All posts by Relax The Back

Relax The Back History

Relax The Back History

Having grown from just one retail store in 1984, Relax The Back stores today are part of a nationwide network dedicated to serving customers seeking relief from and prevention of back and neck pain.

In 1984, an osteopath in Austin, Texas established a unique specialty retail store with nearly 40 products geared toward health and posture.  In 1987, an entrepreneur recognized the potential of this business and decided to purchase the original store. The systems developed and used by the Austin store were then packaged into a business format that was successfully duplicated in franchised locations.

In 1996, Relax The Back’s largest franchisee recognized the business opportunity offered in providing long-term solutions to back pain, and soon bought the company, serving as CEO.

In 1999, Relax The Back.com was launched as another method to introduce consumers to the brand.  The company also focused on an aggressive catalog program created to direct customers to the retail stores and the internet site.

During the first half of 2001, the company was again purchased by 2 investment companies and formed a new management team.  By April 2001, the company had successfully reorganized and began focusing on the expansion of support programs to rebuild a stronger network.

The Relax The Back franchise network has experienced strong growth as a result of the expanding support programs.  Existing franchise owners are developing new stores, and new franchise owners are joining Relax The Back to develop new markets.

Today, the Relax The Back franchise program offers entrepreneurs the opportunity to benefit by representing the Relax The Back brand and become part of the strongest network in the $70 billion Health & Wellness Industry.

With over 100 locations in 31 states and Canada, Relax The Back remains the North America’s largest retailer of comfort, wellness and ergonomic products.  Relax The Back continues to change lives by helping people live a healthier, more comfortable life.

 

Spondylosis

presented-by-spine-universeSpondylosis is arthritis of the spine, sometimes called spinal osteoarthritis.  Spinal arthritis can affect the cervical (neck), thoracic (mid-back), and lumbar (low back) spine.  Typical symptoms include inflammation, pain, and stiffness that may limit movement.

Degenerative disorder
Spondylosis is a degenerative, wear and tear disorder related to growing older.  This type of arthritis affects the spine’s joints; the facet joints.  At the back of each vertebral body is a pair of facet joints.  Like other joints, each facet joint is covered in cartilage to facilitate smooth movement.  Age- and activity-related spinal degeneration contributes to erosion of cartilage.  As cartilage wears away, joints become inflamed, stiff, and painful.

A degenerative cascade of cumulative effects causes spondylosis to alter the spine’s structures.  Degeneration at one level can lead to change (deterioration) at another level of the spine.  These changes can create stress and increase wear and tear of the spine’s discs and ligaments.  Many patients with spondylosis also have degenerative disc disease.

Are you at risk?
Similar to other disorders, some risks are controllable and others are not.

Risks you control

  • Balanced diet
  • Body weight; extra weight (obesity) stresses spine structures
  • Do not smoke (tobacco use)
  • Exercise
  • Overuse of joints during work or sports-related activities

Risks beyond your control

  • Age; everyone ages (arthritis is common in people over age 50)
  • Family history of arthritis
  • Gender: women are at higher risk
  • Spine injury, trauma

Talk with your doctor
Sometimes arthritis symptoms flare up, such as during periods of increased activity, illness, or weather changes.  No two patients with spondylosis are the same.  Pain that is chronic, severe, and/or progressive is a good indication that you should see your doctor.

Treatment
Few patients require surgery to treat spondylosis.  Most patients lead full and productive lives and manage spondylosis with cold/heat therapies, exercise, medications, spinal injections, and alternative treatment such as acupuncture.

Your doctor may recommend a physical therapy program to improve your posture, increase flexibility, and build strength and endurance.  Biomechanics and ergonomic training is part of an organized program of physical therapy.  Proper posture and movement at rest or during any activity benefits patients with spondylosis.

Spine Sprain and Strain

presented-by-spine-universeA neck sprain or strain is a common spine injury.  A sprain or strain is a painful soft tissue disorder.  A sprain is an injury to a ligament.  A strain is an injury to a tendon or muscle.  Whiplash is an example of a sprain and strain type injury.

Symptoms

Sprain and strain symptoms include:

Cervical (Neck) Lumbar (Low back)
Pain; mild to intense Pain; mild to intense
Pain that spreads (radiates) into the shoulders, upper back, arms Pain that spreads (radiates) into the buttocks, legs
Upper body stiffness Lower body stiffness
Headache Sciatica
Dizziness
Jaw pain

Talk with your doctor

Sprain and strain symptoms may not be apparent after injury.  Sometimes symptoms develop hours or days after.  Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor.  Even if you have consulted with your doctor about a sprain or strain, seek medical if any of these symptoms develop:

  • Weakness
  • Loss of coordination; hand clumsiness
  • Balance problems
  • Difficulty walking
  • Bladder or bowel dysfunction (rare)
  • Paralysis (rare)

Diagnosis

Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI to study and confirm you diagnosis to direct your treatment plan.

