Chronic pain isn’t fun. I’ve been there.

Something happened to me that allowed me to understand my patients on a much deeper level. A couple of years ago, I overexerted myself in the gym and was left with excruciating pain from my lower back into the posterior part of my left leg. After months of frustration, sessions of physical therapy and a rigorous home exercise program, I was finally able to walk more than one block without having to rest to relieve my pain.

The symptoms I was experiencing were due to a condition called “lumbar radiculopathy,” which is the medical term for a pinched nerve in the lower back.

A nerve can become pinched for several different reasons. My specific symptoms were a result of the L5 nerve root getting pinched by the intervertebral disc. Common causes of radiculopathy include, but are not limited to, a herniated disc, narrowing of the spinal canal or neuroforamina, degenerative disc disease, bone spurs, facet arthritis and ligament hypertrophy.

First line treatment for this condition involves medications, physical therapy, epidural steroid injections and resumption of activity as tolerated. Research has shown that these treatments, when used in combination, are more effective than any single treatment is alone. If symptoms persist despite these treatments, a surgical evaluation may be considered.

Medication management for radiculopathy includes non-opioid medications such as anti-inflammatories, muscle relaxers and medications for nerve pain. Many of these medications are well tolerated. Occasionally, a steroid dose pack or very brief (1-2 week) course of opioid medication may be prescribed for acute pain.

Physical therapy involves strengthening the muscles around the painful area to take pressure off of the joints or nerves that are generating pain. My best analogy for this is the muscles around the joint function as a shock absorber for the painful joint. Better shock absorbers will generally allow for more comfort and less wear and tear over time.

Epidural steroid injections deposit a powerful anti-inflammatory medication at the exact location of the source of the pain. This is administered by a physician and often utilizes guidance of an x-ray machine (fluoroscopy) to ensure the medication is in the correct location. The procedure usually takes only 10-15 minutes, and the patient is allowed to go home the same day. Normal activity can be resumed as tolerated post-procedure. Epidural steroid injections typically last 3-6 months, but can provide longer relief depending on the patient’s pathology. These injections may also be repeated if symptoms persist.

Patients are typically encouraged to continue normal activity as tolerated throughout treatment of radiculopathy. Research has shown that simple exercises, such as walking, have led to improvement of symptoms. For specific guidance regarding activity level, it is recommended to consult your healthcare professional.

In summary, you shouldn’t have to live in chronic pain as there are treatment options for low back and leg pain. Come see one of our spine specialists at The Spine Center for a consultation and a plan catered to your individual needs.

Water Therapy and the Spine

With summer heat upon us, it’s the perfect time to cool off in a pool. But did you know there are also numerous benefits for the spine? Water therapy allows for various exercises to be done in a pool. These exercises can be performed to help strengthen the core muscles of the spine. Water therapy can be performed on one’s own time or with the supervision of a trained physical therapist. This form of therapy can be beneficial to those who cannot tolerate a land-based exercise program.

There are numerous benefits to water therapy because of the physical properties of the water. These properties include buoyancy, viscosity, and hydrostatic pressure. There is a decrease of the stress placed on your spine because of the buoyancy provided by the water. Buoyancy allows one to twist and turn more freely; therefore, allowing one to perform Range of motion (ROM) exercises that are not possible on land. Additionally, water provides a resistance of 600 times that of air helping muscles to strengthen. The risk of falling is eliminated in water allowing for improved mobility.

Water temperature is important during the exercises. Pool temperature should be between 86-98 degrees Fahrenheit. If the temperature is lower it can result in muscle tension. And, if the temperature is higher it could result in overheating or fatigue. Normal fatigue after a water therapy workout should only last 2-3 hours. If the fatigue lasts longer, one should reduce the intensity of the next pool session or consult a physician.

Water therapy does have some limitations and may not be for everyone. This type of therapy should be avoided if one has a fever, infection, or an open wound.  Also, it is not recommended in individuals with heart failure.

Exercises range from simple routines to more advanced using special equipment. Below you can find various exercises that can be performed on your own at home. Also, you may download our pdf  with detailed exercise instructions.

