Shingles (herpes zoster) is an acute infection of the nerves that supply sensation to the skin, generally at one or several spinal levels and on one side of the body (right or left). Patients with shingles usually have had chickenpox earlier in life. The herpes virus that causes chickenpox is believed to exist in a dormant state within the spinal nerve roots long after the chickenpox resolves. In people with shingles, this virus reactivates to cause infection along the sensory nerve, leading to nerve pain and usually an outbreak of shingles (tiny blisters on the same side of the body and at the same nerve level). The back pain in patients with shingles of the lumbar area can precede the skin rash by days. Successive crops of tiny blisters can appear for several days and clear with crusty inflammation in one to two weeks. Patients occasionally are left with a more chronic nerve pain (postherpetic neuralgia). Treatment can involve symptomatic relief with lotions, such as calamine, or medications, such as acyclovir (Zovirax), for the infection and pregabalin (Lyrica) or lidocaine (Lidoderm) patches for the pain.
In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Compression fractures of vertebrae associated with osteoporosis can also be treated with a procedure called vertebroplasty or kyphoplasty, which can help to reduce pain. In this procedure, a balloon is inflated in the compressed vertebra, often returning some of its lost height. Subsequently, a "cement" (methymethacrylate) is injected into the balloon and remains to retain the structure and height of the body of the vertebra. Pain is relieved as the height of the collapsed vertebra is restored.
Low back pain may be classified based on the signs and symptoms. Diffuse pain that does not change in response to particular movements, and is localized to the lower back without radiating beyond the buttocks, is classified as nonspecific, the most common classification. Pain that radiates down the leg below the knee, is located on one side (in the case of disc herniation), or is on both sides (in spinal stenosis), and changes in severity in response to certain positions or maneuvers is radicular, making up 7% of cases. Pain that is accompanied by red flags such as trauma, fever, a history of cancer or significant muscle weakness may indicate a more serious underlying problem and is classified as needing urgent or specialized attention.
Spinal fusion eliminates motion between vertebral segments. It is an option when motion is the source of pain. For example, your doctor may recommend spinal fusion if you have spinal instability, a curvature (scoliosis), or severe degeneration of one or more of your disks. The theory is that if the painful spine segments do not move, they should not hurt.
Foraminotomy is an operation that “cleans out” or enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness, and weakness in an arm or leg. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve pressure on the nerve.
A sedentary lifestyle can lead to having weak and tight hip flexors as they are always in the shortened position. Tight hip flexors can lead to a limited range of motion, poor posture, lower back, and hip pain, and even injuries. These muscles need to get a workout when you are standing and doing movements such as raising your leg to climb stairs, run, or ride a bicycle.
Start in a runner’s lunge with right leg forward, right knee over right ankle and back leg straight. Walk right foot over toward left hand, then drop right shin and thigh to the floor, making sure to keep right knee in line with right hip. Allow left leg to rest on the floor with top of left foot facing down. Take a moment to square your hips to the front of the room. Hold here, or hinge at hips and lower torso toward floor, allowing head to rest on forearms. Hold for at least 30 seconds, then repeat on opposite side. You want to feel a moderate stretch in the outside of the right thigh, but if this pose hurts your knees or feels too uncomfortable, stick with Thread the Needle.
How to do it: Stand with your feet together, holding dumbbells by your sides. Take a wide step out to your right and lower into a side lunge, reaching dumbbells on either side of right leg [as shown]. Bend your left knee and shift your weight into both legs, into a wide squat position, reaching the dumbbells to floor in front of you, then extend your right leg and shift your weight to the left, moving into a side lunge with your left leg.
Swimming is a low impact form of exercise that can help to relieve the pressure on your joints. It’s thought that water aerobics may help to reduce the impact on your joints by up to 75%!2 Be careful though; start with a beginner’s class and always do only what you’re comfortable with – try to avoid over-exercising or pushing your muscles too far!
A healthy diet is important for a number of reasons when you have lower back pain. First, eating well can help you maintain a healthy weight. Excess weight puts extra strain on your lower back, adding to your pain. Second, a diet that’s high in key nutrients can help promote bone growth and keep your bones strong. These must-have nutrients include:
Disk tear. Small tears to the outer part of the disk (annulus) sometimes occur with aging. Some people with disk tears have no pain at all. Others can have pain that lasts for weeks, months, or even longer. A small number of people may develop constant pain that lasts for years and is quite disabling. Why some people have pain and others do not is not well understood.
Just because your hip flexor region feels sore doesn’t necessarily mean the muscles there are tight — in fact, they might need strengthening. This is where that sports science debate we mentioned earlier comes into play. It’s important to identify whether you’re tight or if the muscles are weak. Again, the Thomas Test will help you identify if you’re maybe stretching something that actually needs strengthening.
