For individuals dealing with chronic sciatica, when pain and other symptoms significantly impact daily activities and the ability to walk, can a musculoskeletal healthcare provider help relieve and manage symptoms through a multidisciplinary treatment plan?
Chronic Sciatica
Sciatica is a common condition that results from compression of the sciatic nerve in the lower back or leg. Chronic sciatica occurs when symptoms last for 12 months or longer.
Advanced Sciatica Symptoms
Advanced or chronic sciatica usually produces pain that radiates or travels down the back of the leg. Long-term sciatic nerve compression can result in:
Leg pain
Numbness
Tingling
Electrical or burning sensations
Weakness
Weakness
Instability of the legs, which can impact the ability to walk.
Severe nerve compression can progress to leg paralysis if the nerve is significantly damaged from chronic compression. (Antonio L Aguilar-Shea, et al., 2022)
Sciatica can progress to nerve damage of the smaller nerves and travel into the legs and feet. Nerve damage/neuropathy can result in pain, tingling, and loss of sensation. (Jacob Wycher Bosma, et al., 2014)
Disabling Sciatica Treatment Options
When sciatica becomes disabling, affecting an individual’s ability to walk, more involved treatment is needed to bring relief. Many cases of chronic and disabling sciatica are caused by problems with the lumbar spine. Compression of the nerve roots that form the sciatic nerve can occur from bulging or herniated discs or spinal stenosis. If symptoms of sciatica persist beyond 12 months with little or no relief from physical therapy, non-surgical mechanical decompression, stretches and exercises, or pain management techniques, surgical procedures may be needed. (Lucy Dove, et al., 2023)
Lumbar decompression surgery encompasses several procedures to create more space in the lumbar spine and relieve nerve compression. Lumbar decompression surgery can include: (Mayfield Clinic. 2021)
Discectomy
This procedure removes a portion of a damaged disc between vertebrae to alleviate root compression from a bulging or herniated disc.
Laminectomy
This procedure removes the lamina, a portion of the vertebrae causing nerve compression, especially if there is a bone spur due to arthritic and degenerative changes in the spine.
Foraminotomy
This procedure widens the foramina, the openings in the vertebrae where the nerve roots exit to relieve compression.
Spinal Fusion
This procedure takes two or more vertebrae fusing them together with metal rods and screws for stabilization.
The procedure can be performed if:
An entire disc is removed.
Multiple laminectomies were performed.
One vertebra has slipped forward over another.
Daily Relief Management for Advanced Sciatica
Achieving relief from advanced sciatica symptoms at home can include regularly practicing methods like taking a hot bath or shower massage, and applying a heating pad to the lower back or glutes to relax tight muscles to help release the tightness surrounding the sciatic nerve.
Corrective or therapeutic exercises like sciatic nerve glides can help reduce tension along the nerve while low-back exercises that move the spine into forward or backward bending can reduce compression. (Witold Golonka, et al., 2021)
Medications like nonsteroidal anti-inflammatory drugs/NSAIDs, muscle relaxants, or nerve-pain medications may be recommended. (Antonio L Aguilar-Shea, et al., 2022)
Advanced sciatica may not be as responsive to conservative treatment methods, as the injury has set in and the nerve and surrounding tissues have become significantly restricted.
