Dr. Rigoberto Tapia in Forest Park

Medical Acupuncture for Back Pain

Prescription to keep yourself healthy and live longer:
A monthly boost of energy with Acupuncture, eight hours of refreshing sleep, daily healthy diet with 1 Hour of exercise; and do not forget to keep in balance the amount of work, leasure activities and minimum stress.

BACK PAIN

FACTS & MISCONCEPTIONS:

Facts

                        •  Back pain is the second most common reason that people visit a physician, right behind the common

cold.

                        • out of 14 people will seek medical care for back or neck pain every year.

                        •  The cost of back injuries exceeds $80 billion in the U.S. each year.

                        • 0% of people over 30 years old will experience back problems at some point; 30% will have recurring

problems.

                         In people younger than 45 years, back pain is the most common cause limiting activities.

                         84% of smokers are likely to develop degenerative disc disease in the lumbar spine, which can be a

source of pain.

 

Misconceptions

Given the large number of people afflicted with back pain, many misconceptions exist about the condition, such as:

• Back belts allow you to lift more weight.

• Bed rest will cure back pain.

• Heat is best for acute back pain.

• Obesity is unrelated to back pain.

• You should not exercise if you have back pain.

 

THESE ARE ALL FALSE!

WHAT CAN YOU DO TO LOWER YOUR RISK OF BACK PAIN?

•   Don’t smoke. Smoking contributes to the potential for back pain as nicotine restricts the flow of blood to the discs that cushion the spine.

• Maintain an ideal body weight. Excess weight, especially in the stomach, puts additional strain on your back muscles. Furthermore, studies have shown a correlation between excess weight and pain from arthritis. Arthritis affects the back just like other joints in the body.

•   Exercise regularly. Exercise, including that focused on strong abdominal muscles, can help prevent back pain.

•   Use proper body mechanics as part of your every day life:

                   Pushing imparts less stress on your back than pulling.

                     When standing, 

                          Distribute your body weight evenly on your feet.  

                          Contract your abdominal muscles slightly to support your spine. 

                          Change positions frequently. 

                          Keep objects you are working with at a comfortable height. 

                          Place one foot on a raised surface, if possible.

                      When sitting, 

                          Sit in a chair that provides proper support for the natural curves of your spine

                        When driving,

                          Position the steering wheel of your automobile within a forearm’s distance from your body.

                      When lifting,

Use the muscles in your legs instead of your back, and contract your abdominal muscles.

 

BASIC SPINE ANATOMY

Your spine is a complex structure of bones and cartilage that encases the spinal cord. Its network of nerve tissue carries sensory and motor impulses between your body and brain. The following information will provide you with a basic knowledge of the anatomy and function of your spine and spinal cord, and familiarize you with medical terms that are commonly used. This in turn will enable you to better understand the effects of your spine disorder and help you be more informed about your care.

 

Vertebrae (1)

The 33 bones that form the spine, or vertebral column. These bones provide structural support for the spine and encase the spinal cord. Each vertebra has a front and a back. The front is called the vertebral body. The back part of the vertebra is called the arch.

 

Facet Joints (2)

The joints that connect a vertebra to the vertebra above or below it.      

Facet joints are paired, meaning that there is a left and a right

joint, and are located to the sides and behind the discs. Facet

joints control the amount and direction of spinal movement.    

Spinal Cord (3)

A cylinder of nerve tissue, about 18 inches long and roughly the thickness of a

finger, that runs down the central canal in the spine, It carries both sensory and motor information between the body and the brain.

.

Discs (4)

Fibrous pads of cartilage that separate vertebrae. The discs allow for flexibility in your spine, assist the muscles as shock absorbers, and provide cushioning between the vertebrae. The center of the disc is called the nucleus pulposus, a jelly-like substance. It is surrounded by tough rings of tissue called annulus fibrosus, which are similar to ligaments.

 

Ligaments (5)

Strong, fibrous bands of tissue that connect vertebra to vertebra.

