Back Troubles

Clinical Depression and Back Pain

Depression is by far the most common emotion associated with chronic back pain. The type of depression that often accompanies chronic pain is referred to as major depression or clinical depression. This type of depression goes beyond what would be considered normal sadness or feeling "down for a few days".

The symptoms of a major depression occur daily for at least two weeks and include at least 5 of the following (DSM-IV, 1994):

• A predominant mood that is depressed, sad, blue, hopeless, low, or irritable, which may include periodic crying spells
• Poor appetite or significant weight loss or increased appetite or weight gain
• Sleep problem of either too much (hypersomnia) or too little (hyposomnia) sleep
• Feeling agitated (restless) or sluggish (low energy or fatigue)
• Loss of interest or pleasure in usual activities
• Decreased sex drive
• Feeling of worthlessness and/or guilt
• Problems with concentration or memory
• Thoughts of death, suicide, or wishing to be dead

Chronic pain and depression are two of the most common health problems that health professionals encounter, yet only a handful of studies have investigated the relationship between these conditions in the general population (Currie and Wang, 2004).

Major depression is thought to be four times greater in people with chronic back pain than in the general population (Sullivan, Reesor, Mikail & Fisher, 1992). In research studies on depression in chronic low back pain patients seeking treatment at pain clinics, prevalence rates are even higher. 32 to 82 percent of patients show some type of depression or depressive problem, with an average of 62 percent (Sinel, Deardorff & Goldstein, 1996). In a recent study it was found that the rate of major depression increased in a linear fashion with greater pain severity (Currie and Wang, 2004). It was also found that the combination of chronic back pain and depression was associated with greater disability than either depression or chronic back pain alone.

Depression is common for those with chronic back pain

Depression is more commonly seen in patients with chronic back pain problems than in patients with pain that is of an acute, short-term nature. How does depression develop in these cases? This can be understood by looking at the host of symptoms often experienced by the person with chronic back pain or other spine-related pain.

• The pain often makes it difficult to sleep, leading to fatigue and irritability during the day.
• Then, during the day, because patients with back pain have difficulty with most movement they often move slowly and carefully, spending most of their time at home away from others. This leads to social isolation and a lack of enjoyable activities.
• Due to the inability to work, there may also be financial difficulties that begin to impact the entire family.
• Beyond the pain itself, there may be gastrointestinal distress caused by anti-inflammatory medication and a general feeling of mental dullness from the pain medications.
• The pain is distracting, leading to memory and concentration difficulties.
• Sexual activity is often the last thing on the person’s mind and this causes more stress in the patient’s relationships.
Understandably, these symptoms accompanying chronic back pain or neck pain may lead to feelings of despair, hopelessness and other symptoms of a major depression or clinical depression.

A recent study by Strunin and Boden (2004) investigated the family consequences of chronic back pain. Patients reported a wide range of limitations on family and social roles including: physical limitation that hampered patients’ ability to do household chores, take care of the children, and engage in leisure activities with their spouses.
Spouses and children often took over family responsibilities once carried out by the individual with back pain. These changes in the family often led to depression and anger among the back pain patients and to stress and strain in family relationships.

Psychological theories about depression

Several psychological theories about the development of depression in chronic back pain patients focus on the issue of control. As discussed previously, chronic back pain can lead to a diminished ability to engage in a variety of activities such as work, recreational pursuits, and interaction with family members and friends.

This situation leads to a downward physical and emotional spiral that has been termed "physical and mental deconditioning" (See Gatchel and Turk, 1999). As the spiral continues, the person with chronic back pain feels more and more loss of control over his or her life. The individual ultimately feels totally controlled by the pain, leading to major depression. Once in this depressed state, the person is generally unable to change the situation even if possible solutions to the situation exist.

Diagnosis of Depression and Chronic Back Pain

One of the biggest problems in treating major depression for the patient with chronic back pain is missing the diagnosis. This occurs for two reasons: the chronic back pain patients often do not realize they are also suffering from a major depression, and the doctor is not looking for depression.

Chronic back pain patients will often define their problem as strictly medical and related to the pain. This is supported by a recent study which found that individuals with chronic pain and depression went to their physicians 20% more often than a comparison group of non-depressed medical patients. In addition, depressed chronic back pain patients were 20% less likely to see a mental health specialist than medical patients without a pain problem (Bao, Sturm, & Croghan, 2003).

The depressive symptoms may be downplayed by the chronic back pain patient who believes that, “just get rid of this pain and I won’t feel depressed” or that acknowledging depression is a sign of weakness in dealing with the pain. When the diagnosis of major depression in the chronic back pain patient is missed or ignored, treatments strictly directed at the pain are much more likely to fail.

As concluded by Ohayon and Schatzberg (2003), the presence of a chronic pain physical condition increases the duration of depressive mood, and chronic pain patients seeking medical consultation should be routinely screened for a major depression.

Simultaneous treatment for depression and chronic back pain
Treatment of depression associated with chronic back pain requires a specialized approach. It is generally accepted that the pain and the depression should be treated simultaneously in a multidisciplinary fashion. The treatment of clinical depression most often includes psychological interventions (e.g. counseling, relaxation training, etc) and anti-depressant medication.

In a recent review of the research from 1980 though 2000 that looks at treatment of depression, it was found that the combined treatment approach of medication and psychotherapy yielded better outcomes than either of the interventions alone (Pampallona et al., 2004). Simultaneous treatment directed at the chronic back pain is critical. It has been found that chronic pain may interfere with depression improvement.