Pool exercises:

  1. Pool Walking- step forward with one leg. Strike pool bottom with heel. Rolling over foot, bring other leg forward.
  2. Side Step- move one leg out to side with knee slightly bent, then bring other leg to it.
  3. Hip Flexion, knee straight- Lift right leg straight forward and up, then repeat on the other leg.
  4. Leg Circle- raise left leg forward to comfortable height, knee straight. Circle same leg in front of body. Then repeat with the other leg.

Golfing with Low Back Pain, Lumbar Stenosis and After Spine Surgery

Golf is one of the most popular sports in the world and it’s a great form of exercise that can be enjoyed by men and women of all age groups.  One of the unfortunate downsides to the sport is the strain it can put on your lower back.  This article will focus on not only the prevention of a lower back injury from playing golf, but also how to enjoy the game if you are someone who has been diagnosed with lumbar spinal stenosis or has had spine surgery in the past.

As with any sports related injury, prevention is key.  Here are some tips to preventing low back pain from golfing:

  1. Stretch before and after playing. Key areas to stretch prior to playing include the hamstrings, shoulders, torso, and hips. It’s better to warm up with short irons first, before taking larger swings with long irons and woods.
  2. A smooth, rhythmic swing produces less stress on the lumbar spine.
  3. Avoid carrying your golf bag if possible. If you must, it is better to have a bag with a built in stand and 2 straps, one for each shoulder. This prevents repetitive bending over to lift the heavy bag and carrying an uneven load on one shoulder.

Some patients suffer from a condition called lumbar spinal stenosis, where the canal that contains the nerves in the lower back is narrowing and can cause low back and sciatica pain. Here are some additional tips (in addition to the tips above) for this group of patients who want to continue to play golf:

  1. Swing 50-75 % of your normal force.  This will prevent additional stress on your lumbar spine.
  2. Wear a low back brace while you play.  The brace acts as a reminder to avoid maneuvers that can strain your lower back, while also providing support and preventing excess motion.  Wearing a brace also increases warmth to the lower back, keeping the muscles and soft tissue loose.
  3. If ok with your doctor, take an anti-inflammatory medication (i.e. NSAID) 30 minutes before playing.
  4. Take a break from golf for a few weeks if low back and sciatica pain worsens.

For patients who have had lumbar spine surgery in the past, here are some general recommendations for returning to the golf course. It should be mentioned that every patient is different, and clearance from your spine surgeon should be granted prior to attempting any activity, especially golf.

For patients who undergo lumbar microdiscetomy:

  1. After 8 weeks post-op, the patient can begin gentle stretching of the low back and core strengthening exercises. Once these are mastered, the patient can transition to light swinging with short irons; eventually progressing to a full swing with long irons and woods as tolerated. Developing good stretching habits before and after golf is a must.
  2. No shots from the sand, rough, or uneven lies should be performed until at least 16 weeks post-op. During this time, patients should avoid riding in carts and not hit any balls off of the tee.
  3. After 16 weeks post-op, it is recommended to play no more than 9 holes at a time to start. Patients can gradually progress to a full 18 hole round of golf once tolerated.
  4. Any flare-up of pain should result in the patient holding all golf activity for at least 4 weeks, and starting from #1 with gentle range of motion stretches and core strengthening.

For patients who undergo lumbar spine fusion:

  1. Recommendations vary patient to patient and it is especially important to get clearance from your spine surgeon prior to starting golf after lumbar fusion surgery.  Return to gentle swinging can vary anywhere from 6 to 18 months post-op.
  2. Once patients are told it is ok to begin playing golf again, they should adhere to the same return to play restrictions as stated above for microdiscectomy patients. Begin with gentle swinging of short irons and gradually progress to long irons and woods.  Eventually working up to playing 9 holes at first and then 18 holes as tolerated.

 

REFERENCES:

What Can I Do to Prevent Back Problems?

Maintaining a healthy spine is both possible and necessary to prevent complications that arise from the normal aging process of the spine.  As we get older, the structures of our spine change in ways that make it easy to injure and cause problems, most commonly with degenerative disc disease, disc bulging, and spinal stenosis. Information on these conditions can be found in other articles available on our website.

