…is a common disorder affecting over 80% of the general population at some point in their life. In addition to causing emotional and physical strain onthe body, it also causes a great amount of financial strain as it is the number one cause of job-related disability.
In this blog I hope to discuss various treatment options as well as explain why I feel that I am best suited to treat your low back pain and how I am the best low back pain specialist!
Causes of Low Back Pain:
First lets discuss one of the most common causes of low back pain. It can be acute, subacute or chronic. Acute low back pain duration is generally less than 4 weeks, subacute is from 4-12 weeks and chronic is low back pain lasting longer than 12 weeks. Also in addition to the duration of low back pain it can be defined as axial or radicular low back pain.
In this first article we will discuss radicular or radiating lower extremity low back pain. Radicular low back pain is pain that originates in your low back and shoots in an electricity like sensation down your posterior legs, at times all the way to your toes.
Back Anatomy:
Next we will discuss some basic anatomy of your lumbar spine. The Lumbar spine (or lower back region) is made up of five vertebrae (L1-L5) and in between each of these vertebrae lies fibrocartilage discs called intervertebral discs. These discs act as cushions or “shock absorbers” for the spine, preventing the vertebrae from rubbing together allowing the vertebrae to comfortably protect the spinal cord as well as provide active range of motion for your lower back.
Your bodies motor and sensory functions are controlled by nerves. These nerves stem from the spinal cord and exit the cord through small holes called foramina which lie within the vertebrae.
Ligaments and musculature of the lower back and abdomen provide stability for the spine and small joints, called facet joints, direct the motion of the spine and is how each vertebrae interact with each other. Facet joints can be thought of like any other joint in the body, just like your finger joint is made up of a number of small bones each connecting with each other through a joint.
Radiculopathy:
Now that we have the basic anatomy of the Lumbar Spine down, we can discuss one of the most common causes of low back pain which are caused by one of the above mentioned structures. One of the most common causes radiating lower extremity or “radicular” low back pain as due to a disc herniation impinging on your spine or nerve roots as they exit the spine.
Herniated Disc:
What is a herniated disc you may ask? Well let me explain. As described above in your spine in between each vertebrae lies a fibrocartilage disc which acts as a shock absorber for the spine. You can think of the discs structure as a jelly donut, with a soft center encased within a tougher exterior. The cause of a disc herniation can result from general wear and tear on the disc,such as while performing jobs that require constant sitting. Disc herniations often result from jobs that require any type of lifting or repetitive bending activities.
If you are someone with complaints of general minor back pain or chronic back tiredness it makes you susceptible to a herniation from only a mild activity such as bending over to pick up a pencil or simple gardening! Disc herniations can also occur from trauma to the body when subjected to any type of accident, be it from a motor vehicle accident or a slip and fall accident.
Lumbar Disc Herniation:
I will now discuss pain symptoms related to lumbar disc herniations. Pain can range from little or no pain if the disc is the only tissue injured, to severe and unrelenting low back pain that radiates into the lower leg regions innervated by the affected nerve roots or spinal cord segments irritated or impinged by the herniated disc material.
Pain complaints often are described to the thighs, knees, calves or all the way to the toes. Other pain symptoms include numbness, tingling, muscular weakness and decreased weakness in the same affected areas as the pain complaints.
Treatment for Radicular Low Back Pain:
Now lets discuss treatment of radicular low back pain. If a disc herniation causes extreme weakness, paralysis or bowel or bladder dysfunction it is considered a surgical emergency and treatment should be sought at the nearest emergency department.
If your symptoms are less severe which is the case in 99% of radiating low back pain patients we start with conservative management of the pain with anti-inflammatory medication treatment, muscle relaxer medication treatment and physical therapy with emphasis on core abdominal muscle strengthening, heat, ice, massage and ultrasound with transition into a home exercise program.
If symptoms persist despite conservative management as detailed above the next step is further diagnostic steps to confirm the location of the disc herniations. To do this generally Magnetic Resonance Imaging or MRI is utilized.
The most common locations of lumbar disc herniations is at L4-L5 or L5-S1 as diagnosed by MRI. Your pain complaints will be to your posterior legs at times all the way to your toes as described above with associated numbness and tingling in the same areas.
Once diagnosis has been confirmed by MRI and conservative treatment measures have failed with anti-inflammatory medications and physical therapy the next step in treatment in treatment is injections directly to the location of the nerve impingement utilizing epidural steroid injections which are performed by a pain management specialist. Of which I consider myself to be one of the best in Manhattan.
Epidural Steroid Injection:
An epidural steroid injection is a minimally invasive procedure that can help relieve radiating low back and leg pain caused by inflamed spinal nerves. Medicines are delivered to the affected spinal nerve through the epidural space, which is the area between the protective covering of the spinal cord, known as the dura, and the vertebrae. The medicine used is generally a combination of a long acting corticosteroid and either saline or a anesthetic numbing agent.
Expected Results:
You may ask what results can be expected with lumbar epidural injections. The relief is dependent on both the severity of the herniation as well as each individual patient as well as the expertise and technique of the physician performing the procedure which it is very important to choose a physician who has been fellowship trained in pain management, which I have been, rather than someone who just took a weekend course in epidural injection treatment.
After Epidural Injection:
Following a first epidural injection you will have a follow up appointment to evaluate your response. Pending your bodies response to the first injection up to 3 injections spaced 1-3 weeks apart may be needed for maximum efficacy.
How Long Does an Epidural Last?
Duration of pain relief varies from weeks to years. Most importantly post injection therapy should be instituted for transition into a home exercise program focusing on strengthening abdominal and low back muscles in hopes of preventing future low back pain episodes. Now finally patients need to know the risks of epidural steroid injections.
Risks of Epidural Injection:
If you choose the correct physician there are few risks involved with the procedure. The correct pain management specialist knows how to screen patients for the appropriate patients for this procedure to ensure that it is not performed on a patient in which it is not beneficial. The proper physician also knows proper technique to ensure appropriate needle position for steroid placement.
Complications generally involve risks associated with needle insertion which involve bleeding, dural puncture, infection, allergic reaction and nerve damage. As described above risk can be mitigated with selection of a skilled physician who knows proper technique and proper patient selection.
The Top Doctor for Epidural Injection?
I have performed thousands of epidural steroid injection procedures without a single complication. So you can be sure you are in skilled hands. Should a complication ever arise, be rest assured that I have been trained to deal with any and every complication. Contact Us today to schedule an appointment.