Sciatica symptoms lasting longer than 12 months require more involved treatment like injections or surgery to address symptoms effectively. (Antonio L Aguilar-Shea, et al., 2022)
Healing Chronic Sciatica
If the underlying cause can be effectively treated then chronic sciatica can be healed. Chronic sciatica often results from spinal conditions like herniated discs or lumbar spinal stenosis. These conditions narrow the space around the nerve roots that exit from the spinal cord and merge to form the sciatica nerve. Surgery is performed to open the space in the spine. (Mayfield Clinic. 2021) Sometimes sciatica is brought on by less common causes like a tumor or a spinal infection. In these cases, symptoms will not resolve until the underlying cause is addressed. Tumors may need to be surgically removed while infections require aggressive antibiotics to prevent spreading to other regions of the body. (Hospital for Special Surgery. 2023)
Pain Specialist Treatment Plan Development
Ongoing pain, numbness, tingling, and weakness are all symptoms that should be addressed with a healthcare provider. A pain specialist can help create a treatment plan that involves: (Hospital for Special Surgery. 2023)
Aguilar-Shea, A. L., Gallardo-Mayo, C., Sanz-González, R., & Paredes, I. (2022). Sciatica. Management for family physicians. Journal of family medicine and primary care, 11(8), 4174–4179. doi.org/10.4103/jfmpc.jfmpc_1061_21
Bosma, J. W., Wijntjes, J., Hilgevoord, T. A., & Veenstra, J. (2014). Severe isolated sciatic neuropathy due to a modified lotus position. World journal of clinical cases, 2(2), 39–41. doi.org/10.12998/wjcc.v2.i2.39
Dove, L., Jones, G., Kelsey, L. A., Cairns, M. C., & Schmid, A. B. (2023). How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 32(2), 517–533. doi.org/10.1007/s00586-022-07356-y
Golonka, W., Raschka, C., Harandi, V. M., Domokos, B., Alfredson, H., Alfen, F. M., & Spang, C. (2021). Isolated Lumbar Extension Resistance Exercise in Limited Range of Motion for Patients with Lumbar Radiculopathy and Disk Herniation-Clinical Outcome and Influencing Factors. Journal of clinical medicine, 10(11), 2430. doi.org/10.3390/jcm10112430
For individuals dealing with chronic pain conditions can having a better understanding of pain management specialists help in developing effective multidisciplinary treatment plans?
Pain Management Specialists
Pain management is a growing medical specialty that takes a multi-disciplinary approach to treating all types of pain. It is a branch of medicine that applies scientifically proven techniques and methods to relieve, reduce, and manage pain symptoms and sensations. Pain management specialists evaluate, rehabilitate, and treat a spectrum of conditions, including neuropathic pain, sciatica, postoperative pain, chronic pain conditions, and more. Many primary healthcare providers refer their patients to pain management specialists if pain symptoms are ongoing or significant in their manifestation.
Specialists
Healthcare providers specializing in pain management recognize the complex nature of pain and approach the problem from all directions. Treatment at a pain clinic is patient-centric but depends on the clinic’s available resources. Currently, there are no set standards for the types of disciplines needed, another reason treatment options vary from clinic to clinic. Experts say that a facility should offer patients:
A coordinating practitioner specializing in pain management and consulting specialists on the patient’s behalf.
Other specialties represented in pain management are anesthesiology, neurosurgery, and internal medicine. A coordinating healthcare provider may refer an individual for services from:
A healthcare provider should have completed additional training and credentialing in pain medicine and be an MD with board certification in at least one of the following (American Board of Medical Specialties. 2023)
Anesthesiology
Physical rehabilitation
Psychiatry
Neurology
A pain management physician should also have their practice limited to the specialty they hold the certification.
Management Goals
The field of pain management treats all types of pain as a disease. Chronic, such as headaches; acute, from surgery, and more. This allows for applying science and the latest medical advances to pain relief. There are now many modalities, including:
Medication
Interventional pain management techniques – nerve blocks, spinal cord stimulators, and similar treatments.
Physical therapy
Alternative medicine
The objective is to minimize and make symptoms manageable.
Individuals determined that surgery does not benefit their condition.
A better understanding of pain syndromes by communities and insurance companies and increased pain studies will help increase insurance coverage for treatments and technology to improve interventional outcomes.
Nalamachu S. (2013). An overview of pain management: the clinical efficacy and value of treatment. The American journal of managed care, 19(14 Suppl), s261–s266.
American Society of Interventional Pain Physicians. (2023). Pain Physician.
For individuals watching their food intake during the Thanksgiving holiday, can knowing the nutritional value of turkey help maintain diet health?
Nutrition and Benefits
Minimally processed turkey can be a beneficial source of protein, vitamins, and minerals. However, processed turkey can be high in sugar, unhealthy fats, and sodium.
Sarcopenia, or muscle wasting, commonly leads to frailty in elderly individuals.
Getting enough protein at every meal is essential for older adults to maintain muscle mass and physical mobility.