Treatment

Surgery to treat a sprain or strain is rare.  Most patients respond to non-surgical care:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Muscle relaxant medication
  • Pain medication (occasionally, a narcotic)
  • Cold and heat therapy
  • Soft cervical collar or brace
  • Soft tissue massage
  • Physical therapy
  • Cervical (neck) or lumbar (low back) traction
  • Alternative therapies (eg, acupuncture)

Your treatment may include information to help you correct any problems with your posture and body mechanics.  Correct posture at rest and during activity can help your sprain or strain to heal and may help recurrence.

Spinal Cord Injury

presented-by-spine-universeSpinal cord injury (SCI) can be a devastating diagnosis.  Whenever spinal cord injury is suspected, urgent medical care is necessary because the spinal cord carries nerve messages between the brain and the rest of the body.  Some patients with SCI have a temporary or permanent loss of sensation and/or function below the injured level of the spine.

Types of SCI
The spinal cord can be injured by inadequate blood flow, bruising, or cutting without severing (rare).  There are two basic types of spinal cord injury; complete and incomplete.  A complete SCI is loss of all feeling and function on both sides of the body below the injury level.  An incomplete SCI means some feeling and function remains below the injury level and one side of the body may have more feeling or function than the other.

Sensation and function
There is a pair of spinal nerve roots at each level of the spine.  There are 5 regions of the spine. In general, each of these 5 regions provides feeling (sensation) and function (movement) to different parts of the body.

Region and Nerve Roots Region and Body Area Affected
Cervical (neck) – 8 pair 

Thoracic (chest – 12 pair

Lumbar (low back) – 5 pair

Sacral (pelvic – 5 pair

Coccyx (tailbone) – 1 pair

Cervical: neck, arms, hands 

Thoracic:  torso, arms

Lumbar: hips, legs

Sacral: groin, legs, toes

Coccyx: anus

Symptoms
There are many possible symptoms associated with SCI.  Symptoms vary and no two patients with spinal cord injury are the same.

  • Inability or difficulty breathing without help
  • Inability to regulate heart rate, blood pressure, body temperature
  • Bladder and/or bowel dysfunction
  • Pain
  • Uncontrollable muscle contractions (spasticity)
  • Infertility, sexual dysfunction

Paraplegia and quadriplegia (tetraplegia) are types of paralysis associated with SCI.  Paraplegia is spinal cord injury below the cervical spine.  Quadriplegia involves the cervical spine and these patients are not able to move their arms or legs.

Causes
The causes of spinal cord injury fall into one of two primary groups: traumatic and non-traumatic.  Examples of trauma include car accidents, gunshots, falling down, diving into shallow water, or sports injuries. Non-trauma causes are restricted blood flow (ischemia), spinal tumor, fracture, and other spine-related problems.

Medical care
The medical staff moves swiftly to quickly assess the patient’s condition noting any difficulty breathing, level of consciousness, ability or inability to move the arms and legs, and pain.

The evaluation process often involves complex and detailed imaging studies to determine where the injury is, its cause, and severity.  Other types of tests may be needed.

Treatment

Powerful anti-inflammatory drugs are often part of the first course of immediate care to control inflammation caused by injury.  Next steps include preserving sensation and function, restoring function (eg, rehabilitation), and minimizing complications during aftercare.   Depending on the extent of the SCI, other concerns may include breathing, nutrition, bladder and bowel care, and skin problems (eg, bed sores).

There are many medical specialists involved in treating spinal cord injury.  These include physiatrists, rehabilitation nurses, occupational and physical therapists, speech pathologists, recreational and vocational therapists, and psychologists.

Depending on the cause and severity of the injury, surgery may be necessary to decompress the spinal cord and stabilize the spine.  Surgery can be important to help prevent pain, spinal deformity, and worsening of neurologic problems (eg, bladder dysfunction, weakness).

Sciatica

presented-by-spine-universeSciatica is not a spinal disease or disorder but a term used to describe a group of symptoms caused by compression of the sciatic nerve.  The sciatic nerve originates in the lower back, travels downward, and branches off behind the hip joint, through the buttocks, thighs, past the knees, and into each foot.

Symptoms
Classic sciatica may involve these symptoms:

  • Pain involves the left or right leg
  • Pain travels below the knee
  • Pain: varying between mild ache to sharp
  • Electric shock-like pains, sudden and unexpected
  • Pain can be made worse during a cough or sneeze
  • Sitting or standing provokes pain
  • Odd sensations include numbness, tingling, burning
  • Muscle weakness
  • Bladder or bowel dysfunction (rare, but requires urgent medical care)

Risks you control

  • Do not smoke
  • Maintain a healthy weight
  • Eat well; a balanced and healthy diet
  • Exercise
  • Practice good posture and body mechanics

Risks beyond your control

  • Nerve damage (eg, diabetes can cause nerve damage)
  • Growing older
  • Degenerative spinal disorders (eg, degenerative disc disease)
  • Spinal trauma (eg, falling)

Talk with your doctor
Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor.  Perhaps your doctor has already diagnosed your sciatica symptoms as caused by wear and tear or a degenerative disorder.  If that is the case, he will want to know about any new symptoms, especially weakness, balance or walking difficulties, or bladder or bowel dysfunction.

