April 25, 2024

F1000 Scientist

Health to Life

3 Conditions Affecting Neck Pain, Back Pain and Sciatica and Their Treatment

There are many causes of neck pain, back pain, and sciatic nerve pain or sciatica in both adults and children. We have discussed back strains and back sprains in a previous article and will now discuss more serious conditions and their symptoms. The conditions are herniated intervertebral discs (IVDs), cervical radiculopathy and spondylolithesis, at times with spondylolysis. The spine itself is made up of 33 bones called vertebrae and extends from the skull to the pelvis. The cervical or neck vertebrae are made up of seven bones, with the atlas articulating (coming into contact) with the skull, the thoracic vertebrae span the region from the seventh cervical vertebrae to the first lumbar vertebra, the lumbar vertebrae are made up of five large, in rare cases six, robust vertebrae at the base of the spine. The sacrum, often referred to as the tailbone, sits at the base of the spine, along with the coccyx (the true tail bone); and, is also part of the pelvis, bringing together the two halves at the sacroiliac joints. We will discuss the breakdown of the sacroiliac and the associated symptoms in an subsequent article. Between each pair of vertebrae there is a disc, and intervertebral disc or IVD, made up of cartilage and a jelly-like center, not unlike a jelly donut. The IVD serves as a shock absorber for not only the spine but the entire body. When anything happens to this support system, this shock absorber, neck pain, back pain, and even sciatic nerve pain, sciatica, generally ensues.

As noted above, and in a previous article, there are many causes of neck pain, back pain, and sciatica. We have already dealt with back pain and sciatica as a consequence of back strains and back sprains, we will now deal with symptoms of herniated discs (IVDs), cervical radiculopathy, and spondylolisthesis. The region of the spine affected by trauma and/or herniated discs will generally dictate what sort of symptoms the neck and back pain sufferer will experience. If the cause of the pain is centered in the cervical region, we often experience what is commonly referred to as a “pain in the neck.” Cervical pain may also affect the shoulder and arm, even into the hand with pain, tingling, and numbness. The thoracic region symptoms are generally more difficult to pinpoint. Symptoms in this area may be expressed as a stiffness, chest pain, back pain radiating laterally, and/or even the feeling that you’re back needs to be “cracked.” In the lumbar region, usually the area most affected by herniated discs and spondylolisthesis (L5 most common of all), back pain may either be localized to the lower back, often radiating across the iliac crest or hip, or it may express itself in pain across buttocks, radiating down one or both legs. This is generally due to pressure on the nerve roots, for a variety of reasons, to include ruptured discs, bulging discs, stenosis (narrowing of the nerve canals), and is referred to as sciatic nerve pain or sciatica.

In the cervical region, cervical radiculopathy is one of the primary causes of neck pain. The condition may be caused by anything from a ruptured disc to normal degenerative changes in the discs as we age. Age-progressive deterioration is a consequence of aging, particularly as it relates to the secondary curvatures of the spine, the cervical and lumbar regions (discussed in a previous article). Once again, the primary symptom is pain that radiates from the neck into the shoulders and arms, even affecting the chest in some individuals. It is not uncommon, to experience numbness and even a tingling feeling in the hands and fingers, something like your hand falling asleep. Treatments for cervical radiculopathy may include anti-inflammatory drugs (such as ibuprofen), corticosteroid injections, ice, and physical therapy. Because the cervical region is so vital, not only in terms of motion but also for regulating basic bodily functions, it is important to be seen by a medical practitioner if pain should continue more than 24 to 48 hours. The only way to diagnose this condition is by X-ray, MRI, and/or CAT scan. Delaying medical treatment may lead to significant and permanent damage.

Spondylolisthesis may be caused by many things and generally affects the lumbar region. The vertebrae most affected are L4 and L5, at the base of the spine, but other regions of the spine may be affected as well. Some of the clauses for spondylolisthesis are trauma, commonly either a stress fracture or an impact due to a sports injury in adolescents, and sometimes adults. Additionally, the vertebral body may break down as a consequence of infection or disease. Spondylolisthesis may coexist or express itself with a condition known as spondylolysis, a vertebral defect predisposing to spondylolisthesis. Spondylolysis is a congenital defect or anomaly causing a separation of the articular facets, the actual joint facets (surfaces) between vertebrae causing the vertebral body itself to slip forward. This condition may lead to incredible back pain, sciatica, tingling, numbness, and even loss of function. Treatments for spondylolisthesis may include a reduction in activity, particularly contact sports and physical labor, artificial supports such as braces, generally discouraged if at all possible due to atrophy and further weakening of the core muscles, exercise of the core muscle group, and even back surgery, known as surgical fusion, when all other measures fail. As previously stated in an earlier article, a spinal fusion is equivalent to opening Pandora’s Box and should be avoided if at all possible!

While surgery used to be the first response for severe neck pain, back pain, and sciatica for many cervical radiculopathy and spondylolisthesis patients, particularly when expressed with spondylolysis, now more conservative treatment is generally exhausted before surgery is indicated. A treatment program consisting of anti-inflammatory medications, ice-compression braces, and exercise to strengthen the core muscles, primarily the abdominal muscles, obliques, spinal erectors, and even some of the larger muscles that either originate or insert in the lower back. It is vitally important to listen to your body, to read the symptoms, and to act in a timely fashion when pain lasts for more than 48 to 72 hours with no indication of relief. There are, as we have noted above, many causes for neck pain, back pain, and sciatica. In children and adolescents back pain is generally an indication of a more serious problem, medical supervision should be initiated immediately. With adults, there are a myriad of conditions that may express themselves as pain in this region. A program, as defined above, is the best first step in the treatment of symptoms of neck pain, back pain, and sciatica; anti-inflammatories, ice, exercise, proper shoes, cushions and support for the feet (orthotics) and even alternative medicine (such as acupuncture), which we will cover in a subsequent article.