Recognizing the ‘mind – body’ relationship is the first step in dealing with the connection and breaking the vicious stress – pain connection.

Botox For Chronic Neck and Back Pain

Besides whisking away your wrinkles, is it possible that an injection of Botox can do away with those painful muscle spasms in your neck? Maybe Botox isn’t just for celebrities anymore! Can it help a person with chronic low back pain or a neck that is constantly in knots?

The jury is still out on Botox, as most experts agree that there is a scarcity of completed testing. More research needs to be done but the drug holds out hope for some sufferers of chronic neck pain. Botox was originally approved by the FDA in 1989 for the treatment of severe muscle contractions, known as cervical dystonia. This was long before it became the new panacea for wrinkled brows and furrowed facial creases - the Baby Boomer’s Delight.

Botox is a purified form of botulinum toxin, Type A, that has been used for over 20 years. This derivative of the bacterium, Clostridium botulinum, produces a protein that blocks the release of acetycholine and relaxes muscles. Type A is just one of seven different types of botulinum toxins, each of which has different properties. In the 1960s, the muscle relaxing properties of the botulinum toxin were investigated for use in realigning ‘crossed eyes’. These early studies paved the way for other uses of the toxin.

Today, used in extremely small doses, Botox has helped over 1 million patients worldwide with conditions caused by overactive muscles. Botox is now authorized for the treatment of cervical dystonia, to help decrease the severity of the abnormal head position and associated neck pain. It has also been approved for the treatment of strabismus (crossed eyes) and blepharospasm, the involuntary muscle spasms around the face and eyes.

Now, a new study has been released that shows Botox may be an appropriate treatment for the relief of pain, caused by chronically contracted neck muscles. This study was published in the January 2004 issue of the American Journal of Pain Management. Researchers evaluated the effects of a single injection of Botox into the affected neck muscles of 25 patients. The injection was combined with physical therapy. After 3 months of follow-up, the patients with combined treatment showed a significant improvement.

The study showed that pain relief from Botox lasted approximately 3 to 6 months. However, researchers question the results of this study and point out that it did not compare the effectiveness of Botox with physical therapy with results that could be gained by physical therapy alone. Experts speculate that the Botox injection relaxed muscles and maximized the potential for rehabilitation and the repair of damaged tissue. As it strengthening weakened muscles, it relieved pain.

Other researchers indicate that treating muscle spasms with a Botox injection has an advantage over oral pain relievers because the injections into the muscle are local. They do not have side effects of sedation, lethargy, fatigue, and dizziness associated with oral pain medications.

Botox advocates suggest that more extensive testing is needed to verify the benefits of its use in relieving back and neck pain.

Back Pain During Pregnancy

Approximately three out of four women have some type of back pain during pregnancy. For some, the symptoms begin early in the pregnancy, during the first trimester, and may occur intermittently until delivery. Over 50% of patients have pain during the last 3 months and the exact causes have not been determined. Recent studies show that women who have had multiple pregnancies, a greater weight gain, with a previous history of back pain, were the most likely to experience this pain again with a subsequent pregnancy.

The causes are believed to be due to:
• Change in body posture
• Poor body mechanics
• Muscle fatigue
• Hormones that cause the connective tissue in ligaments, especially in the pelvic region, to relax..
• Sciatica type pain may appear in the second or third trimester and it is believed to be caused by pressure of the baby on the sciatic nerve.
• Excessive weight gain is also believed to be a contributing factor.

The following activities seem to cause or increase back pain:
• Standing or walking for more than 30 minutes
• Standing on one leg
• Climbing stairs
• Bending forward
• Stepping in or out of bed
• Turning over in bed
• Driving for more than 30 minutes
• Poor posture such as sitting slumped at a computer
• Carrying a baby on one hip
• Wearing shoes that throw the weight backwards
• Carrying heavy bags, packages, or boxes

Treatment
• A pelvic belt may be prescribed
• Regular exercise and conditioning exercises such as walking, swimming, bicycling
• Moist heat and cold packs help relieve back pain
• Any medication, including over-the–counter ones, should only be taken under a physician’s care.
• Bedrest or increased rest periods when having back pain
• Massage may be recommended by the physician.

Prevention
• Avoid excessive weight gain during the pregnancy
• Maintain good posture
• Practicing proper body mechanics
• An exercise program to strengthen the back
• Wear low heeled shoes

Back pain is not usually persistent during the entire pregnancy and the good news is that it usually disappears after delivery.

Back Pain Due To Facet Joint Compression

The facet joints of the spine lock the vertebrae together, holding the spine erect but allowing a complex range of movements:

• Flexion (bending forward)
• Extension (bending backwards)
• Bending from side to side
• Rotation, clockwise or counter-clockwise

If the joints become compressed, the vertebrae no longer move freely and you become stiff and there is decreased flexibility of the spine.

If the cartilage which covers the surface of the facet joints becomes worn, you can no longer move your head or lower body smoothly and without pain. The stiffness gradually worsens and can lead to spinal osteoarthritis. Occasionally, to make up for the weakening joint, the body may begin to produce bone spurs, called osteophytes. These bone spurs worsen the problem, as they may project out from the facet joint, protruding into the spinal canal, pinching nerves.

If a bone spur projects from the facet joint and presses upon a disc, which is the tough cartilage cushion between each vertebrae, there can be trouble. The spur may cause the disc to bulge out into the spinal canal, pinching nerves, and often causing low back pain or sciatica symptoms. Sufficient pressure from the bone spur may even cause the disc to herniate.

Another cause of back pain can develop when the nerves of the spinal cord leave the vertebral column. First, it is necessary to understand the formation of the vertebrae. Each has a large opening in the center, called the foramen, through which the spinal cord runs. The vertebrae are stacked one on top of another to make up the spinal column. When two vertebrae are locked together by the facet joints, there is a small opening formed on the side of the spinal column. It is not present in a single vertebra and two are required to make a single opening. This is known as an intervertebral foramen and the nerves branching off the spinal cord exit the vertebral column through these holes. If the facet joints become compressed, the intervertebral foramen becomes smaller, reducing the space through which the nerves must exit. This leads to nerve root compression, known as impingement.

The effects of facet joint compression can be wide reaching, leading to:

Referred pain

Organ dysfunction

Tingling and numbness in affected extremities.

Once a diagnosis has been made, there are a variety of treatments to alleviate pain:

• NSAIDS, non-steroidal anti-inflammatory medication such as ibuprophen or naproxyn are helpful.
• Physical therapy may improve mobility, range of motion, and strength.
• Corticosteroid and local anesthetic may be injected into the joint to relieve inflammation.
• Blocking the dorsal medial nerve branch that innervates the inflamed joint may be effective.
• Fusion of the joint has been discussed but there are no published reports of this type3 of treatment.
• New procedures for the surgical removal of bone spurs have been effective.

Patients need education about every aspect of this problem and should be informed of all treatment options. It is very important that they use good body mechanics to prevent worsening of their symptoms.