Ligaments prevent excessive movement of the joint.

 

Intervertebral Foramina (6)

(sing., foramen) The spaces within the vertebral column through which the spinal nerves pass.

 

Spinal Nerves (7)

These 31 pairs of nerves, located on each side of your spinal cord, transmit sensory and motor impulses between your brain and the rest of your body. They branch off the spinal cord and exit into your muscles through the intervertebral foramina (6).

 

Arch (8)

Bony structures, which make up the arch, are the transverse processes (9), lamina (10) and spinous processes (11). Muscles and ligaments attach to the arch to help support and stabilize the spinal column.

Muscle

Elastic tissue that is able to contract and relax, allowing parts of the body to move. (Not shown in diagrams.) Muscles of the spine attach vertebrae to each other or to other bones, such as the ribs, in order to allow movements like bending, rotating, and stretching.

 

Tendons

Fibrous tissue that joins muscle to bone. (Not shown in diagrams.)

 

Spinal Curves

The spinal column can be compared to a series of napkin rings (vertebrae) stacked one on top of the other. The purpose of the spinal column is to support your body and allow it to move. The spinal column also protects the spinal cord and the spinal nerves, which enter and exit from the spinal cord. The spinal column is divided into five sections: cervical (neck), thoracic (chest area), lumbar (low back), sacral and coccyx.

 

•   Cervical (neck) curve 7 vertebrae

•   Thoracic (middle spine) curve— 12 vertebrae

•   Lumbar (lower spine) curve 5 vertebrae

•   Sacral curve (base of the THORACIC spine) 5 fused vertebrae

•   Coccyx tail bone, 3-5 fused vertebrae

 

BASIC SPINE CONDITIONS

Back Strain

This non-radiating back pain occurs as a result of stress placed on the lower spine. Back strain may be related to strain on the muscles or ligaments caused by either a specific traumatic episode (such as a car accident) or poor body mechanics.

 

Degenerative Disc Disease

Discs are fibrous pads of cartilage which separate vertebrae. The discs allow for flexibility in your spine, assist the muscles as shock absorbers, and provide cushioning between the vertebrae. As a disc ages, it can dry out, flatten, and lose its elastic, springy quality. As a result, the vertebrae above and below the disc move closer together and can pinch the nerves of the spinal cord. Also, vertebra ends can thicken and form bony growths, or spurs, called osteophytes, which can further irritate the nerves.

 

Disc Injury

Disc injury is among the most common spine problems, and usually results from repetitive and excessive stress on the annulus fibrosus (tough rings of tissue that protect the nucleus pulposus, the center of the disc). Disc injury can also be caused by a loss of normal movement in other areas of the spine and in the extremities, and by any sudden movement. A disc injury may be referred to as a bulging, herniated, or extruded disc, terms which indicate the extent to which the disc is damaged. Following, each term is defined.

BULGING DISC

As a disc ages, it dries out and begins to shrink and lose its original height. This loss of disc height produces a bulging of the outer portion of the disc, either on the entire periphery of the disc or on one side of it. A bulging disc produces increased tension on surrounding soft tissue structures, such as ligaments and nerves, and can cause pain, stiffness, or a muscle spasm.

HERNIATED DISC

When some of the annulus fibrosus tears, portions of the nucleus pulposus can herniate, or squeeze, through the defect. When the herniated part of the nucleus stays in contact with the annulus fibrosus, the condition is called a herniated disc. If the herniation is large, it can irritate or compress the spinal nerves. A herniated disc may cause pain, stiffness, tingling, numbness, and weakness in the upper or lower extremities. In rare cases, the herniation can exert pressure on the spinal cord itself, causing weakness or paralysis of the arms or legs, or both. These are symptoms of a type of spine condition called myelopathy.

 

EXTRUDED DISC

                               When the herniated portion of the nucleus (see above definition) is no longer in contact

                               with the annulus fibrosus, the condition is known as an extruded disc. The extruded nuclear

                               pulposes material may be referred to as a fragment. When the disc fragment moves above

                               or below the disc from which it came, the condition is referred to as a sequestrated disc.

