|
 Low Back Pain
JAY
W. NIELSEN, M.D.
Lumbar disc disease
is the leading cause of disability in America
low back pain is the number one
cause of work loss from pain in the U.S. This is a combined effect of poor
work habits in the workplace, unsafe lifting techniques and vehicle trauma.
The fact that insurers and Workmen's Compensation will allow surgery and
physical
therapy and little other care causes patients to wax and wane trying
to avoid operation.
The principle problem
with low back pain management is failure to make an accurate diagnosis. There
are more than a dozen different causes of
low back pain. Most patients suffer
from at least two or three causes confounding the therapy. The fact is that
ligament instability is a common factor to each every cause and it is the only
therapy that stands any chance to correct enough of the problems to get the
patient working with a permanently repaired back.
Intervertebral Disc
Bulging and
disc herniation is the best-recognized and most feared cause of back
pain by patients. This is so because it is the one disorder visible on
MRI
and
myelogram. This does not mean that it is the cause of the back pain. Pain
below the knee associated with back pain is almost always nerve root pressure
from a
herniated disc.
Associated numbness
below the knee strongly supports the diagnosis. The cause of leg pain is not
simply herniated disc material pressing on the nerve. The narrowed disc leaves
the Intervertebral ligaments to long allowing abnormal movement that causes
the nerve to rub or chafe.
Correcting the
ligaments can improve range of motion, reduce leg pain and protect the disc
against further degeneration.
Disc
degeneration is a separate disorder. Many
older patients have dried brittle discs that have not bulged or herniated.
These discs may also lose their blood supply and undergo tissue death with
deterioration, fermentation and gas formation causing diskitis. This is
visible on plain x-ray as air inside the disc.
|
