Study Gets to the Core of Back Pain in Runners

Study Gets to the Core of Back Pain in Runners

The onset of back pain among runners may stem from a general weakness in their deep core muscles, new research indicates.

Such deep muscles are located well below the more superficial muscles typified by the classic six-pack abs of fitness magazine fame, the researchers noted.

Using computer simulations, they found that runners with relatively weak deep core muscles end up relying more and more on their superficial muscles to keep on running. The result is a higher risk for back pain.

“We measured the dimensions of runners’ bodies and how they moved to create a computer model that’s specific to that person,” said study lead author Ajit Chaudhari. “That allows us to examine how every bone moves and how much pressure is put on each joint.”

Chaudhari is an associate professor of physical therapy and biomedical engineering at Ohio State University’s Wexner Medical Center.

The investigators found that “when your deep core is weak, your body is able to compensate in a way that allows you to essentially run the same way,” Chaudhari said in a medical center news release, “but that increases the load on your spine in a way that may lead to low back pain.”

The study team said it’s not uncommon to find avid athletes who fail to put sufficient focus on their deep core strength, perhaps because superficial muscle maintenance tends to get a lot more public attention.

However, Chaudhari said, “working on a six-pack and trying to become a better runner is definitely not the same thing.

“If you look at great runners, they don’t typically have a six-pack, but their muscles are very fit,” he said. “Static exercises that force you to fire your core and hold your body in place are what’s really going to make you a better runner.”

The study was published online recently in the Journal of Biomechanics.

More information

The American Academy of Family Physicians has information on low back pain.

SOURCE: Ohio State University Wexner Medical Center, news release, Jan. 3, 2018

Electrical Pulses May Ease Pain From ‘Slipped’ Disc

Electrical Pulses May Ease Pain From ‘Slipped’ Disc

Radiofrequency ablation:

A new treatment that aims electrical pulses at irritated nerves around the spinal cord appears effective at relieving chronic lower back pain and sciatica, a preliminary study suggests.

The minimally invasive procedure, called image-guided pulsed radiofrequency, eased lingering pain in 80 percent of 10 patients after a single 10-minute treatment. Ninety percent were able to avoid surgery.

“Given the very low risk profile of this technique, patients suffering herniated disc and nerve root compression symptoms may undergo a safe and fast recovery, going back to normal activities within days,” said study author Dr. Alessandro Napoli. He’s an interventional radiologist at Sapienza University, in Rome, Italy.

“In fact,” he added, “one of the dramatic advantages of this technology is that we can perform it in a day-surgery setting, without anesthesia, and [patients] go home the same day.”

Napoli’s study is scheduled for presentation Wednesday at the Radiological Society of North America’s annual meeting, in Chicago. Studies presented at scientific conferences typically haven’t been peer-reviewed or published, and results are considered preliminary.

About 8 in 10 people suffer from lower back pain at some point in their lives, according to study documents. This pain can be due to a herniated disc in the lower spine. Sciatica is radiating leg pain caused by a pinched nerve in the lower spine, which also may be due to a herniated disc.

Also called a slipped or ruptured disc, a herniated disc occurs when the spongy material inside a spinal disc squeezes through its tough outer shell because of aging or injury. This material can press on surrounding nerves, causing pain and numbness or tingling in the legs, according to the American Academy of Orthopaedic Surgeons (AAOS).

Conservative, nonsurgical approaches typically ease symptoms of a herniated disc over time, according to the AAOS. These treatments include rest, gentle exercise, pain relievers, anti-inflammatory drugs, cold or hot compresses and physical therapy.

However, about 20 percent of those with acute low back pain don’t find relief through these measures. That leads some to decide on surgery to remove disc material pressing on their spinal nerves. For these people, Napoli said, image-guided pulsed radiofrequency treatment may become a viable option if larger studies reinforce his findings.

Napoli’s research included 80 people who had experienced at least three months of low back pain from a herniated disc that hadn’t responded to conservative treatments.

Image-guided pulsed radiofrequency treatment uses computed tomography — a CT scan — to help physicians insert a needle to the location of the herniated disc and surrounding nerves. A probe that’s inserted through the needle tip delivers pulsed radiofrequency energy to the area over a 10-minute period, resolving the herniation without touching the disc, Napoli explained.

More than 80 percent of the 80 study participants were pain-free a year after a single treatment. Six people required a second treatment session.

Pulsed radiofrequency has been widely used in pain medicine for other types of chronic pain, Napoli noted.

He said the treatment works by “eliminating the inflammation process” in nerves surrounding the herniated disc, hindering painful muscle contractions. “The aim was to interrupt this cycle and give the body the chance to restore a natural healing,” he added.