                               Extruded and sequestrated discs cause the same symptoms as herniated discs.

 

Ligament Strain

Ligament strain is caused by a partial tear in the ligament. The initial symptom is pain felt immediately

after injuring the ligament, followed by stiffness and limited mobility without pain. A backache may

develop when a person with an injured ligament practices poor body mechanics, attempts to lift or support

heavy objects, or stands for a prolonged period of time, especially when wearing high-heeled shoes.

 

Mechanical Back Pain

This type of back pain usually occurs as a cumulative effect of poor body mechanics, which place

tremendous stress on the spinal structures. Mechanical back pain can occur as a result of lifting, bending, or

twisting, remaining in the same position for an extended period of time, or a combination of these

activities.

 

Osteoarthritis

Osteoarthritis, sometimes called spondylosis, is a disease that causes the breakdown of joint tissue, leading

to joint pain and stiffness. It affects almost every person over age 60 to some degree.

In healthy joints, a firm, rubbery material called cartilage covers the edge of each bone, acting as a cushion between the bones. When osteoarthritis occurs, the smooth cartilage surface becomes pitted and frayed and eventually wears away, leaving the ends of the bone exposed. Without the cartilage between the bones, the bones rub together and cause pain, and the joint may lose its normal shape. The bone ends may eventually thicken and form bony growths, or spurs, called osteophytes. When this occurs in the spine, it can lead to degenerative disc disease.

The causes of osteoarthritis include wear and tear on the joints, especially the joints that bear weight the knees, hips, feet, and spine. Other factors are heredity, obesity, poor diet, and trauma to the joint, such as a fracture.

 

Osteoporosis

Like skin, bone steadily gets rid of its old cells and replaces them with new ones. As people reach their mid- to late 30s, however, more cells are removed than are replaced, causing bones to deteriorate. Osteoporosis, a sometimes crippling bone condition, occurs when the bones deteriorate so much that they become brittle and more susceptible to fractures. Osteoporosis commonly occurs in post-menopausal women and can affect the bones of the spine, rib cage, and extremities.

 

Sciatica

                      Sciatica is pain that radiates along the sciatic nerve. The pain sometimes extends from the buttock down the

                      back of the leg to the foot. Symptoms can include numbness, weakness in the legs and ankles, and a prickly

                      sensation. The most common cause of sciatica is a disc injury, although any kind of pressure on the sciatic

                      nerve or disorder that involves nerves can produce this condition.

 

Spinal Stenosis

There are two forms of spinal stenosis (the word stenosis means

narrowing). One form, central spinal stenosis, occurs when bony growths in the spinal canal

reduce the diameter of the spinal canal, squeezing the spinal cord, which is inside. Central spinal

stenosis may cause pain, weakness, numbness, and shock-like sensations in one or more of the extremities.

                                  The second form of spinal stenosis, foraminal spinal stenosis, is caused by the narrowing of the intervertebral

                                  foramina, the spaces within the vertebral column through which the spinal nerves pass. In this case, the nerve

                                  roots may be pinched. Foraminal stenosis may cause numbness, tingling, and pain in the arms or legs.

 

Spondylosis

See Osteoarthritis entry.

 

Spondylolisthesis/Spondylolysis

Spondylolisthesis is the forward slipping of one vertebrae over another. It most commonly occurs in the

lumbar (lower) spine but may also occur in the cervical (upper) spine. Spondylolisthesis may be caused by

recurrent microfractures, congenital abnormalities of the spine, or osteoarthritis.

Spondylolysis is the term used when a fracture occurs in a specific area of the back (arch) of the vertebrae. These two conditions do not necessarily occur together; patients may experience one or both. Symptoms, which are not always evident, may include back pain and, less commonly, leg pain.

 

WHAT TREATMENTS ARE AVAILABLE TO RELIEVE BACK PAIN?

