ANKLE PAIN CARPAL TUNNEL SYNDROME CHRONIC PAIN ELBOW PAIN HIP PAIN IMPAIRMENT & DISABILITY KNEE PAIN MUSCLE WEAKNESS MYOFASCIAL PAIN NECK & LOW BACK PAIN NUMBNESS SHOULDER PAIN WRIST PAIN Spence Rehabilitation Center 9305 Calumet Ave. Suite C-1 Munster, IN 46321 Phone : (219) 513-2267 Fax      : (219) 836-1276         What are some potential Causes? Often the exact etiology is unclear and can be resulting from a combination of many different factors. Some potential causes can include:   1. Muscle Strain 2. Facet arthritis: The joints that help to stabilize spine at the neck level develop arthritis. Over time, bony arthritis can form on the vertebra which is called spondylosis and this can narrow the spinal canal where the spinal cord or nerve roots are located. Bony narrowing of the spine is also known as spinal stenosis. 3. Disc bulging: The fibrous tissue that make up the disc become less elastic and the disc begins to dry out. Consequently, the disc can bulge out and pinch on the spinal cord or a nearby nerve root. 4. Disc herniation: The disc contain a jelly material called the nucleus pulposis that helps to cushion the spine. With aging, the outer fibrous tissue can develop a hole and the inner jelly can protrude out resulting in a herniation. This jelly material can compress on the spinal cord or nearby nerve root. Also, there are inflammatory irritants in this jelly material that can affect the spinal cord or nearby nerve root resulting in pain. 5. Other causes of neck and low back pain: Ometimes tumors, infection or inflammatory diseases can mimic musculoskeletal pain. Patients with risk factors must be worked up closely to rule these diseases out. Important risk factors include history of cancer, recent unintentional weight loss, severe pain that wakes patients from sleep, new numbness or weakness, fevers or chills, and recent trauma.     Important factors to consider in your medical history.   1. Pain intensity 2. Is the pain intermittent or constant 3. Does the pain radiate or move to other areas of your body? Pain that radiates down the extremities can sometimes be due to an irritated nerve root which may require special attention 4. Are there certain positions that make the pain worse? Pain that is aggrevated by neck flexion can sometime be due to disc bulging or herniation while pain that is aggrevated with extension can be caused by compression from behind as in spinal stenosis 5. Are there certain activities that make it better? 6. Do you have a history of trauma such as a fall, motor vehicle accident, etc? 7. Do you have a history of cancer or inflammatory disease such as rheumatoid arthritis or lupus? 8. What medications have you tried? 9. Have you had imaging tests in the past such as X-rays or MRIs? If so, please be sure to bring your films or reports to your doctor. They can be used to look for new changes and minimize doing unnecessary repeat studies 10. Have you had physical therapy and if so, what exercises were performed, were they helpful? 11 Have you had injections before such as trigger point injections, epidural steroid injections, or pain procedures performed in a surgery center? 12 Have you had surgeries performed on the spine in the past? 13 Do you have a history of anxiety or depression or sleeping difficulties?     What are common factors to consider on physical exam?   1. Neck and back range of motion: A limitation can be caused by inflammatory diseases, muscle imbalances, or caused by pain. 2. Tenderness on the spine: The spine can be due to fractures or focal abnormalities of the spine itself. 3. Muscle atrophy: Also known as muscle wasting. Atrophy can be caused by compression of a nerve root or elsewhere. 4. Sensation: If a deficit is present, It’s location can hint on the cause. If a nerve root is compressed, the level can sometimes be determined by the sensory exam. 5. Reflexes: If reflexes are decreased, it could mean nerve root compression. If they are increased, it hints at compression of the spinal cord itself or an abnormality of the central nervous system. 6. Muscle spasm or trigger points: Tender bands of muscle that limit range of motion. For more information, please refer to the myofascial pain section. 7. Special Tests: Certain tests or provocative maneuvers can be used to further characterize the pain.     What are common Studies used to evaluate for neck pain?   1. X-rays are used to rule out fracture. Sometimes flexion and extension films are need to rule out spondylolisthesis which is movement of one vertebrae on the other resulting in narrowing on the spinal canal which can compress on nerve roots or the spinal cord. X-rays are important if pain has not gone away and the physical therapist is planning to perform traction or spinal mobilization. 2. CT and MRI studies: MRIs are used to evaluate for soft tissue abnormalities such as disc herniations, tumors, or infections that could be causing compression. CT scan are more helpful in assessing for bony arthritis of the spine. 3. Blood tests: Sometimes lab work is necessary to check for inflammatory problems such as rheumatoid arthritis or spondyloarthropathies. 4. Electromyography and Nerve Conduction Studies: This study is used to check the integrity of nerves. This test is typically ordered if numbness or weakness is present. It can locate whether a nerve is pinched, where, when, and how bad is the damage. The test is also helpful to rule out other nerve disorders that can mimic nerve compression.     