Facet Syndrome

We’ve all suffered from joint pain at one time or another. It not only is an uncomfortable experience but it can be debilitating and lead to emotional problems. The thought of struggling with such discomfort is a fear that can be difficult to face, but thousands of people every day have to deal with such an epidemic.

Facet syndrome, which occurs when the joints in your spinal vertebrae are injured, is one common problem that targets every age. Recognized as one of the more frequent illnesses, facet syndrome can be extremely painful. When the spine is irritated, one can experience a variety of symptoms. From pain in an isolated area to pinched nerves and a loss of motion, the pain usually gets worse when you bend backwards or straighten your posture. For gymnasts and other athletes, facet syndrome is common problem.

Given that they are constantly moving around and stretching their spines, it is no wonder why vertebrae may sustain injuries or get irritated. Facet syndrome may also be caused by whiplash or the aging process. No matter how you have contracted it, it is vital that you put an end to the pain. First and foremost, consult a physician. Creating your own rehabilitation plan is not only dangerous but could worsen the situation.

For this reason, seek a professional so that he/she can evaluate your back. In many cases, they may recommend that you see a physical therapist. While it depends on the severity of facet syndrome, many find that spinal decompression therapy works wonders. Recognized as a non-invasive and non-surgical procedure, spinal decompression therapy can significantly reduce symptoms. Surprisingly, the treatment itself is relaxing and normally pain-free. It consists of having a harness wrapped around you that is then hooked up to a computer. The machine sends pressure to your spine, enabling the discs to stretch apart.

As a result, lost nutrients such as blood supply and Oxygen flow back into this area, which promotes healing. In order to truly feel the effects of such a procedure, it is imperative that you undergo 4-5 sessions per week for a total of twenty five sessions. While this may sound like quite a time commitment, each session is only thirty minutes long. That’s right - you don’t have to worry about quitting your job or putting other plans on hold. You can get help and still live your life. For most patients, it finally gives them hope and an answer to their constant pain. If you feel that you need additional treatments, acupuncture may be another alternative.

Acupuncture, which consists of placing needles in your skin, is a great way to naturally alleviate the discomfort. With no medicine required, this technique balances your energy and ensures pain relief. It also is known to promote calmness, allowing you to de-stress at the same time. Chinese medicine can be a difficult topic to grasp, but it certainly is another way to get rid of facet syndrome.

(Brought to you by West Palm Beach Chiropractor)

Facet Joint Syndrome

The facet joints are the connections between the vertebrae of the spine. Just like the knee or elbow or any other joint in the body, they allow the spine to bend and twist. They are also stabilizing joints that prevent excessive motion and help hold the body upright.

The joints are on the back of each vertebrae and they link one vertebra to the vertebrae directly above and below to form a working unit that allows movement. The surfaces of the joints are covered with a tissue called the articular cartilage. The joint itself is lined with a membrane called the synovium and the joint is enclosed in a fibrous sac, the joint capsule. Synovial fluid, a thick liquid which acts like lubricating grease and surrounds the joint, allows the bones to move without friction.

When these joints become inflamed secondary to injury or arthritis, pain and stiffness occur. If the joints in the neck or cervical spine are affected, these symptoms develop:

• Headaches
• Pain in the neck, shoulders, and upper back.
• Difficulty rotating the head
• Patients often complain that they have to turn their entire body to look to the right or left.

When Facet Joint Syndrome affects the lower back, there is:

• Pain in the lumbar area
• There may be referred pain to the buttocks and thighs
• Stiffness of back
• Difficulty getting out of a chair
• Difficulty standing up
• Complaints that the patient must walk hunched over

An injury or changes associated with aging may cause the cartilage cushion that covers the bones to wear away, resulting in pain as the bones in the joint rub together. Also, small nerves that branch off the larger spinal nerves can become irritated or pinched, causing pain. Facet Joint Syndrome is more common in people over 50 and is usually associated with aging.

Causes of Facet Joint Syndrome

• Whiplash Injury can cause the syndrome in the cervical area.
• Sports activities,such as gymnastics, where neck is extended
• Arthritis
• Poor posture which pushes the spine out of alignment
• Inflammation
• Infection
• Degeneration of the joint
  

Diagnosing Facet Joint Syndrome

• History and Physical should be done
• An X-ray, CT (computerized tomography) scan of the spine or an MRI (magnetic resonance imaging) will rule out fracture or herniated disc.
• Facet joint block would determine if the joints are the source of pain.
• A local anesthetic is injected into or near the nerves that supply the joint. If there is a significant decrease in pain, the diagnosis is confirmed.
  

