Back pain beyond the odd muscle spasm or two. (By Hans de Wit – StretchingSA)
In some rare cases, we have found patients complaining about back pain, but it seems that the signs and symptoms are simply not adding up as a normal musculoskeletal problem. Muscle spasms and possible associated degenerative and musculoskeletal disorders are simply not just the only answer. Therefore, it is very important to have a specialist do a proper diagnosis on your back condition when you have one of those “chronic ailments” “no one” seems to be able to fix.
In this article I will attempt to bring you some alternative reasons for back pain, what can cause them, and what is the most likely outcome. Also having said that, I will attempt to tell you which conditions CANNOT BE FIXED BY ANY FORM OF PHYSICAL THERAPY. At StretchingSA we are very aware of this, and will not hesitate to send a patient to the right medical expert when it becomes clear that the outcome is not favourable for stretch therapy. We’ll call this CONTRAINDICATIONS to stretch therapy. In medicine, a contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a reason to use a certain treatment.
Possible contraindications are:
- Cauda Equina lesions
Low back pain is very common. It affects millions of people. In most cases, you don’t need surgery for low back pain. But in rare cases, severe back pain can be a sign of cauda equina syndrome (CES), a condition that usually requires urgent surgical treatment. People with cauda equina syndrome often are admitted to a hospital as a medical emergency. Here’s what you need to know about cauda equina syndrome.
What Is Cauda Equina Syndrome?
Cauda equina syndrome is a rare disorder that usually is a surgical emergency. In patients with cauda equina syndrome, something compresses on the spinal nerve roots. You may need fast treatment to prevent lasting damage leading to incontinence and possibly permanent paralysis of the legs.
CES affects a bundle of nerve roots called cauda equina (Latin for horse’s tail). These nerves are located at the lower end of the spinal cord in the lumbosacral spine. They send and receive messages to and from your legs, feet, and pelvic organs.
It may be hard to diagnose cauda equina syndrome. Symptoms vary and may come on slowly. They also mimic other conditions. If you have any of these symptoms, see your doctor right away:
- Severe low back pain.
- Pain, numbness, or weakness in one or both legs that causes you to stumble or have trouble getting up from a chair.
- Loss of or altered sensations in your legs, buttocks, inner thighs, backs of your legs, or feet that is severe or gets worse and worse. You may experience this as trouble feeling anything in the areas of your body that would sit in a saddle (called saddle anasthesia).
- Recent problem with bladder or bowel function, such as trouble eliminating urine or waste (retention) or trouble holding it (incontinence).
- Sexual dysfunction that has come on suddenly.
The meninges are membranes that cover the brain and spinal cord. Meningitis is a condition involving the inflammation of these membranes. Meningitis can be caused by a virus or bacteria, with bacterial meningitis being much more severe. Symptoms of bacterial meningitis include high fever, headache, spinal stiffness, nausea, vomiting and even back pain, according to the Mayo Clinic. It is important to diagnose meningitis properly to ensure the appropriate treatment. For bacterial meningitis, antibiotics are an effective treatment and can help prevent the spread of the infection to others, according to the centres for Disease Control and Prevention.
- Bacterial Endocarditis
Bacterial endocarditis, also known as infective endocarditis, is an infection that attacks the inner lining of the heart, called the endocardium, and the heart valves. This infection is rare in people with normal hearts, but is a very real concern for anyone who has damaged heart valves or heart tissue. Bacteria that manage to enter the bloodstream lodges on damaged heart tissue and can further destroy the heart. Quick diagnosis and treatment are necessary to prevent severe damage. According to a 1977 study published in the journal Annals of Internal Medicine, bacterial endocarditis may manifest many musculoskeletal symptoms, including back pain.
Tuberculosis is an infection that can attack any part of the body, but usually resides in the lungs. Once the infection lodges in the lungs, explains the British charity TB Alert, it causes symptoms of a pervasive cough that lasts for many weeks and gets worse over time, weight loss for no apparent reason, loss of appetite, night sweats, fatigue and fever. According to TBalert.org, all forms of tuberculosis are curable without lasting effects if they are diagnosed and treated early enough. Only tuberculosis of the lungs and throat are potentially infectious. A tuberculosis infection can travel to other parts of the body and can cause a variety of symptoms, including back pain.
- Urinary Tract Infection
The urinary tract includes structures such as the kidney, bladder, the ureters and the urethra. The function of the urinary tract is to eliminate waste. According to the National Kidney and Urological Disease Information Clearinghouse, or NKUDIC, urinary tract infections are the most common infection in human body. The NKUDIC also reports that when the infection reaches the kidneys, symptoms may include frequent urination, painful or burning urination, a feeling of fullness, a general feeling of weakness, back pain, nausea and vomiting.
- Bacterial infection
Antibiotics are being investigated as a new way to treat chronic lower back pain. It’s thought that up to one in four cases may actually be caused by infection and not by mechanical problems such as poor posture or improper lifting.
In a Danish study, more than half the patients were either cured or much improved after 90 days of daily antibiotics. A much larger trial is now under way, with results expected later this year.
Many patients improve within three months of this initial visit, but up to 50 per cent continue to suffer pain and disability. Carrying heavy items and sleeping on soft mattresses are common causes, but in many cases the problem is a herniated or slipped disc. The discs, which are slotted between each of the vertebrae, are made up of a hard, fibrous outer ring with a soft inner part called the nucleus. The discs can degenerate with wear and tear; the outer part then cracks, forcing the pulpy centre to bulge into the spinal canal. This can irritate the nerves running from the spinal cord down the leg, causing back pain and pins and needles down the leg. Conventional treatments range from lifestyle changes and physiotherapy to painkillers and surgery.
However, it’s thought bacteria may be implicated, after MRI scans of patients with herniated discs have shown key changes in the vertebrae – the bone itself around the affected area swells. The scans showed that this occurs in up to seven out of ten patients with a herniated disc. Patients with normal healthy discs do not develop these changes. In the pilot study, 29 patients with lower back pain and these bone changes were given the antibiotic amoxicillin-clavulanate for three months. Following treatment, 52 per cent of the patients reported that they were much better or cured and 24 per cent were moderately better. Nobody’s symptoms worsened, although symptoms had been getting more severe in the months before treatment. Researchers believe that when a disc becomes herniated, bacteria can enter and cause an infection. That results in an immune system response – the visible bone changes
Neoplasms commonly invades the spine. In addition to metastatic solid tumors, such as breast and prostate cancer, lymphomas and myeloma often involve vertebral bodies and produce back pain. Tumors arising from the spinal cord, nerve roots, or surrounding tissues are much less common. Some benign tumors, such as spinal meningioma’s and neurofibromas, also cause pain when they occur.
Back pain can be caused by numerous types of infections. Bacteria can invade the vertebral bodies (osteomyelitis) or causes abscesses inside the spine. Chronic infections, such as Lyme disease, can involve the structures inside the spine. Viruses, such as the zoster virus causing shingles, can attach specific levels of the spine and cause back pain.
Sources: livestrong.com, webmd.com, Wikipedia.com, encyclopedia.com, dailymail.co.uk, healingchronicpain.org, tbalert.org