Frequently Asked Questions

Annulus fibrosis – Cartilage-like material formed in a series of rings surrounding the nucleus pulposus (soft center) of a disc.

Backache – An ache or pain affecting the back, most commonly the lower back. This is because the low back supports most of the body’s weight. You may have a tingling or burning sensation, a dull aching, or sharp pain and may also experience weakness in your legs or feet.

Cauda equina – A region at the lower end of the spinal column in which nerve roots branch out in a fashion that resembles a horse’s tail.

Cervical – The neck region where the vertebrae (bones of the spine) curve forward.

Chemonucleolysis – A surgical procedure in which an enzyme is injected to dissolve a portion of the intervertebral disc.

Chiropractic – A system of alternative medicine of mechanical therapeutics first introduced in 1895 in the USA. Chiropractic associates many diseases on the poor alignment of the vertebrae resulting in a disruption in the functioning of the nerves.

Chiropractors – Treat disease with traction, manipulation and adjustment of the displaced vertebrae in order to relieve pressure on the nerves.

CT scan – A sophisticated x-ray using a computer to produce a detailed crosssectional three-dimensional picture of the bone and discs.

Discectomy – Surgical removal of part or the entire herniated intervertebral disc.

Electrical nerve stimulation – A type of physical therapy treatment that utilizes various frequencies and wave forms of electrical current, which have therapeutic effects on the nervous and musculoskeletal systems.

Electromyography (EMG) – Procedure that tests nerves and muscles providing information to help determine if surgery may be required.

Herniated disc – Also known as a slipped disc – A disc that is displaced from its position between two vertebrae, with injury to the annular ligament.

Ligament – Strong, dense structures made of connective tissue that stabilize a joint, connecting bone to bone across the joint.

Low back pain – Pain at the base of the spine that can be caused by several factors.

Lumbar – The low back region that curves forward in the same direction as the cervical spine.

Lumbago – a symptom defined as a mid to lower back pain which may extend to the buttocks, thighs and legs in either a unilateral or bilateral fashion. One of the most common causes of lumbago is a herniated intervertebral disc.

Magnetic Resonance Imaging (MRI) – Magnetic radio frequency energy used to see internal structures of the body, including bone, discs, and nerves without the use of xrays.

Nucleus pulposus – Soft center of an intervertebral disc, made up of gel-like substance.

Osteophyte – A small, abnormal bony outgrowth.

Pinched nerve – A pinched nerve is a nerve with pressure applied to it. In the spine, a pinched nerve is usually caused by a herniated disk pressing on it. Pinched nerves in the spine tend to happen in the neck and low back as these are the areas that do the most moving. Symptoms of a pinched nerve are: weakness, tenderness, prickly sensation, stabbing sensation, burning sensation .

Prolapsed disc – A disc that bulges out from its position between two vertebrae.

Ruptured disc – A disc with a torn annulus (the tough outer covering of a disc).

Sciatic nerve – The nerve that serves the legs and originates from several levels of the lower back.

Sciatica – An inflammation of the sciatic nerve usually marked by tenderness along the course of the nerve through the buttocks, thigh, and leg.

Spinal cord – The column of nerve tissue that runs from the brain to the lower back.

Spinal fusion – A process in which the disc and cartilage is removed from between the vertebrae, and bone grafts (often harvested from the pelvis) are placed between or alongside the vertebrae to join the bones together.

Stenosis – Narrowing of a portion of the spinal canal, usually because of bony overgrowth.

Slipped disc – Also known as a herniated disc (medical term: prolapsed intervertebral disc) – The disc does not actually “slip,” but rather a portion of the disc breaks off or bulges and protrudes into the spinal canal creating pressure against one or more of the spinal nerves which can cause pain, weakness or numbness in the area of the body served by those nerves.

Tendons – White glistening fiber bands of tissue that attach muscle to bone.

Thoracic – The trunk region where the vertebral column curves in a rearward fashion.

Vertebral column – Flexible structure that forms the “backbone” of the skeleton, arranged in a line from the base of the skull to the tailbone, houses and protects the spinal cord; also called the spine.

Whiplash – The sudden movement of the head backwards, forwards or sideways is commonly referred to as whiplash. Whiplash injury most commonly occurs in car crashes involving sudden deceleration but the injury can also occur in other strenuous physical activities by an accidental motion or force applied to the neck that results in movement beyond the neck’s normal range of motion causing neck pain.

“Conservative treatment” is a common term used to describe the different types of non-surgical treatments. Since almost all people who have spine-related problems do not require surgery, conservative treatments play a major role in dealing with spinal disorders. However, there are wide selections of conservative treatments available, and sometimes it can be very difficult to make sense of all the choices.

