Back Pain

Back Pain Relief in San Francisco at San Francisco Back Pain Relief

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Back pain is the leading workers' comp injury and the leading reason for disability for people under the age of 45
It will strike 90% of all American adults.  Low back surgery is the second-leading surgical procedure - and it's only getting worse.

• Up to 85% of the US Population will have Back Pain at some time in their life.
• On any given day, 6.5 million people are in bed because of back pain.
• 5.4 million Americans are disabled annually due to back pain.
• An estimated 93 million workdays are lost each year due to back pain.
• 90% of all back pain resolves in 6-12 weeks
• 5-10% of low back pain becomes chronic.
• Only 20% of all back surgeries are successful after 2 years
• The total number of spine surgeries in the U.S. approaches 500,000 per year.
• An estimated $45 - 54 billion is spent on the treatment of low back pain per year.

CAUSES OF LOW BACK PAIN

Low back pain and lower extremity (leg) pain often get put into one category, but the causes, and therefore the treatments, can be different. Leg pain, when it radiates from the low back, is usually the result of pressure on a nerve. Low back pain is often related to the mechanics of the spine. Muscle strain, arthritis, trauma, osteoporosis, and fracture are often causes.

Back pain can be caused by many different diseases and conditions. Some of these conditions can be very serious but these, fortunately, are not very common. These serious conditions include: cancer, tumors, neoplasm, inflammatory arthritis and infection. Several common conditions that can cause back pain are listed below.

Fractures and Dislocations

Fractures and dislocations can occur anywhere in the body. The vertebral bodies break, resulting in a "compression fracture". These types of fractures can be very painful and even disabling.

It is important to determine the nature of these fractures. Some of these fractures can be caused by dangerous or serious conditions such as cancers, malignancies, or advanced osteoporosis. These are called pathological fractures. Other types of fractures may occur through traumatic events - from falls, from athletic injuries, or lifting.

A dislocation is a term used to describe a condition where a joint has been pulled out of place and has separated to the point where the two bones are no longer touching. When a spinal joint is dislocated, the spine becomes unstable and is unable to protect the spinal cord or the exiting spinal nerves.

Degenerative Disc Disease (Spinal Disc Degeneration)

Degenerative Disc Disease (DDD) is a natural condition of the body that causes deterioration of the intervertebral discs. This is a gradual process that can create spinal problems. DDD is relatively common. The intervertebral disc is one structure prone to degenerative changes associated with aging. Long before Degenerative Disc Disease can be seen on an x-ray, structural changes occur. As the disc collapses, the spinal joints touch each other, which can cause Facet Syndrome, which can be very painful.

Herniated Disc

Herniation of the nucleus pulposus (HNP) occurs when the nucleus (a gel-like substance in the center of each disc) breaks through the annulus fibrosis (a tire-like structure which is the outside of the disc). Injury to the disc may result in pressure on the spinal nerve, resulting in tingling, pain,numbness, or loss of muscle strength. Disc injuries in the low back may affect the legs or feet. People between the ages of 30 and 50 appear to be more vulnerable, because the elasticity of the disc and water content of the nucleus decreases with age.

Facet Syndrome ("fuh-set')

Facet syndrome is a common spinal disorder affecting the spinal joints that are in the back of the spine.  Like any other joint in the body, these joints can be sprained, resulting in pain, stiffness and inflammation. In a typical Facet Syndrome, the symptoms of pain, discomfort and weakness are in a specific place in the spine.

Foraminal Stenosis  (literally, "hole narrowing")

The spinal nerve passes through an opening on the side of the spine, which are called intervertebral ("between the vertebra") foramen ("hole"). Foraminal stenosis occurs when these openings are smaller than normal. This condition can be the result of injury, degenerative change or congenital anomaly. The smaller opening may result in compression of the nerve. This irritation often causes symptoms of numbness, weakness, burning or tingling in the involved extremity. Long standing or severe stenosis may result in a functional loss.

Spinal Stenosis

Spinal stenosis is a condition where the size of the spinal canal (where the spinal cord goes) is reduced - usually from calcium being deposited, or sometimes from a disc herniation. This may lead to compression of the spinal cord. Symptoms often include pain, numbness, tingling and weakness. Severe cases may actually cause loss of function and may even lead to disability. Spinal stenosis is more common in patients over fifty years of age. Many factors can cause stenosis including injury and degenerative change.

Fibromyalgia

Fibromyalgia is a chronic disorder associated with widespread soft tissue pain, tenderness and fatigue. A person with fibromyalgia will experience pain when up to 18 specific areas called tender points are pressed. Pushing carefully on these specific points during an examination causes discomfort or pain. The pain of fibromyalgia is more than normal muscle aches common after physical exertion. Fibromyalgia often can be severe enough to disrupt a person's daily work and activities. The cause of fibromyalgia is not known.

Osteoporosis

Osteoporosis is commonly called the "fragile bone disease." It is due to loss of bone density caused by a deficiency in such bone-building nutrients as calcium, vitamin D and other vitamins and minerals. The most common complication of osteoporosis is compression fracture. In people with advanced osteoporosis, compression fractures can occur as the result of simple daily activities such as bending, carrying heavy loads, or a minor fall.