Diagnosis
Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI to study and confirm you diagnosis to direct your treatment plan.

Treatment
Sciatica seldom requires surgical intervention.  Usually, one or more non-surgical treatments are very effective at relieving symptoms.  These include:

  • Medications: non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain; muscle relaxants to calm spasm; and, occasionally narcotic painkillers.
  • Cold/heat therapy
  • Spinal injections
  • Physical therapy: stretching to increase flexibility, therapeutic exercise to build muscle strength and endurance; posture and importance of maintaining good posture (ergonomics) at rest, work, and during other activities.
  • Alternative therapies, such as acupuncture

Pregnancy and Back Pain

presented-by-spine-universeMost women experience back pain while pregnant.  Throughout pregnancy the body undergoes many changes: hormones release to relax connective tissue, the body’s center of gravity shifts with weight gain, and weight distribution—especially the abdominal area adds stress on the low back (lumbar spine).

Talk with your doctor

Before you begin any type of back pain treatment, be sure to talk with your doctor.

In general, the following may help you to relieve and possibly prevent back pain:

  • Cold therapy to reduce inflammation
  • Heat therapy to ease muscle spasm and pain
  • Regular stretching and exercise; stay as fit as possible
  • Practice proper posture during rest and activity (proper body mechanics)
  • Sleep on your side with a pillow between your knees
  • Change positions often
  • Avoid high-heeled shoes
  • Talk with your doctor about a maternity support belt
  • Use a lumbar support while seated
  • Acetaminophen (Tylenol) only with your doctor’s consent

In addition, your doctor may prescribe physical therapy that includes passive treatment such as massage.  Physical therapists understand the challenges you face during pregnancy to maintain correct posture at rest and activity.  They can offer you beneficial information to make the remaining months or weeks as comfortable as possible.

Osteoporosis

presented-by-spine-universeMillions of women and men have osteoporosis or are at risk to develop the bone disease.  Osteoporosis develops when your body loses more bone than it can replace.  Throughout life, healthy bones are in a continuous state of removing old bone (resorption) and building new bone.  The natural balance of bone remodeling can be upset by such things as growing older, hormonal change, hereditary factors, disease, lifestyle, and poor diet.  Osteoporosis causes bones to lose density, mass, and become thin, weak, and susceptible to fracture.

Are you at risk for osteoporosis?

Fortunately, osteoporosis is considered a highly preventable disease and treatable, if discovered early enough.  Similar to other diseases, some risks are controllable and others are not.  These risks are summarized in the table below.

Risks you control Risks beyond your control
Eat a balanced diet Gender (women are at higher risk)
Take calcium and Vitamin D Age; everyone ages
Do not smoke or use tobacco Family history of osteoporosis
Perform regular weight-bearing exercise Race (Caucasian, Asian, Hispanic)
Moderate alcohol use Small-boned, thin

Other things that can increase your risk

  • Steroids (corticosteroids)
  • Some types of anti-convulsant drugs
  • Eating disorders
  • Gastrointestinal disorders
  • Rheumatoid arthritis

Your doctor can help you identify your risks and test your bone mineral density.  The test is called dual energy absorptiometry x-ray, or DEXA.  DEXA measures your bone density and compares it to that of a normal, healthy 30-year-old of your sex and race.  The result, called a T-score helps to predict your risk of osteoporosis.

Treatment can help control and prevent progression of osteoporosis

Depending on your medical history, risk factors, physical examination, DEXA and/or other tests, your doctor can determine if you are at risk or have osteoporosis.  Your doctor may recommend:

  • A balanced diet rich in calcium and Vitamin D; supplements
  • Regular exercise makes core muscles stronger to better support your spine, improve body flexibility, strength, and endurance.  Anti-gravity exercise, such as walking, helps build bone density.
  • Physical therapy to help you learn how to exercise safely and use good body mechanics during rest and activity.
  • A medication called a bisphosphonates – these include alendronate, risedronate, ibandronate, and zoledronic.  These drugs slow down bone resorption.
  • Hormone therapy, such as estrogen

Fibromyalgia

presented-by-spine-universeFibromyalgia, a chronic pain disorder, primarily affects women.  It is characterized by tender points located over the neck, elbows, chest, back, hips, buttocks, and knees.  There are a total of 18 tender points and a patient may be diagnosed with fibromyalgia if 11 tender points are detected.  Each tender point is small and may easily be highly sensitive even to slight finger pressure.

Researchers and doctors do not completely understand fibromyalgia including the cause(s) and best way to diagnose the disorder.  Many patients with fibromyalgia also suffer with depression.  Besides tender points, anxiety and depression, patients may experience widespread pain, fatigue, and sleep difficulties.

