Electromyogram or EMG is defined as a test that records the electrical activity of muscles. Normal muscles produce a typical pattern of electrical current that is usually proportional to the level of muscle activity. Diseases of muscle and/or nerves can produce abnormal electormyogram patterns.
Bleeding in the pelvis is rare without significant trauma and is usually seen in patients who are taking blood-thinning medications, such as warfarin (Coumadin). In these patients, a rapid-onset sciatica pain can be a sign of bleeding in the back of the pelvis and abdomen that is compressing the spinal nerves as they exit to the lower extremities. Infection of the pelvis is infrequent but can be a complication of conditions such as diverticulosis, Crohn’s disease, ulcerative colitis, pelvic inflammatory disease with infection of the Fallopian tubes or uterus, and even appendicitis. Pelvic infection is a serious complication of these conditions and is often associated with fever, lowering of blood pressure, and a life-threatening state.
^ Pinto, RZ; Maher, CG; Ferreira, ML; Hancock, M; Oliveira, VC; McLachlan, AJ; Koes, B; Ferreira, PH (18 December 2012). Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Annals of Internal Medicine. 157 (12): 865–77. doi:10.7326/0003-4819-157-12-201212180-00564. PMID 23362516.
Steroids: Oral steroids can be of benefit in treating acute sciatica. Steroid injections into the epidural space have not been found to decrease duration of symptoms or improve function and are not currently recommended for the treatment of acute back pain without sciatica. Benefit in chronic pain with sciatica remains controversial. Injections into the posterior joint spaces, the facets, may be beneficial for people with pain associated with sciatica. Trigger point injections have not been proven helpful in acute back pain. Trigger point injections with a steroid and a local anesthetic may be helpful in chronic back pain. Their use remains controversial.
^ Anheyer, D; Haller, H; Barth, J; Lauche, R; Dobos, G; Cramer, H (6 June 2017). Mindfulness-Based Stress Reduction for Treating Low Back Pain: A Systematic Review and Meta-analysis. Annals of Internal Medicine. 166 (11): 799–807. doi:10.7326/M16-1997. PMID 28437793.
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Poor posture can damage the spine and its associated muscles and ligaments. A hunched stance places abnormal stress on muscles and ligaments, causes backache and fatigue, and can even cause the spine to become fixed in an abnormal position.
Cauda equina syndrome is a serious but rare complication of a ruptured disc. It occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots, causing loss of bladder and bowel control. Permanent neurological damage may result if this syndrome is left untreated.
The thinking on how to treat lower back pain has shifted several times in the past few decades. For example, physicians long suspected bed rest would be the ideal way to recuperate. Then a series of studies in the 1980s and 1990s revealed that resting actually slowed recovery.
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Such conclusions should have shut down the market for unnecessary fusion surgeries, she proposes. Instead, the number of operations performed every year increased 600% between 1993 and 2011, jumping from 61,000 annual procedures to more than 465,000.
Forseen, SE; Corey, AS (Oct 2012). Clinical decision support and acute low back pain: evidence-based order sets. Journal of the American College of Radiology : JACR. 9 (10): 704–712.e4. doi:10.1016/j.jacr.2012.02.014. PMID 23025864.
When a herniated disc is compressing the nerve roots, hemi- or partial- laminectomy or discectomy may be performed, in which the material compressing on the nerve is removed. A mutli-level laminectomy can be done to widen the spinal canal in the case of spinal stenosis. A foraminotomy or foraminectomy may also be necessary, if the vertebrae are causing significant nerve root compression. A discectomy is performed when the intervertebral disc has herniated or torn. It involves removing the protruding disc, either a portion of it or all of it, that is placing pressure on the nerve root. Total disc replacement can also be performed, in which the source of the pain (the damaged disc) is removed and replaced, while maintaining spinal mobility. When an entire disc is removed (as in discectomy), or when the vertebrae are unstable, spinal fusion surgery may be performed. Spinal fusion is a procedure in which bone grafts and metal hardware is used to fix together two or more vertebrae, thus preventing the bones of the spinal column from compressing on the spinal cord or nerve roots.
If you have any underlying emotional issues and unresolved trauma, it can profoundly influence your health, particularly in terms of physical pain. A 2004 study on back pain supports this theory. Its researchers followed patients over the course of four years. All of the patients, who were back pain-free at the start of the study, underwent psychological tests. Afterwards, the researchers compared which of the participants remained pain-free and which ones developed back pain.
^ French, SD.; Cameron, M.; Walker, BF.; Reggars, JW.; Esterman, AJ. (2006). Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews (1): CD004750. doi:10.1002/14651858.CD004750.pub2. PMID 16437495.