Osteoarthritis (DJD)

Osteoarthritis, also called degenerative joint disease (DJD), is the most common type of arthritis. OA can occur in almost any joint of the body but most commonly occurs in the fingers, hips, knees and spine. Over time changes occur within the smooth cartilaginous surfaces of the joint. These changes lead to a loss of elasticity and the cartilage becomes stiff or brittle making it susceptible to injury. This will lead to stiffness, pain and crepitation at the joint. Advanced cases may actually result in significant damage to the bone itself.

Antero-listhesis

Antero-listhesis occurs when one vertebrae slips forward over the vertebra below. The spine becomes unstable. The ability of a vertebrae to "slip" in relation to its neighbor can be caused by many factors, including facet or disc degeneration, trauma or a defect in a region of the vertebrae called the pars interarticularis. Severe cases may result in spinal cord or nerve compression and can require surgical intervention.

Sprain/Strain

Sprains and strains are two of the most common causes of back pain. They can be caused by trauma, overuse, lack of conditioning, and improper body mechanics. The term sprain is used when this injury occurs in a ligament. Conversely, strain is used when the affected tissue is muscle or tendon. Typically, patients will complain of increased pain with activity and relief at rest.

Compression Fracture

Compression fractures can occur in any vertebra (spinal bones) and is described as a collapse of the vertebra.

Symptoms - The first symptom of a compression fracture may be sudden and severe back pain that remains in one local area. Some persons may experience numbness/tingling, or weakness in the arms or legs if the spinal cord or nerves leading away from the fracture have been compressed. If multiple fractures occur in an area of the back, the person will develop a forward hump-like curvature to the back.

Causes - There are many possible causes of compression fractures. Car accidents, falls, and weakening of the bone due to pathology (i.e. cancer), or Osteoporosis are common.

Diagnosis - The diagnosis is based on observation of the aforementioned symptoms and x-rays of the spine. Additional tests (i.e. bone scan, blood tests) may be needed to diagnose the actual cause of the compression fracture.

Cancer

If you have severe back pain, it is natural to wonder whether or not the pain might be a sign of cancer. Tumors in the spinal column may cause pain from expansion of the bone or from weakening the bone, which in turn can result in spinal fractures, compression (pinching) of the nerves, or spinal instability.

Obesity

According to the American Obesity Association (AOA) 64.5 percent of adult Americans (about 127 million) are categorized as being overweight or obese (1). The unfortunate truth is that obesity is becoming a global epidemic affecting adults and children.

Connection to Back Pain

Most people know that obesity contributes to the development of coronary heart disease, diabetes, high blood pressure, and colon cancer. However, did you know that obesity is a contributing factor to back pain? It is true. Being overweight or obese can significantly contribute to symptoms associated with osteoporosis, osteoarthritis (OA), rheumatoid arthritis (RA), degenerative disc disease (DDD), spinal stenosis, and spondylolisthesis.

Trauma

Trauma to the spine refers to injury that has occurred to bony elements, soft tissues and/or neurological structures. The two things that surgeons are most concerned about, in the case of spinal trauma, are instability of the vertebral column and actual or potential neurological injury.

Stability to the spinal column can be compromised when bony elements are injured or there is disruption to soft tissues such as ligaments. Instability causes the back to become unable to successfully carry normal loads, which can lead to permanent deformity, severe pain and in some cases catastrophic neurological injuries. Most often the instability comes from a fracture in one of the bony parts of the vertebra, specifically the vertebral body, the lamina or the pedicles.

In the case of trauma, dislocations and fractures happen simultaneously and can result in a very unstable spinal column. They can occur in any region of the spine and are associated with a degree of neurological injury. Obviously, acute traumatic injuries require
may require medical intervention.

Radiculopathy (problem with a spinal nerve root)

Lumbar radiculopathy, which refers to pain in the lower extremities in a dermatomal pattern. A dermatome is a specific area in the lower extremity served by a specific lumbar spinal nerve root. This pain is caused by compression of the roots of the spinal nerves in the lumbar region of the spine. Diagnosing leg and back pain begins with a detailed patient history and examination.
Radiculopathy is frequently caused by a bulging or herniated disc. effectively treated with spinal decompression.

Sciatica

This is a condition which causes pain down the back of one or both thighs. Inflammation of the sciatic nerve (which is the largest nerve in the body-about the diameter of your little finger) can be either constant or intermittent. Success in solving this problem is directly correlated to the diagnosis. Sciatica is frequently caused by a pinched nerve as it exits the low back.  Please see the "Sciatica" tab.

MANY OF THESE PROBLEMS CAN BE EFFECTIVELY TREATED USING SPINAL DECOMPRESSION. Call Dr. Rosenstein (415-686-9119) to see if your particular problem is a candidate for this innovative treatment.

So  - How do I get started?

Contact me at (415) 686-9119 (or email me at drmatt1@aol.com) to schedule your free, initial one hour consultation.  We will go over all of your x-ray and MRI reports, review your physical findings and discuss in depth your treatment options.

One of the problems that I frequently see is that the people who come in for consultations with severe problems have NEVER had a chance to really "get it explained" from a doctor. Well, here is your opportunity to finally get a clear picture of what is going on with your spine, to learn about your treatment options and to have the time with a doctor to actually get all of your questions answered.

Oh - and please feel free to bring a spouse, relative or friend to your consultation.  It's always good to have a a friend with you to better evaluate our services.

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