A New Look To The Natural History Of Back Pain
S Rezaian. A New Look To The Natural History Of Back Pain. The Internet Journal of Minimally Invasive Spinal Technology. 2006 Volume 1 Number 1.
1. History. The most patients particularly so called the blue collar laborer after the injury report something snapped or popped or disrupted on my back. But medical literatures are silent to describe what anatomical structure initiates the back pain. This author believe inter spinal ligament is a thin, non stretchable fails in first instant and causes back pain.
2. Clinically, there is tenderness, sometimes gap as the results of rupture of inter spinal ligament. If it is incomplete it will be relieved in time, but if it' is complete, will cause spinal instability and later sciatic pain, secondary to herniated disc. If we inject 2 ml. local anesthesias between the tender spinal processes, the patients pain temporarily completely will relieve. This proves the theory subjectively.
3. Radiology. A flexion and extension x-rays will show an increased gap between the 2 spinal processes with injured ligament and objectively confirm the diagnoses. This is one of the most important point which leads to litigation with extra, stress and expenses. The patient originally complains of back pain/sprain and later develops leg pain (herniated disc). The insurance authorities accept the responsibility for the back pain but refuse to authorize treatment for the leg pain. This is one of the important point of litigation and consequences.
Secondly, How Low back pain produce neck Pain? This important point is concerning the physio-pathology of cervical, thoracic and lumbar curvatures. This author had found these curvature acts as inter connected water tubs. We read in high school, if one tub fills up with water, it will affect the rest of the tubs. Similarly if we do not treat well the herniated disc of lumbar spine on time it will produce hyper-lordosis lumbar spine. It will affect thoracic spine produce hyper-kyphosis; in turn it will produce cervical hyper lordosis and eventually neck pain, and pain also on the upper extremity (ies) as result of herniated disc. These are the natural history of back pain by one injury. The reverse may happen; a simple whiplash neck injury due to affect on spinal curvature may lead to herniated disc in lumbar spine. The denial of such claim is very common.