Saturday, 26 November 2016

Severe Causes of Low Back Pain

The differential diagnosis for lower back pain can be as simple as muscle spasm to complicated or severe and complicated cauda equina syndrome that required immediate surgical decompression. It is important for primary contact health care providers to recognise and rule out serious conditions of the lower back so that a detailed treatment program for the management of the lower back pain can be prescribed. Imaging of the lumbar spine may be needed in order to rule out serious underlying condition the lower back.

Learn more about back pain. https://www.mychiro.com.my/spine/back-pain/

Patients who aged above 60, have a history of osteoporosis and/or are taking steroids over a prolonged period of time are more susceptible to compression fracture of the spine even with a minor trauma. Therefore, plain-film radiography or CT scan maybe required for these patients who are suffering from severe back pain after a minor trauma.

Cauda equina syndrome is a serious spinal condition that may lead permanent nerve damage if it is not treated immediately. Typical signs and symptoms of cauda equina syndrome include low back pain, sciatica, loss of sensorimotor in the lower limbs, bowel and bladder dysfunction, urinary retention, saddle paresthesia of the perineum, pain, numbness and weakness in both lower limbs. Direct mechanical compression, venous congestion and ischemia are the possible causes of nerve root damage in the lumbar spine. Lumbar disc herniation, trauma and vertebral metastasis are the common causes that lead to secondary spinal canal stenosis and compression of the cauda equina. MRI of the lumbar spine can identify the source and location of the compression of the cauda equina.


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Monday, 21 November 2016

MRI and Low Back Pain

Lower back pain is very common in our population and is commonly believed to be benign and self-limiting. However, debilitating pain and severe paresthesia can affect the activity of daily livings if the lower back pain is not treated properly. MRI of the lumbar spine may be needed in certain cases in order for the health care practitioner to differentiate serious spinal pathology from non-specific low back pain. A detail history and examination of the patient is required to assess the lower back condition of the patient.

Learn more about back pain. https://www.mychiro.com.my/spine/back-pain/

MRI of the lumbar spine is needed to rule out serious pathology when “red flag” findings are present during the assessment of the patient. Lower back pain with radicular leg pain or other significant signs and symptoms may require imaging to rule out serious spinal pathology. Disc herniation or slipped disc and degenerative disc disease are the most common causes of lower back pain. These findings can be easily located and localized on MRI of the lumbar spine. These two conditions can be treated with conservative managements. Other serious underlying conditions of the spine include trauma, cauda equina syndrome, progressive neurologic deficit, infection and malignancy.

The patient’s history or the mechanism of injury with a detailed assessment of the lower back is needed to determine if further imaging of the spine is required. The health care practitioner should determine if X-ray, CT scan, MRI of the spine or other imaging or laboratory test is needed for further evaluation of the condition.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Wednesday, 16 November 2016

Functional Spinal Instability in Low Back Pain

Bony restraint from facet joint orientation and ligamentous support are the major contributors to the passive stability of the lumbar intervertebral segments. However, these segments are unstable upon movement of the spine in the absence of dynamic neuromuscular control. A combination of dynamic muscular forces and passive ligamentous support are required to provide stability and movements of the spine for activities of daily living and sports activity. Spinal instability has been reported in some cases of spondylolisthesis which involves the forward slippage of the spinal segment. The presentation of spinal instability in these cases includes hypermobility or increased displacement or range of motion.

Learn more about spondylolisthesis:. https://www.mychiro.com.my/articles/spondylolisthesis/

There are two major muscle groups in the lower back, local and global muscles, which should be working together to provide stability and mobility of the lumbar spine. Global muscles are large, dynamic, phasic muscles that connect the pelvic to the rib cage which generates torque movements and general trunk stabilization. Rectus abdominus, external oblique and upper part of lumbar iliocostalis are considered as global muscles.

Local postural, tonic muscles are attaching directly to the lumbar vertebrae and are the major contributors to the lumbar segmental stability. Lumbar multifidus, psoas muscle, quadratus lumborum, lumbar parts of iliocostalis and longissimus, transversus abdominis, the diaphragm, and the posterior fibers of the internal oblique are a few examples of the local muscles in the lower back. These muscles are important to maintain the spinal stability during movement of the trunk.


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Friday, 11 November 2016

Common Causes of Lower Back Pain 2

Abnormal movement of a spinal segment can be associated with lower back pain. Either too much or too little movement of an isolated intervertebral segment can be a major component of lower back pain. Constant irritation of the surrounding soft tissue as a result of isolated segmental hypermobility or possible structural lumbar instability. Correction of spinal segments with restricted joint movement is a major part of the treatment program.