Talk with your doctor
Much time may elapse between when you begin to experience symptoms and when your doctor can make a diagnosis of fibromylagia.  Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI.  Special lab testing may be needed.

Treatment

A combination of medications, physical therapy, exercise, stress management, emotional therapy, and acupuncture may be recommended to help treat and manage symptoms.

  • Medications may include anti-depressants, sleep promoting drugs, muscle relaxants, non-narcotic analgesics, and narcotic drugs.  More recently, anti-seizure medication has shown to be effective in the treatment off fibromyalgia.
  • Physical therapy helps improve flexibility, build strength, and endurance.  Therapeutic exercises and those that become part of a home exercise program, can help improve pain and mood.
  • Passive physical therapies include heat, deep tissue massage, and ultrasound.
  • Stress management is important to relieve fatigue, frustration, and pain.
  • Emotional therapy develops positive thinking, feelings of well-being, and builds coping skills.  Group support can help patients share their problems and solutions.
  • Acupuncture is a whole body holistic approach.  It helps to release endorphins, the body’s natural pain killers.

Your treatment may include information to help you correct any problems with your posture and body mechanics.  Correct posture at rest and during activity can you help prevent injury.

Degenerative Disc Disease

presented-by-spine-universeDegenerative disc disease (DDD) is a normal part of aging. Some people do not know they have DDD until symptoms start. DDD can cause disc structure to change. Discs in the neck (cervical spine) and low back (lumbar spine) can lose normal height decreasing the size of nerve pathways. Nerve impingement, inflammation and pain can develop. The loss of disc height also affects the amount of space between the spine’s joints; the facet joints. Lost space in between the facet joints can result in osteoarthritis (spondylosis), inflammation, and pain that may be constant.

Symptoms

The type of symptoms you experience may depend on the level of the spine affected by degenerative disc disease and its severity.

Cervical (Neck)
Lumbar (Low Back)
Neck pain
Low back pain
Pain that spreads (radiates) into the shoulders, upper, down one or both arms
Pain that spreads (radiates) into the buttocks, thighs, down one or both legs
Numbness, tingling sensations
Numbness, tingling sensations
Weakness
Weakness

Talk with your doctor

Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor. Perhaps your doctor has already diagnosed you with degenerative disc disease. If that is the case, he will want to know about any new symptoms, especially weakness, problems with balance or when walking, or bladder or bowel dysfunction.

Diagnosis

Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms. A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain. During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.

A set of plain x-rays help to rule out other disorders such as infection or tumor. The x-rays also reveal information about disc height. Other imaging tests may be ordered by your doctor to study and confirm your diagnosis and direct your treatment plan.

Treatment

Most cases of cervical and lumbar degenerative disc disease do not require surgery. Often, one or more non-surgical treatments are very effective at relieving symptoms. These include:

  • Medications: non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain; muscle relaxants to calm spasm; and, occasionally narcotic painkillers.
  • Cold/heat therapy
  • Spinal injections
  • Physical therapy: stretching to increase flexibility, therapeutic exercise to build muscle strength and endurance; posture and importance of maintaining good posture (ergonomics) at rest, work, and during other activities.
  • Chiropractic
  • Alternative therapies, such as acupuncture

Surgery may be recommended if pain cannot be managed, spinal instability develops, or neurologic symptoms develop or progress. Your doctor will explain why he recommends surgery and the type of procedure involved, including what to expect before and after surgery.

Whiplash

presented-by-spine-universeWhiplash is a common type of injury often caused by being rear-ended in a motor vehicle accident.  Whiplash is a severe type of neck sprain caused when the head is whipped quickly forward (hyperflexion) and backward (hyperextension).

Symptoms

Whiplash symptoms include:

  • Neck pain; mild to intense
  • Pain that spreads (radiates) into the shoulders, upper back, arms
  • Sharp, dull, throbbing, and/or burning pain
  • Neck and upper body stiffness
  • Headache
  • Dizziness
  • Jaw pain (immediate or delayed)
  • Ringing in the ears

Talk with your doctor

Whiplash symptoms may not be apparent after injury.  Sometimes symptoms develop hours or days after.  Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor.  Even if you are being treated for whiplash, contact your doctor if any of these symptoms develop:

  • Weakness
  • Loss of coordination; hand clumsiness
  • Balance problems
  • Difficulty walking
  • Bladder or bowel dysfunction (rare)
  • Paralysis (rare)

Diagnosis

Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI to study and confirm you diagnosis to direct your treatment plan.

Treatment

The need for surgery is rare.  Most patients with whiplash respond to non-surgical care:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Muscle relaxant medication
  • Pain medication (occasionally, a narcotic)
  • Cold and heat therapy
  • Soft cervical collar or brace
  • Soft tissue massage
  • Physical therapy
  • Cervical (neck) traction
  • Alternative therapies (eg, acupuncture)

A soft cervical collar or brace is worn to help mobilize the neck, support the weight of the skull, and relieve pain while neck tissues heal.

