word lumbago refers to low back pain. Low back pain sometimes occurs with
sciatica. Sciatica refers to the leg pain. Back pain (lumbago) is
usually due to degenerative disc disease whereas leg pain (sciatica) is most
often caused by a pinched nerve.
Degenerative disc disease (DDD) is a term used by
doctors to describe disc problems. It is actually a misnomer. It is
not always degenerative and is not actually a disease. The term
"degenerative disc disease" is the label applied to almost any problem that
affects the disks in the back.
Disc disease is the leading cause of lower back pain in
young adults. With age, the problem becomes more common. We all have some
degeneration, or “wear and tear,” in our vertebral discs.
At birth, a vertebral disc is about 80 percent water
and functions as a shock absorber between the vertebral bones. As the disc ages,
the water content decreases and the disc becomes stiffer and more fragile. Tears
develop in the outer shell of the disc and the softer tissue inside can leak
Magnetic resonance imaging (MRI) is most commonly used
to diagnose disc disease.
Twenty-five to thirty million Americans suffer from
chronic low back pain, the number one cause of lost days from work in the U.S.
Certain jobs, excess weight, alcohol use, and smoking all increase the chance of
Q. What if the MRI Scan shows a
herniated disc? What do I do then?
A. If you have a herniated disk, you should see a spine
specialist. The doctor will first diagnose the cause of the problem.
Unless there is severe pain or weakness, conservative care will usually be
recommended. Exercise and pain medications are used first.
Chiropractic or acupuncture may be helpful. If these do not help, a
steroid shot may be advised. Surgery is usually the last resort.
Q. What is a Drop Foot
A. Drop foot is not a disease but a symptom. It is caused by weakness of
the muscle that lifts the foot up at the ankle (the tibialis anterior muscle).
The drop foot may be temporary or permanent. Drop
foot is most frequently caused by injury to the L5 nerve root.
The L5 nerve is usually injured by a bad L4-L5
disc. Occasionally, a drop foot can be caused by an injury to the peroneal
nerve. The peroneal nerve is a branch of the sciatic nerve and can be
injured during hip or knee surgery. It can be injured by a deep bruise or a bad
laceration. Drop foot can also be caused by Amyotrophic Lateral Sclerosis
(ALS) and Multiple Sclerosis (MS). The cause can be determined using MRI
(magnetic resonance imaging), and EMG (electromyogram). A drop foot
can be an emergency condition, and you should see your spine doctor immediately
if you develop this problem.
The type of treatment is dependent on the cause of the
drop foot. An ankle foot orthosis (AFO) brace, can prevent falls. The damaged
nerve should, however, be repaired as soon as possible. If a disc is the
problem, it should be corrected immediately. If the nerve is damaged by a
knife wound, repairing it is also urgent.
Q. How can I protect my back?
Click on pictures to enlarge
A. Strengthening exercises and stretching
exercises are recommended as above.
B. Follow several simple guidelines which have
published by the North American Spine Society:
Standing - Keeping one foot
forward of the other, with knees slightly bent, takes the pressure off
your low back.
Sitting - Sitting with your
knees slightly higher than your hips provides good low back support.
Reaching - Stand on a stool
to reach things that are above your shoulder level.
Moving Heavy Items -
Pushing is easier on your back than pulling. Use your arms and legs to
start the push. If you must lift a heavy item, get someone to help you.
Lifting - Kneel down on one
knee with the other foot flat on the floor, as near as possible to the
item you are lifting. Lift with your legs, not your back, keeping the
object close to your body at all times.
Carrying - Two small
objects (one in either hand) may be easier to handle than one large one.
If you must carry one large object, keep it close to your body.
Sleeping - Sleeping on your
back puts 55 pounds of pressure on your back. Putting a couple of pillows
under your knees cuts the pressure in half. Lying on your side with a
pillow between your knees also reduces the pressure.
Weight Control - Additional
weight puts a strain on your back. Keep within 10 pounds of your ideal
weight for a healthier back.
Quit Smoking - Smokers are
more prone to back pain than nonsmokers because nicotine restricts the
flow of blood to the discs that cushion your vertebrae.
Minor Back Pain - Treat
minor back pain with anti-inflammatories and gentle stretching, followed
by an ice pack.
For Information on fibromyalgia click here.
For Information on sacroiliitis click here..
For Information on the pyriformis
syndrome click here.
Click here to see the page
on neck pain.
Click here to go the next chapter on procedures.