Treatment

• NSAIDs (Non-steroidal Anti-inflammatory Drugs) such as ibuprophen, Naproxyn
• Muscle relaxants and narcotic pain relievers might be prescribed for more severe pain.
• Physical therapy
• Exercise program to improve flexibility and increase pain free movement
• Posture correction
• Activity Modification to avoid excessive lifting, stretching, bending
  

Approximately 80% of the patients who follow an active rehabilitation program and take NSAIDs become pain free. This usually lasts several months.

When conservative treatment fails, a surgical procedure called, Raiofrequency Rhizotomy, uses an electrical current to destroy the sensory nerves to the joint, resulting in pain relief.

(Brought to you by Jupiter Spinal Decompression)

Discitis and Back Pain

Discitis is relatively uncommon but it usually affects children under the age of ten. It is a low grade infection, usually caused by staphylococcus or a virus. It affects the disc space between two vertebrae and develops very slowly. Medical experts say this should be viewed in the same category as vertebral oseomyelitis (infection within the vertebrae). It can lead to severe, debilitating, neurological damage.

Disease Process

The infection does not start primarily in the in disc space but migrates there from other sources in the body. Urinary tract infections, pneumonia, and soft tissue infections are believed to be the most common sources. Often, no site of infection is discovered. The lumbar (lower) back is affected most often, followed by the cervical spine (neck) and last is the thoracic spine (upper back). Some post-surgical patients have developed the disease weeks after their operation, and, in their case disease diagnosis is not delayed. They rarely develop neurological deficits.

The edges of the disc erode and the degree depends upon the amount of infection and destruction within the disc. These areas become calcified, once healing begins, and, eventually, there is an interbody fusion, when healing is completed

Disease in Adults

This infection has a slow, insidious onset which can result in diagnosis being delayed for months. Pain in the back and neck are the most common complaints and movement makes it worse. Because the symptoms are similar to those of back strain, there is usually a delay in seeking medical attention. A doctor is often not seen until the sufferer develops an elevated temperature and chills, with weight loss. This delay can lead to a severe condition and the mortality rate (death rate) ranges between 2% to 12%. It more commonly affects males, with a ratio of 2:1 that has gone as high as 5:1.

Disease in Children

The onset is often more sudden, acute, and the back pain is accompanied by a refusal to walk, sit up, and there is extreme irritability. There may be localized tenderness over the spine and decreased range of motion.

Common Symptoms in Adults And Children

• Elevated temperature
• Chills
• Sweating
• Feeling of fatigue
• Loss of appetite
• Localized tenderness of spine
• Pain may travel to other parts of the body, including abdomen, hip, leg, groin.
• Movement aggravates pain.

Diagnosis

• Laboratory studies
• Sputum cultures may be done to isolate bacteria for diagnosis.
• Blood Culture
• X-rays of spine may show narrowing of disc space.
• Nuclear scan of spine
• CT Scan (Computerized Tomography)
• MRI (Magnetic Resonance Imaging)
• Echocardiogram can identify bacterial endocarditis which is responsible for some cases of discitis.
• Needle Biopsy of painful area to obtain tissue for culture

Treatment

• Antibiotics specific to kill organism once it’s identified
• IVs for hydration and supportive care
• Immobilization is necessary.
• Usually 2 weeks of bedrest
• Back brace when patient is able to ambulate
• This allows vertebrae to fuse in an aligned position.
• Bracing may be necessary for 3 to 6 months following treatment to avoid collapse of vertebrae and development of kyphosis ( curvature of spine – ‘round back’)

Discitis occurrence in the US ranges from 1 in 100,000 to 1 in 250,000 but in less developed countries, it is more common. In some parts of Africa, 11% of all patients seen for back pain were diagnosed with discitis.

(Brought to you by Lake Worth Chiropractor)

Diagnosis and Treatment Of Coccydynia

Coccydynia is pain in the coccyx, the tailbone, which can cause a great amount of discomfort and limit mobility. Sometimes, this pain is not taken seriously by general practitioners but it is important to learn the cause if the pain persists. In some cases, the cause is obvious as pain develops after a fall or injury. A pilonidal cyst also creates pain in the coccyx and since there is often a visible abscess, diagnosing the problem is simple.

Other causes of coccydynia are more complex and require a thorough examination and diagnosis. One of the first goals is to rule out the possibility of cancer as a cause of the pain. Before deciding upon a plan of treatment, it is important to distinguish coccyx pain from low back pain or other causes not related to the coccyx.

