Conditions & Treatments

Ankylosing Spondylitis (arthritis of the spine)

Arthritis can occur in many places throughout the body and is characterized by pain, swelling and limited movement in joints and connective tissues. The most common type of arthritis is osteoarthritis, which involves weight-bearing joints such as the knee, hip and spine. Rheumatoid arthritis may affect all of the joints and is an inflammatory disease involving the lining of the joints.

Arthritis that affects the spine is called ankylosing spondylitis (AS). It is a disease which causes inflammation of the spine and large joints resulting in stiffness and pain. When this happens, it could result in erosion at the joint between the spine and the hip bone and the formation of bony bridges between vertebrae in the spine, fusing those bones. Although genetics are suspected, the cause of AS is still unknown. It affects young people ages 17 to 35, but can occur in children and older adults. It also affects more young men than women

Symptoms of Ankylosing Spondylitis

The most common symptoms may appear and disappear over a period of time and affect each individual differently:

  • Back pain, usually most severe at night
  • Early morning stiffness
  • Stooped posture in response to back pain (bending forward tends to relieve the pain)
  • Straight and stiff spine
  • Inability to take a deep breath, if the joints between the ribs and spine are affected
  • Appetite loss
  • Weight loss
  • Fatigue
  • Fever
  • Anemia
  • Joint pain
  • Mild eye inflammation
  • Organ damage, such as the heart , lungs and eyes

Only trained physicians, such as Valley specialist can diagnosis AS, as these symptoms may also resemble other medical conditions.

Treatment of Ankylosing Spondylitis

Treatment options for AS seek to reduce pain and stiffness, prevent deformities, and maintain as normal and active a lifestyle as possible for the patient.

Options may include:

  • Nonsteroidial anti-inflammatory medications
  • Tumor-necrosis-factor blockers also known as biologic medications
  • Short-term use of corticosteroids
  • Short-term use of muscle relaxants and pain relievers
  • Surgery
  • Maintain proper posture
  • Regular exercise, including exercise that strengthens back muscles

Arthritis and other rheumatic diseases are often mistakenly associated with old age, because osteoarthritis (the most common form) occurs more often in elderly people. However, the diseases affect people of all ages.

Arthritis Rehabilitation

Conducted on an inpatient or outpatient basis, arthritis rehabilitation programs comprise a team of skilled Valley specialists who include:

  • Orthopedist/orthopedic surgeon
  • Rheumatologist
  • Internist
  • Rehabilitation nurse
  • Dietitian
  • Physical therapist
  • Occupational therapist
  • Social worker
  • Psychologist/psychiatrist
  • Recreational therapist
  • Vocational therapist

Kyphosis

Kyphosis or commonly referred to as “humpback” is a forward curvature of the back bones in the upper back area. It is defined as a curvature of the spine 50 degrees or greater on an x-ray. It is considered congenital or present at birth due to acquired conditions that may include:

  • Metabolic problems
  • Neuromuscular conditions
  • Osteogenesis imperfecta or “brittle bone disease”
  • Spina bifida
  • Scheuermann’s disease – condition that causes the vertebrae to curve forward in the upper back area
  • Postural kyphosis- the most common type of kyphosis that generally becomes noticeable in adolescence and can be associated with slouching versus a spinal abnormality

Kyphosis is more common in females.

Symptoms of Kyphosis

  • Each individual may exhibit different symptoms, but the following are common:
  • Difference in shoulder height
  • The head bends forward compared to the rest of the body
  • Difference in shoulder blade height or position
  • When bending forward, the height of the upper back appears higher than normal
  • Tight hamstrings (back thigh muscles)

Always consult a Valley specialist for a proper diagnosis, as symptoms may resemble other spinal conditions or deformities.

Treatment of Kyphosis

The goal of treatment for kyphosis is to stop the progression of the curve and prevent deformity. It could result in any of the following options:

  • Observation and repeat examinations
  • Bracing
  • Surgery

Low Back Pain

The National Institutes of Health finds that eight out of ten people have back pain at some point in their life and back pain is a common cause of activity limitation in young adults.

