Thứ hai, 03 Tháng 11 2014 18:43

Tips to Prevent Neck Pain

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(ĐTĐ) - Neck pain is an extremely common complaint; some of it is caused by the standard wear-and-tear of aging, but many people can actually prevent it from occurring by making a few simple changes.

Thứ sáu, 24 Tháng 10 2014 17:37

Sleeping and Neck Pain

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(ĐTĐ) - Many times when you’re in pain, you just want to go to sleep. But for a lot of people, sleep may be causing their pain – one common source of neck pain is poor sleeping posture.

Thứ sáu, 26 Tháng 9 2014 17:11

Cervical and Lumbar Spondylosis Explained

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(ĐTĐ) - The word “spondylosis” means a stiffening or fixation of the vertebrae in the back and neck due to a disease process. Spondylosis is the degenerative changes such as degenerating discs and bone spurs. Quite often, these changes are called osteoarthritis. Spondylosis can occur anywhere on the spine: cervical (neck), thoracic (upper/mid back), and lumbar (low back). However, the most common is cervical and lumbar.

Thứ sáu, 08 Tháng 8 2014 17:14

Cervical Spondylosis And Radiculopathy

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(ĐTĐ) - Although medical terms that might confuse many people, cervical spondylosis and radiculopathy have a common link with one another. Understanding one (cervical spondylosis) is needed to understand how the other (radiculopathy) works within contexts involving the former. That’s mainly because cervical spondylosis often plays a role in causing radiculopathy in people. In this article, let’s take a closer look at the relationship between cervical spondylosis and radiculopathy.

Understanding cervical spondylosis

Spondylosis is a generalized term referring to the gradual degradation of the spine as a person gets older. It typically starts affecting people sometime after age 30. Cervical spondylosis refers to a specific type of gradual degradation within the spine, namely the degradation of the vertebrae and small tissues of the spine’s cervical portion, otherwise known as the neck.

As people get older, they start losing both elasticity and moisture within the soft tissues of their back, including their ligaments, tendons and the gel-filled cartilage discs that act as cushions in between vertebrae. When the discs start drying out, they start becoming fragile, and cracks and fissures start forming within the drying cartilage. Once these discs start becoming damaged enough, conditions like disc herniation and degenerative disc disease may start developing.

Spondylosis, in general, also causes the cartilage around the spinal joints to eventually wear away. That cartilage plays a role in preventing the bones of each joint from rubbing against each other. When that protective layer wears away, the bones start sustaining damage from grinding against each other. If it persists, the bones might start developing bone spurs (osteophytes) or abnormal bone protrusions.

Understanding cervical spondylosis and radiculopathy

How does cervical spondylosis relate to radiculopathy? First, let’s look at what radiculopathy is. Radiculopathy is a medical term describing pain and other symptoms associated with a compressed nerve root. Sciatica is a common form of radiculopathy that affects the legs and lower back. That condition is caused by the compression of the nerve roots linked to the sciatic nerve within the lumbar spine, otherwise known as the lower back.

When the cervical spine starts degenerating, it may cause nerve root compression, too. Fluid from prolapsed discs or even spinal stenosis (the narrowing of the spine) may cause some form of radiculopathy. Bone spurs also cause compressed nerves, since they put pressure on nerves where the bones start to protrude and subsequently pinch nerves.

People who have developed radiculopathy from cervical spondylosis experience pain and stiffness within their necks, in addition to numbness and/or tingling within their shoulders and arms. Some also experience pain within their arms, chests and shoulders. The relationship of cervical spondylosis and radiculopathy has everything to do with compressed nerves. That’s why when cervical spondylosis is mentioned in some context, radiculopathy usually is a common symptom stemming from the aforementioned condition.

The symptoms of cervical spondylosis and radiculopathy

As we described in the previous section, both cervical spondylosis and radiculopathy have symptoms that best characterize each condition. In most cases, people with cervical spondylosis exhibit symptoms relating to radiculopathy.

Symptoms from cervical spondylosis typically start with sharp pain traveling down the arm, usually in the area of where the originating nerve resides. Some people feel a distinct ‘pins and needles’ sensation or, in uncommon cases, complete numbness. Some people feel weak when they perform certain activities, which is a direct result of the nerve issues caused by cervical spondylosis and radiculopathy

The symptoms may even worsen over time, especially due to certain movements. Movements like extending or straining the neck or even turning the head can worsen the condition.