Treatment for the chronic pain might include such things as physical rehabilitation aimed at restoration of function, trying to “normalize” one’s life as much as possible even with the pain, appropriate medication management, among other things. Multidisciplinary treatment of the chronic back pain and major depression will ultimately give the patient more of a sense of control over the pain and start a “positive spiral” toward physical and mental re-conditioning.

Further Information about Chronic Pain and Depression can be found at
Click Link: Psychology Today

If you have osteoporosis, you might mistakenly think exercise will lead to fracture. In fact, though, using your muscles helps protect your bones.

Osteoporosis is a major cause of disability in older women. So if you have osteoporosis, how can you reduce your risk of the spinal problems and broken bones that can result in loss of mobility and independence?

The answer: Exercise.

If you've always been physically active, good for you!

Even though your bones may lose some density as you age, they're less likely to become brittle enough to break if you slip and fall.

But it's not too late to start exercising after menopause, when the pace of bone loss really picks up. Even then, starting an exercise program will increase your muscle strength, improve your balance and help you avoid falls and it may keep your bones from getting weaker.

Other possible benefits of exercise include:
 Increasing your ability to carry out daily tasks and activities
 Maintaining or improving your posture
 Relieving or lessening pain
 Increasing your sense of well-being

The key to exercising with osteoporosis is to find the safest, most enjoyable activities for you, given your overall health and amount of bone loss. There's no one-size-fits-all prescription.

Before you start

Consult your doctor before starting any exercise program for osteoporosis. You may need a bone density test and a fitness assessment first.

In the meantime, think about what kind of activities you enjoy most. If you choose an exercise you enjoy, you're more likely to stick with it over time.

Choosing the right form of exercise

Three types of activities are often recommended for people with osteoporosis:
 Strength training exercises, especially those for the back
 Weight-bearing aerobic activities
 Flexibility exercises

Because of the varying degrees of osteoporosis and the risk of fracture, certain exercises may be discouraged. Ask your doctor or physical therapist whether you're at risk of osteoporosis-related problems, and find out what exercises are appropriate for you.

Strength training

Strength training includes the use of free weights, weight machines, resistance bands or water exercises to strengthen the muscles and bones in your arms and upper spine. Strength training can also work directly on your bones to slow mineral loss.

Osteoporosis can cause compression fractures in your spinal column. These fractures often lead to a stooped posture, increasing the pressure along the front of your spinal column, and result in even more compression fractures. Exercises that gently stretch your upper back, strengthen the muscles between your shoulder blades and improve your posture can all help to reduce harmful stress on your bones and maintain bone density.

Weight-bearing aerobic activities

Weight-bearing aerobic activities involve doing aerobic exercise on your feet, with your bones supporting your weight. Examples include walking, dancing, low-impact aerobics, elliptical training machines, stair climbing and gardening. These types of exercise work directly on the bones in your legs, hips and lower spine to slow mineral loss. They can also provide cardiovascular benefits, which boost heart and circulatory system health.

Swimming and water aerobics have many benefits, but they don't have the impact your bones need to slow mineral loss. However, these activities can be useful in cases of extreme osteoporosis, during rehabilitation following a fracture or for only increasing aerobic capacity.

Flexibility exercises

Being able to move your joints through their full range of motion helps you maintain good balance and prevent muscle injury. Increased flexibility can also help improve your posture. When your joints are stiff, your abdominal and chest muscles become tight, pulling you forward and giving you a stooped posture.

Stretches are best performed after your muscles are warmed up — at the end of your exercise session, for example. They should be done gently and slowly, without bouncing. Avoid stretches that flex your spine or cause you to bend at the waist. These positions may put excessive stress on the bones in your spine (vertebrae), placing you at greater risk of a compression fracture. Ask your doctor which stretching exercises would be best for you.

Movements to avoid

If you have osteoporosis, don't do the following types of exercises:

 High-impact exercises, such as jumping, running or jogging. These activities increase compression in your spine and lower extremities and can lead to fractures in weakened bones. Avoid jerky, rapid movements in general. Choose exercises with slow, controlled movements.
 Exercises in which you bend forward and twist your waist, such as touching your toes, doing sit-ups or using a rowing machine. These movements also put pressure on the bones in your spine, increasing your risk of compression fractures. Other activities that may require you to bend or twist forcefully at the waist are golf, tennis, bowling and some yoga poses.

If you're not sure how healthy your bones are, talk to your doctor. Don't let fear of fractures keep you from having fun and being active.

Syringomyelia (sih-ring-go-my-E-lee-uh) is the development of a fluid-filled cyst (syrinx) within your spinal cord.

Over time, the cyst may enlarge, damaging your spinal cord and causing pain, weakness and stiffness, among other symptoms. If left untreated, syringomyelia symptoms may worsen, in some cases requiring surgery.

Syringomyelia has several possible causes. The majority of syringomyelia cases are associated with Chiari malformation, a condition in which brain tissue protrudes into your spinal canal. Other causes of syringomyelia include spinal cord tumours, spinal cord injuries and damage caused by inflammation around your spinal cord.

If syringomyelia isn't causing any problems, monitoring the condition may be all that's necessary. But if you're bothered by symptoms, you may need surgery.

