Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Perhaps you bent the wrong way while lifting something heavy. Or you're
dealing with a degenerative condition like arthritis. Whatever the cause, once
you have low back pain, it can be hard to shake. About one in four Americans say
they've had a recent bout of low back pain. And almost everyone can expect to
experience back pain at some point in their lives.
Sometimes it's clearly serious: You were injured, or you feel numbness,
weakness, or tingling in the legs. Call the doctor, of course. But for routine
and mild low back pain, here are a few simple tips to try at home.
Chill it. Ice is best in the first 24 to 48 hours after an injury
because it reduces inflammation, says E. Anne Reicherter, PhD, PT, DPT,
associate professor of Physical Therapy at the University of Maryland School of
Medicine. "Even though the warmth feels good because it helps cover up the pain
and it does help relax the muscles, the heat actually inflames the inflammatory
processes," she says. After 48 hours, you can switch to heat if you prefer.
Whether you use heat or ice -- take it off after about 20 minutes to give your
skin a rest. If pain persists, talk with a doctor.
Functions of the low back, or lumbar area, include
structural support, movement, and protection of certain body tissues.
Pain in the low back can relate to the bony
lumbar spine, discs between the vertebrae, ligaments around the spine and
discs, spinal cord and nerves, muscles of the low back, internal organs of the
pelvis and abdomen, and the skin covering the lumbar area.
Treatment of low back pain is optimally directed toward a diagnosed or suspected
specific cause. For acute lumbar strain, use of a home remedy initially can be beneficial.
What is the anatomy of the low back?
The first step to understanding low back pain is appreciating the normal design
(anatomy) of the tissues of this area of the body. Important structures of the
low back that can be related to symptoms in this region include the bony lumbar
spine (vertebrae, singular = vertebra), discs between the vertebrae, ligaments
around the spine and discs, spinal cord and nerves, muscles of the low back,
internal organs of the pelvis and abdomen, and the skin covering the lumbar
area.
The bony lumbar spine is designed so that vertebrae "stacked" together can
provide a movable support structure while also protecting the spinal cord from
injury. The spinal cord is composed of nervous tissue that extends down the
spinal column from the brain. Each vertebra has a spinous process, a bony
prominence behind the spinal cord, that shields the cord's nervous tissue from
impact trauma. Vertebrae also have a strong bony "body" (vertebral body) in
front of the spinal cord to provide a platform suitable for weight bearing of
all tissues above the buttocks. The lumbar vertebrae stack immediately atop the
sacrum bone that is situated in between the buttocks. On each side, the sacrum
meets the iliac bone of the pelvis to form the sacroiliac joints of the
buttocks.
The discs are pads that serve as "cushions" between the individual vertebral
bodies. They help to minimize the impact of stress forces on the spinal column.
Each disc is designed like a jelly donut with a central, softer component
(nucleus pulposus) and a surrounding, firm outer ring (annulus fibrosus). The
central portion of the disc is capable of rupturing (herniating as in a
herniated disc) through the outer ring, causing irritation of adjacent nervous
tissue and sciatica as described below. Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae to each other and surround each of the discs.
The nerves that provide sensation and stimulate the muscles of the low back as well as the lower extremities (the thighs, legs, feet, and toes)
all exit the lumbar spinal column through bony portals, each of which is called a "foramen."
Many muscle groups that are responsible for flexing, extending, and rotating the waist, as well as moving the lower extremities, attach to the lumbar spine through tendon insertions.
The aorta and blood vessels that transport blood to and from the lower extremities pass in front of the lumbar spine in the abdomen and pelvis. Surrounding these blood vessels are lymph nodes (lymph glands) and tissues of the involuntary nervous system that are important in maintaining bladder and bowel control.
The uterus and ovaries are important pelvic structures in front of the pelvic
area of women. The prostate gland is a significant pelvic structure in men. The
kidneys are on either side of the back of the lower abdomen, in front of the
lumbar spine.
The skin over the lumbar area is supplied by nerves that come from nerve roots
that exit from the lumbar spine.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Diffuse idiopathic skeletal hyperostosis (DISH or Forestier's disease) is a form of degenerative arthritis. It is characterized by calcification along the sides of the vertebrae of the spine. Symptoms include stiffness and pain in the upper and lower back. Anti-inflammatory medications are used to treat DISH.
Endometriosis is the growth of cells similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder. Treatment of endometriosis can be with medication or surgery.
One in every 20 people develop a kidney stone at some point in their life. A kidney stone is a hard mineral and crystalline material formed within the kidney or urinary tract. Kidney stones symptoms and signs are, blood in the urine and pain in the abdomen, flank (lower back), or groin. A number of different conditions can lead to kidney stones including: gout, hypercalciuria, people with inflammatory bowel disease, kidney disease, and hypoparathyroidism. Some medications also increase the risk of kidney stones.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms.
Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is
"hardening of the arteries" called arteriosclerosis.
Blood in semen is also known as hematospermia. Blood in semen can be caused by many conditions affecting the tubes that distribute semen from the testicles (seminal vesicles) or the prostate gland. Symptoms that may accompany blood in semen include blood in the urine, fever, painful urination, pain with ejaculation, tenderness, and swelling in the testes or groin area. Urinalysis, ultrasound, and MRI may be used to diagnose blood in the semen. Treatment depends upon the underlying cause of blood in the semen.
