Back injuries can develop due to a numerous amount of different factors and circumstances. Some people are more likely to develop back pain than others. Something as simple as twisting the wrong way in bed can cause misalignment of the vertebrae while others may sustain back injuries while working, at home, or from an automotive accident or another traumatic event. Relief from back pain is one of the most common reasons why people seek chiropractic care.
While lower back injuries are the most common, pain in the thoracic pain (middle of the spine) and cervical pain (neck region) of the spinal cord also often occurs. These injuries affect the vertebrae, discs, soft tissues, muscles, and joints of your body. Other parts of your entire body can be affected due to these injuries.
Muscle strain often contributes to lower back pain. The erector spinae, which help keep the spine erect, can become enflamed and spasm. Discs that are not in their proper place due to malformation can cause damage to surrounding discs, joints, nerves, muscles, ligaments, and tendons.
Herniated or degenerative discs are often a cause for upper back pain. Typically rest, ice/heat packs, over-the-counter inflammatory medicine, and pain medicine such as aspirin treat back pain until the muscles are able to return to their lower positions. However, if pain persists after more than a couple weeks, the back may begin to atrophy and become significantly weak. This can leave you open to further injury.
Most cases of back pain are mechanical, meaning they are typically not caused by any serious conditions.
Back pain is experienced by 31 million Americans at any given time and the single leading cause of disability worldwide. According to the US Department of Labor, workers in the health care industry sustain back injury more than any other profession. The number one reported injury in health care is patient handling. 40 to 50 percent of nurses sustain back injury. Workplace injuries cost a total of nearly $50,000 per injury on average for medical treatment and indemnity cost.
Fact joints are what guide and limit the movement of the spine. These joints are located in pairs on each segment of the spinal cord except for the very top of your vertebrae. Roughly one-fifth of the twisting ability of your neck and lower back is controlled by facet joints.
A small capsule surrounds each facet joint providing a nourishing lubricant for the joint. Each joint is supplied with tiny nerve fibers that provide a painful stimulus when the joint is injured or irritated. These joints can degenerate over time due to aging or disease, which can result in numerous conditions of pain.
Damage to the lower back may cause stiffness resulting in difficulty standing up or maintaining good posture. Cervical damage (near the neck) can make it difficult to move and twist your head.
When the cartilage in joints wears thin, the body begins to produce a material to shore the cartilage (these are called bone spurs). This material can calcify, hardening and causing stiffness in the joint. This can lead to inflammation and osteoporosis. Powerful muscle spasms can occur due to the inflammation. The joints can also degenerate and slip forward in a advanced cases such as spondylolisthesis.
Sacroiliac joint dysfunction, a common joint disorder, refers to pain in the sacroiliac joint region that is caused by abnormal motion in the sacroiliac joint (around your hip). This can result in debilitating pain due to inflammation of the sacroiliac joint. Common symptoms include lower back pain, buttocks pain, sciatic leg pain, groin pain, hip pain, urinary frequency, numbness, prickling, or tingling. The pain can range from dull to stabbing pain and increases with motion.
Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and density and that leads to an increased risk of fracture. In osteoporosis, the bone mineral density (BMD) is reduced, bone microarchitecture deteriorates, and the amount and variety of proteins in bone are altered.
Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density of 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults) as measured by dual-energy X-ray absorptiometry; the term “established osteoporosis” includes the presence of a fragility fracture. The disease may be classified as primary type 1, primary type 2, or secondary.
The form of osteoporosis most common in women after menopause is referred to as primary type 1 or postmenopausal osteoporosis. Primary type 2 osteoporosis or senile osteoporosis occurs after age 75 and is seen in both females and males at a ratio of 2:1. Secondary osteoporosis may arise at any age and affect men and women equally. This form results from chronic predisposing medical problems or disease, or prolonged use of medications such as glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis.
The risk of osteoporosis fractures can be reduced with lifestyle changes and in those with previous osteoporosis related fractures medications. Lifestyle change includes diet, exercise, and preventing falls. The utility of calcium and vitamin D is questionable in most. Bisphosphonates are useful in those with previous fractures from osteoporosis but are of minimal benefit in those who have osteoporosis but no previous fractures. Osteoporosis is a component of the frailty syndrome.