Diagnosing Coccydynia

• History and Physical must be completed.
• CT Scan (Computerized Tomography)
• MRI ( Magnetic Resonance Imaging)
• Dynamic X-rays –this means x-rays taken when sitting and standing. A comparison may show a coccyx that dislocates when the patient sits, causing pain.
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Treatment Of Coccydynia

Falls

• Use a cushion or well padded seat to relieve pressure on the coccyx when sitting. Several new devices have been developed which are far superior to rubber donuts or foam pads. Many can be found on the internet when doing a search for ‘coccyx cushions’. This cushion may be necessary for an extended period of time.
• Rest and avoid re-injury.
• Anti-inflammatory medications, such as ibuprophen and naproxyn, are helpful.
• Corticosteroid or local anesthetic injections may dramatically relieve persistent pain.

Unstable Or Dislocating Coccyx

• Rest and avoid re-injury.
• Corticosteroid injections are helpful.
• If pain persists and corticosteroids are unsuccessful, the coccyx may be removed surgically.

Childbirth

• Rest often allows the coccyx to return to its normal position.
• If this fails, treatment as for Unstable or Dislocating Coccyx is appropriate.

Repetitive Strain

This is due usually to long periods of rowing or bicycle riding.

• Rest – avoid activities that caused the pain.
• Anti-inflammatory medications, such as ibuprophen or naproxyn relieve discomfort.

Misaligned or Long Coccyx

• Injections of corticosteroids are often helpful.
• Surgery is not recommended.

Boney Spur or Spicule On Coccyx

• Local injection of corticosteroids and/or local anesthetic have been helpful.
• Surgery has been successful.

Muscle Spasms Of Gluteus Maximus Muscle

• Physical therapy and massage have been effective in relieving spasm.

Piriformis Syndrome

• Physical therapy
• Stretching exercises
• Injections of Corticosteroids Locally

Pilondal Cyst

• Surgical removal is necessary as infection reoccurs repeatedly.

Coccyx pain and the associated difficulty with sitting and movement can be most miserable and memorable. Sufferers who gain relief are always anxious to avoid any reoccurrence whenever possible.

(Brought to you by Coral Springs Spinal Decompression)

Diagnosing Causes of Sciatica

Sciatica is a painful symptom of a disorder in the lumbar spine. There are a variety of conditions which cause sciatica and the first step in developing a treatment plan is arriving at an accurate diagnosis.

Since trauma, such as one caused by a sports injury, a fall, or involvement in a car accident, can lead to sciatica, obtaining an accurate history is the first step toward diagnosis. The physician may ask you such questions as:
1. When did the pain start?
2. Was there an injury or accident that you recall?
3. How did your pain develop?
4. Describe the pain. Does it radiate down your leg? Is there numbness or tingling?
5. On a scale of 1 to 10, with 10 as the most severe pain, how do you rate yours?
6. What activities make this pain worse? For instance, sitting for long periods of time?
7. Does walking up or down hill make the pain worse?
8. Does coughing, sneezing, or straining increase your pain?
9. Have you tried any form of treatment?
10. What helped relieve your pain?

The physician will complete a thorough physical examination, evaluate your posture, test your range of motion and note any specific movements that cause pain. He will examine your spine, note its curvature and alignment and check for muscle spasms. The physician will test your reflexes, your muscle strength, neurological changes, and pain distribution.

In addition, the following tests may be done:
1. Lab tests for symptoms of infection
2. Spinal X-rays
3. MRI –Magnetic resonance imaging which produces cross-section images of your back to detect tumors, or damage to discs and ligaments.
4. CT scan-Computerized tomography which can identify spinal damage.

The MRI and CT scan are more effective than x-rays at showing the soft tissues in your spine and are helpful in identifying conditions such as a bulging or herniated disc. In addition, your physician may decide additional tests are needed to help in a diagnosis:
1. Bone scan will help identify osteoporosis, vertebral fractures, or infection
2. Discogram in which dye is injected and x-rays are taken to confirm the diagnosis that a disc is causing your pain.
3. Myelogram which shows a spinal canal or spinal cord disorder after an injection of dye and an x-ray or CT scan.