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Kidney stones are solid masses of crystalline material that form in the kidneys. Symptoms of kidney stones can include pain, nausea, vomiting, and even fever and chills. Kidney stones are diagnosed via CT scans and specialized X-rays. Treatment of kidney stones involves drinking lots of fluids and taking over-the-counter pain medications to medical intervention including prescription medications, lithotripsy, and sometimes even surgery.
This is not to suggest that all spine surgeons or specialists are villains, of course. Sometimes surgery is necessary, though many top spine specialists interviewed for Crooked agreed that surgery is overused. A spinal surgeon at Cedars-Sinai Medical Center in Los Angeles, Hyun Bae, explained why this might be, saying, “It’s not only a financial conflict. It’s an emotional conflict. We get paid to do the work. We want to make the patient better. So we concentrate on the good results and we dismiss the bad results.”
Radicular pain. This type of pain can occur if a spinal nerve root becomes impinged or inflamed. Radicular pain may follow a nerve root pattern or dermatome down into the buttock and/or leg. Its specific sensation is sharp, electric, burning-type pain and can be associated with numbness or weakness (sciatica). It is typically felt on only one side of the body.
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Mental health factors: Pre-existing mental health issues such as anxiety and depression can influence how closely one focuses on their pain as well as their perception of its severity. Pain that becomes chronic also can contribute to the development of such psychological factors. Stress can affect the body in numerous ways, including causing muscle tension.
Strained muscles and ligaments often cause back pain. Strain commonly occurs with incorrect lifting of heavy objects and sudden awkward movements. Strain can also result from over-activity. An example is the sore feeling and stiffness that occurs after a few hours of yard work or playing a sport.
Mechanical pain. By far the most common cause of lower back pain, mechanical pain (axial pain) is pain primarily from the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine. This type of pain tends to be localized to the lower back, buttocks, and sometimes the top of the legs. It is usually influenced by loading the spine and may feel different based on motion (forward/backward/twisting), activity, standing, sitting, or resting.
^ Posadzki, P; Ernst, E (September 2011). Yoga for low back pain: a systematic review of randomized clinical trials. Clinical rheumatology. 30 (9): 1257–62. doi:10.1007/s10067-011-1764-8. PMID 21590293.
Another condition is spondylolistheses where one vertebra slips over the one beneath it. This is usually at the lower lumbar L4 to L5 or L5-S1. This can compress the nerve resulting in leg pain and conceivably, foot pain.
^ a b Vinod Malhotra; Yao, Fun-Sun F.; Fontes, Manuel da Costa (2011). Yao and Artusio’s Anesthesiology: Problem-Oriented Patient Management. Hagerstwon, MD: Lippincott Williams & Wilkins. pp. Chapter 49. ISBN 1-4511-0265-8. Archived from the original on 8 September 2017.
Researchers have been questioning the costs for a long time, however, and increasingly, the medical community is considering a much simpler solution. Mounting evidence suggests that exercise is among the best remedies because it is able to reduce pain, improve mobility and prevent future discomfort. “[Back pain is] not the only thing that’s been overmedicalized,” says back pain specialist Daniel C. Cherkin of the Kaiser Permanente Washington Health Research Institute.* “But it’s probably the poster child for how things can go wrong in terms of patient outcomes and cost to society.”
Depending on your condition, the short-term use of a back support belt may be beneficial, especially if used in conjunction with other forms of treatment like physical therapy. Your physician likely won’t recommend long-term or preventative use. To avoid additional back problems, talk to your spine specialist at the Southeastern Spine Institute about whether a belt is right for you.
^ Hayden JA, van Tulder MW, Malmivaara A, Koes BW (2005). Exercise therapy for treatment of non-specific low back pain. The Cochrane Database of Systematic Reviews (3): CD000335. doi:10.1002/14651858.CD000335.pub2. PMID 16034851.
Additionally, Stuart McGill, Ph.D. and professor of spine biomechanics at the University of Waterloo, says; “True spine stability is achieved with a balanced stiffening (co-contraction) of the entire trunk musculature, including the abdominals, the latissimus dorsi and the back extensors. Focusing on a single muscle generally results in less stability.”
Low back pain has been with humans since at least the Bronze Age. The oldest known surgical treatise – the Edwin Smith Papyrus, dating to about 1500 BCE – describes a diagnostic test and treatment for a vertebral sprain. Hippocrates (c. 460 BCE – c. 370 BCE) was the first to use a term for sciatic pain and low back pain; Galen (active mid to late second century CE) described the concept in some detail. Physicians through the end of the first millennium did not attempt back surgery and recommended watchful waiting. Through the Medieval period, folk medicine practitioners provided treatments for back pain based on the belief that it was caused by spirits.