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Your Aching Back
Nearly everyone will experience back and neck pain at some point. In fact, more people seek medical advice for musculosketal pain than any other health concern. Your aching neck and back could be the result of a number of conditions ranging from simple muscle strain to the presence of a tumor or infection.
Two of the most common causes of back and neck pain are injury and situations in which the person is engaged in strenuous, out-of-the-ordinary physical activity. Muscles are attached to the entire length of the spine by tendons. Muscles can become strained from lifting (especially while in an off balanced position), overexertion, and the performance of an unfamiliar activity. Minor, episodic back and neck pain usually last for several days and are alleviated with bed rest and over-the-counter pain relievers such as aspirin, ibuprofen, or acetaminophen.
More severe back and neck pain is often accompanied by numbness and tingling sensations in the hands and arms, and legs and feet. These symptoms are typically associated with a problem related to the spine rather than muscles. Nerves and nerve roots, connective tissue, vertebrae and discs or other structures of the back may be affected. This pain is more serious, lasts longer, and requires professional intervention and treatment.
Many people who suffer with severe and chronic musculosketal pain may be experiencing a degenerative process that can be related to aging, previous trauma, arthritis, or degenerative joint disease. Persistent back pain can also be the result of tumor growth as well as infection.
Herniations of intervertebral discs are a common result of overuse. These most often occur in the lumbar (low back) and cervical (neck) areas of the spine. These are the most mobile parts of the spine and most likely to be affected by overuse.
In simple terms, a disc is herniated when the cushiony inner material of the disc pushes through to the outer portion of the disc. The hernia applies pressure to spinal nerve roots and can cause neurological symptoms as well as pain. Symptoms include numbness, tingling, burning, or a feeling like an electric shock running down the arms and/or legs and sometimes into the hands and feet. Motor weakness, and bowel and bladder complications may also result.
In the case of infection, a persistent fever will generally accompany the musculosketal pain. Examination by a specialist is necessary to rule out the possibility of a tumor and/or infection.
Musculoskeletal pain and the aging process
Arthritic spurs, inflamed and swollen joints, thickened ligaments and the wearing away of intervertebral discs are common age-related phenomena. These conditions are most often accompanied by stiffness, diminished mobility, and intermittent pain.
Spinal stenosis is most common over the age of 50. (It can, however, develop in younger adults as the result of injury and/or excessive exercise.) This condition is characterized by the deterioration of intervertebral discs, which are intended to act as both cushions and separators between vertebrae. When discs wear away, vertebrae can rub together. In addition, bone spurs can also develop, further narrowing the spaces between vertebrae. When vertebral space is narrowed, nerves that run through the spinal column and between vertebrae can become pinched. Severe pain can result from each of these conditions.
The Spine Center, a collaboration of Newton-Wellesley Hospital and
Massachusetts General Hospital
Susan, an active mother of three in her 40s, was referred by her primary care physician to an orthopaedic surgeon. Pain in her lower back became so intense that she was unable to bear normal activities, let alone her daily jogging routine. Radiologic testing revealed a herniated disc and surgery was recommended. Susan hoped there might be an alternative to surgery. “I have a busy life with three children,” she comments, “and the prospect of being limited for months felt almost as bad as living with the pain.”
Susan’s back problem and her response to the prospect of surgery is not unusual. In fact, she is a prime example of one of the types of patients for whom The Spine Center, a collaboration of Newton-Wellesley Hospital and Massachusetts General Hospital, was developed.
Opened at Newton-Wellesley Hospital in July 2002, The Spine Center offers the expertise of the leading back and neck experts in the Boston area, in a convenient suburban setting. It is a unique health care service that brings together a multidisciplinary team of professionals – including orthopaedic surgeons, neurosurgeons, radiologists, physiatrists (also known as physical medicine and rehabilitation medicine), physical therapists and other specialists – to develop individualized treatment plans for people with spine- related problems. “Our programs and services,” states Kenneth Polivy, MD, Co-Medical Director of the Center, “are appropriate for anyone who suffers from back or neck-related pain that interferes with work, recreational activities, daily living functions, and the overall enjoyment of life. Our staff is committed to helping patients obtain relief from pain and to achieve their highest level of independence and physical function.”