Sciatica pain, caused by irritation of the sciatic nerve, typically radiates from the low back to behind the thigh to below the knee. Disc herniation is usually the cause of sciatica. Medication to alleviate pain, physical therapy, and bed rest are treatments for sciatica.
Coccydynia is an inflammation of the bony area (tailbone or coccyx) located between the buttocks. Coccydynia is associated with pain and tenderness at the tip of the tailbone between the buttocks. Pain is often worsened by sitting. There are many causes of tailbone pain that can mimic coccydynia including: fracture, pilonidal cysts, infection, and sciatica. Treatment methods include medication and rest.
Degenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
Scoliosis causes an abnormal curvature of the spine. When the cause of scoliosis is unknown the disorder is described based on the age when the scoliosis develops (infantile, juvenile, or adolescent idiopathic scoliosis). In functional scoliosis, curvature develops due to a problem somewhere else in the body. With neuromuscular scoliosis, there is a problem when the bones of the spine are formed. Treatment typically involves observation, bracing, and surgery and is dependent upon the severity of the curvature.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Vancomycin-resistant enterococci (VRE) infection is the most common type of infection acquired by patients while hospitalized. Patients at risk for VRE are those who are already ill, and hospitalized, including individuals with diabetes, elderly, ICU patients, kidney failure patients, or patients requiring catheters. Enterococci can survive for months in the digestive tract and female genital tract. Other risk factors for acquiring VRE include those how have been previously treated with vancomycin and combinations of other antibiotics. Treatment of VRE is generally with other antibiotics other than vancomycin. Prevention of VRE can be achieved by proper hand hygiene.
Sacroiliac joint (SI) dysfunction is a general term to reflect pain in the SI joints. Causes of SI joint pain include osteoarthritis, abnormal walking pattern, and disorders that can cause SI joint inflammation including gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis. Treatment includes oral medications, cortisone injections, and surgery.
A herniated disc may be caused by injury or degeneration from age. Symptoms depend on the location of the herniation and whether nerve tissue is being irritated. An MRI or CT scan is performed to diagnose a herniated disc. Treatment may involve physical therapy, cortisone injection, pain medications, antiinflammatory medications, muscle relaxants, and surgery.
A pinched nerve can be caused of a variety of conditions, for example, carpal tunnel syndrome, herniated disc, sciatica, arthritis, spinal stenosis, trauma, and more. Common symptoms of a pinched nerve include pain, numbness, tingling, and weakness. Treatment of a pinched nerve depends on the cause of the pinched nerve.
The five types of spondylolisthesis include 1) dysplastic, 2) isthmic, 3) degenerative, 4) traumatic, and 5) pathologic. The most common symptom of spondylolisthesis is lower back pain. Treatment depends on the type and severity of spondylolisthesis. Surgery is required in some cases of spondylolisthesis.
Radiculopathy, a condition in which a nerve or nerves along the spine are compressed causing pain, numbness, weakenss, and tingling along the nerve(s). Some causes of radiculopathy include bone spurs, disc hernation, osteoarthritis, tumors, infection, and neuropathy. Treatment depends on the are of nerve compression. Surgery is generally not required.
Osteomyelitis is an infection of the bone. Potential causes include injections around the bone, fractures that puncture the skin, recent surgeries, and bacterial infections that travel from other areas of the body, spreading through the blood to the bone. Symptoms include pain, fever, chills, stiffness, and nausea. Treatment involves antibiotics and pain medications. Surgery is sometimes necessary.
Cauda equina syndrome is a medical emergency condition that is caused by the uncommon compression of the nerves at the end of the spinal cord. Symptoms of cauda equina syndrome include lower back pain, tingling and/or numbness in the buttocks and lower extremities, bowel or bladder incontinence, and weakness in the legs. Causes of cauda equina syndrome include herniated discs, hematomas, or infection. Treatment is generally prompt surgery.
Typhus is a disease caused by Rickettsia bacteria. Symptoms and signs include fever, headache, nausea, vomiting, diarrhea, and rash. Antibiotics are recommended as the treatment for endemic and epidemic typhus infections.
Porphyria is a group of disorders that affect the nervous system, skin, or both. Porphyria is often an inherited condition that causes blistering, itching, and swelling of the skin. Treatment of porphyria may include avoiding triggers, receiving heme, taking medication, or having blood drawn to reduce iron levels in the body.
Cauda equina syndrome is an uncommon compression of the nerves at the end of
the spinal cord within the spinal canal. The terminology, "cauda equina,"
literally means tail of horse and refers to the normal anatomy of the end of the
spinal cord in the low back where it divides into many bundles of nerve tracts
resembling a horse's tail. Compression of the spinal cord at this level can lead
to a number of typical symptoms of the syndrome (low back pain,
sciatica, saddle
sensory changes, bladder and
bowel incontinence, and lower extremity motor and
sensory loss).
What are the causes of cauda equina syndrome?
Cauda equina syndrome can be caused by any condition that results in direct
irritation or pinching of the nerves at the end of the spinal cord. Causes of
cauda equina syndrome include herniation of lumbar intervertebral discs,
abnormal growths (tumor or cancer) adjacent to the ...
