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Back Pain Blog - hosted by: Rebuild Your Back - Part 3

18 May 2009 03:32 pm

What is Radiculopathy?

Mmmm, soothing…

Radiator Kitty

Looks like Kittums is feeling no pain… neck or otherwise.

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I received a rather lengthy email this week from a reader who asked a number of really good questions about neck pain, his symptoms, and various treatment options. It would take too long to attempt to address them all in a single post so I’ve decided to just focus on one of them this time. I’ll cover the rest in future posts.

Here goes…

Dear Dean

I followed your advice and went to see my doctor today about the pain in my neck and arm. I thought I had sciatica, but he said sciatica was only in the legs and then he called it something different. I should have written it down because we talked about several things after that and now I can’t remember what he said it was.

[Then proceeds with the rest of his questions.]

Sincerely,
Guy Who Writes Really Long emails

Hi Guy,

The term you’re searching for is probably radiculopathy.

Radiculopathy is a condition that gets its name from the fact that the symptoms radiate into the extremities along the path of the affected nerve root. For example, cervical radiculopathy is when a pinched nerve in the neck causes pain, numbness and tingling to radiate into the shoulder, down the arm and possibly even into the hand and fingers.

Radiculopathy that starts in the lower back and radiates down through the legs is often referred to as sciatica. It gets its name from the fact that it follows the sciatic nerve, which exits the spine in the lumbar region and travels all the way from there to your toes.

For lack of a better term, I refer to this as a phantom pain because the injury is actually in the neck or back even though it’s felt at some distant location. There is nothing really wrong with your arm or leg.

These strange symptoms are caused by mechanical problems in the spine including (but not limited to) herniated discs, stenosis (narrowing of the spinal column), loss of disc height, bone spurs or a combination of these and other factors.

Pain that Radiates

Don’t feel bad about getting the term wrong. Your doctor is used to it by now.

Besides, it’s quite understandable when you’re hearing a bunch of strange new terms for the first time to start getting them confused. After all, they’re pretty closely related.

Just remember radiculopathy – the pain that radiates.

  • Cervical radiculopathy is in the neck
  • Lumbar radiculopathy (commonly referred to as sciatica) is from the waist down.
  • One Final Thought

    Sometimes a bad radiator can be a pain in the neck…

    bad_radiator3

    Don’t you just hate it when that happens?

    Later,
    Dean

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18 May 2009 03:26 pm

What About Cervical Collars?

cervical collar dog

Buddy here looks like he’s planning on bilking the insurance company out of some major coin.

*****

I’m sure it comes as no surprise that every once in awhile someone will write to me and ask about those cervical collars you occasionally see people wearing. For example, here’s a letter I received about a month ago…

Hi Dean,

I’m 37 and a working Mom. I slipped and fell at home about a week ago and I’ve had this awful neck pain ever since. It’s worse first thing in the morning, gets better by mid-day, but by the end of the day it’s hurting again. My doctor said there was nothing seriously wrong and prescribed Motrin for the pain but I’ve been wondering if I should go back and ask him about one of those collars to support my neck while it heals. I don’t really want to wear one of those things, but maybe that would help my neck heal faster?

What do you think? Any advice would be appreciated.

Thanks,
Sandy

My response…

Hi Sandy,

There was a time when cervical collars were considered a viable option for treating neck pain. And there was a certain logic behind the practice.

After all, it made sense to try and protect the injured tissue and give it a chance to heal. The goal was to prevent repetitive injury, which would ultimately delay your recovery.

CERVICALCOLLAR

However, these days most doctors don’t prescribe cervical collars for minor neck injuries. They’ve found that it actually slows recovery time and weakens the neck if the collar is worn for any length of time.

Here’s what the American Academy of Orthopaedic Surgeons has to say on the subject…

“In the past, whiplash injuries were often treated with immobilization in a cervical collar. However, the current trend is to encourage early movement, rather than immobilization. The soft collar may be used for a short term and on an intermittent basis.” [1]

The basis for this position can be found in the current research, which indicates that a certain amount of movement actually helps the injury heal faster…

“Research has shown that whiplash patients who rest for several weeks and wear a soft collar actually recover more slowly than those who try to follow a normal routine.” [2]

“In the past, some people have worn a neck collar for long periods after a whiplash sprain, and have been reluctant to move their neck. Studies have shown that you are more likely to make a quicker recovery if you do regular neck exercises, and keep your neck active rather than resting it for long periods in a collar.” [3]

And here are a couple more quotes along the same lines…

“Mealy and associates, in a prospective randomized trial comparing use of a soft cervical collar and analgesic medications with a regimen of active therapy, found that the group treated actively had significant improvement in both neck pain and mobility compared with the group treated with a soft collar.” [4]

“In a third prospective randomized study… Patients encouraged to remain at their normal level of activity had a better outcome than patients treated with immobilization and time off from work.” [4]

So there you have it.

Brooke_Burns_neck_brace

I think the only time cervical collars are used for minor neck injuries is if you need support at night when you’re sleeping. Since you are waking up with neck pain, your doctor may decide that support at night might be helpful in your case.

However, I suspect that he will not want you to wear it during the day. (Even if you are trying to set a new fashion trend.)