Symptoms of syringomyelia usually develop slowly over time. If your syringomyelia is caused by Chiari malformation — a condition in which brain tissue protrudes into your spinal canal — symptoms may begin during your teenage years or early adulthood. In some cases, a fall, minor trauma, coughing or straining may trigger symptoms of syringomyelia, although none of these causes syringomyelia.

Symptoms:

The following early signs and symptoms of syringomyelia may affect the back of your neck, shoulders, arms and hands first:

 Muscle weakness and wasting (atrophy)
 Loss of reflexes
 Loss of sensitivity to pain and temperature
Other signs and symptoms of syringomyelia may include:
 Stiffness in your back, shoulders, arms and legs
 Pain in your neck, arms and back
 Bowel and bladder function problems
 Muscle weakness and spasms in your legs
 Facial pain or numbness
 A tingling sensation rapidly spreading down your trunk and into your legs when you flex your neck sharply (Lhermitte's sign)

When to see a Doctor:

If you have any of the signs or symptoms associated with syringomyelia, see your doctor. Because many signs and symptoms of syringomyelia can be associated with other disorders, a thorough medical evaluation is important for accurate diagnosis.

If you've experienced a spinal injury, watch carefully for signs and symptoms of syringomyelia. Many months to several years may pass after an injury before syringomyelia develops. If you have syringomyelia symptoms, when you go for an evaluation make sure your doctor knows you had a spinal injury.

Causes:

Although it's unclear exactly how and why it happens, when syringomyelia develops, cerebrospinal fluid — the fluid that surrounds, cushions and protects your brain and spinal cord — collects within the spinal cord itself, forming a fluid-filled cyst (syrinx).

The following conditions and diseases can lead to syringomyelia:

 Chiari malformation — a condition in which brain tissue protrudes into your spinal canal
 Meningitis — an inflammation of the membranes surrounding your brain and spinal cord
 Tethered spinal cord syndrome — a disorder caused when tissue attached to your spinal cord limits its movement
 A spinal cord tumour
 A spine injury

Complications:

In some people, syringomyelia can become a progressive disorder and lead to serious complications. In others, there may be no associated symptoms and no intervention necessary. Complications that may occur as a syrinx grows, or if it damages nerves within your spinal cord, include:

 Scoliosis — an abnormal curve of your spine

 Horner syndrome — a disorder that can occur when the nerves that run from your brain to your eye and face (sympathetic nerve fibers) are damaged, leading to decreased sweating on the side of your face that's affected, a drooping eyelid and a small (constricted) pupil

 Chronic pain

Tests and Diagnosis:

To diagnose syringomyelia, your doctor will begin by asking about your medical history and doing a complete physical examination.

If your doctor suspects syringomyelia, you'll likely undergo a magnetic resonance imaging (MRI) scan of your spine and spinal cord. An MRI is the most reliable tool for diagnosing syringomyelia.

Using magnetic fields and radio waves, an MRI produces 3-D, high-resolution images of your spine and spinal cord. If a syrinx has developed within your spinal cord, your doctor will be able to see it on an MRI. A dye or contrast medium can be injected for the test, and once it travels to your spine, it can enhance the MRI images. An MRI is a safe and painless test. Over time, repeat MRIs can be used to monitor the progression of syringomyelia.

In some cases, syringomyelia may be discovered incidentally when a spine MRI or computerized tomography (CT) scan is done for other reasons.

Treatments and Medications:

Treatment for syringomyelia depends on the severity and progression of your signs and symptoms.

Monitoring

If syringomyelia is discovered on an MRI scan that's done for an unrelated reason, and it's not causing signs or symptoms, monitoring with periodic MRI and neurological exams may be all that's necessary. In rare cases, a syrinx may resolve on its own without treatment.

Surgery

If syringomyelia is causing signs and symptoms that interfere with your daily life, or if signs and symptoms rapidly worsen, surgery is usually recommended. The goal of surgery is to remove the pressure the syrinx places on your spinal cord and to restore the normal flow of cerebrospinal fluid. The type of surgery you'll need depends on the underlying cause of syringomyelia.

Typically, surgery for syringomyelia includes one or more of the following:

 Treating Chiari malformation. If syringomyelia is caused by Chiari malformation, your doctor may recommend surgery that involves enlarging the opening at the base of your skull (suboccipital craniectomy) and expanding the covering of your brain (dura). This surgery can reduce pressure on your brain and spinal cord, restore the normal flow of cerebrospinal fluid and, in most cases, resolve syringomyelia.

 Draining the syrinx. To drain the syrinx, your doctor may surgically insert a drainage system, called a shunt. It consists of a flexible tube with a valve that keeps fluid from the syrinx flowing in the right direction. One end of the tubing is placed in the syrinx, and the other is placed just outside your spinal cord. The shunt remains inside your spine after surgery. In some cases, your doctor may be able to drain the syrinx during surgery with a small tube (catheter), and a shunt is not required.

 Removing the obstruction. If something within your spinal cord is hindering the normal flow of cerebrospinal fluid, such as a tumour or a bony growth, surgically removing the obstruction may restore the normal flow and allow fluid to drain from the syrinx.

 Correcting the abnormality. If a spinal abnormality is hindering the normal flow of cerebrospinal fluid, surgery to correct it — such as a releasing a tethered spinal cord — may restore normal fluid flow and allow the syrinx to drain.

Surgery doesn't always effectively restore the flow of cerebrospinal fluid, and the syrinx may remain, despite efforts to drain the fluid from it.