Turkey can help meet guidelines suggesting lean meat consumption 4-5 times a week to maintain muscle health with aging. (Anna Maria Martone, et al., 2017)
Reduces Diverticulitis Flare-Ups
Diverticulitis is inflammation of the colon. Dietary factors that influence the risk of diverticulitis include:
Fiber intake – lowers risk.
Processed red meat intake – raises risk.
Intake of red meat with higher total fat – raises risk.
Researchers studied 253 men with diverticulitis and determined that replacing one serving of red meat with a serving of poultry or fish reduces the risk of diverticulitis by 20%. (Yin Cao et al., 2018)
The study’s limitations are that the meat intake was recorded in men only, the intake was self-reported, and the amount consumed at each eating episode was not recorded.
It may be a helpful substitution for anyone at risk for diverticulitis.
Turkey is a lean alternative to other low-sodium meats, especially if the skin is removed and cooked fresh.
Turkey is also high in the amino acid arginine.
Arginine can help keep arteries open and relaxed as a precursor to nitric oxide. (Patrick J. Skerrett, 2012)
Allergies
Meat allergies can happen at any age. A turkey allergy is possible and may be associated with allergies to other types of poultry and red meat. Symptoms can include: (American College of Allergy, Asthma & Immunology. 2019)
Martone, A. M., Marzetti, E., Calvani, R., Picca, A., Tosato, M., Santoro, L., Di Giorgio, A., Nesci, A., Sisto, A., Santoliquido, A., & Landi, F. (2017). Exercise and Protein Intake: A Synergistic Approach against Sarcopenia. BioMed research international, 2017, 2672435. doi.org/10.1155/2017/2672435
Cao, Y., Strate, L. L., Keeley, B. R., Tam, I., Wu, K., Giovannucci, E. L., & Chan, A. T. (2018). Meat intake and risk of diverticulitis among men. Gut, 67(3), 466–472. doi.org/10.1136/gutjnl-2016-313082
For individuals with back pain, how can health practitioners incorporate non-surgical solutions to reduce spinal pain?
Introduction
The spine is one of the most important structures in the human body, providing host mobility and stability when vertical pressure is pressing on the spinal structure. The spine is surrounded by various muscles, ligaments, and tissues that help support the upper and lower body portions and extremities. When normal factors like heaving lifting, improper stances, obesity, or pre-existing conditions start to affect the body, it can cause the spinal structure to potentially cause unwanted issues that lead to back, neck, and shoulder pain. When experiencing these three common body pains often correlate with other associated symptoms that can affect the other extremities. When this happens, many individuals begin to miss out on work or daily activities that can cause them to be miserable, and they even try to look for various solutions to reduce the pain they are experiencing. Today’s article looks at one of the common body pains like back pain and how it can cause numerous issues that affect a person’s ability to function, and how non-surgical solutions can not only reduce the pain-like effects but also provide the necessary relief that many people deserve in their health and wellness journey. We speak with certified medical providers who incorporate our patients’ information to provide numerous treatment plans to ease the pain-like symptoms associated with spinal issues causing back pain. We also inform our patients that there are non-surgical options to reduce these pain-like issues and restore spinal mobility to the body. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with the lower back. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.
Back Pain Affecting The Spine
Do you often experience radiating pain in your lower back that causes symptoms of numbness or tingling sensations down to your legs and feet? Do you feel muscle stiffness in the morning while getting up, only to slowly disappear throughout the day? Or do you feel symptoms of muscle aches and pain when carrying a heavy object from one location to another? Many individuals, more often than not, have dealt with back pain associated with various factors. With back pain being in the top three common problems in the workforce, many individuals have dealt with the common problem in multiple ways. From improper heavy lifting to excessive sitting at a desk, back pain can cause musculoskeletal issues that many are trying to find relief. Low back pain can either be acute or chronic, depending on the severity. It can lead to mobility impairment within the thoracic, lumbar, and sacroiliac spinal regions, causing referred pain to the lower extremities. It can lead to a life of impairment without any symptoms or signs of serious medical or psychological conditions associated with environmental factors. (Delitto et al., 2012) Back pain is also associated with spinal conditions like inflammation, asymmetric loading, and muscle strain, which can cause the spinal structures to be compressed, thus causing disc herniations. (Zemková & Zapletalová, 2021)
Additionally, back pain is a multifactorial musculoskeletal condition that causes many individuals to be in a socio-economic situation that can decrease their quality of life. Many examples of back pain are correlated with altered motor control within the spinal erector muscles that causes impaired proprioception in the spine. (Fagundes Loss et al., 2020) When this happens to many individuals, they often experience a hindrance of lumbar stability, body balance, posture, and postural control. At the same time, when many working individuals are having severe back pain associated with everyday factors, the amount of pain they are in can change the threshold of the mechanoreceptors that are transmitting the pain signals through the spinal cord. To this point, back pain can affect the neuromuscular response and affect normal musculoskeletal functionality. Fortunately, numerous treatments can help reduce back pain and provide relief to spinal pain that is affecting many individuals.
