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back pain, Facet joint radiofrequency denervation, neck pain

FACET JOINT RADIOFREQUENCY DENERVATION FOR NECK PAIN AND BACK PAIN

S Bara

FACET JOINT

The spine is a column of bones arranged one on top of the other. The bones are linked at the back by joints called facet joints, one on each side. The facet joints hold the bones together and stabilise the spine, while also allowing movement.

The facet joints may become painful either due to wear and tear (also called degenerative change), stress or injury, although the reason is not always clear. Pain is felt around the facet joints and in the surrounding area. For example, pain starting from the joints of the lower back will often be felt in the buttocks and upper legs.

WHEN IS DENERVATION USED?

The denervation procedure is usually considered after trying less invasive treatments, such as medication, physiotherapy, transcutaneous nerve stimulation (TENS).

Exercise, acupuncture, yoga/pilates and relaxation therapy may also help ease back pain. Spine surgery could be also considered in selected cases.

Denervation is usually only considered if you have responded well to local anaesthetic injections near the affected areas, and these have helped to reduce pain.

WHAT IS THE FACET JOINT RADIOFREQUENCY DENERVATION

Facet joint radiofrequency denervation is a procedure in which nerve fibres supplying the painful facet joints are selectively destroyed by heat produced by radio waves and delivered through a needle.

The treatment is usually performed after an injection of a local anaesthetic close to the affected joints has helped to reduce feeling and pain.

The denervation treatment involves placing a special needle (radiofrequency probe) near the nerve of the joint; when a radiofrequency current is passed down the probe, a very small area of heat is created that causes a break in the nerve. This procedure does not affect any other part of the body. https://www.nice.org.uk/researchrecommendation/radiofrequency-denervation-what-is-the-clinical-and-cost-effectiveness-of-radiofrequency-denervation-for-chronic-low-back-pain-in-the-long-term

back pain, Back pain after bending over, Back pain after exercise

5 REASONS FOR BACK PAIN AFTER BENDING OVER

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(1) Muscle spasms

Muscle spasms or cramps are quite common. They can happen at any time of the day, but especially during exercise or in the days following a workout. They are commonly caused by muscle overuse, nerve compression, lack of blood flow, dehydration.

Muscle spasms in the lower back often occur when you are bent over and lifting something, but they can happen during any movement involving your lower body.

(2) Strained muscle

A strained or pulled muscle occurs when a muscle is overstretched or torn. It’s commonly caused by overuse, physical activity, lack of flexibility.

(3) Herniated disc

The spine is made up of many parts including spinal discs and vertebrae. If a disc slips, it means that the soft center of the disc has bulged out, which can irritate the nearby spinal nerves. A slipped disc may be accompanied by severe shooting pain.

(4) Spondylolisthesis

Spondylolisthesis is caused by an injured vertebra shifting or slipping forward on the vertebra directly below it. More likely in younger people who participate in sports like gymnastics and weightlifting, spondylolisthesis is often the result of untreated spondylolysis. Spondylolysis is a stress fracture or crack in the small, thin portion of the vertebra that connects the upper and lower facet joints.

(5) Arthritis

Lower back pain may be the result of arthritis. Your joints are protected by cartilage, and when your cartilage deteriorates, it can cause pain and stiffness. There are many different types of arthritis, including osteoarthritis, psoriatic arthritis, rheumatoid arthritis.

The back pain you are feeling when you bend over is likely due to a muscle pull or strain. It could, however, be something more serious such as a herniated disc. If you are experiencing severe back pain, blood in urine, changes in bowel or bladder habits, pain when you lie down, or fever, you should get medical help right away.
If your back pain does not go away or improve over time, schedule an appointment with your doctor for a full diagnosis. https://www.nhs.uk/conditions/back-pain/

L5-S1 herniation, L5-S1 LUMBOSACRAL JOINT OF SPINE COLUMN

L5-S1 LUMBOSACRAL JOINT OF SPINAL COLUMN

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The spinal column on the back is made up of vertebrae. Vertebrae are the 33 individual bones that interlock with each other. The vertebrae are numbered and divided into regions: cervical (there are 7 vertebrae in this region), thoracic (there are 12 vertebrae in this region), lumbar (there are 5 vertebrae in this region), sacrum (there are 5 fused vertebrae in this region), and coccyx (there are 4 fused vertebrae in this region). Only the top 24 vertebrae are moveable; the vertebrae of the sacrum and coccyx are fused.

