Tag Archives: low back pain

Straight, No Chaser: When Back Pain Could Be Life Threatening

February 22, 2017Neurology, Orthopedics/Bones844-SMA-TALK, Behind the Curtain, Cauda Equina Syndrome, Conditions and Diseases, low back pain, sciatica, spinal stenosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition)Jeffrey Sterling, MD

Back pain hurts, but there are various causes of that pain that will kill or cripple you. Here’s some information on some diseases that present with back pain representing life-threats. Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards. Forewarned is forearmed.
Let’s start where we left off on post discussion general low back pain and identify what I was talking about….
Here are a few clues to help you hone in on whether your back pain requires emergency attention. Remember pain and pathology (serious disease) are two different considerations. I’m describing medical emergencies here and admittedly being overly simplistic.

Direct blow to your back: Think Fracture
- The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back. It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy. That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
Fever and new onset back pain: Think Spinal Epidural Abscess
- A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones. It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood. Antibiotics for about a month and/or surgery may be required.
Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
- There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies. CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects. This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs. Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
New onset back pain after age 65: Think Cancer
- There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer. The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement. Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present. It could represent a significant advancement of disease.
Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
Night-time back pain: Think Metastatic Cancer.
- Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer, that which spreads throughout the body.
Sudden sexual dysfunction: See Cauda Equina Syndrome above
Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
Unexplained new weight loss and new onset back pain: Think Cancer
- There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
Work-related back injuries
- This isn’t as much a life-threatening consideration as it is a limb and career-threatening one. Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed. Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.

Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs. I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future. The take home consideration here is to use these cues to know when to get rapidly evaluated. Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: My Back and Neck Pain Has a Name – Herniated Disks

February 20, 2017Orthopedics/Bones, Musculoskeletal System844-SMA-TALK, Behind the Curtain, herniated disks, low back pain, ruptured disk, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

It’s quite common for someone to come to me and say, “I have a herniated disk.” I used to ask how they knew, but I came to realize the answer to be unimportant. The pain and relative disability of those suffering from low back pain can be dramatic, both physically and emotionally. Being able to place a name of what’s causing that discomfort is meaningful in and of itself.

We’ve discussed low back pain (LBP) before on Straight, No Chaser, but herniated disks are special considerations among its causes. A herniated (aka ruptured or slipped) disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. A common and effective way to understand a spinal disk is to picture a jelly donut, with a softer center captured inside of a tougher exterior. A herniated disk occurs when some of the softer portion protrudes through the exterior. Keep in mind that your spinal column runs from your neck down your lower back, so herniation may occur anywhere along the spine, although the low back is the most common site.
Herniated disks may or may not produce symptoms, and you may not even know you have one. Of course, some herniated disks are extremely painful and incapacitating. The problems with herniated disks aren’t just related to the manual eruption of the disk’s contents. You can experience irritation of surrounding nerves, which can produce pain, numbness or weakness in an arm or leg.
The most common signs and symptoms of a herniated disk are relative to the nerves affected by the herniation. Nerves have a distribution (i.e., affected areas of the body) associated with them. The following symptoms can be produced by a herniated disk and will be seen along that distribution.

Arm or leg pain Arm and shoulder pain may result from herniated disks in your neck, including pain that radiates down the arm. Certain motions and actions (e.g., coughing, sneezing and neck rotation) may exacerbate your symptoms. If your herniated disk is in your lower back, intense pain may be present in your buttocks, thigh, calf and part of the foot.
Numbness or tingling
Weakness Similarly, muscles that are served by nerves affected by a herniated disk tend to weaken, and this may cause stumbling and other signs of lessened strength (e.g., decreased ability to lift or hold).

Factors that increase your risk of a herniated disk may include a genetic predisposition, excess weight producing ongoing stress on the apparatus of the back,and various jobs (including those involving heavy or repetitive lifting, bending, twisting, pushing or pulling).
The next post will address treatment options and self-help considerations for herniated disks.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Sciatica

February 19, 2017Neurology, Musculoskeletal System844-SMA-TALK, Behind the Curtain, Conditions and Diseases, low back pain, sciatica, spinal stenosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition)Jeffrey Sterling, MD

My pain has a name, and it’s sciatica. There’s always a sense of relief in patients when a name is given to a medical sign or symptom. This Straight, No Chaser places sciatica in context among various problems of the low back and gives you basic information for you to use in seeking solutions.
What is sciatica?