Follow Up:

Follow-up care after surgery is critical because syringomyelia may recur. You'll need regular examinations with your doctor, including periodic MRI tests, to assess the outcome of surgery. Other syrinxes may form, requiring additional surgery. Even after treatment, some signs and symptoms of syringomyelia may remain, as a syrinx can cause permanent spinal cord and nerve damage.

* Pain and stiffness that doesn’t ease up within the first three days.

* If a back or neck spasm is accompanied by tingling, numbness or weakness, see your GP immediately.

What Your Symptom Is Telling You

You bend down to pick up a piece of paper off the floor. You cradle the phone with your chin while chatting. You hoist your groceries out of your car boot. Suddenly, you're ambushed by a tightness that painfully twists your body like a corkscrew.

When a muscle goes into spasm, all the fibres within the core of a muscle contract simultaneously. This most commonly occurs when you suddenly move or overextend a tensed-up muscle that hasn't been properly prepared for the movement.

Quickly bending over after sitting, for example, can overstretch your back muscles and injure the area. In response, the surrounding muscle fibres instantly tighten, forming a kind of protective splint that guards the back against further irritation.

This triggers a back-stabbing cycle: Contracted fibres squeeze off blood flow to the muscle, creating irritation and more pain. The additional pain triggers even tighter contractions. You're caught in a painful vice without a chance of the muscle relaxing on its own.

Unlike an ordinary muscle cramp that also involves a sudden contraction, a spasm does not usually release with movement. If your back locks in spasm, you can't move.

The prime targets for spasms are the muscles in the neck and back. These areas are often tight, tense and more vulnerable to becoming overstressed by the least little thing. A cool breeze, for example, might blow over neck muscles already tensed from working at a computer or playing tennis. These muscles suddenly clench against the chill.

Now you have the classic "crick" and probably won't be able to turn your head to see out your car's side window.
A sudden spasm in your back or neck that's accompanied by numbness, tingling or weakness, could mean a ruptured disk or nerve injury.

Symptom Relief

Spasms have a way of holding on stubbornly. To release that grip, try any of these techniques.

Get off your feet. "Lying down will take the strain off already stressed tissues." If the spasm is in your back, gently bring your knees up to your chin and hold them there for a minute or more (as long as there is no pain). "This should help release some of the shortened connective tissue and muscle fibres."

Try a gentle ice massage. "Rubbing an ice cube directly over the sore area in slow circles can numb the area in about five minute’s flat." (If you can't reach the area yourself, ask a friend or family member to lend a hand.) What's more, at first the ice narrows the blood vessels, then they open up super wide. This allows a rush of healing blood to flow in, helping to release the clenched fibres. "Just be sure to keep the ice moving so you don't freeze and injure surface tissues." Repeat the rub once an hour.

Swallow a pain reliever. Aspirin or another no steroidal anti-inflammatory such as ibuprofen are "the best pain relievers you can get without a prescription." Acetaminophen may bring less effective relief because it's not an anti-inflammatory.

Limber gently; don't jerk. After icing, moving slowly and gently will help restore normal circulation and ease fibres back into their customary patterns of contraction and relaxation. Don't stretch too aggressively, however. "Stretching could make the spasm worse."

After icing your sore shoulder, for example, simply move it through its full range of motion. Do this by gently raising your shoulders up to your ears, rolling them forward, then back, and also moving your arm diagonally across your chest. "This actually reprograms the fibres in the shoulders, telling them where to go so they don't clench up again."

Get it warm. If the spasm still has you in its grip after three days, you can try treating the area with heat. Once the acute pain and swelling subside, heat will nudge blood flow to the sore site. Simply wrap a hot, wet towel around the area, cover it with plastic wrap and then wrap it with a dry towel to seal in the heat. Apply these hot packs five times a day for no more than 20 minutes at a time.

Break up the knot. Once the pain and swelling have subsided somewhat, you may be left with a tough little knot of muscle that is still in spasm. Try pressing your thumb, finger or even the tip of a broom handle directly into a stubborn spasm. This may help move the built-up fluid, relax the muscle and separate fibres. If direct pressure doesn't do the trick, you may need to see a Practitioner who specializes in musculoskeletal pain.

David from Kintbury:

Q: My MRI showed loss of normal cervical lordosis in C3-C-7. Is it normal for my fingers to tingle?
and feel numb at the tips? At first the numbness was in my thumb and now it's all finger and runs up my arm. I have been able to deal with the pain in my neck as long as I take mobic daily (anti-inflamatory) lifting something as simple as a gallon of milk is very painful. What can this be?

Answer:Yes it is...
The primary symptom of cervical radiculopathy is pain radiating into the arm, neck, chest, and/or shoulders. Numbness or tingling in fingers or hands may also be present, as well as muscle weakness. Other symptoms may include lack of coordination, particularly in the hands.

Radiculopathy refers to disease of the spinal nerve roots (from the Latin radix for root). Radiculopathy produces pain, numbness, or weakness radiating from the spine.

Description

At the joints between the vertebrae, sensory nerves (nerves conducting sensory information toward the central nervous system) and motor nerves (nerves conducting commands to muscles away from the central nervous system) connect to the spinal cord. Each spinal nerve divides or fans out just before merging with the spinal cord. These smaller, separate nerve bundles are termed the roots of the nerve because they are reminiscent of the way the roots of a plant divide in the ground.