L5-S1 helps transfer loads from the spine into the pelvis and legs. The L5-S1 motion segment has distinctive anatomy and receives a higher degree of mechanical stress and loads compared to the segments above. These characteristics may make L5-S1 susceptible to traumatic injuries, disc herniation, degeneration, and/or nerve pain.

Conditions affecting the L5-S1 spinal motion segment are usually treated with non-surgical methods. If the lower back and/or leg symptoms worsen or do not improve despite non-surgical treatments, or in case of certain medical emergencies, such as tumors or cauda equina, surgery may be recommended.

NON-SURGICAL & SURGICAL TREATMENTS FOR L5-S1

NON-SURGICAL TREATMENTS FOR L5-S1

  • Medication. Over-the-counter (OTC) medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first for pain stemming from L5-S1. For more severe pain, prescription medication, such as opioids, and/or corticosteroids may be used.
  • Physical therapy. Specific exercises and physical therapies can be designed to target pain stemming from L5-S1. These therapies help stabilize the back and keep the muscles and joints well-conditioned for long-term relief, while also providing a healing environment for the tissues in the lower back.
  • Chiropractic manipulation. Manipulation of the lumbar spine through chiropractic adjustment may help relieve pain stemming from L5-S1.
  • Self-care. Mild to moderate pain may be treated with heat and ice at home. For sciatica pain, it is usually advised to stay active and continue daily activities as tolerated. While bed rest may provide temporary relief from symptoms, it usually does not aid in faster or long-term recovery for sciatica.
  • Lumbar epidural steroid injections. Steroids injected directly into the spinal epidural space can help decrease inflammation and reduce the sensitivity of nerve fibers to pain, generating fewer pain signals. These injections are more effective in treating the inflammatory causes of pain, such as pain from herniated disc fragments.

SURGICAL TREATMENTS FOR L5-S1

  • Microdiscectomy: A small part of the disc material near the nerve root is taken out. A portion of the bone adjacent to the nerve root may also be trimmed to relieve compression.
  • Laminectomy: A part or all of the lamina (area of bone at the back of the vertebra) is removed to provide more room for the cauda equina.
  • Foraminotomy: The opening for the spinal nerve root (intervertebral foramen) is enlarged by trimming bony overgrowth, relieving the compression.
  • Facetectomy: The facet joints are trimmed to relieve compression of nerve roots.
  • Lumbar interbody fusion: A degenerated disc is removed and L5-S1 vertebrae are fused with implants or bone grafts. https://www.nhs.uk/conditions/lumbar-decompression-surgery/
Pain Management Specialist

PAIN MANAGEMENT SPECIALIST. FIRST VISIT TO A PAIN MANAGEMENT DOCTOR.

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PAIN MANAGEMENT SPECIALIST
A pain management specialist is a doctor who evaluates your pain and treats a wide range of pain problems. A pain management doctor treats sudden pain problems such as headaches and many types of long-lasting, chronic, pain such as low back pain.

FIRST VISIT TO A PAIN MANAGEMENT DOCTOR
On the first visit, a pain management doctor will ask you questions about your pain symptoms. He or she may also look at your records, your medication list, and prior diagnostic studies (X-ray, MRI, CT). The doctor will perform a thorough physical exam. At the first visit, It helps to have a pain journal or at least, to be aware of your pain patterns.