Dr. Scott Roberts, a physiatrist with Christiana Care Health System in Wilmington, Del., said the new findings showed “an impressive drop in pain and improvement in function.” However, he noted that the research didn’t include a control group for comparison with people not given the treatment.

“With no control group, we don’t know how much of the improvement we’re seeing would have happened anyway,” Roberts said. “I was very encouraged by [the study] because its results are significant, but it’s far from conclusive without a control group.”

Don’t Let Summer Strain Your Back

Don’t Let Summer Strain Your Back

Summer is the time when everyone dives into yard work and takes family vacations. But all that time spent bending, lifting and traveling can strain your back, spine experts say.

An estimated 3.7 million Americans sought care for back pain and injuries at doctors’ offices in the summer of 2014, according to the American Academy of Orthopaedic Surgeons (AAOS).

“Many back injuries occur from sudden movements during daily activities such as bending, lifting and twisting,” said Dr. Afshin Razi, a spokesperson for the academy.

“Always be mindful of the way you’re positioning your body and practice safe lifting techniques during these motions. Keep the core muscles in your back and abdomen strong and flexible. Strengthening your core muscles will help to support your spine,” Razi said in an AAOS news release.

The academy offers these tips for protecting yourself from back injuries during the summer:

  • Lift heavy items with your legs instead of your back, and don’t bend over. Bend your knees instead and keep your back straight.
  • Get someone to help you lift heavy objects. Turn to your friends or family or hire someone to assist.
  • Pack as lightly as possible when traveling, and try to spread heavier items among several boxes or bags.
  • Take breaks, regardless of whether you’re sitting or working, and stretch between tasks.
  • Watch your posture and sit with your back in a slightly arched position. Your chair should support your lower back and your head and shoulders should be upright.
  • Be careful about your footwear. Your shoes should fit properly and have rubber non-skid soles to protect you from falling, especially when you’re traveling or working outdoors.
  • If you’re outside, make sure hoses, rakes and garden tools are out of your path so you don’t trip over them.
  • Pets like to be underfoot and can pose a tripping hazard. Consider putting a bell on your pet so you know its location when it’s moving around.
Seniors Get Good Results From Herniated Disc Surgery

Seniors Get Good Results From Herniated Disc Surgery

People over age 65 shouldn’t avoid surgery for a herniated disc just because of their age. Seniors benefit from the procedure as much as younger patients, Norwegian research shows.

The study involved more than 5,500 people with a herniated, or “slipped” disc. The condition occurs when one of the discs that cushions bones in the spine gets damaged, causing it to push forward. The result is lower back pain that can extend to the leg and foot, and even lead to paralysis.

Exercise, heat and pain medication provide relief in some cases. But people with severe pain or disability may need surgery, according to researchers at St. Olav’s Hospital in Trondheim, Norway and the Norwegian University of Science and Technology (NTNU).

The investigators compared patient-reported outcomes after disc surgery. The study included nearly 5,200 patients under age 65, and about 380 older patients.

The researchers reported that older patients had less back pain after surgery than younger patients. But the seniors experienced more minor complications and had slightly longer hospital stays. However, the study authors said that these issues were not serious and didn’t affect the success of their treatment.

“This study shows that it is fully possible to do good surgical research on elderly patients,” study leader Mattis Madsbu said in a NTNU news release. Madsbu is a medical student at the university.

The study was published recently in JAMA Surgery.

More information

The U.S. National Library of Medicine has more about herniated discs.

SOURCE: The Norwegian University of Science and Technology, news release, May 2017

Whiplash Injury

Whiplash Injury

What is a whiplash?

Whiplash is an injury to your neck. It is caused by your neck bending forcibly forward and then backward, or vice versa. The injury, which is poorly understood, usually involves the muscles, discs, nerves, and tendons in your neck.

What causes a whiplash?

Most whiplash injuries result from a collision that includes sudden acceleration or deceleration. Many whiplash injuries occur when you are involved in a rear-end automobile collision. They also happen as a result of a sports injury, particularly during contact sports.

What are the symptoms of a whiplash?

These are the most common symptoms of whiplash:

  • Neck pain
  • Neck stiffness
  • Shoulder pain
  • Low back pain
  • Dizziness
  • Pain in your arm or hand
  • Numbness in your arm or hand
  • Ringing in your ears
  • Blurred vision
  • Concentration or memory problems
  • Irritability
  • Sleeplessness
  • Tiredness

The symptoms of whiplash may look like other conditions and medical problems. Always see your healthcare provider for a diagnosis.

How is a whiplash diagnosed?