While we can’t stop the aging process, we are able to lower the odds of developing and/or delaying these conditions. The most important factor is exercise!  The benefits of regular exercise are vital to prevention of back problems. Combined with diet and weight loss, exercise strengthens the muscles of the low back and abdomen that correspond with the spine. This will reduce the risk of fall or injury. Stretching can reduce and prevent muscle spasms. Aerobic exercise, which gets your heart pumping and increases your pulse, releases chemicals called endorphins that work as a pain reliever. Strength training or resistance exercises increase muscle mass and muscle endurance. This helps to keep your spine strong and lessens the chance of a disc bulging or tearing with normal motion and activity.

The level and type of exercise will be different for every person and should be chosen based on your level of fitness, and whether or not there is known damage or injury to the spine. This can be discussed with your doctor for guidance. Types of aerobic exercise include walking, bike riding, jogging, swimming, or running. Strength straining includes Yoga and Pilates classes as well as weight lifting and resistance bands. Lower impact exercises are recommended for patients with back pain. Yoga improves functional range of motion across the entire body leading to greater flexibility and agility with less likelihood of injury.

Another key to spine health is correct body mechanics. Good posture and proper body mechanics prevent progression of spine problems and should be practiced at all times. This includes normal daily activity such as sitting, standing, lifting or sleeping.

  1. Standing: maintain neutral pelvic position; prop one foot on a stool with prolonged standing; alternate feet.
  2. Sitting: use a seat with good lumbar support; make sure knees and hips are level; change position frequently.
  3. Lifting: avoid heavy objects; use proper lifting techniques with your legs doing the work instead of your back; bend only at the knees.
  4. Sleeping: keep your back in the neutral position; sleep on good support (mattress not too hard or soft); use pillows for support and place a pillow between your knees if sleeping on your side.

Frequently overlooked factors known to degrade spine health include use of tobacco and alcohol.  Smoking interferes with the oxygen supply used by spine discs to absorb nutrients from the bloodstream. This causes discs to become dehydrated leading to higher risk of bulging or tearing.  Smoking also decreases bone density which leads to a higher risk of fractures and bone deterioration.  Alcohol abuse causes sedation and dizziness, also increasing the chance of fall or injury.

While there is no way to completely erase your risk of back problems, implementing the above recommendations as part of a long-term maintenance program can definitely combat spine problems.  It will also lead to a slowing of progression of pre-existing conditions. Please talk to your doctor about specific recommendations that can be customized to your back to allow a strong defense against spinal disease in the years to come.

What is Lumbar Spinal Stenosis?

Lumbar spinal stenosis is narrowing of the spinal canal in the lumbar area, which is the area in lower back. The narrowing of the spinal canal can be caused by growth of bone, or tissue, or even both. These growths can tighten the area around the nerves and in the canal.  Classic symptoms of lumbar stenosis are low back pain or leg pain with walking or standing. The pain is relieved with sitting. People with lumbar stenosis often lean forward to allow them walk longer.

WHAT ARE CAUSES OF LUMBAR SPINAL STENOSIS?

There can be several causes of Lumbar Spinal Stenosis. Typically, it is related to degeneration of the spine and becomes most noticeable around 50-60 years old.  It is usually a gradual process and is associated with decreased physical activity and development of kyphosis (leaning forward.)  Lumbar stenosis can also be congenital where the patient is born with a smaller canal than normal.  Certain bone diseases can also cause lumbar stenosis such as Pagets disease or Ankylosing Spondylitis. Another condition called Spondylolysis can cause lumbar stenosis. This condition is a defect or fracture that causes the vertebrae to slide forward or back over the bone causing the canal to be narrowed. Additional causes can be a spinal fracture, tumor, or scar tissue from previous back surgery.

WHAT ARE THE SYMPTOMS OF LUMBAR SPINAL STENOSIS?

The symptoms usually start gradually and get worse over a long period of time. The most common symptom is leg pain with walking or standing that goes away with sitting. The symptoms will reoccur if a patient gets back into an upright posture. Numbness, tingling, or weakness may accompany the pain. In severe cases, there can be a loss of bladder or bowel control.

HOW IS THE DIAGNOSIS MADE?

The diagnosis can typically be made based on clinical findings. Plain X-rays of the lumbar spine can be obtained which may or may not show spinal stenosis. Usually a CT or MRI scan is needed to identify the narrowed canal.

WHAT IS THE TREATMENT FOR LUMBAR SPINAL STENOSIS?