Spondylolisthesis

presented-by-spine-universeSpondylolisthesis is a lumbar spine (low back) disorder.  It occurs when one vertebra slips forward over the vertebra beneath.  There are two types of spondylolisthesis:

Degenerative spondylolisthesis is most common in women over age 60.  It is caused by degenerative (eg, age-related) changes in vertebral structures that allow a vertebral body to slip forward.  Degenerative spondylolisthesis may cause lumbar spinal stenosis.

Isthmic spondylolisthesis is caused by a defect or fracture of the pars interarticularis; a bone that connects the upper and lower spinal joints (facet joints).  Sometimes accumulated spinal stress causes this type of fracture.  This is usually the type of spondylolisthesis that affects young athletes.

Symptoms
Not all people with a spondylolisthesis know they have the disorder.  Many are symptom-free.  Sometimes it is discovered when they undergo x-ray or other spinal imaging test to diagnose a different problem.  Spondylolisthesis symptoms may include:

  • Low back pain
  • Sciatica
  • Muscle spasms
  • Leg weakness
  • Tight hamstring muscles
  • Irregular gait or limp

Talk with your doctor
Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor.  Perhaps your doctor has already diagnosed you with a spondylolisthesis.  If that is the case, he will want to know about any new symptoms, especially weakness, balance or walking difficulties, or bladder or bowel dysfunction.

Diagnosis
Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI to study and confirm you diagnosis to direct your treatment plan.

Spondylolisthesis grading
There are five Grades of spondylolisthesis.  Grade I is a small slip and Grade V is a complete slip.  From your imaging studies (eg, x-ray) your doctor can Grade your spondylolisthesis.

  • Grade I:  1-24%
  • Grade II: 25-49%
  • Grade III: 50-74%
  • Grade IV: 75%-99% slip.
  • Grade V: Complete slip (100%), known as spondyloptosis

The grade of your slip and symptoms help your doctor to recommend the best treatment options for your spondylolisthesis.  In general, more severe slips, such as Grade III and greater, may require surgical treatment.

Treatment

Non-surgical treatment may include:

  • Best rest for a short time
  • Activity restriction
  • Over-the-counter or prescription pain medication
  • Non-steroid anti-inflammatory drugs (NSAIDs)
  • Muscle relaxants
  • Steroid injections
  • Physical therapy
  • Bracing

Once again, depending on the severity (grade) of your spondylolisthesis, if it is or may become progressive, and existence or extent of related neurological symptoms, surgery may be recommended.  The goals of surgery may involve restoring spinal stability and relieving pain.

Spinal Arthritis

presented-by-spine-universeThere are more than 100 types of arthritis.  The most common type that affects the spine is spondylosis, or simply osteoarthritis.  Inflammatory types of arthritis also can cause joint stiffness and pain.  These include juvenile or adult rheumatoid arthritis and ankylosing spondylitis.  Spinal arthritis can affect the cervical (neck), thoracic (mid-back), and lumbar (low back) spine.

Degenerative disorder
Spondylosis is a degenerative, wear and tear disorder related to growing older.  This type of arthritis affects the spine’s joints; the facet joints.  At the back of each vertebral body is a pair of facet joints.  Like other joints, each facet joint is covered in cartilage to facilitate smooth movement.  Age- and activity-related spinal degeneration contributes to erosion of cartilage.  As cartilage wears away, joints become inflamed, stiff, and painful.

A degenerative cascade of cumulative effects causes osteoarthritis to alter the spine’s structures.  Degeneration at one level can lead to change (deterioration) at another level of the spine.  These changes can create stress and increase wear and tear of the spine’s discs and ligaments.  Many patients with spondylosis also have degenerative disc disease.

Are you at risk?
Similar to other disorders, some risks are controllable and others are not.

Risks you control

  • Balanced diet
  • Body weight; extra weight (obesity) stresses spine structures
  • Do not smoke (tobacco use)
  • Exercise
  • Overuse of joints during work or sports-related activities

Risks beyond your control

  • Age; everyone ages (arthritis is common in people over age 50)
  • Family history of arthritis
  • Gender: women are at higher risk
  • Spine injury, trauma

Talk with your doctor
Sometimes arthritis symptoms flare up, such as during periods of increased activity, illness, or weather changes.  No two patients with osteoarthritis are the same.  Pain that is chronic, severe, and/or progressive is a good indication that you should see your doctor.

Treatment
Few patients require surgery to treat spondylosis.  Most patients lead full and productive lives and manage osteoarthritis with cold/heat therapy, exercise, medications, spinal injections, and alternative treatment such as acupuncture.

