The primary goal of treatment is to get you back to your everyday activities. During your initial visit, Dr. Gus Varnavas will assess your medical history and collect more specific information during the exam. In order to better understand your back or neck problem, Dr. Gus Varnavas may gently move your joints and limbs. It is important to answer all the physician’s questions honestly, because your answers help determine a correct diagnosis.
Doctors who focus mainly on pain symptoms often recommend the exact opposite course of action that is optimal for recovery from a back problem. For example, years ago, doctors treated back pain with bed rest and heavy drugs in order to mask the patient’s discomfort. Patients became sedentary and increasingly dependent on drugs. It was later discovered that this treatment was actually damaging to the back, because it weakened muscles and caused more pain.
Pain is a signal from the body to the brain that something is wrong. Either a certain motion placed too much strain on the back, or the back is too weak or inflexible. Your specialist will help determine the origin of your pain and the best treatment for it.
Give it some time - Time is your most valuable asset. In cases where pain is focused in the low back or when there are red flag symptoms, take the time to help yourself. Check out our home remedy section.
Limiting rest - Studies have reported that rest and inactivity should be limited to two days at most. After that time, patients should be encouraged to start moving and exercising to strengthen the back muscles and increase flexibility. And part of the rehabilitative process can require a commitment on the part of the patient to work closely with the therapist during those first few weeks to ensure a successful long-term recovery.
While drugs and manipulation may relieve initial pain, neither of these alters the musculature of the back, which is essential for long-term recovery. Only exercise can strengthen the back muscles and make them more flexible and resistant to future strain.
Outlined below are some of the diagnostic tools that Dr. Gus Varnavas may use to gain insight into your condition and determine the best treatment plan for your condition.
Medical history: Conducting a detailed medical history helps the doctor better understand the possible causes of your back and neck pain which can help outline the most appropriate treatment.
Physical exam: During the physical exam, Dr. Gus Varnavas will try to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted.
X-rays are usually the first step in diagnostic testing methods. X-rays show bones and the space between bones. They are of limited value, however, since they do not show muscles and ligaments.
MRI (magnetic resonance imaging) uses a magnetic field and radio waves to generate highly detailed pictures of the inside of your body. Since X-rays only show bones, MRIs are needed to visualize soft tissues like discs in the spine. This type of imaging is very safe and usually pain-free.
CT scan/myelogram: A CT scan is similar to an MRI in that it provides diagnostic information about the internal structures of the spine. A myelogram is used to diagnose a bulging disc, tumor, or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into the low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems lie.
Electrodiagnostics: Electrical testing of the nerves and spinal cord may be performed as part of a diagnostic workup. These tests, called electromyography (EMG) or somato sensory evoked potentials (SSEP), assist your doctor in understanding how your nerves or spinal cord are affected by your condition.
Bone scan: Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also used for finding lesions for biopsy or excision.
Discography is used to determine the internal structure of a disc. It is performed by using a local anesthetic and injecting a dye into the disc under X-ray guidance. An X-ray and CT scan are performed to view the disc composition to determine if its structure is normal or abnormal. In addition to the disc appearance, your doctor will note any pain associated with this injection. The benefit of a discogram is that it enables Dr. Gus Varnavas to confirm the disc level that is causing your pain. This ensures that surgery will be more successful and reduces the risk of operating on the wrong disc.
Injections: Pain-relieving injections can relieve back pain and give the physician important information about your problem, as well as provide a bridge therapy.
For damaged structures to heal, good blood supply is essential for repair and to remove waste products. The bones, ligaments and muscles in the back have a good blood supply, so the back can heal reasonably well. The problem is that they usually heal with a special type of tissue called scar tissue, which is strong but not as flexible as normal muscles, ligaments, etc. However, discs have a poor blood supply and this often results in slower healing. Discs, therefore may be more easily damaged if care is not taken to prevent this. The most common type of injury to the back is to the soft tissue – the muscles, tendons and ligaments. Most of these soft tissue injuries heal well, and this is why most people with back injuries recover.
Back pain is often an unseen injury to others. As such, it is sometimes difficult to understand the problems that a person with back injury has to live with daily. To help yourself, it is important to keep as mobile as possible and learn how to move your body to prevent strain on your back.
Not only is it relaxing, but massage has notable health benefits that are an important part of back rehabilitation. Massages release toxins in muscles, increasing circulation, releasing endorphins, reducing inflammation, alleviating muscle cramps, breaking down scar tissue and calming the nervous system.
Aside from the physical health benefits, massage has a psychological impact by teaching the patient to feel relaxed. For the chronic back pain sufferer, even the simple luxury of drifting off to sleep may not be a reality. Massage can provide that feeling of calm.
For thousands of years, Eastern medicine has emphasized the importance of the mind in controlling physical health. In the West, these ideas were touted as mystical and scientifically unfounded. Recently, however, as more scientific connections are being made between mind-body healing, Western science is starting to appreciate and incorporate this type of therapy into pain rehabilitation.
Due to its objective means in tracking progress, biofeedback is one of the more popular mind-body therapies in pain rehabilitation. During biofeedback sessions, electrodes are attached to the body to monitor body temperature, heart rate, muscle tension, skin resistance and perspiration.
Through biofeedback, the patient is taught to recognize how stress and relaxation chemically alters the body's functions. The patient can learn to lower heart rate and muscle tension. The biofeedback equipment records statistics and gauges progress as the patient learns to control the body, thus controlling pain.
After recognizing the body’s signals during biofeedback sessions, the patient is able to recognize them in daily life and arrest the onset of muscle spasms or high blood pressure. This can reduce pain and even eliminate it.