The exact cause cannot be found, but back pain may be a symptom of many different causes including any or several of the following:

  • Overuse, strenuous activity or improper use
  • Trauma, injury, or fracture
  • Infection
  • Abnormal growth (tumor)
  • Obesity
  • Poor muscle tone in the back
  • Muscle tension or spasm
  • Sprain or strain
  • Ligament or muscle tears
  • Joint problems (e.g. spinal stenosis or a narrowing or constriction of blood vessels in the spine)
  • Smoking
  • Protruding or herniated (slipped) disk
  • Disease (e.g. osteoarthritis, spondylitis, compression fractures)

Prevention of Low back pain

  • practicing correct lifting techniques
  • maintaining correct posture while sitting, standing and sleeping
  • exercising regularly (with proper stretching before participation)
  • avoiding smoking
  • maintain a healthy weight
  • reducing emotional stress which may cause muscle tension

Treatment of Low back pain

Your specific treatment regimen will depend on a number of factors regarding your particular situation. These include issues like age, overall health, medical history, extent of the condition, etc. Treatment options include:

  • activity modification
  • medication
  • physical rehabilitation and/or therapy
  • if overweight, weight loss
  • no smoking
  • following a prevention program as directed by your physician
  • surgery
  • assistive devices (e.g. mechanical back supports)

Rehabilitation for low back pain

There are a number of Valley specialists on hand to help you with your lower back pain rehabilitation. Generally it involves three phases. The first is the acute phase in which the physiatrist and treatment team focus on making a diagnosis, developing a treatment plan and implementing the treatment regimen to reduce the initial low back pain and source of inflammation. The second phase is recovery. Once the pain and inflammation are better managed, the team then moves to helping the patient restore working function of the body. This includes returning the patient to normal daily activities while implementing a specialized exercise program that is designed to help the patient regain flexibility and strength. The last phase is maintenance. Maintenance involves educating the patient on ways to prevent further injury and strain, and helping the patient to maintain an appropriate level of physical fitness. This will help them increase strength and endurance.

Neck Pain

The causes of neck pain can vary from injury to inflammation. Some typical causes of neck pain are the following:

  • injury (damage to the muscles, tendons and/or ligaments)
  • herniated cervical disk
  • arthritis (osteoarthritis, rheumatoid arthritis)
  • cervical disk degeneration
  • congenital abnormalities of the vertebrae and bones
  • tumors

Treatment of Neck Pain

Your specific neck pain treatment plan will depend on a number of factors specific to you including your age, overall health, medical history, extent of your condition, etc. Some typical treatments may include the following:

  • medication to reduce inflammation
  • medication to control pain
  • rest
  • physical therapy
  • neck brace or immobilization
  • exercise
  • surgery

Torticollis (Wryneck)

This condition is a twisting of the neck, which causes the head to rotate and tilt at an odd angle. The exact cause is unknown; however congenital muscular torticollis is more likely to occur in first-born children. It may also be acquired due to irritation to the cervical nerves from trauma or vigorous movement. Other causes include:

  • sleeping in an awkward position
  • anxiety
  • neck muscle injury at birth
  • burn injury
  • any injury that causes heavy scarring and skin shrinkage
  • neck muscle spasm
  • Or, torticollis could be a secondary condition that results from:
  • slipped facette (two small joints on the side of the spine)
  • herniated disc
  • viral or bacterial infection

Symptoms of Torticollis

Each individual may experience symptoms differently, but the following are common symptoms:

  • neck muscle pain or pain down the spine
  • inability to turn the head, usually holding it twisted to one side
  • spasm of the neck muscles
  • awkward position of the chin

These symptoms may resemble other neck conditions and an examination by a physician is required for proper diagnosis.