Your doctor may recommend a physical therapy program to improve your posture, increase flexibility, and build strength and endurance.  Biomechanics and ergonomic training is part of an organized program of physical therapy.  Proper posture and movement at rest or during any activity benefits patients with spondylosis.

Rheumatoid Arthritis

presented-by-spine-universeRheumatoid arthritis (RA) is a chronic type of inflammatory arthritis related to an autoimmune disease.  In the spine, it causes inflammation of multiple spinal joints (facet joints) and affects children and adults.  RA is considered a systemic disease because it can affect other parts of the body (eg, eyes).  Although rheumatoid arthritis is a long-lasting (chronic) disease, symptoms may flare up and then not return for a long time period.  Ankylosing spondylitis is a type of inflammatory spinal arthritis.

Although the cause of rheumatoid arthritis is not known, it is thought that something in the environment or infection can trigger the body’s immune system to attack itself.  This attack sets off an inflammatory cascade of problems that destroy cartilage and erode bony joints.

Rheumatoid arthritis and the spine
Pain is the foremost symptom.  If the cervical spine is affected, pain may be felt at the base of the skull, neck, upper back, shoulders, or arms.  In the lumbar spine, low back pain may be accompanied by leg pain.  Other symptoms may include:

  • Headache
  • Stiffness
  • Loss of joint motion
  • Loss of muscle strength
  • Fatigue
  • Loss of appetite
  • Fever
  • Difficulty sleeping

Talk with your doctor
If your pain is chronic, severe, or progressive, talk with your doctor.  He will want to know if pain is accompanied by neurological problems such as numbness, tingling sensations, and weakness.

More serious (rare) symptoms, requiring urgent medical care, include difficulty walking, loss of coordination, and bladder or bowel dysfunction.  These symptoms can be caused by pressure on the spinal cord or cauda equina (low back).

A proper diagnosis is important to treatment.  Your doctor will review your medical history, current symptoms and compare it to information collected during a physical and neurological examination.  Special lab tests may be orders to evaluate your rheumatoid factor and immune system function, determine your liver function, measure your blood count, and other information essential to your health.

Treatment
There are many non-surgical therapies your doctor may recommend to ease the pain and symptoms related to spinal rheumatoid arthritis.

  • Over-the-counter medications: acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs)
  • Prescription drugs: oral steroids to reduce inflammation, disease-modifying anti-rheumatic drugs (DMARDs) and tumor necrosis factor (TNF) alpha inhibitors to reduce prevent joint damage, immune suppressants, pain relievers, and anti-depressants
  • Physical therapy; stretches to increase flexibility, exercise to build muscle
  • Occupational therapy; performing activities of daily living, coping skills
  • Stress management
  • Alternative therapies such as acupuncture

Most patients with spinal RA do not need surgery.  Surgery may be recommended if pain is uncontrollable, neurologic problems develop (nerve root or spinal cord compression), spinal instability, or weakness is severe.

Pinched Nerves

presented-by-spine-universeA pinched nerve is a common cause of neck and back pain.  Different types of spinal disorders can cause a spinal nerve to be slightly compressed or pinched.  The nerve’s first reaction to compression is inflammation and pain.

Common causes of a pinched nerve in the spine include:

  • Degenerative disc disease
  • Disc herniation
  • Fracture
  • Spinal stenosis
  • Spondylosis
  • Spondylolisthesis

Symptoms
Symptoms of a pinched nerve depend on where the nerve is compressed.  Examples of cervical and lumbar symptoms include the following:

Cervical (Neck) Lumbar (Low back)
Pain; mild to intense Pain; mild to intense
Pain that spreads (radiates) into the shoulders, upper back, arms Pain that spreads (radiates) into the buttocks, legs
Upper body stiffness Lower body stiffness
Headache Sciatica
Tingling, burning sensations Tingling, burning sensations
Weakness Weakness

Talk with your doctor
Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor.  Even if you have consulted with your doctor about a spinal problem, seek medical if any of these symptoms develop:

  • Loss of coordination; hand clumsiness
  • Balance problems
  • Difficulty walking
  • Bladder or bowel dysfunction (rare)
  • Paralysis (rare)

Diagnosis
Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI to study and confirm you diagnosis to direct your treatment plan.

Treatment
Most patients respond to non-surgical care, such as:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Muscle relaxant medication
  • Pain medication (occasionally, a narcotic)
  • Cold and heat therapy
  • Soft cervical collar or brace
  • Spinal injections
  • Physical therapy
  • Cervical (neck) or lumbar (low back) traction
  • Alternative therapies (eg, acupuncture)

Your treatment may include information to help you correct any problems with your posture and body mechanics.  Correct posture at rest and during activity can help you heal and prevent recurrence or spinal injury.

Spine surgery may be considered if neurological symptoms develop or progress and/or the cause of the pinched nerve creates spinal instability.

Multiple Sclerosis

presented-by-spine-universeMultiple Sclerosis, abbreviated MS, is a chronic disease affecting the myelin sheath; a tissue composed of fats and proteins covering nerves.  Myelin speeds impulses up and down nerves enabling the brain and body to exchange messages.