Obtaining an accurate diagnosis of the cause of sciatica pain is not always a simple process. Once the cause of your pain is determined, your physician will be able to develop a treatment plan that is appropriate for your condition.
(Brought to you by Spinal Decompression)

A Controlled Study Of Spinal Decompression And TENS For Treatment of Low Back Pain

Several studies have been completed and reported on the success rates of the treatment of Chronic Low Back Pain using the mechanized Spinal Decompression machine. One study recently appeared in May 2007 in Chiropractic and Osteopathy. It compared success rates from the use of a non-surgical intermittent mechanized traction machine with the use of TENS in relieving low back pain due to a herniated or bulging disc.

First, to understand any study, you need a picture of the disorder and the chronic misery it causes. Back pain due to an injury or accident is the leading Workmen’s Comp injury and the main reason for disability in people under 45. The spinal column is made up vertebrae stacked one on top of another. Between each vertebra is a tough, fibrous cushion, called an intervertebral disc, which contains a jelly-like substance. These discs act as cushions absorbing shock and allowing the spine to bend, twist and turn. Healthy discs are thick, flexible and compress when pressure is put upon them, like a sponge.

When there is an injury, the vertebra may shift out of alignment or compress the disc causing the disc to bulge or rupture, out the jelly like substance. This herniated disc or bulging disc causes pressure on the spinal nerves, resulting in pain, numbness, and may progress to decreased function in the affected arm or leg.

It is also known as:

• a pinched nerve
• sciatica
• a blown out disc
• a slipped disc

The protrusion of the disc or its core material not only causes pressure on the spinal nerves, it compresses blood vessels and interferes with circulation to the area. Deprived of nutrients and oxygen, the disc cannot heal, and, over time, flattens, becoming stiff and hard, just like a dry sponge. This condition develops into degenerative disc disease.

Standard treatment has included:

• Physical/chiropractic therapy
• epidural injections (an injection into the epidural space of the spinal cord)
• NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
• Hot or cold packs with massage
• Electrical stimulation (TENS)
• Non-Surgical Spinal Decompression
• Acupuncture
• Surgery – as a final resort

A treatment method that is gaining support is Non-Surgical Spinal Decompression, in which some studies show a success rate of 71% to 90%. An FDA approved machine, using a computerized program gently stretches the patient’s spine, slowly drawing the vertebrae apart, relieving pressure on the disc, allowing it to heal.

Testing of the machine continues and a recent study compares treatment results of Spinal Decompression Therapy with that of the TENS ( Transcutaneous Electrical Nerve Stimulation) unit. TENS is a small unit which can be worn during therapy. This FDA approved treatment for back pain delivers low-volt electrical current to the affected area through electrodes. Its electrodes pierce the skin just deep enough to reach nerve fibers, usually 1 to 2 inches. It activates the body’s pain fighting mechanisms and may be used several hours a day.

The Study

The object of the study was to compare the effectiveness of the two treatment methods in relieving pain and improving mobility in patients with a bulging or herniated disc.

Subjects were recruited through newspaper advertisements and had to meet several criteria for inclusion in the testing:

• Disc protrusion or herniation confirmed by MRI (Magnetic Resonate Imaging) or CT scan (Computerized Tomography)
• Low Back Pain for 3 months or more; could be associated with pain radiating to one or both legs.
• Average duration of pain was 7.3 years

The study enrolled 44 patients; the average age was 42 years. The group was initially divided into 2 groups of 22 people each.

• Spinal Decompression treatments consisted of 30 minute sessions, 5 times a week for 4 weeks. This was followed by once a week treatment for 4 additional weeks.
• The TENS Group received treatment with a TENS unit for 30 minutes daily for 20 days. This was followed by a weekly treatment for 4 additional weeks.
• Both groups were able to take anti-inflammatory and non-narcotic pain relievers.

The Results

The outcome was measured by the 10 centimeter Visual Analog Pain Scale (VAS) and a disability scale. The disability scale rated the subject’s ability to perform their most affected activity on a 0 to 4 scale, with 4 being “could do an activity without limitation”.

Success was defined as a 50% improvement in the VAS, showing the degree of pain relief. Any decrease in disability was given a positive rating. During the study, 4 subjects dropped out, leaving 19 in the Spinal Decompression Group and 21 in the TENS Group, a total of 40 participants.

Conclusions:

Spinal Decompression:

• 13 out of 19 people (68.4%) showed improvement.
• The 6 months follow-up showed 7 out of 19 people maintained their level of improvement

TENS Treatment:

• 0 out of 21 subjects showed any improvement.

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Additional scientific studies are being planned or are underway now to demonstrate conclusively the treatment effectiveness of Spinal Decompression Therapy.

(Brought to you by Lake Worth Spinal Decompression)