Damage to the spinal nerve roots can lead to pain, numbness, weakness, and paresthesia (abnormal sensations in the absence of stimuli) in the limbs or trunk. Pain may be felt in a region corresponding to a dermatome, an area of skin innervated by the sensory fibers of a given spinal nerve or a dynatome, an area in which pain is felt when a given spinal nerve is irritated. Dynatomes and dermatomes may overlap, but do not necessarily coincide.

Radiculopathies are categorized according to which part of the spinal cord is affected. Thus, there are cervical (neck), thoracic (middle back), and lumbar (lower back) radiculopathies. Lumbar radiculopathy is also known a sciatica. Radiculopathies may be further categorized by what vertebrae they are associated with. For example, radiculopathy of the nerve roots at the level of the seventh cervical vertebra is termed C7 radiculopathy; at the level of the fifth cervical vertebra, C5 radiculopathy; at the level of the first thoracic vertebra, T1 radiculopathy; and so on.

Radiculopathy is to be distinguished from myelopathy, which involves pathological changes in or functional problems with the spinal cord itself rather than the nerve roots. Sometimes, radiculopathy is also distinguished from radiculitis, the latter being defined as irritation (hence the "itis" suffix) of a nerve root that causes pain in the dermatome or dynatome corresponding to that nerve. Radiculopathy, on the other hand, denotes spinal nerve dysfunction (not just irritation) presenting with pain, altered reflex, weakness, and nerve-conduction abnormalities. Pain may not be present with radiculopathy, but is always present with radiculitis.

Millions of persons experience some form of radiculopathy at some point in their lives. Because many of the causes of radiculopathy are long-term diseases (e.g., ankylosing spondylosis, diabetes) or diseases that tend to affect the elderly (e.g., arthritis), radiculopathy occurs more often in the middle-aged and elderly than in the young. However, injuries due to sports, heavy lifting, or bad posture affect the young as well. Cervical disc herniation with radiculopathy (mostly involving the C4 to C5 levels) affects 5.5 per 100,000 adults every year, with the highest risk being for adults 35 to 55 years year old.

Causes and symptoms

Radiculopathy can be caused by any disease or injury process that compresses or otherwise injures the spinal nerve roots. Violent blows or falls, cancer, some infections such as flu and Lyme disease, diseases that lead to degeneration of the vertebrae and/or intervertrebral discs (osteoarthritis), slipped or herniated discs, scoliosis, and other factors can cause radiculopathy. For example, extreme backward bending of the neck can trigger cervical radiculopathy. This has given rise to a recently-recognized category of radiculopathy termed "salon sink radiculopathy," so-called because salon patrons are asked to tip their heads sharply backward into sinks for shampooing. Spondylosis (immobilization and growing-together of one or more vertebral joints, often due to osteoarthritis) can deform the structures of bone, cartilage, and ligament through which spinal nerves must pass, leading to cervical and lumbar radiculopathy. Thoracic and lumbar radiculopathies are a common result of diabetes, which can impair blood flow to the spinal nerve roots.

Diagnosis

Radiculopathy is a possible diagnosis when numbness, pain, weakness, or paresthesia of the extremities or torso are reported by a patient, especially in a dermatomal pattern. However, these symptoms can also be caused by nerve compression remote from the spine, and the physician must rule out this possibility before ruling in favor of radiculopathy. Electrodiagnostic studies can help distinguish radiculopathy from other diagnoses. These techniques include current perception threshold testing, which tests patient ability to sense alternating electric currents at several frequencies; electromyographic nerve conduction tests; and testing of sensory evoked potentials (changes in brain waves in response to sensory stimuli).

When radiculopathy is diagnosed, the location of the affected nerve roots and, ultimately, the cause of their dysfunction must be determined. Diagnosticians look at the precise features of radicular symptoms in order to determine the spinal level of the affected root or roots. For example, radiculopathy at the C7 level (the nerve root most often affected by herniated cervical disc) is characterized by weak triceps and wrist extensor muscles and a numb middle finger. Radiculopathy at the L3 (third lumbar disc) level is characterized by decreased patellar (kneecap) reflex, loss of sensation and/or pain in the anterior (forward) part of the thigh, and weakness in quadriceps muscle; and so on.

X ray or MRI may be used to confirm the diagnosis. A herniated disc, for example, will be revealed by imaging. A herniated disc is one that has partly popped or bulged out from between the vertebra above and below it. This may place pressure on the nerve roots and on the spinal cord itself.

In persons with spinal cancer or other progressive disorders, the appearance of radiculopathy may be an important sign that pressure is beginning to be exerted by the tumour or some other changing structure. This may signal that it is time for surgical intervention.

Treatment

Treatment for radiculopathy varies with the nature and severity of the disease process or injury that has caused the disorder. Conservative (non-surgical) treatment is often attempted first. This consists primarily of rest, exercise, and medication. Patient-specific exercises are prescribed by a physical therapist for the targeted strengthening of muscles and other supporting tissues to relieve pressure on affected spinal nerve roots. Weight loss may be advised to decrease stress on the spine. Medications may include oral opioids (e.g., morphine) or other analgesic (anti-pain) medications. In severe cases, injection of an opioid by an external or implanted pump directly into the affected area may be prescribed. Epidural corticosteroid injections, selective nerve root block, and epidural lysis (destruction) of adhesions are also used to treat radiculopathy. A soft neck collar may be prescribed for persons with cervical radiculopathy.