Researchers don’t know exactly what causes MS, but it is thought it may be triggered by an autoimmune response.  This means the body attacks itself.  Multiple sclerosis affects the central nervous system – that being the body’s main system for communication that includes the brain, spinal cord, and nerve roots.

Symptoms related to multiple sclerosis widely vary.  Listed below are examples of symptoms.

  • Vision problems:  blurred, double, certain color distortions, blindness
  • Muscle weakness: difficult to stand or walk
  • Difficulty with balance, dizziness
  • Paralysis: partial, complete, temporary
  • Sensations such as numbness, pins and needles, tingling
  • Hearing loss
  • Speech impediment
  • Problem with concentration, memory
  • Depression
  • Symptoms vary in severity and may come and go

As you can imagine, many of these symptoms are caused by other, and completely different, types of medical disorders.  Therefore, it is important to remember that the opinion of a neurologist or MS specialist is necessary for an accurate diagnosis.

MS seems to affect people during the prime of life; between the ages of 20 and 40.  It can be difficult to make an early diagnosis and the disease is quite unpredictable.  Unfortunately, at this time, there is no cure.  However, research has advanced understanding of multiple sclerosis, more efficient diagnostic practices, treatment, and improved quality of life for people affected by MS.

To learn about Multiple Sclerosis, please visit the National Multiple Sclerosis Society.

Disc Herniation

presented-by-spine-universeA cervical (neck) or lumbar (low back) disc herniation is a common cause of pain.  The intervertebral discs; the discs between each vertebral body, work with other parts of the spine to absorb and distribute stress.  Each disc is made up of an annulus fibrosus; a tough tire-like outer band, and the nucleus pulposus; a gel-like inner substance.

A disc herniation occurs when the nucleus pushes through the annular wall.  The nuclear material releases a chemical irritant that sets off a cascade of inflammation, nerve compression, and pain.

Symptoms
Typical symptoms of a cervical or lumbar disc herniation include:

Cervical Disc Herniation Lumbar Disc Herniation
Neck pain Low back pain
Movement may intensify pain Bending, coughing, sneezing, other movement may intensify pain
Dull or sharp pain in the shoulders, upper back Muscle spasm, cramping
Pain spreads (radiates) down into the arms, hands, or fingers (extremities).  Called cervical radiculopathy Sciatica (pain, burning, tingling, numbness that extends into the buttocks and legs)
Tingling, numbness in the shoulders, upper back, or extremities Leg weakness, functional loss

Risk factors
Sudden stress from injury or trauma can cause disc herniation.  Sometimes a disc herniation gradually develops over weeks or months.

Risks you control

  • Do not smoke
  • Maintain a healthy weight
  • Eat well; a balanced and healthy diet
  • Exercise
  • Practice good posture and body mechanics

Risks beyond your control

  • Growing older
  • Injury or trauma

Talk with your doctor
Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor.  Perhaps your doctor has already diagnosed you with a bulging (has not broken through the anular wall) or herniated disc.  If that is the case, he will want to know about any new symptoms, especially weakness, problems with balance or when walking, or bladder or bowel dysfunction.

Diagnosis
Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI to study and confirm you diagnosis to direct your treatment plan.

Treatment
Most cases of disc herniation do not require surgery.  Often, one or more non-surgical treatments are very effective at relieving symptoms.  These include:

  • Medications: non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain; muscle relaxants to calm spasm; and, occasionally narcotic painkillers.
  • Cold/heat therapy
  • Spinal injections
  • Physical therapy: stretching to increase flexibility, therapeutic exercise to build muscle strength and endurance; posture and importance of maintaining good posture (ergonomics) at rest, work, and during other activities.
  • Alternative therapies, such as acupuncture

Surgery may be recommended if pain cannot be managed, spinal instability develops, or neurologic symptoms develop or progress.  Your doctor will explain why he recommends surgery and the type of procedure involved, including what to expect before and after surgery.

Ankylosing Spondylitis

presented-by-spine-universeAnkylosing spondylitis (AS) is a chronic inflammatory disease that may begin in the spine’s sacroiliac joints at the back of the pelvis. The sacroiliac joints are on either side of the spine. The hallmark symptoms include pain and progressive stiffness that may spread to other levels of the spine such as the neck and chest. Other symptoms include hip and shoulder stiffness, eye inflammation, and fatigue.

AS is more common in men and onset, in either sex may begin between the ages of 15 and 45.

A type of inflammatory arthritis

AS is an inflammatory arthritis and part of a group of rheumatic diseases that have the human antigen HLA-B27 in common. Because ankylosing spondylitis develops gradually, its degenerative effects to the spine may not be apparent on early x-ray studies. In addition to considering the patient’s symptoms, the doctor relies on results of a physical and neurological exam and imaging studies. A special blood test may be ordered to determine if the antigen HLA-B27 is present in the patient’s blood. Most AS patients have this blood antigen.