The Role Of Chiropractic Care- Video
How many times a day do you experience back pain associated with stiffness, general aches, or pains that are affecting your ability to work? Do you notice you hunching more when moving from one location to another? Or do you feel aches and pain in your back after stretching in the morning? Many individuals dealing with these common environmental factors are closely associated with back pain. Back pain is in the top three most common problems many individuals have experienced at some point in their lives. More often than not, many people have dealt with back pain by using home remedies to reduce the pain-like effects. However, research studies reveal that when many individuals start to ignore the pain, it can lead them to a life of disability and cause numerous amounts of distress if not treated right away. (Parker et al., 2015) Hence, non-surgical treatments can not only reduce the pain associated with back pain but also help restore spinal mobility. Non-surgical treatments like chiropractic care incorporate spinal manipulation, which can positively affect the spine. (Koes et al., 1996) What chiropractic care does is that it includes mechanical and manual manipulation techniques to stretch out tight muscles and reduce trigger points from reforming. The video above shows how chiropractic care can positively affect the individual while being part of a health and wellness journey to reducing back pain.
Non-Surgical Spinal Decompression For Back Pain
Just like chiropractic care, spinal decompression is another non-surgical treatment that uses traction to gently pull and stretch the spine to alleviate compressed spinal discs associated with back pain and help stretch out tight muscles. When many people start to incorporate spinal decompression as part of their routine, they will notice that spinal decompression can reduce intradiscal pressure within the negative range. (Ramos, 2004) What this does is that when the spinal discs are being pulled by gentle traction, all the fluids and nutrients that were not hydrating the disc flow back and help kickstart the body’s natural healing process. When many people begin to utilize spinal decompression for their back pain, they will notice a huge reduction in their pain after a few consecutive sessions. (Crisp et al., 1955) When many people start to combine other various non-surgical therapies with spinal decompression, they will be able to regain their spinal mobility while being more mindful of what environmental factors are affecting their spine and not repeat the issue to allow back pain to return.
References
Crisp, E. J., Cyriax, J. H., & Christie, B. G. (1955). Discussion on the treatment of backache by traction. Proc R Soc Med, 48(10), 805-814. www.ncbi.nlm.nih.gov/pubmed/13266831
Delitto, A., George, S. Z., Van Dillen, L., Whitman, J. M., Sowa, G., Shekelle, P., Denninger, T. R., & Godges, J. J. (2012). Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy, 42(4), A1-A57. doi.org/10.2519/jospt.2012.42.4.a1
Fagundes Loss, J., de Souza da Silva, L., Ferreira Miranda, I., Groisman, S., Santiago Wagner Neto, E., Souza, C., & Tarrago Candotti, C. (2020). Immediate effects of a lumbar spine manipulation on pain sensitivity and postural control in individuals with nonspecific low back pain: a randomized controlled trial. Chiropr Man Therap, 28(1), 25. doi.org/10.1186/s12998-020-00316-7
Koes, B. W., Assendelft, W. J., van der Heijden, G. J., & Bouter, L. M. (1996). Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine (Phila Pa 1976), 21(24), 2860-2871; discussion 2872-2863. doi.org/10.1097/00007632-199612150-00013
Parker, S. L., Mendenhall, S. K., Godil, S. S., Sivasubramanian, P., Cahill, K., Ziewacz, J., & McGirt, M. J. (2015). Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes. Clin Orthop Relat Res, 473(6), 1988-1999. doi.org/10.1007/s11999-015-4193-1
Ramos, G. (2004). Efficacy of vertebral axial decompression on chronic low back pain: study of dosage regimen. Neurol Res, 26(3), 320-324. doi.org/10.1179/016164104225014030
Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International Journal of Environmental Research and Public Health, 18(10), 5400. doi.org/10.3390/ijerph18105400
For older individuals experiencing posture problems, slumping, slouching, and upper back pain, could adding rib cage exercises help bring relief and prevent the condition from worsening?