Along with a complete medical history and physical exam, tests  for whiplash may include the following. Many whiplash injuries include damage to soft tissue that can’t be seen on X-rays:

  • X-ray. Electromagnetic energy beams produce images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI). Large magnets and a computer make detailed images of organs and soft tissue structures in your body.
  • Computed tomography (CT) scan.  X-rays and computer technology make horizontal, or axial, images (often called slices) of your body. A CT scan shows detailed images of any part of your body, including your bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

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How is a whiplash treated?

Your healthcare provider will determine specific treatment for whiplash, based on:

  • Your age, overall health, and medical history
  • Extent of your injury
  • Your tolerance for specific medicines, procedures, or therapies
  • Expectations for the course of your injury
  • Your opinion or preference

Treatment may include:

  • Ice applications for the first 24 hours
  • Cervical (neck) collar
  • Gentle, active movement after 24 hours
  • Nonsteroidal anti-inflammatory medicines (NSAIDs such as ibuprofen)
  • Muscle relaxing medicines
  • Physical therapy
  • Osteopathic manipulation

What are the complications of a whiplash injury?

While most people who have a whiplash injury recover within a few weeks to a few months, some have persistent pain for several months or longer.

When should I call my healthcare provider?

If your symptoms have not improved within the time frame your healthcare provider suggested, let him or her know. Also, if your symptoms get worse or you get new symptoms, tell your provider.

Key points about whiplash

  • Whiplash injury is poorly understood, but usually involves the muscles, discs, nerves, and tendons in your neck.
  • It is caused by the neck bending forcibly forward and then backward, or vice versa.
  • Many whiplash injuries occur if you are involved in a rear-end automobile collision.
  • Your healthcare provider will determine specific treatment for your whiplash.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Common Painkillers Don’t Ease Back Pain, Study Finds

Common Painkillers Don’t Ease Back Pain, Study Finds

Painkillers like aspirin, Aleve and Advil don’t help most people with back pain, a new review finds.

The researchers estimated that only one in six people gained a benefit from taking these nonsteroidal anti-inflammatory drugs (NSAIDs).

Meanwhile, previous research has suggested that another common painkiller, Tylenol (acetaminophen), isn’t very useful either, the study authors added.

The findings raise the prospect that no over-the-counter painkillers really ease back pain, at least in the short term, and some may raise the risk of gastrointestinal problems.

“There are other effective and safer strategies to manage spinal pain,” said review author Gustavo Machado. He is a research fellow with the George Institute for Global Health in Sydney, Australia.

Back and neck pain are the leading cause of pain worldwide, the researchers said.

For the review, the investigators examined 35 studies on the use of NSAIDs to treat back pain. The studies most commonly examined the drugs ibuprofen (Advil), naproxen (Aleve), cox-2 inhibitors (but not Celebrex) and diclofenac (which is available in the United States, but not widely known).

The studies, which tracked about 6,000 people, “showed that commonly used NSAIDs have only small effects on pain relief and improvement of function,” Machado said. “Moreover, these small effects may not be perceived as important for most patients with spinal pain.”

The researchers also found that participants taking the drugs were 2.5 times more likely to experience gastrointestinal side effects, compared with those who took inactive placebos.

The review only included studies of people who took the drugs for an average of seven days.

“Unfortunately, there are no studies investigating the effects of NSAIDs for spinal pain in the medium-term (three months to 12 months), and the long-term (more than 12 months),” Machado explained.

Dr. Benjamin Friedman is an associate professor of emergency medicine with Albert Einstein College of Medicine and Montefiore Medical Center in New York City. He estimated that the painkillers might be even more ineffective than the review suggests, with fewer than one in 10 patients getting substantial relief.

What should patients with back pain do? Friedman said he often recommends the drugs even though they’re not likely to provide benefits.

“The happiest back pain patients I know are the ones who have found relief with some type of complementary therapy such as yoga, massage or stretching,” Friedman noted.

Study author Machado said, “Patients should discuss with their doctors whether they should take these drugs, considering the small benefits they offer and likelihood of adverse effects.”

As for whether opioid painkillers — such as Oxycontin — might work, he suggests that patients avoid them for back pain since research by his institute’s team has suggested they aren’t very effective either.

However, Friedman said they’re often prescribed for very brief periods for unbearable pain, along with physical therapy.

As for other suggestions, Machado points to guidelines that recommend patients with back pain remain active and avoid bed rest.

“There is also evidence that physical therapies and psychological therapies — such as cognitive behavioral therapy — bring benefits to these patients,” he said.

Also, Machado said, “people should focus on preventing back pain in the first place. Having a healthy lifestyle and engaging in physical activities is a very important way of achieving this.”

The review was published online Feb. 2 in the Annals of the Rheumatic Diseases.