- Excess alcohol: Although small amounts of alcohol are probably beneficial (bone density increases with increasing alcohol intake), chronic heavy drinking (alcohol intake greater than three units/day) probably increases fracture risk despite any beneficial effects on bone density.
- Vitamin D deficiency: Low circulating Vitamin D is common among the elderly worldwide. Mild vitamin D insufficiency is associated with increased parathyroid hormone (PTH) production. PTH increases bone resorption, leading to bone loss. A positive association exists between serum 1,25-dihydroxycholecalciferol levels and bone mineral density, while PTH is negatively associated with bone mineral density.
- Tobacco smoking: Many studies have associated smoking with decreased bone health, but the mechanisms are unclear. Tobacco smoking has been proposed to inhibit the activity of osteoblasts and is an independent risk factor for osteoporosis. Smoking also results in an increased breakdown of exogenous estrogen, lower body weight, and earlier menopause, all of which contribute to lower bone mineral density.
- Malnutrition: Nutrition has an important and complex role in the maintenance of good bone health. Identified risk factors include low dietary calcium and/or phosphorus, magnesium, zinc, boron, iron, fluoride, copper, vitamins A, K, E, and C (and D where skin exposure to sunlight provides an inadequate supply). Excess sodium is a risk factor. High blood acidity may be diet-related and is a known antagonist of bones. Some have identified low protein intake as associated with lower peak bone mass during adolescence and lower bone mineral density in elderly populations. Conversely, some have identified low protein intake as a positive factor, protein is among the causes of dietary acidity. Imbalance of omega-6 to omega-3 polyunsaturated fats is yet another identified risk factor.
- Underweight/inactive: Bone remodeling occurs in response to physical stress, so physical inactivity can lead to significant bone loss. Weight-bearing exercise can increase peak bone mass achieved in adolescence, and a highly significant correlation between bone strength and muscle strength has been determined. The incidence of osteoporosis is lower in overweight people.
- Heavy metals: A strong association between cadmium and lead with bone disease has been established. Low-level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures, especially in the elderly and in females. Higher cadmium exposure results in osteomalacia (softening of the bone).
- Soft drinks: Some studies indicate soft drinks (many of which contain phosphoric acid) may increase the risk of osteoporosis, at least in women. Others suggest soft drinks may displace calcium-containing drinks from the diet rather than directly causing osteoporosis.
Sports injuries are injuries that occur in athletic activities. They can result from acute trauma, or from overuse of a particular body part.
Traumatic injuries account for most injuries in contact sports such as Ice Hockey, Association football, rugby league, rugby union, Australian rules football, Gaelic football, and American football because of the dynamic and high collision nature of these sports. Collisions with the ground, objects, and other players are common, and unexpected dynamic forces on limbs and joints can cause injury.
Traumatic injuries can include:
- Contusion or bruise – damage to small blood vessels which causes bleeding within the tissues.
- Strain – trauma to a muscle due to overstretching and tearing of muscle fibers
- Sprain – an injury in a joint, caused by the ligament being stretched beyond its own capacity
- Wound – abrasion or puncture of the skin
- Bone fracture
- Head injury
- Spinal cord injury
In sports medicine, a catastrophic injury is defined as severe trauma to the human head, spine, or brain.
Concussions in sport became a major issue in the United States in the 2000s, as evidence connected repeated concussions with chronic traumatic encephalopathy and increased suicide risk.
Overuse and repetitive stress injury problems associated with sports include:
- Runner’s knee
- Tennis elbow
Some activities have particular risks:
- Bicycle safety
- Gun safety
- Sailing ship accidents
Soft tissue injuries
When soft tissue experiences trauma, the dead and damaged cells release chemicals, which initiate an inflammatory response. Inflammation is characterized by pain, localized swelling, heat, redness and a loss of function. Small blood vessels are damaged and opened up, producing bleeding within the tissue. In the body’s normal reaction, a small blood clot is formed in order to stop this bleeding and from this clot special cells (called fibroblasts) begin the healing process by laying down scar tissue.
The inflammatory stage is therefore the first phase of healing. However, too much of an inflammatory response in the early stage can mean that the healing process takes longer and a return to activity is delayed. Sports injury treatments are intended to minimize the inflammatory phase of an injury, so that the overall healing process is accelerated. Intrinsic and extrinsic factors are determinant for the healing process.
