Neck and Back Pain : What might it be and when to get Imaging
The spine is made up of three distinct types of vertebrae including cervical, thoracic and lumbar. The cervical vertebrae are located at the neck and are made up of 7 bones. The thoracic spine is located in the middle of the trunk and is made up of 12 bones. Lumbar spine is the low back and is made up of 5 bones that attach to your sacrum and tailbone. Between each vertebra there is a disc that is made up of connective tissue and water. Nerves exit between each vertebra and supply strength and sensation to all the muscles of the body.
Different types of back pain:
Spinal Stensosis: spinal stenosis is a narrowing in the canal that houses your spinal cord. The narrowing can put pressure on the nerves that exit the spine and provide the body.
Degenerative Disc Disease (DDD): Degenerative disc disease is the shortening of the height of the discs that sit in between the vertebrae. The purpose of the disc is to act as cushion and shock absorption for the spine. The outer portion of the disc is made up of firm connective tissue and the inner area is made up of soft tissue that is made up of 90% water. Over time the compression of the spine reduces the amount of fluid the discs can hold. This can cause compression to the joint and also possible pressure on the nerves.
Disc herniation: There are different types and severity of disc herniation. The first type is a disc bulge where the fluid and soft inner tissue is pushed out past the spinal column. A disc herniation occurs when there is damage or a tear in the outer layer that allows the inner pushes out in to the space close to the nerve. The disc bulge and herniation can cause pressure on the nerves that are exiting the spine.
The Role of PT:
Physical Therapists take pride in being known as a “movement expert.” A physical therapist can analyze how a patient moves and identify certain weaknesses that can lead or put a patient at risk for injury. The first visit is an evaluation that allows the physical therapist to take a history of the injury/ pain and then to take the patient through different movements to test the motion, strength and function of the back. After the initial evaluation the physical therapist will set up a catered treatment plan that include hands on treatment from the therapist and specific exercises that address the individual weaknesses. The treatment plan will be communicated with your orthopedic or primary care doctor to establish good communication with your whole healthcare team.
Getting physical therapy early in the injury process can lead to reduced healthcare costs by minimizing unnecessary medical tests, avoiding/reducing the amount of prescription medicines and even potentially avoiding surgery. A recent article written by Fritz et al states that a patient can save up to 2,700 by receiving physical therapy as an early intervention.
The three most common imaging types that are provided to help diagnose back and neck pain include x-ray, Magnetic resonance imaging (MRI) and computer tomography. X-rays are used to rule out significant bony abnormalities. This can include fracture, arthritis or spinal stenosis. MRI and CT scans are used to look at soft tissue injuries that can include the intervertebral disc that was addressed earlier.
Imaging can be unnecessary and expensive early on in the treatment of neck and low back pain. It is important to know when it is important to get the tests done and when it is ok to hold off on the tests while completing a trial of conservative physical therapy.
Signs and symptoms that you should get an MRI early can include unexplained weight loss, changes in bowel/bladder habits, weakness in both of your hands or both of your feet, difficulty walking, night sweats, fever and excessive fatigue that cannot be explained. Tell your doctor or physical therapist if you have or are experiencing any of the previous symptoms to help them address or specific medial needs.
When you get the Results… Don’t Panic
If you are battling neck or back pain please contact the physical therapist at Richmond or Ashland Physical therapy. If you are unsure if PT is right for you , we offer 15 minute free consultations that can answer your questions and help guide your care.