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Return to activity | Diagnostics | Pain relief | Time | Limit rest | Physical therapy | Exercise | Injection therapy | Medication | Massage | Biofeedback | Acupuncture | Download Brochure
The primary goal of treatment at DenverSpine is to get you back
to your everyday activities. During your initial visit, the physician
will assess your medical history and collect more specific information
during the exam. To better understand your back or neck problem,
the physician may gently move your joints and limbs. It is important
to answer all the physician’s questions honestly because
your answers help determine a correct diagnosis.
Types of diagnostics you may encounter
Time is your most valuable asset. In cases where pain is focused in
the low back or when there are no red flag symptoms, take the time to
help yourself. Check out the home remedy section of this Web site for
ways to self-treat your neck and back pain.
A study released by The New England Journal of Medicine revealed that the treatment of most back pain cases should involve no more than two days of rest and inactivity. After that, patients should start moving and exercising to strengthen back muscles and increase flexibility. The rehabilitative process requires a commitment on the part of the patient to work closely with a therapist during the first few weeks to ensure a successful long-term recovery. While drugs and manipulation may relieve initial pain, neither
of these alters the musculature of the back, which is essential
for long-term recovery. Only exercise can strengthen the back muscles
and make them more flexible and resistant to future strain.
Physical therapy increases flexibility and strengthens muscles that
support the spine. Greater strength and flexibility will help prevent
future back strain. A therapist may use ultrasound, electrical stimulation,
heat or ice, mobilization and exercises to reduce pain and get you back
to activity. Click here to learn more about physical therapy.
For most back or neck pain sufferers, exercise is the last thing you would want to do. Years ago, however, a New Zealand physical therapist named Robin McKenzie noticed that some of his patients with herniated discs experienced relief of pain symptoms simply by bending over and extending. Since then, McKenzie flexion and extension exercises have been used by back pain clinics around the world to help people recover from back and neck pain without surgery. Here’s how these exercises work. The back is composed of vertebrae which are separated by soft discs that act as shock absorbers. These discs resemble jelly donuts because of their jelly-like center. In some cases, the wall of the disc ruptures, causing the center of the disc to herniate outward. This places painful pressure on the nearby nerves that branch off from the spinal cord. Many herniations occur at the back of the disc wall. Special extension exercises in which the back arches backward can compress the back side of the disc, which creates a vacuum toward the front of the disc. This vacuum can suck the herniation back inward, thereby relieving pressure on the adjacent nerve root. While the disc herniation has not been fixed, the pain generated by the herniated disc may be lessened. It is important to work with a therapist to make sure exercises are done properly. When doing exercises, don't hold your breath. Breathe normally. Move slowly when you stretch. Never bounce or jerk abruptly. Never do any exercise that causes pain to your back. Just as it took years for you to become less flexible, it will take months of stretching to restore flexibility. Back exercises can be done several times a day as needed. Some of the standing exercises can be done at work. If you have to sit at a desk a lot during the day, take a break every hour and stand, move around and do stretches to help out your back. Walk up or down stairs rather than taking the elevator. Click here to learn about
specific back pain exercises. For years, spine physicians have used cortisone injections, epidural steroid injections, trigger point injections and nerve blocks to relieve pain in the spine. These injections are intended to be a means to an end. The goal is to provide the patient with enough pain relief to bridge from inactivity to physical therapy, where back problems can be better treated with special exercises. There has been conflicting research about the value of injection therapy.
Some studies have questioned the benefit of epidural steroid injections.