Improved Posture
It’s common to associate a collapsed upper back posture with age, but other factors can also contribute to the problems. (Justyna Drzał-Grabiec, et al., 2013) The rib cage and the pelvis are important to body structure and comprise much of the core. If these bone structures become misaligned due to unhealthy posture, the muscles that attach to them become tight, weak, or both, and the surrounding muscles have to compensate, causing a worsening of the condition and further injury.
Unhealthy postures can be caused by a rib cage that compresses down onto the pelvic bone.
As the upper back slumps or compresses, height can begin to decrease.
Posture awareness exercises can help lift the rib cage off the pelvic bone.
Rib Cage Exercises
This exercise can be done sitting or standing. A daily routine can help improve posture and relieve back problems and pain.
The sitting version helps keep the focus on doing the exercise right.
The standing version challenges body awareness, allowing the individual to feel how the rib cage and upper back movements affect pelvic and lower back posture.
To begin, it is recommended to start in a sitting position.
Once the basics are learned, then certainly progress to standing.
Exercise
Position the pelvis so it is in a slight forward tilt.
This forward tilt will exaggerate the low back curve slightly while tightening the lower back muscles in a good way.
Establishing and maintaining this curve in the sitting position should feel natural.
Inhale and exaggerate the upward lift of the rib cage.
Inhaling causes the spine and ribs to extend slightly.
Exhale and allow the rib cage and upper back to return to their natural position.
Repeat up to 10 times once or twice a day.
For this exercise, use breathing to develop the rib cage’s lift and carriage incrementally.
Don’t max out on the spinal extension.
Instead, focus on how breathing/inhaling supports the movement of the ribs and upper back and develops the muscles from there.
Try to lift the rib cage equally on both sides as the body allows.
With practice, individuals will realize the healthy posture changes and increased distance between the ribs and pelvis.
Guidance and Variation
Perform the exercise with the back against a wall for upper back guidance.
Another variation of the pelvis and rib cage posture training exercise is to raise the arms.
This will create a different posture awareness training perspective.
Focus on rib cage movement when the arms are raised.
Does lifting the arms make the exercise easier, harder, or different?
To enhance posture improvement, stretch the pectoral muscles.
Yoga
Individuals looking for more ways to strengthen healthy posture should consider yoga.
A study published in the International Journal of Yoga suggests that a great way to activate the core may be to include a variety of yoga postures into the routine. (Mrithunjay Rathore et al., 2017) The ab muscles attach to various places on the rib cage and play a role in posture, alignment, and balance. The researchers identified two muscles, the external obliques, and the transverse abdominal, as key to a healthily aligned posture.
Core Strength
References
Drzał-Grabiec, J., Snela, S., Rykała, J., Podgórska, J., & Banaś, A. (2013). Changes in the body posture of women occurring with age. BMC geriatrics, 13, 108. doi.org/10.1186/1471-2318-13-108
Rathore, M., Trivedi, S., Abraham, J., & Sinha, M. B. (2017). Anatomical Correlation of Core Muscle Activation in Different Yogic Postures. International journal of yoga, 10(2), 59–66. doi.org/10.4103/0973-6131.205515
Papegaaij, S., Taube, W., Baudry, S., Otten, E., & Hortobágyi, T. (2014). Aging causes a reorganization of cortical and spinal control of posture. Frontiers in aging neuroscience, 6, 28. doi.org/10.3389/fnagi.2014.00028
Facet hypertrophy is an incurable, chronic disease that affects the facet joints in the spine. Can recognizing symptoms, help in diagnosis, and treatment?