There are various treatments for lumbar spinal stenosis. If one has spinal stenosis, there may be a need for activity modifications. These modifications will help the patient avoid worsening their symptoms. A clinician may order physical therapy or exercises.  The exercises will not cure the stenosis, but help the patient to remain as active as tolerated. Medications can also be used to help alleviate the pain. Various medications may be used such as NSAIDS, muscle relaxers, nerve desensitizing medications, or a short course of opioid medications for severe cases.  If a patient continues to remain symptomatic, then surgery may be needed.  The surgery would remove the area of compression such as bone or tissue causing the canal to be narrowed.

WHEN TO CALL THE DOCTOR?:

  • New episode of loss of bladder or bowel function
  • Leg pain accompanied by persistent weakness, numbness, or tingling
  • Significant back pain or leg pain that doesn’t improve

Text Neck

It seems almost impossible nowadays to go anywhere or do anything without the aid of smartphones.  Approximately two-thirds of American adults and roughly 85% of teenagers own a smartphone, with the daily usage varying from 2 to 5 hours per day and the average person checking their phone 85 times per day.  One potential hazardous effect of the growing smartphone use is neck pain – termed “text neck” by some medical professionals.

Text neck can cause symptoms ranging from a slow chronic onset of nagging neck pain to a severe acute onset of upper back pain due to muscle strain or spasms.  Other symptoms may include shoulder pain and tightness, headaches, eye strain, thumb and elbow pain, or even radiating nerve pain into the shoulders or arms.

The main issue with smartphone overuse is primarily posture related. A recent study found that for every inch forward the head tilts, the pressure on the spine doubles. The human head weighs approximately 12 pounds, but with head flexion (or looking down as one would do on a smartphone) that weight on the spine increases to 27 pounds at 15°, 40 pounds at 30°, 49 pounds at 45°, and 60 pounds at 60°.  This is most concerning in younger patients, as chronic smartphone use can potentially lead to early onset neck arthritis, chronic muscle strain, and a decrease in the natural curvature of the neck.

As with any overuse injury, prevention is key.  Pain and discomfort with excessive smartphone use is an early indicator of future neck injury.  Here are a list of ways to avoid developing some of the symptoms of text neck:

  • Take frequent breaks from your smartphone, at least every 20 minutes.
  • Hold your phone or tablet at eye level to avoid excessive bending at the neck. One good alternative is to lay flat on your back or use a stand to hold the device for you.
  • Stretch regularly – a short list of neck stretches is included below. These are great to do while you are taking a break from your device.
  • Stay fit as poor neck posture can lead to low back pain as well. Core strengthening of the abdomen and low back, as well as improving neck strength and mobility decrease the risk for developing text neck.
  • If you develop any of the symptoms of text neck, early treatment should include rest, avoidance of the smartphone or any other devices, anti-inflammatories, and an icepack to the area in pain.

As technology continues to develop, smartphone use will only increase.  The key to avoiding the potential adverse effects of text neck is prevention. Keeping these preventative measures in mind while using your smartphone, tablet, or laptop can help you or your children avoid developing chronic neck pain and enjoy your devices throughout the day.


References:

Dry Needling

More than 25% of Americans have a musculoskeletal condition that requires medical attention. Chronic back pain accounts for most of the common musculoskeletal pain conditions and can be treated non-operatively or surgically, depending on the acuity of the problem and its symptoms.

One popular and cost-effective alternative is dry needling. This involves inserting a dry filament needle into the ‘trigger point’ to alleviate pain. The trigger point is a hyperirritable area of tissue that is tender when compressed and can give rise to pain.  Trigger points occurring in muscles are referred to as myofascial trigger points, but they can also occur in other types of connective tissue, such as ligaments, tendons, and skin.

Unlike acupuncture, which is a traditional Chinese medicine technique, dry needling practitioners insert needles directly into the muscles and nerve pathways causing the pain. The purpose for this is to cause the trigger point to twitch or spasm which will disrupt the “neurological feedback loop” that keeps the muscle in a contracted state of pain, and as a result, will release the pressure.

A variety of musculoskeletal problems can be treated with dry needling, such as but not limited to, acute/chronic injuries, headaches, neck/back pain, tendinitis, muscle spasms, sciatica, hip/knee pain, muscle strains, and fibromyalgia.