Medication Therapy

The goal with any pain medication should include opening a window of opportunity for the patient to do the proper core exercises so that muscles can be strengthened and further injury can be prevented as injured tissues heal. There are many first line drug therapies available, the efficacy of which depends largely on patient history and the nature of the back pain.

 

Physical Therapy

Under the direction of a physician, physical therapists educate the patient regarding proper body mechanics and establish an individualized exercise program that enables self-management of the condition at home. Compliance with home exercise programs can be encouraged by therapists and physicians by educating patients that home exercises are the most effective ‘medication’ for their back pain, and, just like other medications, need to be administered regularly to be beneficial.

Consistent exercise is really key for patients who suffer from back pain. Patients maintaining a home exercise program strengthen core muscles, which in turn keep pressure off of the spine. By stretching tight muscles affecting the injured area and strengthening weak muscles supporting the injured area, the patient is allowed to heal naturally.

The progression of an exercise program can be supported through treatments such as heat, ice, electrical stimulation, massage, medications, injections and manipulations. Throughout these treatments, it is recommended that the lines of communication between specialists and the patient’s general practitioner be kept open. A good physical therapist will provide progress notes and keep the referring physician informed about potential problems or plateaus in treatment.

Lower back pain (LBP) can be challenging to diagnose and treat effectively, but the continually emerging evidence in support of exercise and physical therapy treatments bodes well for present and future LBP sufferers. Exercise empowers patients to take an active role in their treatment. It also encourages the long­term prevention of repeat injury.

 

Surgery

Two general types of surgery comprise the most common procedures performed to treat low back pain: decompression and spinal fusion.

•  Decompression back surgery involves removing a small portion of the bone over the nerve root and/or disc material from under the nerve root to relieve pinching of the nerve and to provide more room for the nerve to heal (a microdiscectomy or laminectomy).

                   •   Spinal fusion involves using a bone graft to stop the motion at a painful vertebral segment, which in

                    turn should decrease pain generated from the joint. Spine surgery instrumentation (medical devices),

                   bone graft procedures, and bone stimulators are sometimes used along with spinal fusion surgery.

                   Artificial discs are also being used as an alternative to spinal fusion.

 

Complementary Medicine!

There is a growing recognition that complementary and alternative medicine (CAM) may hold special value in meeting todays consumers health needs. Thanks to increased research over the past twenty years, doctors are now befter able to understand the role these therapies can play in helping treat and prevent disease, such as low back pain.

                  A recent survey conducted by the National Center for Complementary and Alternative Medicine and

                  the National Center for Health Statistics found that back pain was the most common condition

                  consumers used complementary medicines to treat. Furthermore, the survey revealed that most people

                  use CAM to supplement the care they receive from their doctor, rather than in place of conventional

                  treatment. Some complementary therapies used to treat low back pain include:

 

                                     •  Acupuncture:

                                       During acupuncture, very thin needles are inserted to various depths at strategic points

                       on your body. Preliminary studies indicate that acupuncture may help relieve low back pain.

 

•   Spinal manipulation: Spinal manipulation is based on the premise that health and disease are directly related to the functioning of the body’s neuromusculoskeletal system, and that with proper alignment of your bones, joints, muscles and associated nerves come health and healing. Research has shown that spinal manipulation is an effective treatment for low back pain, especially shortly after the pain begins.

 

•   Massage: During a massage, a therapist manipulates your body’s soft tissues your muscles, skin and tendons using his or her fingertips, hands and fists. Massage can relieve tension in your muscles and most people use it for relaxation, relief of stress and anxiety. Massage can also cause your body to release natural painkillers, and it may boost your immune system. Back pain might be relieved by massage, however research results have been contradictory and more study is required.

 

•   Yoga: Yoga is comprised of a series of postures along with controlled breathing exercises. According to the National Institutes of Health, yoga decreased symptoms of back pain in a well-designed study, with the improvement lasting several months.