In 1997, Britain's Royal College of General Practitioners noted in its
back care guidelines that epidural steroid injections relieve low back
pain with sciatica (leg pain) better than some other treatments. The
Royal College is less supportive of facet joint injections and trigger
point injections. It sees little evidence that these injections improve
clinical outcomes. With that said, many spine specialty centers believe
in the benefit of injections and continue to use them. In conclusion,
injection therapy is a viable alternative to explore before considering
surgery. Spinal Injection Patient Information Your physician has recommended that you receive a spinal injection for diagnostic and/or therapeutic purposes. This handout will provide general information pertaining to your injection experience. Additional, specific details about your injection can be found at: www.DenverBackPain.org > Educational Videos and Brochures, or www.spine-health.com. Our medical practice team will answer any other questions you may have. Your injection may target specific structures within the cervical (neck), thoracic (mid-back), or lumbosacral (low back) regions. Facet blocks involve injection of local anesthetic and corticosteroid into the joints that connect one spinal bone to the next. Medial branch blocks anesthetized (numb) the small nerve branches that go to the facet joints. Sacroiliac joint injections target those joints in the pelvis and include injection of anesthetic and corticosteroid. Epidural injections can be done through the nerve exit holes at the side of the spine (transforaminal epidural steroid injections or selective nerve root blocks), or into the space above the nerves and fluid sac within the spinal canal (interlaminar epidural steroid injection). Occasionally, injections are done into the discs (discography) in order to determine if one or more discs are a cause of pain. The small nerves to the facet joints are occasionally targeted and cut by the use of a needle with a heatable tip (radiofrequency neurotomies). These injections are performed using fluoroscopy (live x-ray) needle guidance to the target. This is necessary for optimal procedural accuracy and safety. The injection procedure includes the following steps:
The injection itself takes only a few minutes. You will be asked to arrive at the procedure site at least one hour before your scheduled procedure time, and you will be observed for 30 to 60 minutes following the procedure. You may be asked to demonstrate movements that provoke pain in the area in question, both before and after the procedure, in order to determine whether or not numbing the structure injected alleviates your pain. This is the diagnostic component of your procedure. You will also be asked to maintain a pain diary, with special attention given to the first several hours following your injection. It may take 2-3 days to feel the effects of the injection, and up to 10-14 days to see the maximum effect. Potential Risks and Complications As with any invasive medical procedure, there are risks associated with spinal injections. In general, the risk is low and complications are rare. Potential risks and/or complications include: Allergic reactions (most commonly to x-ray contrast), bleeding, and infection (minor infection rate <1% of all injections with severe infections being rare, less than or equal to 0.1% of all injections), worsening of pain, local injection site discomfort, Spinal headaches, or nerve or spinal cord damage paralysis (very rare, but possible as a result of direct needle trauma or secondarily from infection, bleeding or injection into an artery). In addition to these risks, it is possible to experience side effects from the corticosteroid medication, if used. These possible side effects include: mood swings, irritability, anxiety or insomnia; dull headache, flushing or a feeling of warmth for several days, fluid retention, weight gain, elevated blood pressure, transient decrease in immunity, or elevation of blood sugar (diabetic patients should inform their primary care physicians about the injection, prior to their procedure date, for guidance in managing their blood sugars). Rarely, general health complications can occur, if steroid use is excessive or prolonged. Notify your doctor if you have had multiple cortisone (steroid) injections within the last six months. Important Pre-Injection Procedure Checklist
Post Injection Precautions, Expectations, and Discharge Instructions
Spinal injection patient information courtesy of J. Scott Bainbridge, M.D.
Not only is massage relaxing but it also has notable health benefits that are an important part of back rehabilitation. Massages release toxins in muscles, increasing circulation, releasing endorphins, reducing inflammation, alleviating muscle cramps, breaking down scar tissue and calming the nervous system. Aside from its physical health benefits, massage has a psychological
impact by teaching the patient to feel relaxed. For the chronic back
pain sufferer, even the simple luxury of drifting off to sleep may not
be a reality. Massage can provide that feeling of calm.
Through biofeedback, the patient is taught to recognize how stress and relaxation chemically alters the body's functions. The patient can learn to lower heart rate and muscle tension. The biofeedback equipment records statistics and gauges progress as the patient learns to control the body, thus controlling pain. After recognizing the body’s signals during
biofeedback sessions, the patient is able to recognize them in daily
life and arrest the onset of muscle spasms or high blood pressure.
This can reduce pain and even eliminate it.
Traditional acupuncture is based on the ancient Chinese theory that there are energy pathways that run throughout the body. These pathways, called meridians, carry the body's vital energy, or chi (pronounced "chee"). The principle behind acupuncture is that disease and pain are a result of an imbalance in the body's energy flow (chi). Through the insertion of thin needles at specific points along meridians, the flow of energy is controlled and rebalanced in the body. Acupuncture dates back to the first century B.C. in China, during the era of the Han dynasty (206 B.C.-220 A.D.). Because Western physicians in the United States have difficulty understanding the correlation between acupuncture philosophies and traditional physiology, acupuncture has not been readily accepted in the United States.
Modern scientists have attempted to explain how acupuncture can relieve pain. Some observe that the traditional Chinese "meridians" overlap with pathways of the central nervous system. By using needles, an acupuncturist can stimulate the nervous system to release endorphins (morphine-like chemicals) in the muscles, spinal cord and brain. These chemicals either relieve pain symptoms or trigger other chain reactions that relieve them. Acupuncture is nonsurgical, does not involve drugs, and has no extremely negative side effects or permanent complications. It may be worth exploring as a nonsurgical option, particularly if you have exhausted the traditional remedies of Western medicine.
Click here or select the image above to download information on DenverSpine non-surgical capabilities and more. [Top]
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