Research has shown that dry needling can improve pain control, reduce muscle tension, normalize biochemical and electrical dysfunction of motor endplates, and facilitate an accelerated return to active rehabilitation. However, patients must be diligent with their daily stretches as assigned by their physical therapist. These exercises can make the effects of dry needling last longer. Patients should also use caution when exercising and remember that stretching aggressively can make things worse.

If you are interested in dry needling, consult with your physician to see if you are a candidate for this great alternative way to relieve pain and stress.

Are You Going to See My Scar?

Dr. Kevin P. McCarthy started his orthopedic spine practice with Bone and Joint Clinic of Baton Rouge in 2005. In 2008, Dr. McCarthy opened The Spine Center at Bone and Joint Clinic. He has since established a thriving practice and an excellent reputation for patient satisfaction and care.

It is through Dr. McCarthy’s desire to treat the patient as a unique individual that he founded Louisiana Aesthetics and Skin Care after recognizing the importance for most patients to maintain a certain level of normalcy in their aesthetic results following surgery. Surgical patients frequently expressed concern with the degree and permanency of scarring associated with their surgeries. Dr. McCarthy has identified the most innovative treatments for scar reduction available and is now offering them as an enhancement to his surgical patients as well as other advanced services for non-patients that might be looking to improve their overall appearance and wellness. LAS laser services not only treat surgical scars but can improve skin elasticity, eliminate wrinkles, improve skin texture and tone, and remove pigmentation and unwanted hair.

Dr. McCarthy has long used Botox for the treatment of musculoskeletal issues in his practice and is now able to offer it for the treatment and prevention of wrinkles as well. The team at LAS also offers Ideal Protein products and dietary lifestyle suggestions to aid in weight loss. With each of these state-of-the-art procedures it is with great care that we are now able to treat each patient from the inside out.

Before

After

Call 225-636-2603 to schedule an appointment or learn more.

Or, email us with questions or additional information.

Louisiana Aesthetics and Skin Care

16645 Highland Rd. Suite F
Baton Rouge, LA 70810

(225) 636-2603

Effective Exercises for Low Back Pain

As the first of the year is upon us, most people make healthy resolutions including weight loss and exercise. For those suffering with low back pain it can be difficult to find a program that won’t aggravate their pain or discomfort.

Many factors can contribute to low back pain including weak muscle strength and endurance. Other problems that can contribute to low back pain include degenerative disc disease and arthritis. For most patients pain related to wear and tear on the disc is usually aggravated with bending forward, and arthritic pain is usually worse with leaning backwards. For this reason some patients find it hard to find an exercise program to strengthen abdominal muscles without aggravating symptoms. In this situation isometric abdominal exercises may be of benefit. Isometric exercises are those that work without using range of motion. This can be done through holding a contraction of a muscle for a period of time without the lengthening or shortening of a muscle. The time to hold a contraction of a muscle can be as short as five seconds for a beginner and 60 seconds for the more experienced patient. Here are a few examples of isometric exercises that are easy to do in the convenience of your own home:

  1. Isometric Abdominal Exercise: Imagine pulling your belly button toward your spine with a string. This exercise is simple and can be done in various positions, including sitting, standing and lying down.
  2. Bridge: This is an exercise that strengthens many different muscles at the same time including your lower back muscles, buttock and abdominal muscles. Lay on your back with your knees bent. In this position, tighten your abdominals by doing the isometric abdominal exercise first. Then lift your hips from the floor, and hold this position for five seconds. Gradually work your way up, holding the exercise longer, until you can hold the bridge for one to three minutes.
  3. Lower Abdominal Isometrics: Lie on your back with your knees bent up and tighten your abdominals in the isometric abdominal exercise. In this position lift one knee, and then lift the other knee to the same position and hold that position for five seconds. Then, slowly lower one knee and then the other back to the ground. One way you’ll know you’re not ready for this exercise is if your back arches when you lift your second knee.
  4. Planks: The plank is the most well-known isometric abdominal exercise and is used in both yoga and Pilates workouts. To perform the Plank, kneel on all fours and rest your forearms on the floor. Walk your legs back so that your weight is supported on your forearms and on the ball of your feet only. Make sure your heels, hips and shoulders form a straight line. Hold this position for the desired duration. Do not allow your hips to drop toward the floor as this places undue strain on your lower back.
  5. Side Planks: Side planks target your abdominals and core muscles. Lie on your side with your legs straight. Rest your elbow on the floor directly underneath your shoulder. Lift your hips off the floor so that your weight is supported on your arm and sides of your feet only. Hold this position for the desired duration.