When conservative treatment fails, surgery may be necessary. The primary purpose of surgery is to take pressure off of affected nerve roots or the blood vessels that serve them and to stabilize spinal structure, but surgery may also sever nerves in order to relieve severe pain. Fusion of vertebrae (i.e., removal of the flexible intervertebral disc and joining of the adjacent vertebrae so that they grow into a single bone) was for many decades a common treatment for intractable radiculopathy.

The Bryan Disc

The Bryan disc is a flexible disc or ring of titanium and Teflon that is used to replace the intervertebral disc in patients with degenerative disc disease. Two versions of the disc, one cervical (for the neck) and the other lumbar (for the lower back) were under development. Early reports from surgeons were positive. The advantage of such an implant over fusion is that the patient does not lose flexibility in that part of their spine.

Recovery and rehabilitation

Exercise is key to the treatment of both conservative and surgical treatment of radiculopathy. It may even be curative in some cases. It is also an important aspect of recovery from surgery. Exercise is done as directed by a physical therapist.

Prognosis

Prognosis varies with the underlying process causing the radiculopathy. For sports injuries, at one extreme, the prognosis is excellent; for degenerative disc disorders, even surgery may not completely or permanently resolve the problem. However, new surgical techniques are improving this picture.

Introduction

First the good news, osteoporosis is a condition that is both preventable and treatable if caught in time. However, the bad news is that there is not enough awareness of the opportunities for prevention and treatment of osteoporosis, and too many people mostly women over the age of 50 suffer significant illness, deformity and sometimes death from this condition.

Osteoporosis itself does not cause back pain. However, osteoporosis can weaken the vertebral body (spine) so that it can no longer withstand normal stress or a minor trauma (e.g. a fall), resulting in a fracture. In fact, a fracture is typically the first outward sign of the disease, and advanced osteoporosis is potentially very painful and disabling.
Osteoporosis—the loss of calcium from bones resulting in weakened bone structure—increases the risk of fracture of vertebral body (the thick block of bone at the front of the vertebrae).

In this type of fracture, the top of the vertebral body collapses down with more collapse in front thus producing the "wedged" vertebrae, the "dowagers" hump and shortened height.
The resulting change in height and spinal alignment can lead to serious health problems, including:

•Chronic or severe pain
•Limited function and reduced mobility
•Loss of independence in daily activities
•Decreased lung capacity
•Difficulty sleeping

Also, studies show that a first osteoporotic fracture makes it five times more likely further fractures will occur. That is why it is important that patients seek medical treatment for osteoporosis before it reaches the fracture stage.

Kyphoplasty compared with Vertebroplasty

Vertebroplasty and Kyphoplasty are both minimally invasive surgical procedures for treating osteoporotic fractures where a cement-like material is injected directly into the fractured bone. This stabilizes the fracture and provides immediate pain relief in many cases.

Kyphoplasty includes an additional step. Prior to injecting the cement-like material, a special balloon is inserted and gently inflated inside the fractured vertebrae. The goal of this step is to restore height to the bone thus reducing deformity of the spine. Most patients return to their normal daily activities after either procedure.

About 8,000,000 people in the UK are said to suffer from some type of arthritic pain At any one time. About 6 million people suffer from back pain in the UK. Each year approximately 2 million people are said to be functionally disabled from back pain.

In the U.K., £5 billion is annually spent on back pain treatment. £18 billion is lost annually in productivity and wages as a result of back pain. These commonly quoted statistics, even if partially accurate, indicate a devastating problem for the United Kingdom. It should be said at this point that statistically, the same ratios of occurrence to gross population may be representative of what goes on in other industrialised nations.

As we all know nutrition is a really important component of our overall health including the health of our back.
Those of us who enjoy too many calories and eat relatively unhealthy foods are more than likely to be a bit heavier than we would like to be!

So common sense should tell us that the more we weigh the more stress is placed on our spine as well as other joints in our bodies which causes extra wear and tear.

So what about the effects of smoking?

If you smoke you probably do not want to hear this, but research shows that there is a direct relationship between smoking cigarettes and having back related problems.

You see smoking slows down your circulation and cuts down the oxygen supply in your bloodstream. A healthy blood and oxygen supply is vital for good health and for proper healing to occur.

*According to a recent study conducted by Georgetown University scientist David Lanier, smoking is a major risk factor in the development of acute lower back pain, an ailment that ranks second only to common colds!

How could smoking cause back pain?

Scientists aren't sure why some smokers are prone to back pain. According to the report in the Annals of the Rheumatic Diseases, nicotine from cigarettes "could affect the manner in which the brain processes sensory stimuli and the central perception of pain"- in other words, cigarettes affect the way the brain sends its pain signals. Smoking may also damage tissue in the lower back and elsewhere in the body by slowing down circulation and reducing the flow of nutrients to joints and muscles, according to the journal.

Should I give up smoking for the sake of my back?

The data may still be a little fuzzy, but the message is clear. As reported in the BMJ, smokers who suffer from back pain have every reason to kick the habit. Giving up cigarettes probably won't immediately banish back pain, but it just might help. Of course, quitting smoking will also dramatically lower the risk of heart disease, cancer, and a host of other diseases.

Answer: An intervertebral disc bulge occurs when the inner jelly substance pushes on the outer wall of the disc but doesn't completely go through the outer wall. The degree of pain and the limitation of pain free movement is dependent on the amount of pressure the bulge is putting on the nerve. A disc bulge is measured in millimetres and can be identified by both x-ray and magnetic resonance imaging (MRI).

