Low Back Pain Management
Back pain can have many causes, and many times back pain will resolve itself in two to four weeks with rest, ice and heat. Roughly 80 percent of Americans will experience back pain at some point in their lives, making back pain one of the most common reasons people visit back pain doctors or miss work.
How common is back pain?
While it is estimated that four out of five people will experience back or lower back pain at some point in their lives, back pain that lasts longer than a few weeks is not normal and it may be necessary to seek advice from lower back pain doctors.
Back Pain Symptoms
Back pain symptoms may include feelings of sharp or aching pain, muscle tightness, stiffness or limited flexibility. People may feel inability to stand with proper posture and experience pain radiating down one or both legs along with tingling and numbness.
Where is my back pain coming from?
Bulging or Herniated Discs
Spinal discs are soft cushions between vertebra. Sometimes, the soft jellylike substance inside the disc can bulge out of place or rupture, putting pressure on the surrounding nerves causing back pain. Disc related pain can be caused by an injury, but can also be age related.
Sciatica
Sciatica refers to back pain that can radiate down the back of either or both legs. It is related to conditions such as spinal stenosis, bulging or herniated discs.
Spinal Stenosis
Spinal stenosis is narrowing of the canal where the spinal cord travels. The condition is usually due to a combination of degenerative disc disease along with arthritic changes of the bone. This combination results in a condition called neurogenic claudication, which results in difficulty standing straight due to low back pain, and tingling, numbness, or weakness in the legs. Pain is resolved with sitting in a flexed position, or using something to lean on, such as a shopping cart or cane. These conditions can be treated with conservative, minimally invasive procedures by our back pain and lower back pain doctors.
Risk Factors for Back Pain
There are a few factors that can increase your risk of developing back or lower back pain, such as:
- Smoking
- Obesity
- Age
- Physical labor
- Sedentary work
- Depression
- Family history of low back pain
Preparing for Your Appointment with Midwest Orthopedic and Musculoskeletal Alliance
Before you meet with your back pain relief doctor, take note of some important facts.
- Is your back pain the result of an injury?
- What movements increase or decrease your back pain?
- What are the symptoms you have been feeling?
- How long have you had this back pain?
- What does your back pain feel like? Dull, aching, stabbing or shooting?
- What type of work do you do?
- What treatments or medications have you already tried to resolve your back pain?
Diagnostic Testing
To help determine the cause of your back pain, your provider may ask you a lot of questions and ask for some diagnostic testing. Learn more about what to expect when you visit a back pain and lower back pain relief doctor at Midwest Orthopedic and Musculoskeletal Alliance.
Some common diagnostic imaging includes:
X-Ray
An X-ray shows the alignment of the bones in your spine and whether you have any broken or arthritic bones that may be causing pain. Always bring your X-ray images with you to a doctor’s appointment to help your doctor understand your full history.
MRI or CT Scan
Magnetic resonance imaging (MRI) or computerized tomography (CT) scans show images of bone, muscle, tissue, nerves, blood vessels, tendons and ligaments. These tests can show disc herniation, muscle tears, and ligament problems, and can help your doctor understand your back pain.
Nerve Studies (EMG)
Electromyography (EMG) is a test used to study nerve and muscle function. There are two parts to EMG testing: a nerve conduction study and a needle exam for muscle testing. The nerve conduction study involves stimulating the nerves at different points with small electric stimulation so their function can be measured. The needle exam involves inserting very fine needles into several muscles, which pick up both normal and abnormal electrical signals given off by a muscle.
The EMG can provide information about the extent of nerve and/or muscle injury and can give some indication as to whether the damage is reversible. An EMG may be performed when the patient has unexplained muscle weakness to distinguish if the problem is in the muscle or due to a nerve disorder. The EMG can detect abnormal electrical activity of muscles and nerves that can occur in many diseases and conditions, including muscular dystrophy, muscle inflammation, pinched nerves, damage to nerves in the arms and legs (peripheral nerve damage), multiple sclerosis, and carpal tunnel syndrome.
Back Pain Treatment Options
There are a number of treatment options that your back pain doctor can perform to help reduce back pain, which include:
- Epidural Steroid Injection
- Discogram
- Facet Joint Injection
- Trigger Point Injection
- Radiofrequency Neuroablation
- Minimally Invasive Posterior Facet Fusion
- Sacroiliac Joint Injection
At Midwest Orthopedic and Musculoskeletal Alliance, our back pain and lower back pain doctors value the importance of an interdisciplinary approach. For back pain treatments we don’t offer, we are able to refer you to another back pain doctor.
Treatment
Medial Branch Blocks and Radiofrequency Ablation Treatment
Overview and indications for procedure:
Facet joints (also known as the Zygapophysial joints or Z-joints) are paired structures on both sides of your spine that allows movement between two vertebrae. When facet joints are strained (car accidents, falls, or injuries) ,degenerative changes settle in these joints or there is a shift between two vertebrae (spondylolisthesis) , the joints could become the source of back pain.
Pain may be localized to the degenerated regions or radiate to nearby structures.
Medial Branch Block
Pain information from the facet joints travels to the brain via small nerve endings called medial branches. In order to determine whether or not the facet joints are causing pain, medial branch nerves can be diagnostically blocked, and the patient can determine whether or not there was a change in their pain after the procedure. Medial branch block (MBB) is performed twice to confirm the correct diagnosis and the correct number of facets contributing to pain. Clinicians are looking for improvement of pain between 50-100% after each diagnostic block. When a patient experiences significantly reduced pain with diagnostic medial branch injections on two separate occasions, he or she is considered a good candidate to proceed to radiofrequency ablation treatment.
Radiofrequency Ablation Treatment
This procedure is performed after diagnostic medial branch injection is performed and it is determined, with a reasonable degree of certainty, that facet joints are the source of an individual’s back pain. Radiofrequency ablation uses radio-magnetic waves to stop the medial branch nerves from transmitting pain signals from the facet joints to the brain. Your interventional physiatrist will use an X-ray to direct specialized needles to specific medial branches. The exact location of the nerve is identified with brief neuromuscular testing. Once the location of each needle is finalized, anesthetic is used, and the radiofrequency procedure is completed in less than 10 minutes. Radiofrequency ablation is performed to reduce pain, improve flexibility, and enhance function, enabling the patient to pursue physical therapy and return to work or leisure activities. At times, the presentation is on both sides, in which case each side is treated separately, 1–2 weeks apart. It is encouraged to couple this treatment with an organized physical therapy exercise program, activity modification, and ergonomic corrections for the optimal outcome.
Get Relief from Low Back Pain
Call us at 414-384-6700 to connect with our interventional pain specialists at Midwest Orthopedic and Musculoskeletal Alliance in Southeastern Wisconsin.