Avoid holding your breath when performing isometric exercises which can cause an elevation in blood pressure. Start out by holding the contraction or doing the exercise for short periods of time (5 -10 seconds) then increase the time as you feel more comfortable with the exercise. Of course each patient has a different type of pain and a different diagnosis. If you have questions about starting any of these exercises discuss them with your health professional first. If you experience severe pain while performing these exercises, discontinue and contact your physician or health care professional.

7 Days and 7 Ways for a Thinner Thanksgiving

Thanksgiving comes around once a year, so why not splurge? Each year, most of us pack on at least a pound during the holidays – and then keep the extra weight permanently. Thanksgiving is 7 days away, so here are 7 tips for a thinner Thanksgiving:

  1. Eat Breakfast – While some may think it makes sense to save calories for the big meal, experts say eating a small meal in the morning can give you more control over your appetite. With a small but satisfying breakfast — such as an egg with a slice of whole-wheat toast, or a bowl of whole-grain cereal with low-fat milk —  you won’t be starving when you arrive at the gathering.
  2. Police Your Portions – Thanksgiving tables are bountiful and beautiful displays of traditional family favorites. Before you start filling your plate, survey the table and see what there is to choose from. Then select reasonably-sized portions of what you just can’t live without. Try not to waste your calories on foods that you generally have all year long.
  3. Slowly Savor – Eat slowly and put your fork down between bites while engaging in conversation. Tasting each mouthful is one of the easiest ways to enjoy your meal and feel satisfied with one plate full of food. Choosing whole grains, fruits, vegetables, broth-based soups, salads, and other foods with lots of water and fiber add to the feeling of fullness. Spread out the food and fun all day long.
  4. Easy on Alcohol – Alcohol calories can add up quickly! Make your wine a spritzer, and between alcoholic drinks, enjoy a glass water. If plain water sounds boring to you, flavor it with fruit or veggie slices for a fun twist.
  5. Focus on Family and Friends – Thanksgiving is not just about the delicious bounty of food. It’s a time to reflect on what you’re thankful for and celebrate relationships with family and friends.
  6. Get Active – Connie Diekman, MEd, RD, former president of the American Dietetic Association (ADA) suggests you create a calorie deficit by exercising to burn off extra calories before you ever indulge in your favorite foods. “Eat less and exercise more is the winning formula to prevent weight gain during the holidays,” Diekman says. “Increase your steps or lengthen your fitness routine the weeks ahead and especially the day of the feast.” Make fitness a family effort. It’s a wonderful way to enjoy the holiday together.
  7. Be Realistic – The holiday season is a time for celebration. With busy schedules and so many extra temptations, this is a good time to strive for weight maintenance instead of weight loss.

 

Source:
http://www.webmd.com/diet/10-tips-for-a-thinner-thanksgiving?page=1

Numbness and Tingling: When to Worry

Numbness and tingling in the arms and legs are abnormal sensations that result from disorders of a nerve or nerves. There are many different possibilities as to the cause of these symptoms. Most of the time the cause is not serious, but certain associated signs and symptoms can signal the need to see your doctor.

A major cause of numbness and tingling is peripheral neuropathy. This refers to an abnormality of the nerves outside the spinal canal. Several causes of neuropathy exist, including, but not limited to diabetes, peripheral nerve entrapment, vitamin and mineral deficiencies, inflammatory or rheumatologic disorders, alcoholism, kidney failure, circulatory issues and damage from chemotherapy and radiation. In diabetics, the numbness and tingling is often accompanied by increased thirst, hunger, and urination. The most common nerve entrapment is carpal tunnel syndrome which affects the hand and wrist. Increased risk of carpal tunnel syndrome is noted in people who do repetitive wrist activity such as typing or cutting hair. Vitamin B-12 and folate are common vitamin deficiencies and can be associated with weakness from anemia, paleness, loss of appetite, and sore tongue and mouth. Long term excessive alcohol drinking can cause numbness and tingling and is usually associated with a wide-based gait. Certain rheumatologic or endocrine conditions that can cause neuropathy include rheumatoid arthritis, amyloidosis, fibromyalgia, thyroid problems, or Raynaud’s phenomenon. Neurologic neuropathies (such as chronic inflammatory demyelinating polyneuropathy) are typically associated with weakness in the arms or legs. Sciatica is a condition where the sciatic nerve is affected after exiting the spinal cord as it passes through the hip or buttock area. This is commonly associated with leg pain and/or back pain.

