Neck pain, back aches, and bad disks – what’s next?

Back and neck pain in middle age is not always a straight-forward matter of just working through it. Some will have a history of disc herniation, chronic pain, or even pain that comes from a failed back surgery. Conditions such as these will have already been treated, and occasional flare-ups will be par for the course and often get medical attention.

However, what if you have symptoms like these, without a significant past history?

• “I get this sharp stabbing pain in my right lower back sometimes. Stretching helps it go away.”
• “I’m on the pc for a few hours and I start getting headaches and burning pain into my shoulders.”
• “After I was setting tiles in the bathroom, it hit me so hard I couldn’t stand up straight for an hour.”
• “I tried to jog for 15 minutes and the next day I had back spasms. I had to call in sick.”

If you’re over 40 there’s a high probability you’ve had one or more of these. You don’t need to rush to the doctor, unless it’s for a sick note. If it persists over a few weeks or is disabling, you should get a checkup and normally it will respond to simple conservative treatment. However, most men (and a lot of women) over the age of 40 have some degree of underlying disc degeneration. Isn’t this something to worry about? The answer to that is another question: when do you decide to do something about it?

Disc degeneration is typically a gradual condition that occurs over the years. It is highest in men whose jobs require physical labor, or seems to follow family patterns. It can result from old sports injuries or other forms of trauma, and sometimes for no reason at all, but whatever the cause it’s usually nothing to worry about, and in most cases it is stable and can be treated like any other musculoskeletal pain with a physical exercise regimen and appropriate medications. But, if you’re having symptoms like these:

• “It takes me 20 minutes to get out of bed. Recently, my leg has been giving way, and I end up on the floor.”
• “I get pain shooting into my shoulder and arm, and it’s numb and tingly in my thumb and index finger.”
• “It’s getting worse and worse. I can’t walk for more than 20 minutes, and I wake up every night. It interferes with my sex life.”

Don’t self-medicate with alcohol or someone’s extra Vicodin. You’ll cover up possible permanent nerve damage from protruding bone spurs, disks, or thickened ligaments. Go for a timely evaluation and get to the bottom of it. Make sure your doctor explains everything so you understand. Take a partner or friend with you for an extra set of ears. There may be a simple explanation, or it may be a serious form of spinal nerve compression.

If you’re having sudden symptoms of weakness or numbness on one side of the body, review the FAST test in this blog (go to Stroke – F.A.S.T. test) because you may be having a stroke.

A person’s perception of back pain (this goes for all pain) is very individual. There are some who miss work days when they feel a twinge while bending over to tie their shoes (no joke). An old story is that of a 62-year-old colleague who presented an x-ray of a lumbar spine with a severe degenerative back condition called “spondylolisthesis, grade 2/3.” (That means one vertebra was slipping more than half-way off the vertebrae below it). Viewing the radiograph with all of its degenerative findings, it looked like a hand grenade had gone off in that spine. As the audience murmured about it, the presenter asked “what level of function do you think this patient has?” They answered “uses a walker,” “probably wheelchair-bound,” “needs surgical stabilization,” etc. The presenting doctor smiled and said “that’s an x-ray of my spine! And I ran a marathon just two weeks ago!” Such a case is unusual but every doctor has seen a few.

Three things to remember about living your life with spine pain are:

1. Maintain a healthy level of activity and avoid bad biomechanics or high impact exercise and sports.
2. To minimize side effects from chronic medication use have them prescribed or monitored by a doctor.
3. Know your body and what signs to watch for if the conditions begin to worsen.

If it’s more complicated than that, you should be going for periodic checkups to a doctor who is familiar with treating your condition.

• http://emedicine.medscape.com/article/1144952-overview – cervical degenerative disease
• Video – http://www.webmd.com/video/spine-dekompressor–  a technique for patients with significant loss of function. Not for everybody!
• http://www.webmd.com/back-pain/guide/lower-back-pain-prevention good preventive advice, especially for exercising.
• http://www.spineuniverse.com/conditions/back-pain/tips-better-sex-even-back-pain detailed information about sex and LBP.
• http://www.herniated-disc-pain.org/herniated-disc-impinging-on-the-thecal-sac.html Disc Impinging on the Thecal Sac

From the orthopedic literature:

• Buckwalter JA: Aging and degeneration of the human intervertebral disc.  Spine 1995; 20:1307-1314
• Battie MC, Videman T, Parent E: Lumbar disc degeneration: Epidemiology and genetic influences.  Spine 2004; 29:2679-2690