Example: a friend of mine went to the hospital after a motorcycle accident. He’d flown over a car and landed hard on his head. Bizarrely, he was sent home with very little care, and no imaging of his back, even though he was complaining of severe lower back pain. A doctor reassured him that it was just muscle spasms. (This all happened at a hospital that was notorious for being over-crowded and poorly run.) The next day, still in agony, he went to see a doctor at a walk-in clinic, who immediately took him for an x-ray … which identified a serious lumbar fracture and imminent danger of paralysis. He had been lucky to get through the night without disaster! He was placed on a spine board immediately and sent for surgery. The moral of the story? Sometimes, when you’ve had a major trauma and your back really hurts, it’s because your back is broken. BACK TO TEXT
Walking is an easy way to strengthen your bones and muscles, burn calories, and lift your mood. If you don't currently walk for exercise, try walking for five to 10 minutes every day. Gradually build up to 30 minutes a day. It's easy to sneak walking into your day. Take up golf, window-shop at a large mall, or visit a walking-only destination, such as a museum or botanical garden.
Stop focusing on a specific diagnosis. Up to 85% of low back pain can be classified as "non-specific." This means that the origin of your pain cannot be localized to one specific structure or problem. While common diagnostic tests for low back pain can show the bones, discs, and joints with great detail, no test can tell the exact cause of your pain with 100% accuracy.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Bridge: Still lying on your back with your feet flat on floor, lift your hips and torso off the floor into a bridge. Then interlace your hands underneath your hips and press your shoulders and upper arms into the floor, lifting your hips higher. Hold for 10 seconds. Lower yourself slowly back down, rolling down from the top of your spine to your tailbone. Repeat three times.
Why is back pain still a huge problem? Maybe this: “It is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of ‘hands-on’ providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.”
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.[5] 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.[5] 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.[5]
Keeping your hips mobile is important for overall hip function and athletic performance. Mobility refers to the ability of your joints to move through a pain-free, unrestricted range of motion. For cyclists, hip mobility is critical since pedaling occurs in one plane of motion, and after miles and miles in the saddle, hip tightness and restriction may develop. The following movements will help with hip mobility.
I think you should mention that for some people, stretching is not the solution and that it will deteriorate their posture. Some people need stretching, but most people I know need to strengthen their "overstretched" hip flexors. Many people can't do a single hanging leg raise. Check this site if you want to know more about the importance of hip flexors ********** www.smarterpage.wixsite.com/unlock-
“Red flags” are signs or symptoms that something medically ominous may be going on. Red flags are not reliable, and their presence is not a diagnosis. When you have some red flags, it only indicates a need to look more closely. Sometimes red flags are missing there really is something serious going on … and sometimes they are a false alarm.18 Check off all that apply … hopefully none or few or only the least alarming of them!
Don’t medically investigate back pain until it’s met at least three criteria: (1) it’s been bothering you for more than about 6 weeks; (2) it’s severe and/or not improving, or actually getting worse; and (3) there’s at least one other “red flag” (age over 55 or under 20, painful to light tapping, fever/malaise, weight loss, slow urination, incontinence, groin numbness, a dragging toe, or symptoms in both legs like numbness and/or tingling and/or weakness).
Age: The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. As people grow older, loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.
Electrodiagnostics are procedures that, in the setting of low back pain, are primarily used to confirm whether a person has lumbar radiculopathy. The procedures include electromyography (EMG), nerve conduction studies (NCS), and evoked potential (EP) studies. EMG assesses the electrical activity in a muscle and can detect if muscle weakness results from a problem with the nerves that control the muscles. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body. NCSs are often performed along with EMG to exclude conditions that can mimic radiculopathy. In NCSs, two sets of electrodes are placed on the skin over the muscles. The first set provides a mild shock to stimulate the nerve that runs to a particular muscle. The second set records the nerve’s electrical signals, and from this information nerve damage that slows conduction of the nerve signal can be detected. EP tests also involve two sets of electrodes—one set to stimulate a sensory nerve, and the other placed on the scalp to record the speed of nerve signal transmissions to the brain.
Located deep in the front of the hip and connecting the leg, pelvis, and abdomen, the hip flexors— surprise, surprise— flex the hip. But despite being some of the most powerful muscles in our bodies (with a clearly important role), it’s easy to neglect our poor hip flexors— often without even knowing it. It turns out just working at a desk all day (guilty!) can really weaken hip flexors since they tend to shorten up while in a seated position. This tightness disrupts good posture and is a common cause of lower back pain. Weakened hip flexors can also increase the risk of foot, ankle, and knee injuries (especially among runners) Hip muscle weakness and overuse injuries in recreational runners. Niemuth, P.E., Johnson, R.J., Myers, M.J., et al. Rocky Mountain University of Health Professions, Provo, VT. Clinical Journal of Sport Medicine, 2005 Jan; 15 (1): 14-21.. So be sure to get up, stand up every hour or so! And giving the hip flexors some extra attention is not just about injury prevention. Adding power to workouts, working toward greater flexibility, and getting speedier while running is also, as they say, all in the hips The effect of walking speed on muscle function and mechanical energetics. Neptune, R.R., Sasaki, K., and Kautz, S.A. Department of Mechanical Engineering, The University of Texas, Austin, TX. Gait & Posture, 2008 Jul; 28 (1): 135-43..