Common things your doctor may ask on the first visit:

  • Where is your pain? (what body part)
  • What does your pain feel like? (dull, aching, tingling)
  • How often do you feel pain? (how often during the day or night)
  • When do you feel the pain? (with exercise or at rest)
  • Setting for the pain? (is it worse standing, sitting, laying down)
  • What makes your pain better? (does a certain medication help)
  • Have you noticed any other symptom when you have your pain? (like loss of bowel or bladder control)

If you find you’re having difficulty managing your pain, ask the GP for a referral to a specialist pain clinic. Pain clinics offer a wide range of treatments and support. They aim to support you in developing self-help skills to control and relieve your pain. https://www.nhs.uk/live-well/healthy-body/how-to-get-nhs-help-for-your-pain/

Uncategorized

BEST SEATING POSITIONS FOR GOOD POSTURE WHEN WORKING ON THE COMPUTER

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(1) SUPPORT YOUR BACK
If your office chair doesn’t have lumbar support, grab a small towel and roll it up. A small pillow will also work. When you slide back in your chair after finding your proper posture, place the towel or pillow between the chair and your lower back. This support device should help you maintain good posture. If the towel or pillow is too large, you could be forcing your spine into an awkward position that will be painful quickly.

(2) ADJUST YOUR CHAIR
Move your seat up or down until your legs are parallel with the ground and your knees are even with your hips. Your arms should be parallel to the ground, too.

Your feet should be resting on the floor. If they aren’t, use a stool or footrest to elevate your feet until you are in this position.

(3) PUT YOUR FEET ON THE FLOOR
Your feet should be flat on the floor. If you’re wearing shoes with heels, removing them may be most comfortable.

Don’t sit with your legs crossed. This can reduce blood flow and cause muscle strain.

(4) KEEP YOUR COMPUTER SCREEN AT EYE LEVEL
Adjust the monitor until it’s about an arm’s length away.

The top of your computer’s screen should be no more than 2 inches above your eye level. Computer monitors that are too low or too high can strain your neck and eyes.

(5) USE A HEADSET IF YOU SPEND A LOT OF TIME ON THE PHONE
If you spend a lot of time on a phone and typing or writing at the same time, use a speakerphone. Bending your neck to cradle the phone can cause stiff muscles, pain, and even ligament damage over time.

(6) TAKE REGULAR BREAKS
Sitting for long periods can reduce blood flow and cause muscle fatigue. To prevent that, take frequent breaks.

When you take a break, stand up and walk away from your desk if you can. Get your blood flowing by doing some calf raises and shoulder shrugs. https://www.nhs.uk/live-well/healthy-body/how-to-sit-correctly/

back pain

5 SLEEPING TIPS FOR BACK PAIN

S Bara

(1) FIND THE RIGHT POSITION
If you sleep on your side, put the pillow between your knees and draw them up slightly toward your chest. If you like to sleep on your back, try the pillow under your knees, or roll up a small towel and place it under the small of your back.

Avoid sleeping on your stomach because it puts a lot of strain on your back. If it’s the only position you can fall asleep in, put a pillow under your stomach to take some of the pressure off your back.

(2) GET A GOOD MATTRESS
The type of mattress you need depends on your body type. A soft mattress can be good if your hips are wider than your waist because it will let your spine stay straight while you sleep. If your hips and waist already line up straight, a harder mattress might feel better because it will give you more support.

(3) GET IN AND OUT OF BED CAREFULLY
Be extra careful when you get in and out of bed. Bending forward at your waist or making quick and jerking motions can cause you more back pain.

Take your time and roll over onto one side and use your arms to push your way up. You can then swing your legs out of bed to stand up slowly. Reverse the movements when it’s time to lie down at night.

(4) EXERCISE YOUR CORE
Getting regular physical activity is a great way to improve the quality of your sleep. But doing targeted exercises to strengthen your core, the muscles in your abdomen, hips, lower back, and pelvis can also help ease back pain.

(5) TRY GENTLE YOGA STRETCHES BEFORE BED
Talk to your doctor about which poses are safe for you to practice and which ones won’t make your pain worse. It might be helpful to start off using yoga props like blocks and bolsters for added support so that you can hold poses comfortably. https://www.nhs.uk/mental-health/self-help/guides-tools-and-activities/tips-to-reduce-stress/

Uneven shoulder and Upper back pain

UNEVEN SHOULDER AND UPPER BACK PAIN

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Uneven shoulders can be the result of an imbalance somewhere else in the body. Playing sports and certain injuries can cause muscular imbalances especially in the upper body. Asymmetrical sports such as tennis, golf, and baseball are especially likely to cause uneven shoulders and postural imbalances.