Physical therapy increases flexibility and strengthens muscles that support the spine. Greater strength and flexibility will help prevent future back strain. A therapist may use ultrasound, electrical stimulation, heat or ice, mobilization and exercises to reduce pain and the likelihood of future injury.
Years ago, the prescription for pain was bed rest. However, we know today that more than a few days of bed rest after an injury can be counterproductive to rehabilitation.
Exercise and movement actually help tissues in the back become stronger, more supportive of the back and resistant to additional injury. Specific exercises can be used to target particular types of back pain. Engaging in activity acts as a lubricant to the back muscles and joints, and it is as necessary to recovery as oil is to the hinge in a squeaky door.
It is important to work with a therapist to make sure exercises are done properly. Never do any exercise that causes pain to your back.
Lying in bed causes muscles to weaken which can inhibit recovery. Even though activity may be uncomfortable or hurt a bit, this doesn’t mean that it’s worsening your condition. On the contrary, building strength in the muscles surrounding the vertebrae can help achieve a full return to activity. Also, on the mental side, being bedridden can lead to feelings of frustration and hopelessness, which can slow you down. Regardless, studies have shown again and again that activity leads to a quicker return to work.
For years, spine physicians have used cortisone injections, epidural steroid injections, trigger point injections and nerve blocks to relieve pain in the spine. They are often provided in a series of three or four injections spanned over a couple weeks. These injections are intended as a means to an end. The goal is to provide enough pain relief to bridge the patient from being inactive to being able to attend physical therapy, where they can better treat their back problems with special exercises.
There has been conflicting research about the value of injection therapy. Some studies have questioned the benefit of epidural steroid injections. In 1997, Britain's Royal College of General Practitioners noted in its back care guidelines that epidural steroid injections relieve low back pain with sciatica (leg pain) better than some other treatments. The Royal College is less supportive of facet joint injections and trigger point injections. It sees little evidence that these injections improve clinical outcomes. With that said, many spine specialty centers believe in the benefit of injections and continue to use them. To come to a definitive conclusion regarding its proven benefit, injection therapy needs to undergo further testing. Some experts theorize that there may be some placebo effect associated with the relief that accompanies an injection. In any case, when a patient gains relief from an injection, it reinforces a physician's desire to use that treatment again.
Common types of injections for back pain relief include:
Selective nerve root block (SNRB)
Facet joint block
Injection therapy is intended to be a means to an end. The goal is to provide the patient with enough pain relief to bridge from inactivity to physical therapy, where back problems can be better treated with special exercises. For years, spine physicians have used cortisone injections, epidural steroid injections, trigger point injections and nerve blocks to relieve pain in the spine.
Epidural injections of cortisone may reduce the inflammation and/or swelling of the nerves in the epidural space resulting in decreased pain, tingling and numbness. The procedure involves inserting a needle of a long lasting steroid (cortisone) through the skin and deeper tissues into the epidural space. The epidural space is the area surrounding the spinal cord and the nerves coming out of it. One or more injections may be needed to relieve symptoms.
The facet joints act as the hinges in our back, connecting alll the vertebral bones in our back yet still allowing us to bend and twist with ease. The illustration above shows a facet injection in progress.
Sometimes from injury or age, these joints can become irritated or they can develop bone spurs, which makes movement painful. To relieve pain symptoms and restore range of motion, the spine physician may inject medication into the facet joint. The medicine in a way can act like lubricant on a rusty door hinge, restoring movement. Typically injections are done as a way to bridge the patient to therapy so the therapist can help the patient retain mobility after the effects of the medication wear off.
Trigger points are painful tissues in and around muscles. Pressure can cause an aching or sharp pain sensation. Trigger point injections are the administration of a local anesthetic and steroid medication in the muscles where pain is occurring. The injection may relieve spasms of the muscle and may last from weeks to months.
A long lasting steroid (cortisone) is injected into the sacro-iliac joint to help decrease inflammation and/or swelling of tissue in the joint space. As a result, patients may experience reduced pain and other symptoms caused by inflammation of the joint. The sacro-iliac joint is located in the low back area. The procedure involves inserting a needle through the skin and deeper tissues into the SI joint. More than one injection may be needed for symptom relief.
Rhizotomy is where the physician may use heat or cold to intentionally damage the ability of a problematic nerve to telegraph pain signals to the brain.
Radiofrequency ablation is a procedure used to reduce pain using a high-frequency radio wave to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area. Radiofrequency ablation is performed on an outpatient basis and requires only local anesthetic and mild sedation, and involves applying heat to certain nerve pathways to "shut off" the transmission of pain signals to the brain. This minimally invasive procedure can provide lasting relief to those suffering from facet joint pain or for patients that experience chronic back and neck pain from the degeneration of joints.
The procedure has a high success and low complication rate and can provide pain relief for up to 2 years. More than 70% of patients treated with Radiofrequency Ablation experience pain relief and is generally well-tolerated, with very few associated complications. Radiofrequency ablation is a proven safe way to help reduce pain with little to no side effects.
The only notable side effect of Radiofrequency Ablation is discomfort, which may include swelling and bruising at the site of the treatment, but this generally goes away after a few days.
COOLIEF® Cooled Radiofrequency is a minimally invasive outpatient treatment option that targets nerves that are causing chronic pain.
This advanced procedure uses cooled radiofrequency energy to safely target the sensory nerves causing pain. The COOLIEF® system circulates water through the device while heating nervous tissue to create a treatment area that is larger than conventional RF treatments. This combination targets the pain-causing nerves without excessive heating, leading to pain relief. Some of the benefits of this procedure may include providing chronic back pain patients with up to 24 months of pain relief, improved physical function, and reduced prescription drug intake. It is common for the patient to feel some pain and discomfort at the site of the procedure for about a week, which can be reduced with ice packs and over the counter pain relief mediation.
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