Of course, the aforementioned symptoms aren’t the only symptoms associated with cervical spondylosis and, to a lesser extent, radiculopathy. Here’s an overview of cervical spondylosis symptoms:

- Pain in the neck that spreads to the shoulders or base of the skull.

- Pain in the neck that eventually spreads down to the arm, hand and/or fingers.

- Pain that tends to flare up on occasion, particularly when using a body part affected by the pain.

- Neck stiffness, sometimes after sleeping.

- Headaches that start from the back of the head (from above the neck) and travel over to the top of the forehead.

- A ‘pins and needles’ sensation in part of the arm or hand, typically originating from radiculopathy.

- Rarely, clumsiness in the hand, problems with walking and/or problems with bladder function.

Some people have their symptoms go away after a few days or a few weeks, though most people take much longer to relieve themselves of their symptoms originating from the condition. Though, it’s not uncommon for either condition to come back after a while. When that happens, people typically need a full medical examination and persistent treatment to subside the symptoms of the condition.

People with cervical spondylosis and radiculopathy are advised to talk to their doctor about their experience with one or both conditions. In most cases, doctors use symptoms from cervical spondylosis and radiculopathy to understand how to diagnose either condition and find solutions for treating them.

Treatment options for cervical spondylosis and radiculopathy

Speaking of treatment, people with cervical spondylosis or radiculopathy have the option of treatment to relieve mild or severe symptoms. Let’s take a look at the forms of treatment available.

Treatment for both cervical spondylosis and radiculopathy typically starts with non-surgical options. This is usually the best course of treatment for people with milder symptoms from either condition.

Soft collars help the muscles of the neck relax and limit the neck’s natural motions, while also decreasing the likelihood of the nerve roots pinching with each movement. They’re typically worn for a short amount of time to prevent the neck muscles form losing strength. Physical therapy also works, as it helps with stretching and strengthening the neck muscles.

Medications are a common form of non-surgical treatment. Non-steroidal anti-inflammatory medications, such as ibuprofen and aspirin are incredibly common for reducing pain from nerve swelling.

Narcotics help treat severe pain, though are prescribed for a limited time due to their addictive nature. Spinal injections of steroids, typically near the pinched nerve, provide near immediate relief for people with nerve pain and swelling.

In rare cases, surgical treatment may be needed to completely relieve symptoms from cervical spondylosis and radiculopathy. This usually involves removing certain parts of the damaged spinal cord or nerve roots (such as herniated discs or bone spurs) to make more room for them.

Thứ bảy, 26 Tháng 7 2014 17:58

Neck Pain from a Herniated Disk

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(ĐTĐ) - The vertebrae of your spinal column are separated by cushiony disks, which absorb shock and allow for movement and flexibility in the spine. Sometimes these disks rupture or slip and bulge out where they shouldn’t, which is known as a slipped, ruptured, or herniated disk; when it occurs in the vertebrae of the neck, it’s called cervical disk herniation.

When a disk bursts or otherwise moves out of place, it can cause pain and other complications, and not only in the neck. Typical symptoms include pain, numbness, and a tingling sensation in the neck, shoulders, and arms, although in some cases, these may be felt in other parts of the body as well. If a particularly large disk has herniated, for example, the effects may be felt in the legs. There may be muscle weakness, usually in the arms or legs, which can affect how well you grip things or raise your arm or leg. Basically, the area of the body that is connected to the nerves around the slipped disk may experience some of the same effects as the neck itself.

The pain often comes on gradually and worsens over time. You may also notice an increase or a shooting pain after sudden movements like a cough or sneeze, or after you spend time in a certain position – sitting or standing for long periods, or just a particular posture.

Herniated disks can occur for a number of reasons. Usually, it’s just the result of wear and tear as we age, where the disks lose moisture and elasticity, making them more susceptible to damage from sudden twists. Heavy lifting is another leading cause: the advice to lift with your legs, not with your back exists for good reason. Twisting while lifting can also cause herniation. People whose jobs require frequent heavy lifting are more prone to herniated disks, as are people who are overweight, which strains the back.