Trigger points are specific sensitive pain-producing points located in tight muscles or fascias that can refer pain to other areas. Trigger points associated with lower back pain are commonly found in quadratus lumborum, erector spinae, gluteal and piriformis muscle. Trigger points may or may not be the initial problem however these can cause significant pain in patients with lower back conditions. The pain resulted from active trigger points with associated muscle spasm or tightness can further aggravate the abnormalities in the underlying joints. Therefore, the resultant pain from trigger points and muscle tightness must be addressed and treated properly.

In an acute low back pain case, abnormalities of the joints are more likely to be the major source of pain. In a chronic low back pain case, muscular and neural abnormalities must be taken into consideration. These components should be treated and re-assessment should be performed from time to time to evaluate the effectiveness of the treatments.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Sunday, 6 November 2016

Slipped disc and Facet Joint Injuries in Lower Back Pain

The two most common causes of lower back pain are slipped disc and facet joint injury. Most of the time, these two conditions can co-exist and can cause severe pain in the back, buttocks or lower limbs. It is challenging to differentiate clinically between a slipped disc and facet joint injuries. There are a few clinical examinations which can be served as a guide to differentiate between a disc damage and facet joint injury. However, these examinations must be correlated with other clinical signs and symptoms in order to make a definite diagnosis.

Learn more about treatments for slipped disc: https://www.mychiro.com.my/treatments- used/rxdecom/

Patients with disc damages are more likely to report pain upon forward bending of the trunk. Whereas patients with facet joint injuries often complain of pain with extension of the lower back. Other than that, the site of maximal tenderness can be different between disc and facet joint injuries. The most tender spot for a patient with disc damage is more centrally around the spinous process. However, the most tender spot for a facet joint injury is more towards the side on the damaged side.

Hypomobility of one or more spinal segments is commonly associated with a slipped disc and facet joint damages. This can be one of the causes that contributes to the lower back pain. Intervertebral segments with restricted movement should be corrected with mobilization or manipulation of the joint in order to manage the lower back pain.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Tuesday, 1 November 2016

Compression Injuries of Slipped Disc

The other type of slipped disc that can cause the pain in the back is a result of compression injuries to the disc. Excessive axial load or weight-bearing leads to fractures of the vertebral end plates. The materials of the nucleus pulposus may be exposed to the blood supply of the vertebral body as a result of the end plate fracture. There will be an increased load on the annulus fibrosus when the degradation of the nucleus pulposus happen
s. It is highly possible that there will be a pain if the degradation process of the nucleus reaches the outer third of the annulus fibrosus. This is because the outer third of the annulus fibrosus is rich in nerve supply.

Learn more about slipped disc or herniated disc. https://www.mychiro.com.my/spine/herniated-disc/

Patients with this type of compression injury of the disc may complain of deep-seated local back pain with or without referred somatic pain to the buttock and lower leg. This is a result of both chemical and mechanical irritation of the pain-producing receptors in the lower back.

Apophyseal joint, or the facet joint, is another common site of injury that can result in low back pain. There are a few types of damages of the apophyseal joints that are capable of causing irritation to the pain receptors. For example, fractures of the subchondral bone, capsular tears, capsular avulsions and bleeding into the joint space.

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Wednesday, 26 October 2016

Low Back Pain due to Slipped Disc

Disc damage or slipped disc/slip disc can be one of the diagnoses for neck or back pain. There are different types of disc damage that can result in pain such as ruptured or herniated disc, degenerated disc, excessive torsional injury and compression injury of the disc. Most of the disc injuries involve damages and abnormalities not only the disc, but also the soft tissue structures around the disc.

Excessive rotational or torsional stress may cause injury to the facet joints, the annulus fibrosus, or most commonly both. The annulus fibrosus is under maximal stress when the disc is being loaded in a bent and twisted position. Therefore, people who always injured their back when they lift heavy objects in a forward bending position with the upper body rotating to one side.

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Repetitive torsional injury to the disc may lead to tears seen on MRI. Annulus fibrosus with tears are more susceptible to nucleus pulposus herniation. An inflammatory reaction may be provoked in response to the annular tear and this will result in pain from chemical irritation. This chemical nociception normally presents as a diffuse back pain that may or may not be referred to the lower limbs. Any movement of the lumbar spine, especially forward bending and twisted, can aggravate the lower back pain from excessive rotational stress.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my