What are common treatments for neck and low back pain? Treatment effectiveness depends on appropriate diagnosis, patient compliance, psychosocial factors, medical comorbidities, and it’s duration. Some treatment options to treat mild, nonspecific neck and low back pain using a conservative approach include: What are common pain medications for neck and low back pain?   1. Tylenol: Be sure not to take more than 4 grams a day because of the drug effect on the liver at excessive doses. Patients who consume alcohol or have liver disease need to be especially careful. 2. Nonsteroid anti-inflammatory medications (NSAIDS): Include naprosyn, ibuprofen, and celebrex. These medications can result in GI irritation or ulcers if used excessively. Patients with kidney problems need to be monitored closely and patients who have a history of heart problems should get clearance from their cardiologist. 3. Antidepressants: Amitriptylene, nortriptylene, and cymbalta have been shown to not only improve mood but also improve pain control. 4. Muscle relaxants: Are most effective when used in combination with an anti-inflammatory medicine. 5. Tramadol also known as Ultram that prevents reuptake of Serotonin and Norepinephrine. It has some opiate like properties so it can be habit forming and should be used carefully.   What are some Nonpharmacologic Treatment options for neck pain?   1. Heat: Apply a moist hot pack to the painful area for fifteen to twenty minutes followed by some range of motion and stretching exercises. 2. Ice: Is most effective at controlling acute pain and following exercises. Apply a cold pack to the painful area for fifteen to twently minutes every four to six hours until your symptoms improve. 3. Massage: Apply gentle pressure to the affected area followed by a stretch. Some commercial devices are available for purchase at your local pharmacy to assist you. 4. Range of motion exercises: Should be done twice a day as tolerated. For specific exercises, please refer to the neck and low back exercise sections. If you are experiencing severe pain, pain shooting down your arm, numbness, or weakness, you should be promptly evaluated by your doctor for a possible pinched nerve.       5. Posture training: Typically reviewed by physical therapists. Also, an ergonomic assessment can be helpful which used to determine what your daily work activities are and whether job modification strategies can help. 6. Stress reduction: Meditation, biofeedback, and relaxation techniques can be taught by certain health clubs and pain centers. 7. Transcutaneous electric nerve stimulation (TENS): A device that provides a low level stimulation to block pain going to the brain. The etiology is unclear but is believed to be due to stimulation of certain receptors that then interfere with transmission of pain receptors. Another theory is that serotonin and dopamine levels are increased which help to decrease pain. 8. Trigger point Injections: Can be used to break the pain cycle and help to reset the hypersensitive muscles. Injections typically include anesthetic agents such as lidocaine with or without a low dose of steroid. Some studies even demonstrated that dry needling (no medication) and Botox can be helpful. Because trigger point injections are often used to treat chronic pain, it is sometimes necessary to perform a series of injections to get optimal effect. The injections are typically performed in two to three week intervals. However, if the pain has not responded after three rounds, it should be considered that there may be some other factor that needs to be assessed further. 9. Acupuncture has been shown to be beneficial under certain conditions. 10. Epidural Steroid Injections: These injections are usually used to target a specific nerve that is suspected to be irritated. The nerve root is localized using X-ray guidance then steroid and an anesthetic are injected at the site. These medications are used to target the inflammatory components that are believed to be causing the pain. Symptoms that typically warrant an epidural steroid injection include severe pain radiating down an extremity that has not responded to conservative treatments. Imaging studies such as an MRI should first be obtained to evaluate for the pain source such as a herniated disc as well as rule out other problems such as infections, tumors, etc. 11. Facet joint injections: These joints initially stabilize the spine but actually become weight bearing with aging which leads to arthritis. Facet arthritis can be targeted with certain procedures if conservative treatments fail. A facet joint injection is typically used to determine if the facet joint is truly the source of the problem. Typically, an anesthetic is injected into the facet joint using X-ray guidance. If the pain subsides following the injection, the facet joint is the likely culprit. This procedure can also help limit pain but it’s effectiveness can be limited which may warrant other procedures such as medial branch blocks or rhizotomies.

Disclaimer

"Nothing contained on this website should be interpreted to be medical advice. This website is for general information only. Please consult a physician for medical advice regarding any medical condition."

© 2008 Spence Rehabilitation Center. All rights reserved. Designed by :