To diagnose, a doctor will examine you for signs of muscle weakness, numbness, difficulty balancing, and diminished reflexes, and ask about any tingling. Other tests such as x-ray or MRI may also be performed. Ample rest is the foremost treatment, with medicine to reduce pain and inflammation; physical therapy or certain stretches may also be recommended, and posture modifications if necessary. In the rare cases involving loss of bladder function and severe pain, surgery may be required.

Thứ ba, 22 Tháng 7 2014 16:41


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(ĐTĐ) - Sciatica can be a difficult condition to pin down, and confusing the issue there is also a condition that is commonly called “pseudo-sciatica.” The condition is called piriformis Syndrome. It has different causes from sciatica, but it mimics the symptoms so it won’t be a surprise if you and your doctor believe that it’s sciatica.

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Sciatica is caused by the compression of the sciatic nerve by a slipped or herniated disc. This nerve runs from the lower back, through the buttocks and all the way down to the feet and toes. This means that you will experience pain throughout your lower body from this condition.

Piriformis syndrome is uncommon, but causes the same kind of compression. The piriformis is a flat muscle just above the buttocks. This muscle spasms and pinches the sciatic nerve, causing the same sort of pain as sciatica. However, it only seems to be sciatica. Sciatica is generally caused by compression caused by the discs in the back, so when the piriformis muscle is the culprit, it may cause some confusion.

Despite the name, there is nothing imaginary about “pseudo” sciatica. The sciatic nerve is being pinched and compressed in the same manner, just from a different cause. The pain is just as real and the “pseudo” in the name just refers to the fact that the syndrome falsely appears like sciatica.


Despite how similar the syndrome is to sciatica, there are two simple physical manoeuvres that can be used to distinguish between the two. This, of course, depends on a patient only having one or another of the conditions. If you have both conditions at the same time, these will not work. The first position is done this way: from a seated position, straighten the leg in which you are having pain, so that your leg is parallel with the floor. If the symptoms increase, there is a good chance that what you have is true sciatica.

The second position is achieved in two steps. Again, take a sitting position. Then, in the leg in which you have pain, bring the knee up to the shoulder on the same side. While this may sound painful, it generally isn’t except in the most severe cases. Once you have done this, move your knee over toward the opposite shoulder. If there is an increase in pain, there is a good chance that you are suffering with piriformis syndrome.


As the name implies, the symptoms are very similar to regular sciatica. The major symptom is pain and burning down the length of the nerve, from the buttocks to the feet. It usually affects only one side of the body, and can be more intense when you are sitting, or after sitting for a long time.

The main difference between regular sciatica and piriformis syndrome is that it often causes more intense pain in the hip, to the point where it can actually cause the patient to limp or have other difficulty walking. Conversely, people with pseudo-sciatica generally don’t have pain in the thigh. Unfortunately, these differences can appear very slight and may not be enough to give doctors a clue what is causing the pain.


Pseudo sciatica can be caused by poor posture or exercise related injury. This is very unlike the causes of regular sciatica, which are often being overweight or not being active enough. Regular sciatica is also often a side-effect of pregnancy.

Pseudo sciatica can also be caused by sitting too long at a computer with your head protruding to look at the screen. It can also be caused by muscular overuse, as in when a parent repeatedly lifts a child into a car seat in the rear of a car. Men can also develop this syndrome by sitting to long on a hard seat with a wallet in the back pocket.


The options for treatment of the syndrome will generally be very similar to the options available for regular sciatica. These include painkillers, anti-inflammatory medicines and physiotherapy. There are exercises you can do to help relieve pain and lessen the nerve compression that you piriformis muscle is causing.


Leg and Knee Stretch

One of the simplest and easiest ways to relieve pain is through a very basic leg stretch. Lie down on the floor with your legs straight. Then bring one knee up to your chest and hug it to you. Then slowly move it toward your opposite shoulder, so that your leg is stretched across your body diagonally. You should be feeling a stretch in your hip and buttock. Hold the stretch for a few seconds, then release it and repeat the stretch on the other side. Lie on the floor with your legs straight. Bend one knee into your chest, hugging it with your arms. Slowly bring the knee up towards your opposite shoulder, stretching it across your body. You should feel a decent stretch through your hip and buttock area. Hold the stretch for several breaths, then release and repeat on the opposite side.

Parivrtta Trikonasana

A yoga pose called Parivrtta Trikonasana, also known as the revolved triangle pose, is able to stretch the piriformis muscle. This is a little more intense than a leg stretch and it will be important to consult with your doctor before you attempt it. However, once you have gotten the go-ahead, you’re ready to work on your yoga.