Other common causes of uneven shoulders include:

  • poor posture
  • pinched nerve
  • uneven hips
  • flat feet
  • osteoporosis
  • shoulder injuries
  • weak or tight muscles
  • overuse or misuse of the shoulders
  • incorrect sleeping position or only sleeping on one side
  • using one side of the body to hold objects

HOW TO TREAT UNEVEN SHOULDERS

  • Regular therapeutic massages help to relieve muscle tension and increase flexibility.
  • It’s a good idea to engage in regular exercise and participate in sports as much as possible. Yoga, swimming, and rowing can help to strengthen and realign your body.
  • Make it a practice to check in with your posture continually throughout the day. It may be helpful to use a mirror. Become aware of your posture not only while you’re standing or sitting, but as you’re completing your usual activities. Start using your non-dominant arm as much as you can to balance out the workload.
  • Incorporating relaxation techniques into your routine can help you to relieve stress, tension, and tightness in the body. This may include meditation, breathing techniques, or anything else that helps you to relax. https://www.nhs.uk/live-well/exercise/common-posture-mistakes-and-fixes/
herniated disk

HERNIATED DISC ON LOWER BACK AND SAFE EXERCISES

S Bara

A herniated disk or a slipped or ruptured disk occurs when some of the soft jelly in the inner part of the disk slips out past the tough exterior. It can be very painful and may cause:

  • back pain
  • neck pain
  • shooting arm pain
  • tingling, numbness, or weakness in the leg or foot
  • tingling, numbness, or weakness in one arm

People with a herniated disk do not usually need surgery. Doctors often recommend physiotherapy to treat the symptoms of a herniated disk. Any disk in the spine can become herniated, including the neck, but it most commonly occurs in the lower back. Different exercises can help relieve symptoms but this depending on where the herniated disk is.

SAFE EXERCISES FOR HERNIATED DISC ON LOWER BACK

(1) Seated chair stretch

For a gentle, seated stretch along the hamstring:

  • Sit in a chair with one foot on the floor and the other extended out straight, with the heel on the floor.
  • Straighten the back and lean forward over the extended leg until there is a stretch along the back of the upper thigh.
  • Hold this position for 15–30 seconds.
  • Switch legs and repeat several times.

(2) Towel hamstring stretch

For a a deeper hamstring stretch, try the following:

  • Lie flat on a yoga mat with one leg lifted into the air.
  • Wrap a towel around the foot of the leg in the air.
  • Holding the towel, pull the leg toward the body.
  • Hold for 15–30 seconds.
  • Switch legs and repeat several times.

(3) Back flexion stretch

Back flexion exercises stretch the spine and back muscles. Speak to a doctor before performing these exercises after a back injury. To perform a back flexion stretch:

  • Lie on the back and hold both knees toward the chest.
  • At the same time, move the head forward until there is a comfortable stretch across the mid and low back.
  • Repeat this several times.

(4) Knee to chest stretch

A knee to chest stretch will work the muscles on each side of the body separately for a gentler stretch. Try the following:

  • Lie on the back with the knees bent and both heels on the floor.
  • Place both hands behind one knee and pull it toward the chest.
  • Switch legs and repeat several times.

Perform all exercises in a slow and controlled manner, especially when bending or lifting. Exercises should not hurt. If a person feels pain, they should stop doing the exercises and speak with their doctor. https://www.nhs.uk/conditions/slipped-disc/

Discectomy, Epidural Steroid Injections, L4-L5 herniation

SLIPPED DISC AT L4-L5, SYMPTOMS AND TREATMENT

S Bara

COMMON SYMPTOMS AND SIGNS OF L4-L5 SLIPPED DISC

Depending on the type and severity of the underlying cause, the L4-L5 slipped disc may cause lumbar radicular pain of the L4 and/or L5 spinal nerves, also called sciatica. Common symptoms and signs include:

  • Sharp pain, typically felt as a shooting and/or burning feeling that originates in the lower back and travels down the leg in the distribution of a specific nerve, sometimes affecting the foot.
  • Numbness in different parts of the thigh, leg, foot, and/or toes.
  • Weakness while moving the thigh, knee, or foot in different directions.
  • Abnormal sensations, such as a feeling of pins-and-needles and/or tingling.