This is important for you to understand. Sciatica is a symptom, not a diagnosis. Sciatica is any of various clinical presentations that result from any injury to or inflammation of the sciatic nerve. The sciatic nerve is a large nerve that extends from the lower back and travels down the back of each of your legs. This nerve provides muscle control and sensation to various parts of your thighs, legs and soles of your feet.
What are the symptoms of sciatica?

Once you know the distribution of the sciatic nerve, the symptoms are pretty self-evident. Simplistically, a nerve is just an electrical conductor sending signals down its distribution. The typical symptoms of sciatica include the following:

Pain (e.g. pins and needles, burning or aching)
Weakness (can progress to an outright inability to move)
Numbness
Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

After sneezing, coughing or laughing
After walking or bending backwards
At night
When standing or sitting

What causes sciatica?

If you ever get diagnosed with sciatica, your immediate next question should be “What’s next?” Be reminded, sciatica is caused by something causing irritation, inflammation or injury to the sciatic nerves. Here are some common and/or important causes of sciatica; feel free to ask your physician if these actual diagnoses are being considered if you’re told you have sciatica.

Bruise or fracture to one of your pelvic bones
Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
Infection (a rare but important cause in those with new fever and back pain)
Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
Pregnancy
Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news).

How is sciatica treated?
If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.

In some cases, no treatment is required and recovery occurs on its own.
Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
Reduced and limited activity is best for the first few days. Bed rest is not recommended.

For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Low Back Pain

February 18, 2017Neurology, Orthopedics/Bones, Musculoskeletal System844-SMA-TALK, Behind the Curtain, Conditions and Diseases, low back pain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

For many, low back pain begins with a slip and subsequently becomes a slippery slope that never seems to end. This Straight, No Chaser will help you understand why you’re having pain.
Lower back pain is a tricky subject for an emergency physician, and it’s seen everyday. In fact, over 40 million Americans suffer from various forms of chronic low back pain. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.
Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.

Let’s point at four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):

Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

2. Strains
Have you ever heard that it’s easier to lift with your legs than your back? Well, I’d never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, it gets worse. Muscle spasms, pain, more strains and protruding discs all become more likely.
3. Fractures
A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.
4. Arthritis and Normal Deterioration (aging)
There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.
Here are a few clues to help you hone in on whether your back pain requires emergency attention:

Direct blow to your back
Fever and new onset back pain
Loss of control of your bowel movements or bladder function
New onset back pain after age 65
Numbness and tingling in both of your legs
Nighttime back pain
Sudden sexual dysfunction
Weakness and/or loss of motion or sensation in your legs
Weight loss and new onset back pain
Work related back injuries

What can you do to prevent or reduce the pain at home?

Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
Wear low-heeled shoes whenever you can, ladies!
Learn how to stretch your back.

Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
Sleep on your side. Try a pillow between your knees.
Walk. Did you know walking is the best (and easiest) exercise for your back?

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: When Back Pain Could Be Life Threatening

February 21, 2016Neurology, Orthopedics/Bones844-SMA-TALK, Behind the Curtain, Cauda Equina Syndrome, Conditions and Diseases, low back pain, sciatica, spinal stenosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Direct blow to your back: Think Fracture
- The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back. It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy. That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
Fever and new onset back pain: Think Spinal Epidural Abscess
- A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones. It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood. Antibiotics for about a month and/or surgery may be required.
Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
- There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies. CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects. This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs. Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
New onset back pain after age 65: Think Cancer
- There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer. The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement. Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present. It could represent a significant advancement of disease.
Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
Night-time back pain: Think Metastatic Cancer.
- Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer, that which spreads throughout the body.
Sudden sexual dysfunction: See Cauda Equina Syndrome above
Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
Unexplained new weight loss and new onset back pain: Think Cancer
- There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
Work-related back injuries
- This isn’t as much a life-threatening consideration as it is a limb and career-threatening one. Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed. Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.

Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs. I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future. The take home consideration here is to use these cues to know when to get rapidly evaluated. Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: My Back and Neck Pain Has a Name – Herniated Disks

February 19, 2016Orthopedics/Bones, Musculoskeletal System844-SMA-TALK, Behind the Curtain, herniated disks, low back pain, ruptured disk, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Arm or leg pain Arm and shoulder pain may result from herniated disks in your neck, including pain that radiates down the arm. Certain motions and actions (e.g., coughing, sneezing and neck rotation) may exacerbate your symptoms. If your herniated disk is in your lower back, intense pain may be present in your buttocks, thigh, calf and part of the foot.
Numbness or tingling
Weakness Similarly, muscles that are served by nerves affected by a herniated disk tend to weaken, and this may cause stumbling and other signs of lessened strength (e.g., decreased ability to lift or hold).

Factors that increase your risk of a herniated disk may include a genetic predisposition, excess weight producing ongoing stress on the apparatus of the back,and various jobs (including those involving heavy or repetitive lifting, bending, twisting, pushing or pulling).
The next post will address treatment options and self-help considerations for herniated disks.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Sciatica

February 18, 2016Neurology, Musculoskeletal System844-SMA-TALK, Behind the Curtain, Conditions and Diseases, low back pain, sciatica, spinal stenosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Pain (e.g. pins and needles, burning or aching)
Weakness (can progress to an outright inability to move)
Numbness
Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

After sneezing, coughing or laughing
After walking or bending backwards
At night
When standing or sitting

What causes sciatica?

Bruise or fracture to one of your pelvic bones
Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
Infection (a rare but important cause in those with new fever and back pain)
Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
Pregnancy
Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news).

How is sciatica treated?
If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.

In some cases, no treatment is required and recovery occurs on its own.
Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
Reduced and limited activity is best for the first few days. Bed rest is not recommended.

For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Low Back Pain

February 17, 2016Neurology, Orthopedics/Bones, Musculoskeletal System844-SMA-TALK, Behind the Curtain, Conditions and Diseases, low back pain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Let’s point at four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):

Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

Direct blow to your back
Fever and new onset back pain
Loss of control of your bowel movements or bladder function
New onset back pain after age 65
Numbness and tingling in both of your legs
Nighttime back pain
Sudden sexual dysfunction
Weakness and/or loss of motion or sensation in your legs
Weight loss and new onset back pain
Work related back injuries

What can you do to prevent or reduce the pain at home?

Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
Wear low-heeled shoes whenever you can, ladies!
Learn how to stretch your back.

Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
Sleep on your side. Try a pillow between your knees.
Walk. Did you know walking is the best (and easiest) exercise for your back?

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: When Back Pain Could Be Life Threatening

December 31, 2014Neurology, Orthopedics/Bones844-SMA-TALK, Cauda Equina Syndrome, Conditions and Diseases, low back pain, sciatica, spinal stenosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Direct blow to your back: Think Fracture
- The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back. It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy. That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
Fever and new onset back pain: Think Spinal Epidural Abscess
- A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones. It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood. Antibiotics for about a month and/or surgery may be required.
Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
- There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies. CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects. This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs. Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
New onset back pain after age 65: Think Cancer
- There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer. The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement. Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present. It could represent a significant advancement of disease.
Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
Night-time back pain: Think Metastatic Cancer.
- Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer, that which spreads throughout the body.
Sudden sexual dysfunction: See Cauda Equina Syndrome above
Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
Unexplained new weight loss and new onset back pain: Think Cancer
- There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
Work-related back injuries
- This isn’t as much a life-threatening consideration as it is a limb and career-threatening one. Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed. Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.

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Straight, No Chaser: Sciatica

December 30, 2014Neurology, Orthopedics/Bones, Musculoskeletal System844-SMA-TALK, Conditions and Diseases, low back pain, sciatica, spinal stenosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Pain (e.g. pins and needles, burning or aching)
Weakness (can progress to an outright inability to move)
Numbness
Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

After sneezing, coughing or laughing
After walking or bending backwards
At night
When standing or sitting

What causes sciatica?

Bruise or fracture to one of your pelvic bones
Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
Infection (a rare but important cause in those with new fever and back pain)
Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
Pregnancy
Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news).

How is sciatica treated?
If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.

In some cases, no treatment is required and recovery occurs on its own.
Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
Reduced and limited activity is best for the first few days. Bed rest is not recommended.

For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress.