It is very important to consider the appropriate conservative treatment for your spine, and this section is specifically designed to provide you with a review of how different health-care professionals, including osteopaths, chiropractors, and physiotherapists approach spinal disorders. This information will aid in your decision of who might help you and who you may want to consult with first.

Conservative treatment is always the first option in order to reduce pain. The most common form of treatment is physical therapy. Physical therapy offers a wide range of treatments for back problems. Physical therapy treatments have four main goals:

• Relieve pain
• Accelerate natural healing processes
• Increase strength and flexibility of back muscles and ligaments
• Help prevent future episodes of back pain

Types of treatment used by the professionals will depend on the nature of the condition being treated. Some treatments have not been proven scientifically but can still be helpful in certain individuals. These treatments include:

• Back education – This involves teaching proper posture and lifting techniques as part of a total back care program. This information helps people to adapt and adopt the right attitudes about the body and its functional use.
• Electrical nerve stimulation – This includes transcutaneous electrical nerve stimulation (TENS), in which electrodes are placed on the back to gently stimulate nerves and helps alleviate pain. TENS appears to be helpful for some people with spinal stenosis, but has not otherwise been found to be generally helpful. An alternative version delivers the electrical stimulation through acupuncture needles. Treatment generally consists of 45 minute sessions three times a day. Most people hardly feel the electrical sensation.
• Flexibility and strengthening exercise programs – These types of programs are important for keeping the lower back muscles flexible and strong. They are among the main safeguards for preventing future back injuries. It is important to begin slowly and progress as tolerated, using pain as your guide. The old adage “no pain, no gain” is not the rule of thumb for the recovery of back pain.
• Heat – Heat usually is applied when there is a small area of tissue damage or inflammation. Electrical currents can be used to relieve pain and also to stimulate circulation in the deeper tissues.
• Hydrotherapy – Hydrotherapy involves the use of water to treat physical disorders and may include baths, spas, pools, or shower sprays.
• Spinal decompression – spinal decompression, or spinal stretching, equipment has been used to help decrease pressure on the nerve roots and provide a stretch to tight muscles in the back. Spinal traction has been well recognized since ancient times as an effective treatment for various spinal disorders.
• Tissue mobilization and massage techniques – Massage and a variety of soft tissue mobilization techniques are being used more often by therapists who specialize in manual therapy. These techniques may be helpful to increase circulation to the area, release muscle spasms, and stretch back tissues.

Back pain problems are very common in both athletes and non-athletes alike. Up to 20% of all sports injuries involve the lower back or neck.

In recent years, in addition to bicycling, running, swimming, racquetball, skiing, golf, and tennis, excessive, exhausting, and even punishing forms of sports, physical training, and exercise are being undertaken. These new types of extreme physical activities include bungee jumping, rollerblading, snowboarding, paragliding, and windsurfing, to name a few.  All of these activities carry with them the risk of sports injuries.

Sports injuries result from acute trauma or repetitive stress associated with athletic activities which can affect bones or soft tissue and require specialized care to promote optimum healing. For obvious reasons, athletes are at greater risk of sustaining a lumbar (lower) spine injury due to physical activity. Whatever the sport, the spine undergoes a lot of stress, absorption of pressure, twisting, turning, and even bodily impact.

There are four main causes of back pain in sports-active individuals:

• Mechanical Low Back Pain: This is the most common type of back problem seen in the sports-active individual. It accounts for 70-75% of all back problems and is usually the easiest to treat.

• Facet Joint Syndrome: The vertebrae are connected by small joints (facet joints) which may become strained and/or inflamed when they undergo forces when the spine is excessively twisting or arching, especially during activities such as tennis, racquetball, or golf.

• Herniated Disc: Also called a “slipped disc”, a herniated disc is the most severe of low back disorders and occurs when the inner center of the disc pushes out, pressing on the nerves and causing pain in the back all the way down to the foot. This can create a condition known as “drop foot” due to strong pressure on the nerves. The inter-vertebral discs can be injured by sudden and severe trauma. Much more common is a small disc bulge which might be present for some time and is only noted when a sports injury is medically evaluated. The good news is that very few herniated discs lead to persistent trouble or require surgery. Although pain can last a few weeks, the majority of disc-related problems are a self-limiting medical condition which may be resolved with physical therapy, decompression, and medication, and very rarely requires surgery.

• Degenerated Discs: The discs act as shock absorbers for the spine cushioning the vertebrae. As we age, the discs can degenerate – drying out, shrinking, and losing elasticity and flexibility. Sometimes, a part of the outer covering of the disc wears away or tears, allowing the parts of the disc or its jelly-like contents to press on the spinal nerve roots. Then we may experience numbness, weakness, tingling, or shooting pain down the back of one leg.  Degenerative disc disease can result from trauma, infection, or the natural processes of aging. Some disc degeneration commonly occurs in people over 40 even without specific sports injuries.