Back Pain and Leg Pain Treatment
Back pain is one of the commonest symptoms known to humans. It is especially common in middle
age.
While it may be due to injury it often occurs for no obvious reason. The pain in the
back may be severe and may be associated with pain extending down the leg associated with pins and
needles or numbness in the foot (sciatica).
Many episodes of back and leg pain will
resolve naturally without need for treatment (some treatments may prolong the problem) and most
patients dont need surgery.
At times though the symptoms can be very severe, disrupting
your life, work and sport, such that you would consider anything to get rid of it, even an
operation. Thats when you need to get the opinion of a surgeon to determine if surgery can help you.
Most people don't need surgery for back pain. Occasionally it can be due to serious diseases
such as cancer or infection.
Back pain is a very common symptom, which can be severe and
distressing but seldom permanent or crippling and can usually be managed by simple treatments.
There are many therapies and many therapists but not all are of proven efficacy.
Only
occasionally is surgery required for back pain (usually fusion). Sometimes back pain is due to
serious conditions including cancer (especially in patients over 50 or who have already had
cancer).
The most important treatment is activity and exercise. Rest should be for a day
or so only and never prolonged.
Back pain has a variety of causes and although certain
changes within the structure of the spine are associated with pain it is not usually possible to
categorically attribute the pain to these changes. We are all constantly aging and our spines all
show the changes of aging. Radiographs (X-rays), CT scans and MRI scans as well as surgical and
post-mortem (autopsy) studies confirm these. Pain studies performed at operation or by injecting
discs, facet joints and nerves show that pain can arise in the outer aspect of the discs, in the
joint capsules or in nerves when inflamed. These injections can be unpleasant so that we tend to
rely on our experienced interpretation of radiographs and MRI scans to determine where the pain is
likely to be originating. We know that many patients who are not in pain also have abnormal scans
our experience and the findings of physical examination help us decide when these changes are
significant.
Pain in the back can be referred from other places, e.g., muscles and
ligaments, sacro-iliac joints, abdominal or pelvic organs, aorta and arteries, and by other disease
processes such as arthritis, infection or cancer.
Although we are familiar with these less
frequent processes common things occur commonly and most patients with back pain will have
abnormalities of the disc or discs.
There is new evidence which shows the benefit of
certain exercises, especially abdominal strengthening, in managing back pain. Advice, reassurance
and counseling can be useful. There are many unproven therapies available see Non-surgical care -
but we prefer to use validated methods.
Some work activities and hobbies such as gardening
or sports such as golf, tennis or squash can cause back pain and may need to be modified. As I
often say it is better to change your job to suit your back than change your back to suit your
job.
Surgery for back pain is contentious (see www.cochrane.org) but our experience
allows us to select some patients for surgery by means of fusion (an operation to stiffen the disc
by placing bone in and around it), usually only at one or two levels.
This operation can be
very successful but does not always work.
In offering a fusion (usually only to patients
who have had longstanding back pain over several years) we make three assumptions:
1. that
the abnormality on scan or other tests is the cause of the pain,
2. that the operation will
achieve a solid fusion,
3. that the elimination of movement by fusion will bring about a
reduction in the pain.
None of these assumptions is 100% true but in well-selected
patients fusion can be beneficial. Obviously, the more levels that are abnormal the more difficult
it is to obtain a fusion and the more movement that will be lost.
Back Pain Information
Leg Pain Information
Back Pain and Leg Pain Glossary
Back Pain Treatment without Surgery
Back Pain Treatment with Surgery
Howie Clinic News
Howie Clinic, Auckland, New Zealand Contact Information
Back Pain Philosophy
Lower Back Pain Causes
Chronic Back Pain FAQs
Back X-Rays,Xrays
Back Pain in Children, Adolescents
Back Pain Causes
Neck / thoracic / pelvis
ACC and Back Pain
Dr Howie, Catherine Howie and Back Pain Philosophy
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