Progressive

Pain and joint stiffness can progress. The disease’s inflammatory process triggers formation of new bone (ossification) on the spine. Bony formations can cause the spine lose flexibility, stiffen, and fuse itself into a fixed position. Ankylosing spondylitis may lead to a stooped forward posture (abnormal kyphosis), swayback (abnormal lordosis), or lead to spinal deformity.

AS can initially present as low back pain that spreads (radiates) into the buttocks and upper legs. Gradually, lumbar motion can be limited. The patient may notice, over time, that discomfort and symptoms move up the spine. Difficulty expanding the chest (thoracic spine) can develop.

Ossification leads to thickening and hardening of tissues, such as the discs, vertebral endplates, and ligaments. Eventually vertebrae may fuse together and increase the risk for spinal fracture. Ossification can affect the spine’s ligaments and contribute to development of spinal stenosis and neurological symptoms such as numbness, tingling, and weakness.

Treatment

Surgery is seldom necessary and most patients lead productive lives. Your treatment options depend on your symptoms, their severity, and disease progression. Although over-the-counter anti-inflammatory non-steroidal drugs (NSAIDs) and analgesics may adequately control symptoms, they do not attempt to control disease progression. A rheumatologist or spine specialist may offer you more effective treatments.

  • Disease-modifying anti-rheumatic drugs (DMARDs); a type of prescription medication that may help symptoms
  • Biologic medications that affect the tumor necrosis factor levels (TNF); these are tied into your immune system’s inflammatory process
  • Before getting out of bed, gently stretch.
  • A warm shower or bath can help relieve stiffness.
  • Physical therapy can teach you how to improve your body’s flexibility and build strength by performing certain exercises. Your physical therapist can give you tips on how to improve posture and biomechanics at rest and during activity.
  • Aquatic exercise, swimming

Living with ankylosing spondylitis

Although ankylosing spondylitis is not curable, most patients are only mildly affected. Pain and stiffness may be episodic and most patients lead productive and active lives.

Spinal Stenosis

presented-by-spine-universe
Spinal stenosis develops when either the spinal canal or spinal nerve pathways narrow.  The term stenosis means to abnormal narrowing.  The spinal canal is a vertical hole that contains the spinal cord.  The shape and structure of the spine’s bones help to protect the spinal cord.  In the low back (lumbar spine), the spinal cord becomes the cauda equina; a bunch of nerves resembling a horse’s tail.  Discs between each vertebral body serve to create natural passageways called foramen through which spinal nerve roots exit the spine.

Cervical spinal stenosis is a common cause of neck pain especially in people over age 50 or those with a history of neck injury or trauma.  Some people are born (congenital) with stenosis.  There are three types of cervical spinal stenosis:

  • Cervical central stenosis means part of the spinal canal is narrow
  • Cervical foraminal stenosis means one or more of the spinal nerve root pathways is narrowed
  • Both cervical central stenosis and foraminal stenosis

Lumbar spinal stenosis

is a common cause of low back pain in people over age 50.  Wear and tear and common conditions including osteoarthritis, degenerative disc disease, and development of bone spurs (osteophytes) contribute to stenosis.

Typical symptoms

Cervical Spine Stenosis Lumbar Spinal Stenosis
Neck pain; mild to severe Low back pain; mild to severe
Numbness, weakness (shoulders, arms, or legs) Numbness, weakness (buttocks, legs)
Hand clumsiness; coordination difficulties Difficulty and pain when walking, standing, bending backward
Burning, tingling sensations in the arms or legs Pain relieved by resting or leaning forward
Difficulty walking Burning, tingling sensations in legs
Bladder or bowel dysfunction (rare) Bladder or bowel dysfunction (rare)
Paralysis (rare) Paralysis (rare)

Talk with your doctor

Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor.  Perhaps your doctor has already diagnosed you with cervical or lumbar spinal stenosis.  If that is the case, he will want to know about any new symptoms, especially weakness, problems with balance or when walking, or bladder or bowel dysfunction.

Diagnosis

Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI to study and confirm you diagnosis to direct your treatment plan.

Treatment

Most cases of cervical and lumbar spinal stenosis do not require surgery.  Often, one or more non-surgical treatments are very effective at relieving symptoms.  These include:

  • Medications: non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain; muscle relaxants to calm spasm; and, occasionally narcotic painkillers.
  • Cold/heat therapy
  • Spinal injections
  • Physical therapy: stretching to increase flexibility, therapeutic exercise to build muscle strength and endurance; posture and importance of maintaining good posture (ergonomics) at rest, work, and during other activities.
  • Alternative therapies, such as acupuncture

Surgery may be recommended if pain cannot be managed, spinal instability develops, or neurologic symptoms develop or progress.  Your doctor will explain why he recommends surgery and the type of procedure involved, including what to expect before and after surgery.