Sports injuries can be treated and managed by using the P.R.I.C.E.S… DR. ABC, and T.O.T.A.P.S regimes:
|P – Protect R – Rest I – Ice C – Compression E – Elevation S – Stabilize||D – Danger R – Response||A – Airway B – Breathing C – Circulation||T – Talk O – Observe T – Touch A – Active movement P – Passive movement S – Skills test|
The primary inflammatory stage typically lasts around 5 days and all treatment during this time is designed to address the cardinal signs of inflammation – pain, swelling, redness, heat, and a loss of function. Compression sportswear is becoming very popular with both professional and amateur athletes. These garments are thought to both reduce the risk of muscle injury and speed up muscle recovery.
Describing a range of injuries to the neck caused by or related to a sudden distortion of the neck. Cervical acceleration-deceleration” (CAD) describes the mechanism of the injury, while the term “whiplash associated disorders” (WAD) describes the injury and symptoms.
There are four phases that occur during “whiplash”:
- Initial position (before the collision),
In the initial position there is no force on the neck due to inertia keeping it stable. Anterior longitudinal ligament injuries in whiplash may lead to cervical instability. They explain that during the retraction phase that is when the actual “whiplash” occurs, since there is an unusual loading of soft tissues. The next phase is the extension, the whole neck and head switches to extension, and it is stopped or limited by the head restraint. The rebound phase transpires as result of the phases that are mentioned.
During the refraction phase the spine forms an S-Shaped curve, and this caused by the flexion in the upper planes and hyperextension at the lower planes and this exceed their physiological limits this phase the injuries occur to the lower cervical vertebrae. At the extension phase all cervical vertebrae and the head are fully extended, but do not surpass their physiological limits. Most of the injuries happen in C-5 and C-6.
Symptoms reported by sufferers include pain and aching to the neck and back, referred pain to the shoulders, sensory disturbance (such as pins and needles) to the arms and legs, and headaches. Symptoms can appear directly after the injury but often are not felt until days afterward. Whiplash is usually confined to the spine. The most common areas of the spine affected by whiplash are the neck and middle of the spine. “Neck” pain is very common between the shoulder and the neck.
A Spinal disc herniation (prolapsus disci intervertebralis) is a medical condition affecting the spine in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) allows the soft, central portion (nucleus pulposus) to bulge out beyond the damaged outer rings. Disc herniations are normally a further development of a previously existing disc “protrusion”, a condition in which the outermost layers of the annulus fibrosus are still intact, but can bulge when the disc is under pressure. In contrast to a herniation, none of the nucleus pulposus escapes beyond the outer layers.
Symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue that become involved. They can range from little or no pain if the disc is the only tissue injured, to the severe and unrelenting neck or lower back pain that will radiate into the regions served by affected nerve roots that are irritated or impinged by the herniated material. Often, herniated discs are not diagnosed immediately, as the patients come with undefined pains in the thighs, knees, or feet. Other symptoms may include sensory changes such as numbness, tingling, muscular weakness, paralysis, paresthesia, and affection of reflexes. If the herniated disc is in the lumbar region the patient may also experience sciatica due to irritation of one of the nerve roots of the sciatic nerve. Unlike a pulsating pain or pain that comes and goes, which can be caused by muscle spasm, pain from a herniated disc is usually continuous or at least is continuous in a specific position of the body. It is possible to have a herniated disc without any pain or noticeable symptoms, depending on its location. If the extruded nucleus pulposus material doesn’t press on soft tissues or nerves, it may not cause any symptoms.
Carpal tunnel syndrome (CTS) is caused by the entrapment of the median nerve in the wrist that then causes paresthesia, pain, numbness, and other symptoms in the distribution of the median nerve. It appears to be caused by a combination of genetic and environmental factors. Some of the predisposing factors include: diabetes, obesity, pregnancy, hypothyroidism, and heavy manual work or work with vibrating tools. The main symptom of CTS is intermittent numbness of the thumb, index, long and radial half of the ring finger. Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction.
