Back pain

George Rappard, MD

Back pain is a serious cause of disability in the United States, affecting nearly 65 million Americans and 20% of the working population. In the U.S., back pain is the number one reason for health care expenditure. While sudden back pain may be caused by muscle spasm, most cases of chronic, or long lasting back pain are caused by degeneration of spinal joints. These joints are called the intervertebral discs and facets. Most cases of back pain will improve with physical therapy and medications, though recurrence is common. Therapy should be intensive with the goal of restoring flexibility and normal spinal segment motion, building strength, removing muscle spasm and indirectly decompressing the spinal segment. Intensive therapy may involve muscle stimulation, thermal therapy, distraction, manipulation, range of motion exercises and resistance training. Despite intensive physical therapy some patients may experience a recurrence in their pain. With recurrence, patients may benefit from pain injections. When these fail, minimally invasive spine procedures may offer a similar benefit as traditional spine surgery. Patients with complex disease or neurological dysfunction may have to undergo a traditional spine surgical procedure.

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