To perform this pose, come into a push-up position with your arms straight. Lift your buttocks towards the ceiling, coming into an inverted “V” shape pose. Step your right foot up between your hands. Keeping your left hand on the ground, revolve your chest towards the ceiling, bringing your arm straight up over your head so that it is pointing toward the ceiling. Don’t support your body with your left arm, rather support it with the muscles in your back. This position is meant to stretch your back and buttocks, so it’s important that you are using those muscles. Hold the pose for 30 seconds, then return to downward-facing dog pose and repeat on the opposite leg.

As with any condition, it is important to know what the root cause of your pain is. Treatment for regular sciatica is not going to be useless, but obviously it will be more effective if you and your doctor understand what you have before you begin with treatment measures.

Thứ bảy, 19 Tháng 7 2014 17:09

A Neck Pain: Stress

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(ĐTĐ) - Stress has become an unfortunately commonplace part of life for many people, so much so that we forget how damaging it can be on the body. Aside from the emotional and mental toll it takes, stress can have negative physical effects as well, from fatigue to bodily pain. Neck pain is one of those physical symptoms of stress.

Stress is part of our ingrained fight-or-flight response, flooding our system with adrenaline and causing our muscles to tense in preparation; this stimulates nerves and diverts blood flow away from muscles, which causes stiffness and pain. With prolonged stress, this leads to sore, tight muscles and – in one of the body’s more vicious cycles – the pain causes muscles to tense further.

The neck is a one of the most common places for painful muscular tension as a result of stress. This is not only because the neck is one of the first places to tense up in response to stress, but also because stress exacerbates underlying neck problems, which many people have to begin with. Poor or improper posture is extremely common, especially between constant computer use and propping up phones between neck and shoulder, so in many cases the potential for neck pain is already in place when stress sets in.

Reducing your stress levels and learning to manage it is essential to treating and preventing neck pain. Being aware of stress and its potential triggers is step one; it may seem self-explanatory, but sometimes we just don’t notice it, or we decide to just push through. If you notice stress or tension building, stop, take a few deep breaths, and take a moment to stretch lightly or do some neck rolls. Make sure you’re maintaining a healthy diet and get some exercise, which is helpful for not only reducing stress but soothing muscle pain as well, because it gets blood flowing – and as we know, lack of blood flow to muscles causes pain.

While you’re working on your stress levels, check on postural triggers. Sit upright in your chair with your head directly above your neck, directly above your shoulders. Take frequent breaks, and adjust your car seat so that you can comfortably reach the wheel rather than leaning forward or extending your arms too far. And don’t forget, there’s always massage – you might have to treat yourself!

Thứ hai, 07 Tháng 4 2014 06:01

Lower Back Pain is N1 Cause of Disability

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(ĐTĐ) - Lower back pain is the leading cause of disability worldwide, according to a large new study published in the Annals of the Rheumatic Diseases.

Researchers in the U.K., Australia and the U.S. studied data from the Global Burden of Disease study, which assessed the health of people in 187 countries. They found that almost one out of ten people (9.4%) suffers from lower back pain – a number likely to rise as the population ages.

Back Pain“Governments, health service and research providers and donors need to pay far greater attention to the burden that low back pain causes,” wrote lead author Dr. Tony Woolf from the Royal Cornwall Hospital in the UK.

“With aging populations throughout the world, but especially in low and middle income countries, the number of people living with low back pain will increase substantially over coming decades.”

Lower back pain was most common in Western Europe, where 15% of the population suffers from it; followed by North Africa and the Middle East. It was least common in the Caribbean and Latin America.

Lower back pain is not usually linked to any serious disease. It can be triggered by any number of everyday activities, including bad posture, bending awkwardly, lifting incorrectly or standing for long periods of time.

“Many people develop back pain for no obvious reasons, and research suggests that it’s impossible to identify a specific cause of pain for around 85 per cent of people in the early stages,” a spokeswoman for Arthritis Research UK told the Daily Express.

“Treatment such as physiotherapy, pain relief and exercise to keep the muscles supporting the spine strong can all help.”

Men (10.1%) are more likely to suffer from lower back pain than women (8.7%).