Treatment of Torticollis

The best treatment plan will be chosen by your physician specific to your needs concerning your age, overall health, medical history, extent of the condition and other individual characteristics. Generally treatment may involve the following:

  • cervical collar
  • heat therapy
  • ultrasound therapy
  • physical therapy
  • surgery

Whiplash

Whiplash occurs when the neck is forced to bend forward forcibly then backward or vice versa. The affected area involves muscles, discs, nerves and tendons in the neck.

Causes of Whiplash

Commonly whiplash is the result of a collision that involves a sudden acceleration or deceleration. Injuries occur in rear-end automobile accidents and sports injury.

Symptoms of Whiplash

Although each individual may experience symptoms differently, the following are a list of common signs of whiplash:

  • neck pain
  • neck stiffness
  • shoulder pain
  • low back pain
  • dizziness
  • pain in the arm and /or hand
  • numbness in the arm or hand
  • ringing in the ears
  • blurred vision
  • concentration or memory problems
  • irritability
  • sleeplessness
  • tiredness

Only a physician can properly diagnosis whiplash.

Treatment of Whiplash

Your treatment plan for a whiplash injury will partly depend on a number of factors specific to you like your age, overall health, medical history, extent of the injury, etc.

Common treatment plans may include the following:

  • ice applications for the first 24 hours
  • cervical collar
  • gentle active movement after 24 hours
  • nonsteroidal anti-inflammatory medications
  • muscle relaxing medications
  • physical therapy

Sciatica

Sciatica is also called lumbar radiculopathy and is a pain that originates along the sciatic nerve which runs from the back of the pelvis down the back of the thigh. It is the primary nerve of the leg and also the larges nerve in the body.

Causes of Sciatica

It is mostly caused by a herniated disk in the spine that presses on the sciatic nerve. There are other causes that may put pressure on the sciatic nerve. They include:

  • tumor
  • abscess
  • blood clot
  • awkward sitting position
  • any nerve disorders
  • other times a cause cannot be identified

Symptoms of Sciatica

How do I know I have sciatica?

These are common symptoms; however each person may experience them differently:

  • lower back pain that radiates down the buttock and back on one thigh
  • pain that extends from the buttock down to the foot
  • numbness in severe cases
  • weakness in severe cases

These symptoms may resemble other conditions, so consult your doctor for a proper diagnosis.

Treatment of Sciatica

Your treatment plan for sciatica will depend on a number of factors specific to you like your age, overall health, medical history, the extent of the injury, etc. Some common treatment options are as follows:

  • nonsteroidal anti-inflammatory medications
  • heat or cold applications to the sore muscle
  • keep your body in motion to minimize inflammation
  • surgery to repair the herniated disk if the condition persists

Scoliosis

Scoliosis is a condition is which the spine appears to have a lateral or side-to-side curvature with the spine looking like an “S” or “C” and a rotation of the back bones. It gives the appearance the person is leaning to one side. Scoliosis should not be confused with just poor posture. It is defined as a curvature of the spine measuring 10 degrees or greater, according to the Scoliosis Research Society. Both mid and lower spine may be affected by scoliosis.

Causes of Scoliosis

In more than some 80 percent of the cases, the cause of scoliosis is unknown, which is called idiopathic scoliosis. But, in other cases, it develops as a result of degeneration of the spinal disks, as in osteoporosis, or as in a hereditary condition that tends to run in families.

Symptoms of Scoliosis

Although, each individual may experience symptoms differently, the following are some common signs:

  • difference in shoulder height
  • the head is not centered with the rest of the body
  • difference in hip height or position
  • difference in shoulder blade height or position
  • when standing straight, difference in the way the arms hang beside the body
  • when bending forward, the sides of the back appear different in height

If you experience back pain, leg pain and changes in bowel and bladder habits, these are signs of idiopathic scoliosis. For a correct diagnosis, consult your physician.