As always, be sure to check with your doctor first before acting on your own.

Take care,
Dean

References:

1. Whiplash. Your Orthopedic Connection. American Academy of Orthopedic Surgeons. [Oct 2000]

2. Kasch H. Whiplash: What causes Whiplash? netdoctor.co.uk [Jan 2005]

3. Whiplash Neck Sprain. Patient UK. patient.uk.co [April 2005]

4. Young WF. The enigma of whiplash injury. Current management strategies and controversies. Postgrad Med Vol 109, No 3:179-86 [Mar 2001]

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18 May 2009 02:43 pm

Back Pain and Anger

oibabycc.0

Yikes! Looks like somebody tried to swipe her Cheerios.

Which reminds me, here’s a portion of an email I received a while back that I decided to save — not because it was unusual — but because it was so typical of the type of thing I hear over and over again…

“I was 40 yrs old and I had never had any back problems prior to this incident. I had lower back discomfort beginning over 10 months ago now from what was over exerting myself while overhead lifting some sheetrock on a scaffold. Looking back I am so regretful, what a dummy that stuff was way heavy and I just got pissed off, we where trying to get this piece to fit and with all the stress in my life at the time and it being 95 plus degrees, I just lost my cool and at the moment was not thinking about my back…”

I can just see your head nodding and you’re thinking, “Yeah… been there, done that.”

And since this is something that seems to affect us all to one degree or another, I decided to look into this problem to see if there wasn’t something we could learn from it.

In a nutshell, what I found was:

  1. Anger definitely places you at risk for injury
  2. You can control how you respond
  3. Awareness of the risk seems to be the key to avoiding injury

Anger and Risk of Injury

leg_in_cast

Wouldn’t you know it? They actually did a study on this and proved what we already knew. Yes indeed, I kid you not. Researchers at the University of Missouri – Columbia (Go Mizzou) have demonstrated emphatically that blowing your top and kicking a fire hydrant is not a good idea.

God bless ’em. I don’t know about you, but I’m definitely going to sleep better now that that’s settled.

But seriously, (and you know I’m always serious) they really did a very interesting study on this and came up with some rather useful observations. Not about kicking cast iron objects, but about anger and the risk factors associated with it.

What they did was survey 2,400 patients from three hospital emergency departments to determine what emotions they were feeling just prior to their injury.

Here’s what they discovered…

In case-crossover analyses, higher levels of all anger variables were significantly associated with increased injury risk among men and women combined. [1]

They then go on to give us some numbers. (These guys love numbers.)

In this study, emotions reflecting externally directed anger were common. The prevalence of anger among injured patients was as follows: 31.7% reported some degree of “irritable” just before the injury, 18.1% reported feeling “angry,” and 13.2% reported feeling “hostile”. [1]

Hang on a minute.

HelloKittyCalculator1

According to my Hello Kitty calculator, that’s over 60% of the people surveyed were feeling somewhere between irritable and downright hostile just prior to the bonehead move that earned them a ride to the ER.

That’s a lot of avoidable accidents, if you ask me. (It is an accident when you punch a wall and break your hand, isn’t it? That’s what I thought. Just checking.)

In essence, what this study discovered was that people who were feeling angry just before getting hurt faced a substantial increase in the risk of injury.

You Can Control Your Anger

Spock

Okay, let’s face it. It’s normal to get angry from time to time. There’s nothing you can do to avoid emotions (unless you’re Leonard Nimoy), but that doesn’t mean that anger has to lead to injurious behavior.

One thing the author of this study noted was that anger seldom led to injury while driving.

Hmm… Isn’t that interesting. He noted that people experiencing road rage almost never put their anger into action.

RoadRageFist

He speculated that the reason people weren’t ramming each other on the freeway was that most of us are well aware of the possible consequences. No matter how enraged we might become at the other drivers on the road, we know that it’s not worth a trip to the hospital (or the morgue).

So we yell, we fume, we make socially unacceptable gestures, but we don’t turn into Kamikaze pilots just because some bozo cuts us off on the way to work.

(California doesn’t count. They’re nuttier than Texans out there.)

Awareness of the risk, key to avoiding injury

Here’s the deal:

If we can reign in our anger on the roadway, we can do the same during life’s other stressful moments. If that piece of sheetrock doesn’t fit, take it down and try it again later. If someone at work is pushing your buttons, just walk away.

Take a breather. Think bad thoughts. Plot your revenge. But don’t act on any of it.

Instead, when you’re tempted to take your anger out on someone or something, just remind yourself of the risk factors. You can do it. You do it all the time when you’re driving.

Yell, cuss, invent new forms of sign language, but don’t kick, hit, strain or otherwise express your anger and frustration physically. It’s not worth a sore toe, a busted hand or a trip to the emergency room with a sprained back.

Okay, maybe it’s easier said than done, but I think it’s worth a try.

By the way, I believe I just found the perfect solution for rush hour traffic.

TankSUV

Later,
Dean

References:

1. Vinson DC, Arelli BS, State Anger and the Risk of Injury: A Case-Control and Case-Crossover Study. Annals of Family Medicine 4:63-68 (2006)

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