The study was funded by the Bill and Melinda Gates Foundation, the Australian Commonwealth Department of Health and Ageing, the Australian National Health and Medical Research Council, and the Ageing and Alzheimer’s Research Foundation.

Thứ sáu, 04 Tháng 4 2014 18:35

10 Ways to Manage Low Back Pain at Home

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(ĐTĐ) - Perhaps you bent the wrong way while lifting something heavy. Or you're dealing with a degenerative condition like arthritis. Whatever the cause, once you have low back pain, it can be hard to shake. About one in four Americans say they've had a recent bout of low back pain. And almost everyone can expect to experience back pain at some point in their lives.

Sometimes it’s clearly serious: You were injured, or you feel numbness, weakness, or tingling in the legs. Call the doctor, of course. But for routine and mild low back pain, here are a few simple tips to try at home.

Chill it. Ice is best in the first 24 to 48 hours after an injury because it reduces inflammation, says E. Anne Reicherter, PhD, PT, DPT, associate professor of Physical Therapy at the University of Maryland School of Medicine. "Even though the warmth feels good because it helps cover up the pain and it does help relax the muscles, the heat actually inflames the inflammatory processes," she says. After 48 hours, you can switch to heat if you prefer. Whether you use heat or ice -- take it off after about 20 minutes to give your skin a rest. If pain persists, talk with a doctor.

Keep moving. "Our spines are like the rest of our body -- they're meant to move," says Reicherter. Keep doing your daily activities. Make the beds, go to work, walk the dog. Once you're feeling better, regular aerobic exercises like swimming, bicycling, and walking can keep you -- and your back -- more mobile. Just don't overdo it. There's no need to run a marathon when your back is sore.

Stay strong. Once your low back pain has receded, you can help avert future episodes of back pain by working the muscles that support your lower back, including the back extensor muscles. "They help you maintain the proper posture and alignment of your spine," Reicherter says. Having strong hip, pelvic, and abdominal muscles also gives you more back support. Avoid abdominal crunches, because they can actually put more strain on your back.

Stretch. Don't sit slumped in your desk chair all day. Get up every 20 minutes or so and stretch the other way. "Because most of us spend a lot of time bending forward in our jobs, it's important to stand up and stretch backward throughout the day," Reicherter says. Don't forget to also stretch your legs. Some people find relief from their back pain by doing a regular stretching routine, like yoga.

Think ergonomically. Design your workspace so you don't have to hunch forward to see your computer monitor or reach way out for your mouse. Use a desk chair that supports your lower back and allows you to keep your feet planted firmly on the floor.

Watch your posture. Slumping makes it harder for your back to support your weight. Be especially careful of your posture when lifting heavy objects. Never bend over from the waist. Instead, bend and straighten from the knees.

Wear low heels. Exchange your four-inch pumps for flats or low heels (less than 1 inch). High heels create a more unstable posture, and increase pressure on your lower spine. According to research, nearly 60% of women who consistently wear high-heeled shoes complain of low back pain.

Kick the habit. Smoking can increase your risk for osteoporosis of the spine and other bone problems. Osteoporosis can lead to compression fractures of the spine. One study found that smokers are about a third more likely to have low back pain compared with nonsmokers.

Watch your weight. Use diet and exercise to keep your weight within a healthy range for your height. Being overweight puts excess stress on your spine.

Try an over-the-counter pain reliever. Anti-inflammatory drugs such as aspirin, ibuprofen (Advil, Motrin, Nuprin), and naproxen sodium (Aleve, Anaprox, Naprosyn) can help reduce back pain. Acetaminophen (Actamin, Panadol, Tylenol) is another over-the-counter option for pain management. Be sure to check with your doctor or pharmacist about any interactions over-the-counter pain relievers may have with other medications you are taking. People with a history of certain medical conditions (such as ulcers, kidney disease, and liver disease) should avoid some medicines.

Call your doctor if:

  • Your low back pain doesn't go away after a few days, and it hurts even when you're at rest or lying down.
  • You have weakness or numbness in your legs, or you have trouble standing or walking
  • You lose control over your bowels or bladder
  • These could be signs that you have a nerve problem or another underlying medical condition that needs to be treated.
Reviewed By Louise Chang, MD - Source 
Thứ năm, 17 Tháng 3 2011 09:01

Low Back Pain Clinical

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A thorough history and physical examination is paramount to arrive at a diagnosis, and initially imaging is often unnecessary.