Treatment of Scoliosis

Your particular treatment plan for scoliosis will depend on a number of factors specific to you including your age, overall health, medical history, extent of the condition, etc. The goal of treatment for scoliosis is to stop the progression of the curve and prevent deformity. Your treatment plan may include:

  • observation and repeated examinations
  • bracing
  • surgery

Spinal Stenosis

Spinal stenosis is a rare condition characterized by an abnormal narrowing or stenosis of the spaces within the spinal canal, spinal nerve root canals, or bones of the spinal column (vertebrae). Individuals may experience pain in the lower back and or the legs. In some cases, patients may have difficulty walking. It may occur as a result of spinal injury, infection, tumor, herniated disc, abnormal bone growth or deterioration. It can also be inherited.

Lumbar spinal stenosis affects the lower back and is a narrowing of the spinal canal that usually starts gradually and develops over a long period of time.

Symptoms of Lumbar Spinal Stenosis

What are the symptoms of lumbar spinal stenosis?

  • Numbness, weakness, cramping or pain in the legs, feet, or behind especially when you stretch or extend your back, such as in walking, standing straight or leaning backwards.
  • Stiffness in legs and thighs
  • Low back pain
  • In some cases, loss of bladder and bowel control

Causes of Lumbar Spinal Stenosis

Lumbar spinal stenosis is most commonly caused by age-related changes in the spine. However, age-related deterioration often occurs with certain disorders. They are Osteoarthritis, which is where the spine wears away joint cartilage and causes bony growth or spurs. Certain bone diseases are also the culprit such as Paget’s disease, ankylosing spondylitis, rheumatoid arthritis and diffuse idiopathic skeletal hyperostosis, which may soften the spinal bones or cause too much bone growth. Spinal stenosis may also be caused by cancer, spinal fracture, an inherited abnormally narrow spinal canal, spondylolysis (fracture on one or both of the wing-shaped parts of vertebrae) or fibrosis.

Preventing Lumbar Spinal Stenosis

It is most commonly caused by age-related changes in the spine. Because of this, some of these changes cannot be prevented; however there are ways to keep your back healthy. Regular exercise, such as flexibility stretches, a health body weight, and good posture all are important. Smoking has been linked to back pain and disc problems because it decreases bone density and increases the risk of fracture and deterioration.

If you have spinal stenosis, there are things you can do to prevent the severity from getting worse. Falls have the potential of worsening your spinal stenosis condition. Limit your use of alcohol and sedative medications such as flurazepam (Dalmane) or diazepam (such as Valium) all which cause drowsiness or dizziness. Also important is removing obstacles in your house that may cause you to trip and fall. Only take medications as directed by your physician. Sleeping pills and pain relievers may increase your chance of falling as well.

Treatment of Lumbar Spinal Stenosis

The goal of treating lumbar spinal stenosis, if it is not severe, is to relieve symptoms without surgery, because most cases do not require surgery. This course of treatment calls for the following:

  • Patient education about your condition and how to relieve symptoms
  • Medications to relieve pain and inflammation, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)
  • To achieve overall good health, exercise
  • To relieve symptoms and slow progression of the stenosis, weight loss
  • Physical therapy to provide instruction and support for self-care

Lumbar spinal stenosis often requires all of the above courses of non-surgical treatment on an on-going basis. An epidural steroid injection may be recommended by your physician if medicines, exercise and physical therapy do not relieve your symptoms. If the condition gets worse the patient might experience numbness, weakness, trouble walking or standing, bladder and bowel control problems. Your doctor may prescribe a hydrocodone or other opioid medication, but these medicines do not work well for symptoms that occur in the legs.

Back surgery may be considered if your symptoms have not improved and you have been pursuing the non-surgical treatment for some time. Your doctor will carefully weigh the benefits of surgery after consulting your treatment plan, MRI results and the severity of your condition.

Back surgery is a viable solution when there are severe symptoms of pain, numbness, or weakness in the legs that restrict normal daily activities. It is also an attractive option when the patient is in otherwise good health and does not have other medical conditions that might make it harder for recovery from surgery.

Surgery for spinal stenosis is not meant to relieve back pain, but pain, numbness or weakness in the legs. Spinal stenosis back pain is often not relieved by surgery and numbness, weakness and pain may return after surgery.