Disorders of the brain and spinal cord also commonly cause numbness and tingling. Problems in the cervical spine can result in symmetrical arm and leg numbness and possible paralysis of the arms and legs. Thoracic (mid back) problems affect the trunk and legs. Lumbosacral (low back and tailbone) conditions affect the hips and legs. Multiple Sclerosis is an autoimmune disorder which can cause these symptoms, but these will rarely occur in a symmetrical pattern. Other spinal cord problems such as tumors or cysts can be associated with pain, weakness, clumsiness, or bowel or bladder problems.

Vascular or circulatory problems leading to lack of blood supply to an area can cause numbness and tingling. This will commonly accompany blue or red discoloration, paleness or cold and painful sensation in the area.

While the potential causes of these symptoms are quite varied, certain causes are obviously of greater concern than others. Numbness and tingling that is associated with weakness, paralysis, or loss of bladder or bowel control warrant emergent evaluation and treatment by a healthcare professional. Also, any symptoms of confusion, vision or speech changes, weakness, or loss of consciousness should prompt a visit to a local emergency department. Numbness and tingling associated with neck or back pain, arm or leg pain, muscle spasms, or rash require a call or visit to your physician but are less urgent in nature. Obtaining a proper history and physical from a physician, as well as diagnostic testing and procedures, are necessary to make a correct diagnosis and implement proper treatment. If any of these symptoms are experienced and persist despite change in position or activity, please consider evaluation with your doctor for appropriate care.

Pars Defect: Condition and Treatment

Spondylolysis, also known as a pars defect, happens when a crack forms in the bony ring on the back of the spinal column. Most commonly, this occurs in the lumbar spine. In this condition, the bone that protects the spinal canal fractures as a result of excessive or repeated stress.  Patients can also be born with a congenital defect in this area and develop symptoms much later in life when this area is injured.

The condition mainly affects young athletes who participate in sports in which the spine is subject to repetitive extension, such as gymnastics, football, and karate. Although pars defect can affect people of any age, children and adolescents are most susceptible. This is because their spines are still developing, and the pars is the weakest part of the vertebra. Placing extra strain on this area of the spine during childhood increases the chance that a pars defect will occur.

Naturally, the vertebra’s initial response to the abnormal strain is to add new bone cells surrounding the injured area. But, if the injuries happen faster than the body can keep up, a crack may form in the weakened bone. This is called a stress fracture. The most common location for this to occur is in the lower lumbar spine at the L5 level. However, a problem with the pars can o

ccur at any lumbar vertebra. Very rarely it occurs in two places simultaneously.

Symptoms of a pars defect are pain and stiffness in the center of the low back. Lumbar extension and twisting typically increases pain. Symptoms get worse with activity and go away with rest. Some may experience pain radiating down one or both legs. This pain comes from pressure and irritation on the nerves that exit the spinal canal near the fracture. Patients can even experience numbness, tingling, and weakness in their legs.

Most patients with pars defect do not require surgery and can experience relief with medications and rest. Anti-inflammatory medications and muscle relaxers are commonly used to treat pain. Often, a lumbar corset back brace is prescribed for the acute phase of the injury. Physical therapy is also initiated once diagnosed. Once PT begins, the therapist will introduce a series of strengthening exercise for the abdominal and low back muscles. Working these core muscles helps patients begin moving easier and lessens the chances of future pain and problems. Patients typically need to attend therapy sessions for 6-8 weeks and should expect full recovery to take up to 6 months. In more severe cases of pain, steroid spinal injections may help. When symptoms are not relieved with nonsurgical treatments patients may require surgery. Surgical options for a pars defect include a pars repair versus a lumbar fusion.

If you are experiencing back or leg pain, and think you may have a pars defect, please call for an appointment today or request an appointment online.