  • Patients most often complain of pain in the lumbosacral area.
    • Determine whether pain is exacerbated by movement or by prolonged sitting or standing.
    • Determine the duration of pain.
    • Determine if pain is relieved by lying down.
    • Establish if pain was sudden in onset or gradual over days or months.
    • Determine if pain is worse in the morning or at night.
    • Find out if the patient can identify a precipitating event such as lifting or moving furniture.
  • Explore the presence of systemic symptoms such as fever, weight loss, dysuria, cough, and bowel or bladder problems.
  • Inquire about current medications that may produce symptomatology.
    • Chronic steroids may predispose to infection or compression fractures.
    • Anticoagulants may result in a bleed or hematoma.
  • Any history of new-onset bowel or bladder dysfunction (eg, urinary hesitancy, overflow incontinence) with back pain is suggestive of cauda equina syndrome. This is particularly true if other, new neurologic deficits are also present.


  • Physical examination of a patient with back pain should include range of motion and a thorough neurologic examination, including assessment of peripheral motor function, sensation, and deep tendon reflexes.
    • Perform straight leg testing with the patient in a supine position. Record response to raising each leg. An approximation of the test may also be performed with the patient sitting and each leg straightened at the knee. An elevation of the leg to less than 60° is abnormal. The straight leg test result is positive only if the pain radiates to below the knee and not merely in the back or the hamstrings. This is the single best test for determining radiculopathy due to disc herniation with a high sensitivity and moderate specificity.
    • Perform an abdominal examination to exclude intra-abdominal pathology.
    • Perform a rectal examination on men older than 50 years to assess prostate size and exclude prostatitis. Also perform a rectal examination on any patient who may have cauda equina syndrome to assess rectal tone and perineal sensation. If cauda equina syndrome is suspected, urinary catheterization for a postvoid residual or bedside ultrasonography of the bladder may be helpful to assess for urinary retention.
    • Perform a rectal examination, if necessary, in younger males who are febrile and have urinary complaints.
    • Perform a pelvic examination, if necessary, in females complaining of menstrual abnormalities or vaginal discharge.
  • Patients with true herniated discs may not present with any findings other than a positive straight leg raising test. Classic presentation includes numbness in a dermatomal distribution corresponding to the level of disc involved, with findings of motor weakness and reflex loss as described below. Herniated discs have different presentations depending on the location as follows:
    • At L4: Pain along the front of the leg; weak extension of the leg at the knee; sensory loss about the knee; loss of knee-jerk reflex
    • At L5: Pain along the side of the leg; weak dorsiflexion of the foot; sensory loss in the web of the big toe; no reflexes lost
    • At S1: Pain along the back of the leg; weak plantar flexion of the foot; sensory loss along the back of the calf and the lateral aspect of the foot; loss of ankle jerk
    • L5 and S1: These nerve roots are involved in approximately 95% of all disc herniations.
  • Spinal stenosis may be present when evidence of degenerative joint disease is present on radiographic studies.
    • Patients with this disease process often complain of progressive pain down the lateral aspect of the leg during ambulation (pseudoclaudication). This pain results from neurologic compression rather than actual arterial insufficiency, which produces true claudication. In cases of spinal stenosis, the straight leg test result is often negative.
    • The stoop test helps distinguish true claudication from pseudoclaudication. Patients with true claudication sit down to rest when pain occurs, while patients with pseudoclaudication attempt to keep walking by stooping or flexing the spine to relieve the stretch on the sciatic nerve.
  • Sacroiliitis usually presents with pain over the involved joints and no peripheral neurologic findings.
  • Osteomyelitis may be subacute or acute.
    • Clinical findings are nonspecific, and the patient may be afebrile on presentation.
    • Classic presentation includes pain on palpation of the vertebral body, elevated sedimentation rate, and complaints of pain out of proportion to physical findings.
    • Patients particularly at risk for development of osteomyelitis include patients who have undergone recent back surgery, intravenous (IV) drug users, patients with immunosuppression, and those with a history of chronic pelvic inflammatory disease (PID).