Straight, No Chaser: Low Back Pain

December 29, 2014Neurology, Orthopedics/Bones, Musculoskeletal System844-SMA-TALK, Conditions and Diseases, low back pain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Now that Christmas is over, you’ve been straining your back lifting all those gifts and taking down those trees. This Straight, No Chaser will help you understand why you’re having pain.
Lower back pain is a tricky subject for an emergency physician, and it’s seen everyday. In fact, over 40 million Americans suffer from various forms of chronic low back pain. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.
Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.
Let’s point at four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):

Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

Direct blow to your back
Fever and new onset back pain
Loss of control of your bowel movements or bladder function
New onset back pain after age 65
Numbness and tingling in both of your legs
Nighttime back pain
Sudden sexual dysfunction
Weakness and/or loss of motion or sensation in your legs
Weight loss and new onset back pain
Work related back injuries

What can you do to prevent or reduce the pain at home?

Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
Wear low-heeled shoes whenever you can, ladies!
Learn how to stretch your back.

Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
Sleep on your side. Try a pillow between your knees.
Walk. Did you know walking is the best (and easiest) exercise for your back?

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress.

Straight, No Chaser: Addressing Your Low Back Pain

April 27, 2014General Health and Wellness, Musculoskeletal System844-SMA-TALK, low back pain, Osteoarthritis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Over 40 million Americans suffer from various forms of chronic low back pain. We must work really hard.

Lower back pain is a tricky subject for an emergency physician. The lower back is a source of many life-threatening emergencies, which I’ll discuss in a separate post, but for now, let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.
Remember the back is the major weight-bearing apparatus of the body, and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.
Let’s review four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):

Spinal problems you were born with can predispose you to and even cause all manner of back difficulties. Any machine works better if well-built.
Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

2. Strains
Have you ever heard that it’s easier to lift with your legs than your back? Well, one would never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, things tend to get worse. Muscle spasms, pain, more strains and protruding discs all become more likely after initial injuries.
3. Fractures
A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.
4. Arthritis and Normal Deterioration (aging)
There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.
Here are a few clues to help you determine whether your back pain may require emergency attention:

Direct blow to your back
Fever and new onset back pain
Loss of control of your bowel movements or bladder function
New onset back pain after age 65
Numbness and tingling in both of your legs
Nighttime back pain
Sudden sexual dysfunction
Weakness and/or loss of motion or sensation in your legs
Weight loss and new onset back pain
Work related back injuries

What can you do to prevent or reduce the pain at home?

Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
Wear low-heeled shoes whenever you can, ladies!
Learn how to stretch your back.
Low back pain exercises
Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
Sleep on your side. Try a pillow between your knees.
Walk. Did you know walking is the best (and easiest) exercise for your back?

Straight, No Chaser: My Back and Neck Pain Has a Name – Herniated Disks

March 15, 2014Musculoskeletal System844-SMA-TALK, herniated disk, low back pain, ruptured disk, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

We’ve discussed low back pain (LBP) before on Straight, No Chaser (both regular causes and life-threatening causes), but herniated disks are special considerations among its causes. A herniated (aka ruptured or slipped) disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. A common and effective way to understand a spinal disk is to picture a jelly donut, with a softer center captured inside of a tougher exterior. A herniated disk occurs when some of the softer portion protrudes through the exterior. Keep in mind that your spinal column runs from your neck down your lower back, so herniations may occur anywhere along the spine, although the low back is the most common site.

Herniated disks may or may not produce symptoms, and you may not even know you have one. Of course, some herniated disks are extremely painful and incapacitating. The problems with herniated disks aren’t just related to the manual eruption of the disk’s contents. You can experience irritation of surrounding nerves, which can produce pain, numbness or weakness in an arm or leg.
The most common signs and symptoms of a herniated disk are relative to the nerves affected by the herniation. Nerves have a distribution (i.e., affected areas of the body) associated with them. The following symptoms can be produced by a herniated disk and will be seen along that distribution.

Arm or leg pain Arm and shoulder pain may result from herniated disks in your neck, including pain that radiates down the arm. Certain motions and actions (e.g., coughing, sneezing and neck rotation) may exacerbate your symptoms. If your herniated disk is in your lower back, intense pain may be present in your buttocks, thigh, calf and part of the foot.
Numbness or tingling
Weakness Similarly, muscles that are served by nerves affected by a herniated disk tend to weaken, and this may cause stumbling and other signs of lessened strength (e.g., decreased ability to lift or hold).