Facet Hypertrophy
Facet hypertrophy causes the facet joints in the spine to enlarge. They are found where the vertebrae come into contact on the back of the vertebrae that form the backbone. These joints stabilize the spine when twisting and bending. Hypertrophy results when damage wears down the cartilage that cushions the bones that meet in the joint. This can include:
Aging
Wear and tear
Arthritis
Other joint diseases can damage facet joints.
Swelling, new bone growth, and bone spurs can occur as the joint tries to repair the damaged cartilage. The swelling and new bone growth can narrow the spinal canal and compress surrounding nerves, causing pain and other sensation symptoms. This ailment does not have a cure and worsens over time. The objective of treatment is to manage the pain symptoms and slow down the disease’s progress.
Types
Facet hypertrophy can be described as unilateral or bilateral.
Symptoms can have a wide range of intensity, from a dull ache to chronic, disabling pain. The location of symptoms depends on the affected joint and the nerves involved, Pain manifests when the enlarged joints and new bone growth compresses the nearby nerves. The result leads to nerve damage and the following symptoms: (Weill Cornell Medicine Brain & Spine Center. 2023) (Cedars Sinai. 2022)
Stiffness, especially when standing up or getting out of a chair.
Inability to stand straight when walking.
Inability to look up to the left or right without turning the whole body.
Reduced range of motion and mobility.
Numbness or a tingling sensation of pins and needles.
Radiating pain from the affected joint into the buttocks, hips, and upper thigh when the affected joint/s are in the lower back.
Radiating pain from the affected joint into the shoulder, neck, and back of the head when the affected joint/s are in the upper back.
Headaches when the affected joint is in the neck.
Causes
A common cause is the age-related degeneration of the joints, called spondylosis. Research indicates that more than 80% of individuals who are 40 or older have radiologic evidence of spondylosis, even though they may not have symptoms. (The University of Toledo Medical Center. N.D.) The following conditions can also increase the risk of facet hypertrophy (Weill Cornell Medicine Brain & Spine Center. 2023)
Unhealthy posture
Being overweight or obese
Sedentary lifestyle
Injury or trauma to the spine
Inflammatory conditions like rheumatoid arthritis or ankylosing spondylitis
Osteoarthritis
Genetic predisposition to the condition
Diagnosis
Diagnosis can be challenging when neck or back pain is the main complaint, as symptoms can mimic conditions such as sciatica from a herniated disc or hip arthritis. (Weill Cornell Medicine Brain & Spine Center. 2023)
A healthcare provider will conduct a complete physical examination, medical history, and discussion of symptoms.
CT scans with or without myelogram – the use of contrast dye in the space around the spinal cord.
MRI
X-rays with or without a myelogram
A diagnosis is confirmed by injecting a diagnostic block that involves administering an anesthetic injection, sometimes with an anti-inflammatory like cortisone, into the joint or nerves near the affected joint. Two injections are given at different times to confirm the effect. (Romain Perolat et al., 2018)
If immediate relief improves after each injection, the facet joint is confirmed as the source of the pain symptoms.
If the block does not decrease the pain, the facet joint is probably not the source of the pain symptoms. (Brigham and Women’s Hospital. 2023)
Treatment
There is no cure for facet hypertrophy.
The goal of treatment is to make the pain more manageable.
Conservative treatment is usually successful in making a difference.
Nonsteroidal anti-inflammatory – aspirin, ibuprofen, and naproxen.
Muscle relaxers – cyclobenzaprine or metaxalone.
Steroid injection into the facet joints.
Injection of platelet-rich plasma/PRP into the joints.
Medial Branch or Facet Block
A medial branch block injects local anesthetic near the medial nerves that connect to an inflamed joint.
Medial nerves are small nerves outside the joint space near the nerve that transmit signals and other impulses to the brain.
A facet block injects the medication outside the joint space near the nerve that supplies the joint called the medial branch.