If you suspect that you have a bulging disc, you will need to see a physician and get a full evaluation including an x-ray or MRI. Make sure the doctor also assesses you from a physical perspective to clinically identify any physical dysfunctions.

There are a variety of treatment options available for a bulging disc but the most powerful one is to identify the muscle imbalances responsible for your physical dysfunctions, dysfunctions that are the true root cause of your bulging disc.

Now let us come to the vital part of our discussion which is regarding bulging disc treatment. Treatment would depend on the severity of the condition; the doctor only in very rare cases will progress towards surgery. Generally the doctor asks the patient to take some rest and strictly avoid those things that can trigger the pain, also it is imperative to mention here that a prolonged rest can only deteriorate your condition, so be careful.

Medications that are generally given are the non-steroidal anti inflammatory drugs. Analgesics, muscle relaxants, even narcotics medications are prescribed sometimes, but before using any of the medication, always consult the doctor.

Another bulging disc treatment you can try out is cold ice and hot packs, both of them used according to one's condition can yield helpful results. A little bit of physical exercises like stretching ones. Yoga, walking, meditation can help you greatly.

The last and perhaps the best bulging disc treatment is surgery, if everything fails, the doctor uses it as a last weapon. But here the patient must be both mentally and physically prepared to face the surgery and also the situation after a surgery.

When it comes to assessing back pain, the upper back and neck region is the most complex area of our body because of the many joints and how those joints work together.
The neck and shoulders can exhibit much the same difficulties as the lower back, such as pulled muscles, disc problems, arthritis, and other issues. While lower back pain affects our ability to ambulate, upper back pain affects our ability to perform daily activities like brushing our teeth or driving a car.

What can cause it?

The two most common reasons for upper back and neck pain are trauma and muscle imbalances, the latter being responsible for what are called "postural dysfunctions." These postural dysfunctions cause abnormal alignment of the head and shoulders and abnormal positioning of the joints that lead to increased wear and tear on the joints, muscles, and ligaments even discs.

The most important thing to understand about any upper back and neck pain is that, barring trauma, these conditions do not happen overnight. You may be come symptomatic very quickly, but it takes a long time for the condition whatever it might be, to become painful.

How is my condition diagnosed?

Your condition can be diagnosed by a GP, a physical therapist, Osteopath or a chiropractor. But in order to get the most comprehensive picture of your condition, you may need to see more than one professional.

What are the symptoms?

The majority of the complaints range from local pain to radiating pain, weakness and pain in the arms, pain and irritation with any movement of the upper body, morning pain and stiffness.

What are my treatment options?

Cortisone injections, prescriptions for muscle relaxants or non-steroidal anti-inflammatory drugs (NSAIDs), and bed rest are most commonly employed.

Osteopathy, Chiropractic care and physical therapy can offer spinal mobilizations, hot packs, ultrasound, electrical stimulation, cervical traction, and therapeutic exercises.

Surgery should always be your last option and should only be considered if the severity of your condition warrants it.

Why do traditional treatments fail?

Most traditional treatments fail because they simply address the symptoms and fail to address the cause of the condition. Your pain is a physical problem and it requires a physical solution. There are no pills or injections that can create postural balance in your body, which is necessary to take the pressure off the nerve or make the joints work better.

Which treatments work best?

The principles of Muscle Balance Therapy address your pain and also pinpoints what is responsible for your condition in the first place.

Through strategic bodily assessments, your individual muscle imbalances can be identified, and a targeted corrective program can be designed for your specific needs. The ultimate goal is to achieve a more balanced body and take the stress off the muscles, joints, and ligaments.

There is continued concern over the levels of obesity among children in the UK. Obesity during childhood is a health concern in itself, but can also lead to physical and mental health problems in later life, such as heart disease, diabetes, osteoarthritis, back pain, increased risk of cancer, low self-esteem and depression. Obesity develops as a result of an imbalance between energy consumption and energy expenditure.

Measuring Obesity in Children

Body Mass Index (BMI) is one of the most widely used methods for assessing body composition or estimating levels of body fat. BMI is calculated by dividing an individual's weight (in kilograms) by their height (in meters) squared and gives an indication of whether weight is in proportion to height. In adults there are static cut off values for BMI between normal weight, overweight and obesity; however these are not appropriate for children. The normal BMI range for children changes substantially with age and is different between boys and girls.

A certain BMI at one age may be the norm but at another age the same BMI may be unusually high or low. Interpretation of BMI values in children therefore depends on comparison with age- and sex-specific growth reference charts. These provide thresholds or cut-off points in the BMI distribution (BMI centiles), which can be used to estimate levels of obesity, overweight and underweight in children. Statistics in this release were derived using the UK 1990 growth reference for BMI (the standard approach in the UK).

The BMI centile cut-offs used to derive the percentages classified as overweight, obese and severely obese are those recommended for the purposes of population monitoring and epidemiological research. The statistics do not represent the percentage of children clinically classified as overweight, obese or severely obese. Use of the cut-offs recommended for clinical practice would result in lower percentages for overweight, obese and severely obese and BMI centile would be only one of a variety of factors taken into consideration before any clinical diagnosis is made.