Tight hip flexors can result in lower back pain, hip pain and injury. A lot of strain is put on those muscles during activities that involve sprinting and kicking. For example, runners are more prone to hip flexor injuries because of the small, repetitive movement during running. But even if you’re not an athlete, hip flexor injuries can occur during everyday activities (for instance, slipping and falling or running to catch a bus). When those tight muscles are suddenly stretched beyond what they are accustomed to, you might also experience pain in the upper groin region, typically where the hip meets the pelvis.
An intervertebral disc has a gelatinous core surrounded by a fibrous ring.[32] When in its normal, uninjured state, most of the disc is not served by either the circulatory or nervous systems – blood and nerves only run to the outside of the disc.[32] Specialized cells that can survive without direct blood supply are in the inside of the disc.[32] Over time, the discs lose flexibility and the ability to absorb physical forces.[25] This decreased ability to handle physical forces increases stresses on other parts of the spine, causing the ligaments of the spine to thicken and bony growths to develop on the vertebrae.[25] As a result, there is less space through which the spinal cord and nerve roots may pass.[25] When a disc degenerates as a result of injury or disease, the makeup of a disc changes: blood vessels and nerves may grow into its interior and/or herniated disc material can push directly on a nerve root.[32] Any of these changes may result in back pain.[32]
Place a mini band around your ankles and spread your feet about shoulder-width apart. Keeping your legs relatively straight (you want the motion to come from your hips) and toes pointing forward, walk forward 10 steps, then backward 10 steps. Take a short break and then walk to the right 10 steps, then to the left 10 steps. Again, focus on keeping your legs straight and toes pointing forward.
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.
Nerve block therapies aim to relieve chronic pain by blocking nerve conduction from specific areas of the body. Nerve block approaches range from injections of local anesthetics, botulinum toxin, or steroids into affected soft tissues or joints to more complex nerve root blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. The success of a nerve block approach depends on the ability of a practitioner to locate and inject precisely the correct nerve. Chronic use of steroid injections may lead to increased functional impairment.
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.
The medication typically recommended first are NSAIDs (though not aspirin) or skeletal muscle relaxants and these are enough for most people.[13][6] Benefits with NSAIDs; however, is often small.[67] High-quality reviews have found acetaminophen (paracetamol) to be no more effective than placebo at improving pain, quality of life, or function.[68][69] NSAIDs are more effective for acute episodes than acetaminophen; however, they carry a greater risk of side effects including: kidney failure, stomach ulcers and possibly heart problems. Thus, NSAIDs are a second choice to acetaminophen, recommended only when the pain is not handled by the latter. NSAIDs are available in several different classes; there is no evidence to support the use of COX-2 inhibitors over any other class of NSAIDs with respect to benefits.[70][13][71] With respect to safety naproxen may be best.[72] Muscle relaxants may be beneficial.[13]
How to: Lie on your back with your right knee bent and foot flat on the floor (a). With your left leg fully extended, press into your right foot to shift onto your left hip. This is your starting position (b). Then, squeeze your right glutes to press your left hip open until you feel a stretch, pause, then return to start. That’s one rep (c). Perform six to eight reps, then repeat on the opposite side.
Overall, the outcome for acute low back pain is positive. Pain and disability usually improve a great deal in the first six weeks, with complete recovery reported by 40 to 90%.[2] In those who still have symptoms after six weeks, improvement is generally slower with only small gains up to one year. At one year, pain and disability levels are low to minimal in most people. Distress, previous low back pain, and job satisfaction are predictors of long-term outcome after an episode of acute pain.[2] Certain psychological problems such as depression, or unhappiness due to loss of employment may prolong the episode of low back pain.[13] Following a first episode of back pain, recurrences occur in more than half of people.[23]
2016 — More editing, more! Added some better information about pain being a poor indicator, and the role of myofascial trigger points. This article has become extremely busy in the last couple months — about 4,000 readers per day, as described here — so I am really polishing it and making sure that it’s the best possible answer to people’s fears about back pain.
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The outlook for low back pain absolutely depends on its precise cause. For example, acute strain injuries generally heal entirely with minimal treatment. On the other hand, bony abnormalities that are irritating the spinal cord can require significant surgical repair and the outlook depends on the surgical result. Long-term optimal results often involve exercise rehabilitation programs that can involve physical therapists.
Since the hip flexors are so easy to overuse and strain, it is important to stretch them before exercise or strenuous activity. Because of their connectedness to other muscle groups in the legs (like the quadriceps), it is important to stretch the muscle group as a whole, not individually. This ensures that the entire area is warmed up and ready for the strain of exercise or activity, not just one or two individual muscles.
Knowing the exact source of your hip pain can provide you with peace of mind—but receiving the right treatment is even better. Let Dr. Hamilton provide you with both peace of mind and relief from your symptoms. Schedule an appointment with Dr. Hamilton today. For your convenience, he is available at Beacon East, Beacon West, or Summit Woods in Ohio as well as Beacon’s Northern Kentucky location.