The relationship between work and CTS is controversial; in many locations, workers diagnosed with carpal tunnel syndrome are entitled to time off and compensation. In the USA, carpal tunnel syndrome results in an average of $30,000 in lifetime costs (medical bills and lost time from work). Some speculate that carpal tunnel syndrome is provoked by repetitive movement and manipulating activities and that the exposure can be cumulative. It has also been stated that symptoms are commonly exacerbated by forceful and repetitive use of the hand and wrists in industrial occupations.
Suggested healthy habits such as avoiding repetitive stress, work modification through use of ergonomic equipment (wrist rest, mouse pad), taking proper breaks, using keyboard alternatives (digital pen, voice recognition, and dictation), and employing early treatments such as taking turmeric (anti-inflammatory), omega-3 fatty acids, and B vitamins have been proposed as methods to help prevent carpal tunnel syndrome.
Scoliosis is a medical condition in which a person’s spine is curved from side to side. It can be caused by vertebral anomalies present at birth, caused by vertebral anomalies present at birth, various other syndromes, or the cause can sometimes simply be unknown. According to recent studies, the most common form of scolioses, late-onset idiopathic scoliosis, is physiologically harmless even without treatment, though rare forms pose risks and complications.
Scoliosis is defined as a spinal curvature of more than 10 degrees to the right or left as the examiner faces the patient. Patients who initially present with scoliosis are examined to determine whether the deformity has an underlying cause. During a physical examination, the following are assessed to exclude the possibility of underlying condition more serious than simple scoliosis.
An orthopedic brace can be used to prevent the spine from curving into a rose position. Pain can also be alleviated with moist heat. Surgery may be required in severe cases.
Regular visits to a chiropractor and observation of the progression of scolioses are important to be sure proper treatment is being given and to insure a long and happy life.
‘Slipped disc’ is a common term used to describe an injury to the lower back. While discs may herniate or bulge from between the bones, they do not actually slip. A herniation is a displaced fragment at the center of the disc that pushes through the outer layer of the disc. Discs that herniate are often in an early stage of degeneration.
Poor nutrition, smoking, lack of exercise, and other poor lifestyle choices are often a source of poor disc health. Poor posture, physically excessive daily activities, as well as injury are other contributing factors. A disc can herniate upon a movement as simple coughing or bending to pick something up.
Herniations often occur between ages 30 and 40. While they may be present without causing pain, symptoms include pain radiating across the hips to the buttocks. Numbness may be experienced in the foot or toes. In severe cases of a lumbar disc herniation, difficulty may be experienced in bowl, bladder, and sexual functions.
Stretching, exercise, and chiropractic care usually treat mild to moderate disc herniations. Spinal decompression may be necessary for advanced cases.
In severe cases, surgery may be required as a last resort if therapy fails to treat the symptoms.
Your cervical spine connects your brain stem to your spinal cord. It is an area rich in blood vessels and other soft tissue, such as ligament and tendons. Neck pain is slightly less common than back pain but no less important or treatable.
Neck pain can occur anywhere in your neck, from the bottom of your head to the top of your shoulders. It can spread into your upper back or arms, and may limit how much you can move your head and neck. Most neck pain is caused by activities that strain the neck. Poor postures such as slouching or sitting at a computer, activities that have you extend your neck like painting a ceiling, or sleeping with your head in improper positions, are a few things that can cause neck pain. These postures or activities can lead to neck strain, muscle spasm and swelling of the neck joints. Neck pain can also be caused by an injury such as A fall, or whiplash from a car accident. Other more serious conditions can also cause neck pain, degenerative arthritis, stenosis (narrowing of the spinal canal), herniated discs, or infection, can also cause neck pain.
Symptoms generally start as a feeling of knotted or stiff achy muscles, that may limit neck motion, however, sometimes you may also have severe neck pain. The pain may extend into your shoulders, upper back, between your shoulder blades, or into your arms. The muscle tightness may also cause headaches. If there is pressure on a spinal nerve root, you might have pain that shoots down your arm. You may also have numbness, tingling, or weakness in your arm.
Most minor ligament or tendon injuries in the neck will subside with proper care, including rest, ice or heat application, If your symptoms do not resolve within a few days it is advisable to visit your chiropractor to have it evaluated and treated. Early treatment can keep your acute neck pain from becoming chronic and long-lasting.