TREATMENT FOR L4-L5

Nonsurgical Treatments for L4-L5

  • Medication. Both prescription and over-the-counter (OTC) medications are used to help relieve pain from L4-L5. Typically, non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first. For more severe pain, opioids, and/or corticosteroids may be used.
  • Physical therapy. Exercise and physical therapy can be modified to specifically target pain stemming from L4-L5 and the lower back. These therapies help stabilise the back and keep the muscles and joints well-conditioned—providing long-term relief.
  • Chiropractic manipulation. Chiropractic adjustment of the lumbar spine may help relieve pain stemming from the L4-L5.
  • Self-care. To promote healing and/or prevent an L4-L5 injury from becoming worse, a few tips include avoiding:
    • Repeated bending of the spine
    • Sudden, abrupt movements, such as jumping
    • High-intensity exercise and lifting heavy weights

Injection Treatments for L4-L5

  • Lumbar epidural steroid injections. Steroids injected directly into the spinal epidural space can help decrease inflammation and reduce the sensitivity of nerve fibres to pain, generating fewer pain signals.
  • Radio-frequency ablation. Radio-frequency ablation may be used to treat pain from the L4-L5 vertebral facet joints.

Surgical Treatments for L4-L5

  • Microdiscectomy. In this surgery, a small part of the disc material near the nerve root is taken out. A portion of the bone adjacent to the nerve root may also be trimmed to relieve compression.
  • Laminectomy. A part or all of the lamina (area of bone at the back of the vertebra) is removed to provide more room for the cauda equina.
  • Foraminotomy. The opening for the spinal nerve root (intervertebral foramen) is enlarged by trimming bony overgrowth, relieving the compression.
  • Facetectomy. Nerve root compression is relieved by trimming and/or removing a part of the facet joints.
  • Lumbar artificial disc replacement. This surgery is not very common and includes a complete replacement of the intervertebral disc to relieve nerve root compression and replace it with an artificial implant.
  • Fusion of L4-L5. Depending on the extensiveness of the surgery and the amount of bone removed, the surgical segment may be fused with the adjacent motion segment to provide stability. https://www.nhs.uk/conditions/slipped-disc/
neck pain

5 ALTERNATIVE NON-SURGICAL TREATMENTS FOR NECK PAIN

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(1) PHYSICAL THERAPY
A physical therapist can design an exercise plan that strengthens your neck muscles and takes the pressure off your spine. They might also apply heat or cold pads during a therapy session to either increase blood flow and range of motion (heat) or decrease blood flow and inflammation (cold). Other physical therapy treatments could include therapeutic massage, chiropractic treatment and/or neck-strengthening exercises you can do at home.

(2) TRIGGER POINT INJECTIONS
A trigger point injection is a procedure where a medication, usually a local anesthetic, is injected into the painful muscle to provide relief. The pain relief should be experienced not only in the affected muscle but in the area of referred pain as well.

(3) ANTI-INFLAMMATORY STEROIDS INJECTIONS
Patients experiencing a herniated disc, a degenerated disc, osteoarthritis or inflammation that reduces the space around the nerves can benefit from this type of treatment. The goal of the injection is to reduce inflammation and associated nerve pain – and the injection itself is given with the patient face down under local anesthetic.

(4) BOTOX INJECTIONS
Botox injections can be effective for the treatment of adults with cervical dystonia —a condition that causes the muscles in your neck to tighten or spasm without your control. It can also reduce the severity of abnormal head position and neck pain.

(5) RADIOFREQUENCY ABLATION
Radiofrequency Ablation (or RFA) is a non-surgical, outpatient therapy procedure that’s used to help patients with chronic head and neck pain related to spinal arthritis. As with any non-surgical treatment, this procedure is only recommended after a thorough examination and diagnosis. https://www.nhs.uk/conditions/neck-pain-and-stiff-neck/