Neurolysis
Neurolysis, also known as rhizotomy or neurotomy, is a procedure that destroys affected nerve fibers to relieve pain, reduce disability, and reduce the need for analgesics. This treatment can relieve pain for six to 12 months until the nerve regenerates, where further treatments may be necessary. (Matthew Smuck et al., 2012) Neurolysis can be performed using one of the following techniques (Romain Perolat et al., 2018)
Radiofrequency ablation RFA – the application of heat through radiofrequency.
Cryoneurolysis – the application of cold temperatures to the targeted nerve.
Chemical neurolysis – applying chemical agents, like a combination of phenol and alcohol.
Severing the nerves with surgical instrumentation.
Surgery
When one or more facet joints are severely damaged, they can become nonfunctional and painful. Surgery may be recommended when symptoms are not relieved by other therapies. (Ali Fahir Ozer, et al., 2015)
Prognosis
Facet hypertrophy is a chronic condition that progresses with age and does not affect life expectancy. (Weill Cornell Medicine Brain & Spine Center. 2023) The disorder is incurable, but symptoms can be managed with conservative therapies
A healthcare provider can help develop a treatment plan based on the extent and location of the joint affected.
Early diagnosis and treatment can help individuals achieve the best results.
Maintaining an active lifestyle and healthy weight can help prevent further joint stress. Individuals may be recommended to do regular stretching and strengthening exercises to lower inflammation, reduce stress, and improve overall health.
Facet Syndrome Treatment
References
Perolat, R., Kastler, A., Nicot, B., Pellat, J. M., Tahon, F., Attye, A., Heck, O., Boubagra, K., Grand, S., & Krainik, A. (2018). Facet joint syndrome: from diagnosis to interventional management. Insights into imaging, 9(5), 773–789. doi.org/10.1007/s13244-018-0638-x
Smuck, M., Crisostomo, R. A., Trivedi, K., & Agrawal, D. (2012). Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM & R : the journal of injury, function, and rehabilitation, 4(9), 686–692. doi.org/10.1016/j.pmrj.2012.06.007
Ozer, A. F., Suzer, T., Sasani, M., Oktenoglu, T., Cezayirli, P., Marandi, H. J., & Erbulut, D. U. (2015). Simple facet joint repair with dynamic pedicular system: Technical note and case series. Journal of craniovertebral junction & spine, 6(2), 65–68. doi.org/10.4103/0974-8237.156049
When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times?
Groin Strain Injury
A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013)
A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
There may also be swelling or bruising in the groin or inner thigh.
An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)
Symptoms
A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013)
A popping sound or snapping sensation when the injury occurs.
Increased pain when pulling the legs together.
Redness
Swelling
Bruising of the groin or inner thigh.
Groin pulls are graded by severity and how much they impact mobility:
Grade 1
Mild discomfort but not enough to limit activities.
Grade 2
Moderate discomfort with swelling or bruising that limits running and/or jumping.
Grade 3
Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.
Signs of a severe groin strain
Difficulty walking
Groin pain while sitting or resting
Groin pain at night
A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
In severe cases, surgery is necessary to reattach the torn ends.
Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013)
Causes
Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017)
Have weak hip abductor muscles.
Are not in adequate physical condition.
Have a previous groin or hip injury.
Pulls can also occur from falls or extreme activities without the proper conditioning.
Diagnosis
A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013)
Medical History Review
This includes any previous injuries and specifics about where and when the symptoms started.
Physical Examination
This involves palpating – lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.
Imaging Studies
Ultrasound or X-rays.
If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.
Differential Diagnosis
Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013)
Sports Hernia
This type of inguinal hernia occurs with sports and work injuries.
It causes a portion of the intestine to pop through a weakened muscle in the groin.
Hip Labral Tear
This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.
Hip Osteoarthritis
This is the wear-and-tear form of arthritis that can present with groin pain symptoms.
Osteitis Pubis
This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.
Referred Groin Pain
This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.
Treatment
Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises.
Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
Physical therapy will be a part of the treatment plan.
Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. doi.org/10.5812/traumamon.12666
Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247. doi.org/10.1177/2325967119897247
Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279. doi.org/10.5435/JAAOS-D-16-00171
Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570. doi.org/10.5435/JAAOS-21-09-558
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