Physician specialties that evaluate and treat low back pain range from generalists to subspecialists.These specialties include emergency medicine physicians, general medicine, family medicine, internal medicine, gynecology, spine surgeons (orthopaedics and neurosurgery), rheumatology, pain management, and physiatry. Other health care providers for low back pain include physical therapists, chiropractors, massage therapists, psychologists, and acupuncturists.
If you’re worried you’re headed toward a surgeon’s office, there might be hope. According to the Arthritis Foundation, the best way to avoid hip replacement surgery is to get active in an exercise program. In a study, people who participated in an exercise program for 12 weeks were 44 percent less likely to need joint-replacement surgery six years later than those who did not exercise.
Mental health factors: Pre-existing mental health issues such as anxiety and depression can influence how closely one focuses on their pain as well as their perception of its severity. Pain that becomes chronic also can contribute to the development of such psychological factors. Stress can affect the body in numerous ways, including causing muscle tension.
If certain activities or overuse are causing hip pain, stop those that aggravate the discomfort and talk to your doctor. Excess weight can put pressure on the hip joint, so losing the pounds can provide relief and help you avoid further problems. Some causes of hip pain, such as fractures or hernias, may need surgical repairs. If your hip pain persists, talk to your doctor about the possible causes and treatments.
Sit in a chair with good lumbar support and proper position and height for the task. Keep shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of the back can provide some lumbar support. During prolonged periods of sitting, elevate feet on a low stool or a stack of books.
Congenital bone conditions: Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine that can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal architecture of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit by support bracing. Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.
Neglect your lower body too often and you risk losing mobility — that thing that allows you to plop down on the floor to play with your kids, or get up and out of even the cushiest chair with ease. “A lot of people sit all day, so they’re not necessarily using their glute muscles,” says Daily Burn Fitness/Nutrition Coach Allie Whitesides. “And a lot of people are in the car all the time, so we’re not using our leg muscles much, either.”
You may hear a clicking noise when you move your hip, but that sound is not necessarily a hip flexor issue. Siegrist says the clicking isn't generally the hip flexor alone and often comes from a moving part, like the joint. "Maybe there is a loose body in the joint or loose cartilage at the edge of the hip joint that is mechanically getting irritated,” she says.
The treatment of hip pain depends on the precise cause of the pain. Treatments can include rest, non-weight-bearing, cold application, and anti-inflammatory medications. For local inflammation, sometimes injection of cortisone medication (steroids) is used to quiet the inflammation. If infection is present, antibiotics are used. Fractures can require treatment with surgical repairs, including pinning, plates and screws, and total joint replacement. For severe arthritis, total joint replacement is performed when possible.
Meanwhile, many non-dangerous problems can cause amazingly severe back pain. A muscle cramp is a good analogy — just think about how painful a Charley horse is! Regardless of what’s actually going on in there, muscle pain is probably the main thing that back pain patients are feeling. The phenomenon of trigger points — tiny muscle cramps, basically11 — could be the entire problem, or a complication that’s more painful and persistent than the original problem. It’s hard to overstate how painful trigger points can be, but they are not dangerous to anything but your comfort.
If low back pain gets worse or does not improve after two to three days of home treatment, contact a primary-care physician. The physician can evaluate the patient and perform a neurological exam in the office to determine which nerve root is being irritated, as well as rule out other serious medical conditions. If there are clear signs that the nerve root is being compressed, a physician can prescribe medications to relieve the pain, swelling and irritation; he or she also may recommend limitation of activities. If these treatment options do not provide relief within two weeks, it may be time to consider other diagnostic studies and possibly surgery.
Arthritis. Osteoarthritis and rheumatoid arthritis are among the most common causes of hip pain, especially in older adults. Arthritis leads to inflammation of the hip joint and the breakdown of the cartilage that cushions your hip bones. The pain gradually gets worse. People with arthritis also feel stiffness and have reduced range of motion in the hip.
Long periods of inactivity in bed are no longer recommended, as this treatment may actually slow recovery. Spinal manipulation for periods of up to one month has been found to be helpful in some patients who do not have signs of nerve irritation. Future injury is avoided by using back-protection techniques during activities and support devices as needed at home or work.
When hip pain comes from muscles, tendons, or ligament injuries, it typically come from overuse syndromes. This can come from overusing the strongest hip muscles in the body such as iliopsoas tendinitis; it can come from tendon and ligament irritations, which typically are involved in snapping hip syndrome. It can come from within the joint, which is more characteristic of hip osteoarthritis. Each of these types of pain present in slightly different ways, which is then the most important part in diagnosing what the cause is by doing a good physical examination.