There he got to help test participants’ balance and grip strength. The tests were part of an interactive display developed by the NASS Exercise Committee to demonstrate how functional tests like these can be used to objectively assess patients with back and neck pain.

Pain can be highly subjective and clinicians strive to use objective measures in order to understand how to best treat their patients. The results can also be used as bench marks to show improvement. As decreased balance has been associated with chronic low back pain and decreased grip strength has been associated with chronic neck pain, these are two useful tests.

Balance was tested by timing participants for up to 30 seconds as they stood on one foot with their arms crossed over their chest. Participants were graded based on how many seconds they could remain on one foot. If they could stand the whole 30 seconds they were then asked to repeat the test with their eyes closed.

Grip strength was tested using a hand held dynomometer. This is a portable hand-held device that can measure strength in Newtons, pounds, or kilograms. The test is performed with the elbow bent to 90 degrees and held close to the body. The results can then be compared to established norms.

Evan says, “People learned a little something new and had a lot of fun trying to out do each other.  We even gave out prizes.”

Learn more about the 2011 annual meeting of the North American Spine Society. 

When a patient asks,”Why does my back hurt?” the answer can take a bit of detective work.  Dr. Christopher Winfree from the Pain Center says that the exact cause is often elusive but there are six anatomical structures in the spine that are the most common sources of chronic low back pain.  He outlined each along with some treatment options in a presentation given at a meeting of the American Association of Neurological Surgeons.

The spine is made up of bones called vertebrae that stack on top of each other from head to tail. There is a hole in the center of each vertebra that, when stacked, forms a bony tube that houses the spinal cord.

The space inside this tube around the cord is called the epidural space and it contains blood vessels, nerves, and lymphatics.   Dr. Winfree says, “This space may be the site of compression, inflammation, and or scarring” and the treatment can include a steroid injection (to decrease the inflammation) or surgery to remove the scarring.

There are two nerve roots inside the epidural space, each formed by a branch coming off the front and back of the spinal cord.  The nerve roots come out of the spine through bony holes on the sides of each vertebra sending out nerves to our arms and legs.  The nerve roots themselves, says Dr. Winfree, “may be subjected to compression or inflammation that typically results in pain down the leg.”  Doctors can inject either a steroid or pain reliever near the nerve root but sometimes surgery is necessary to remove whatever is compressing it.

In the back of the spine, where the bottom of one vertebra meets the top of another, are two facet joints.  These joints get their feeling from nerves that come right off of the spinal cord and are “thought to be the pain generator in about a third of low back pain cases,” says Winfree.  The simplest and least complicated neurosurgical treatment is an injection at the joint, but the nerve to the joint is sometimes cut to completely eliminate the pain.

At the bottom of the spine, the vertebrae widen and fuse together forming the Sacrum.  The Sacrum sits right above the tail bone and is connected to the pelvis on each side forming what are called the Sacroiliac joints.  Winfree says that though these joints don’t move much, they have a lot of sensory nerves and, “inflammatory and degenerative processes may be quite painful here.”  In the early 1900′s this joint made up the bulk of back pain diagnoses.  Today it is thought to be the cause in about one sixth of cases.  As with the other structures, it can be relieved by injection.

Sitting between each vertebra is a pad called the intervertebral disc. With an outer layer of cartilage and an inner more jelly-like center, it is a great shock absorber but, it is also the cause of about a third of all low back pain.  A number of problems can arise from this disc including degeneration, tears, bulging, collapse or herniation.  Any of which can cause terrible low back and or leg pain. One of the newest and least invasive treatments for the disc involves inserting a coil and heating it up from the inside.  This effectively shuts off feeling in the disc so there is no more pain.

The rounded block-like bone at the front of the vertebra is called the vertebral body and the main concern with this part of the spine is fracture.  Fractures or cracks in the bone can occur due to osteoporosis or accident and they can cause severe low back pain.  For many years, the only treatment was weeks of bed rest, pain relievers and maybe a back brace.  Now surgeons can inject liquid cement into the break to instantly stabilize it.  If the break is bad and the bone looses it’s shape, they can inflate a balloon to re-establish the right shape and then stabilize it with a thicker kind of cement.  Both of these procedures are minimally invasive and have been known to give instantaneous relief.

Dr. Winfree emphasized that despite the very specific nature of these diagnoses and treatments, the patient must be seen as a whole person and that a multidisciplinary  approach is best.  He also talked about what he calls a “treatment ladder.”  That is, “to start with the easiest, safest, and least invasive and progress to more complex and invasive measures only as simpler options fail.”

To learn more see our page on Lower Back Pain.

The Pain Center team also has specialized expertise in the treatment and management of a range of other syndromes including anesthesia dolorosa, headache, hemicrania continua, intercostal neuralgia, low back pain, neck pain, occipital neuralgia, pelvic pain, postherpetic neuralgia, and trigeminal neuralgia.

Led by Dr. Christopher Winfree, the Pain Center is a multidisciplinary entity. This allows professionals from diverse fields to bring their abilities to bear upon the needs of each individual patient. For example, many chronic pain conditions are actually caused by peripheral nerve injuries [Peripheral Nerve Center]. Thus, the combination of peripheral nerve and pain neurosurgical techniques allows for the optimal management of these disorders.