Please refer to Pathophysiology, which describes specific causes of back pain in detail. Certain clinical clues can help differentiate between causes. Generally, impingement syndromes produce positive straight leg raising tests, whereas pure irritation does not. To assess for a functional disorder as the cause of low back pain, consider the following:

  • Mechanical low back pain is a common complaint in patients with functional disorders. In addition, a functional overlay or component of secondary gain may be present in some patients with true organic pathology. The degree of psychosocial issues affecting the patient's condition may be assessed by the following:
    • Patient may receive compensation for injury.
    • Patient has pending litigation.
    • Patient dislikes job.
    • Patient has symptoms of depression.
    • Patient caused the accident resulting in back pain.
  • Physical clues that help identify patients with significant functional overlay or component of secondary gain include the following:
    • Findings of nonanatomic motor or sensory loss
    • Nonspecific tenderness or generalized tenderness over the entire back
    • Overly dramatic behavior and loss of positive straight leg raising test when patient is distracted
  • A particularly useful test is to have patients hold their wrists next to their hips and turn their body from side to side. This test gives the illusion that you are testing spinal rotation, but no actual stress is placed on any muscles or ligaments. Any complaint of pain during this maneuver is strongly suggestive of a functional overlay or component of secondary gain in the presentation.

Laboratory Studies

  • Consider performing urinalysis if the problem is not clearly musculoskeletal or an exacerbation of chronic back pain.
  • Perform a complete blood count (CBC) and erythrocyte sedimentation rate (ESR) if the patient is febrile or if an epidural or spinal abscess, or osteomyelitis is suspected. While ESR has moderate specificity, the sensitivity is relatively high in cases of abscess, and it can be used as a screening test.
  • Other laboratory studies are rarely needed unless a disorder other than back pain is strongly suspected.

Imaging Studies

  • Radiography
    • Lumbosacral spine series are expensive and expose the reproductive organs to significant radiation. Annually, 7-8 million such tests are obtained, but most have little value in directing therapy, particularly among adults younger than 50 years.
    • Osteophytes are the most frequently seen abnormality of plain films followed by intervertebral disc space narrowing. Both increase with age. Disc space narrowing appears to be more frequent in women. Disc space narrowing at 2 or more levels is strongly associated with back pain pathology.
    • Unless a history of traumatic injury or systemic illness is present, such films should be obtained only for suspicion of malignancy or infection. Malignant involvement of vertebral bodies can be evident on plain film when as little as 30% of the vertebral body has been replaced.
    • Other indications that suggest the need for radiographic imaging include chronic steroid use and acute onset of pain in patients older than 50 years or in the pediatric age group.
    • The physician may also consider obtaining radiographs in patients whose cases involve (or potentially involve) litigation or for patients seeking compensation.
  • CT and MRI
    • CT and MRI are generally considered the studies of choice for more precise imaging of the vertebrae, paraspinal soft tissues, discs, or spinal cord. CT images cortical bone with higher resolution and can delineate some fractures better than MRI.
    • MRI is generally the preferred imaging modality for detecting disc, cord, or soft tissue abnormalities.
  • Ultrasonography may be useful if the differential diagnosis includes appendicitis, a pathologic pelvic process, or abdominal aneurysm.
  • True emergencies that necessitate imaging include the following:
    • Patients with a history of malignancy and new evidence of nerve entrapment
    • Patients with back pain associated with paralysis or gross muscle weakness
    • Patients with bilateral neurologic deficits associated with bowel or bladder function loss
    • Patients in whom an epidural hematoma or epidural abscess is suspected
    • Postoperative patients with a recent lumbar laminectomy or hip replacement

Improvement occurs in almost all patients within 4-6 weeks, except those with infection, occult malignancy, or systemic illness. If pain fails to significantly improve or resolve in this time frame, imaging is always indicated.

Other Tests

  • Perform the straight leg raising test with the patient in a supine position. Record the response to raising each leg. An approximation of the test may be performed with the patient sitting and each leg straightened at the knee. The examiner should take care to make sure that the quadriceps muscle is relaxed while passively raising the leg to ensure that the sciatic nerve is being adequately stretched during the testing. If the quadriceps is contracted, it will take the pressure off the sciatic nerve and may give a false-negative result.
  • The stoop test helps distinguish true claudication from pseudoclaudication. Patients with true claudication sit down to rest when pain occurs, while patients with pseudoclaudication attempt to keep walking by stooping or flexing the spine to relieve the stretch on the sciatic nerve.
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