The release updates annual statistics on high and low body mass index (BMI) for Primary 1 school children, and includes data to school year 2007/08. The statistics are derived from height and weight measurements recorded at routine health reviews for ten NHS Boards in Scotland which participate in the CHSP-School system. Statistics are presented by: participating NHS Board, Council Area, Community Health Partnership, gender and UK Index of Multiple Deprivation (SIMD) quintile.

KEY POINTS

Based on centile cut-offs on the 1990 UK growth reference charts used for population monitoring purposes:

•In 2007/08, among the ten participating NHS Boards, 20.0% of Primary 1 children were classified as overweight, including 7.9% obese and 3.9% severely obese.

•Levels of high BMI increased slightly, and very gradually, between 2000/01 and 2005/06. Over the last two years, levels of high BMI have decreased slightly and the percentages for 2007/08 are similar to those for 2000/01 (19.7% overweight, including 8.0% obese and 3.9% severely obese).

As the number of NHS Boards submitting data has increased since 2000/01 (from four to ten Boards) the trend for ‘All participating NHS Boards’ should be interpreted with a degree of caution. However, a similar trend is observed among the Boards participating throughout the eight year period.

INTERPRETATION

Statistics in this release are derived from centiles, using the 1990 UK growth reference standards. These growth reference charts are based on data collected between 1978 and 1990 from UK surveys (they therefore represent children's weight relative to height before the recent rise in levels of obesity in children). Cut-off points for population monitoring purposes, based on these studies, define overweight as children whose BMI is in the top 15% of the UK 1990 reference range for their age and sex.

Obese and severely obese children are defined as those whose BMI is in the top 5% and 2% of the reference range respectively. Children with a BMI within the 5th - 85th centile range are considered to be in the normal range (although BMI may incorrectly categorize a small minority of children with heavy musculature as being overweight or obese). These statistics classify underweight and very underweight as children with a BMI in the bottom 5% and 2% of the reference range respectively.

All NHS Boards in the UK provide a Child Health Surveillance Programme where children are offered routine reviews at various stages of their life. The majority of Boards record these reviews using the Child Health Systems Programme (CHSP). Statistics in this release are derived from height and weight measurements collected at routine health reviews in Primary 1 through the CHSP-School system. As CHSP-School is implemented in the majority of NHS Boards, data from this system can be used to estimate prevalence of over- and under- weight children in Scotland.

Data for NHS Grampian, NHS Orkney, NHS Shetland, NHS Highland and the former NHS Greater Glasgow are not included. The BMI statistics cover approximately 88% of children in Primary 1 among the ten participating NHS Boards, and approximately 52% of children in Primary 1 across Scotland.

Figures for Community Health Partnerships, Council Areas and NHS Boards with small numbers of reviews should be interpreted with care as the small numbers may result in fluctuations in the percentages from year to year etc. The smaller the number of reviews, the poorer the precision of the estimate (percentage) and the wider the associated confidence interval.

DETAILED FINDINGS

Based on centile cut-offs on the 1990 UK growth reference charts used for population monitoring purposes:

•In 2007/08, among the ten participating NHS Boards, 20.0% of Primary 1 children were classified as overweight, including 7.9% obese and 3.9% severely obese.

•Levels of high BMI increased slightly, and very gradually, between 2000/01 and 2005/06. Over the last two years, levels of high BMI have decreased slightly and the percentages for 2007/08 are similar to those for 2000/01 (19.7% overweight, including 8.0% obese and 3.9% severely obese). As the number of NHS Boards submitting data has increased since 2000/01 (from four to ten Boards) the trend for ‘All participating NHS Boards’ should be interpreted with a degree of caution. However, a similar trend is observed among the Boards participating throughout the eight year period.

•In Primary 1, levels of high BMI amongst boys tend to be slightly higher than those for girls. In school year 2007/08, 20.5% of boys were classified as overweight (including 8.2% obese and 4.1% severely obese) compared to 19.6% of girls (including 7.6% obese and 3.6% severely obese).

•Primary 1 figures for 2007/08 indicate that the most deprived areas have the highest percentage of children classified as overweight, obese and severely obese (21.7% overweight, including 9.2% obese and 4.5% severely obese) while the least deprived areas had the lowest percentage (18.1% overweight, including 6.3% obese and 3.0% severely obese), however this pattern is not clearly observed for all previous years.

•The percentage of Primary 1 school children with low BMI (classified as underweight) was 3.2% in 2007/08. Levels of low BMI have remained relatively stable at around 3% in recent years.

Development of Obesity

Industrialization and modernization has had a tremendous impact on our food. For example, food can be purchased just about anywhere. No longer is it necessary to expend physical effort to hunt and forage for food. There are vast numbers of processed food products available and labour-saving devices (e.g., microwave ovens) to cook food. The market for many convenience foods and kitchen devices came about when women entered the work force.

Childhood obesity is on the rise due to many factors that include sedentary behaviour (e.g., computer games), eating when not hungry, television advertising high-calorie 'tasty' foods, and even genetics.

According to the Department of Heath "Call to Action to Prevent and Decrease Overweight and Obesity," 40% of adults in the United Kingdom do not participate in any leisure-time physical activity and less than 1/3 engage in at least 30 minutes of physical activity most days.

Another consideration is where meals are eaten. In 1992, 38% of the food pounds were spent on foods eaten away from home. It can be difficult to control what you eat and how the food is prepared (e.g., fried versus broiled) at a restaurant; especially 'fast food' establishments.

If you are overweight, obese, or working at maintaining a healthy weight, there are many tools available to empower your efforts.