Susan eventually found her way to The Spine Center at Newton-Wellesley Hospital. “I’m glad I got a second opinion,” she states. “I really didn’t want to have surgery. I also appreciated the personal approach I found at The Spine Center. Everyone focused on who I am, how I live my life, and my preferences. I had to be reminded to be patient with the process. But, I was willing to invest my time and attention to participate in solutions to my problems that are less invasive than surgery. I am now back to running six pain-free miles a day. Through The Spine Center, I have also learned how I can prevent further injury to my spine.”
Many spine-related problems that cause pain and limit function can be treated without surgery. Traditional surgical procedures are sometimes necessary, however, and recommended for patients by Spine Center staff. The Newton-Wellesley/Massachusetts General Hospital Spine Center is unique in that traditional surgery is not the only option offered to patients, but rather one of many treatment modalities available. This is the result of The Spine Center’s multidisciplinary philosophy, which brings together the expertise of numerous professionals from varied disciplines.
Patients are evaluated at The Spine Center through state-of-the-art diagnostic and imaging technologies. Spine Center physicians and therapists discuss and evaluate each patient’s progress on a weekly basis. Optimal patient care is offered through this team approach, and each patient’s care is seamlessly coordinated among the members of the team. Spine Center physicians and therapists all practice at Newton-Wellesley Hospital, Massachusetts General Hospital, or both. Each has years of training, specialty credentials, and experience in spine care.
Many disciplines have spine care expertise
Most people associate spine care only with the medical specialty of orthopaedics. But, many medical specialties have expertise about and approaches to spine problems and care. A variety of medical disciplines participate in patient care at The Newton-Wellesley/ Massachusetts General Hospital Spine Center, including the following:
Physiatry
Also known as physical medicine and rehabilitation medicine, Physiatrists are medical doctors with specialized training in the evaluation and nonsurgical management of spinal disorders. Physiatrists are trained in the following areas: diagnostic evaluation, diagnostic and therapeutic spinal and soft tissue injections, pharmacologic (medication) treatment, biomechanical (physical function) evaluation, exercise prescription, injury assessment, spinal bracing, and medical acupuncture.
Neurosurgery
Neurosurgery staff have special training and expertise in disc microsurgery, tumor and vascular spinal surgery, fusion surgery, spinal trauma, Arnold-Chiari and other congenital spinal disorders, and various procedures that relieve spinal pain including implantable spinal cord stimulators.
Neurology
Neurologists specialize in the evaluation and management of pain, numbness, and weakness that may be caused by degenerative, inflammatory, infectious, and autoimmune disorders involving the spinal cord or its nerve roots.
Physical Therapy
Physical therapists are trained in manual spinal intervention techniques such as joint mobilization and manipulation, therapeutic exercise development, biomechanical analysis, job site and task analysis, ergonomic consultation, and patient education. Physical therapy for Spine Center patients is provided at Newton-Wellesley Hospital’s new state-of-the-art therapeutic rehabilitation center, which includes equipment rivaling that of the best commercial fitness centers.
Anesthesiology and Pain Management
Anesthesiologists provide both diagnostic and therapeutic spinal injections, nerve blocks, acupuncture, and other nonsurgical methods of controlling nerve pain.
Psychiatry and Psychology
A mental health team helps evaluate and treat stressors that can cause or worsen back pain. Behavioral medicine, biofeedback, psychopharmacology, and mind/body pain reduction techniques are offered.
Rheumatology
Rheumatologists specialize in managing arthritis, which can be the underlying cause of spinal pain.
Radiology
Diagnostic imaging, using techniques such as MRI and CAT scans as well as interventional injection techniques, are a central element of The Spine Center’s services.
Other specialty consultations can be arranged through The Spine Center such as thoracic and vascular surgery, endocrinology, nutrition and weight loss management, and surgical obesity management, as well as other health care services such as massage therapy.
When surgery is necessary
The orthopaedic spine surgeons at the Newton Wellesley/Massachusetts General Hospital Spine Center have specialized fellowship training in spine surgery. They provide expertise and skill in a variety of surgical procedures ranging from new minimally invasive disc surgery techniques to complex fusion and instrumentation surgeries for spinal trauma and degenerative conditions. If surgery is necessary, Spine Center surgeons are highly skilled in all current surgical techniques and instrumentation.
Don’t grin and bear it
There have been incredible developments in every area of medical expertise and treatment over the past several decades, and there is no reason to take a “grin and bear it” attitude toward spine pain. The ongoing experience of pain can have devastating affects on the quality of one’s life. Chronic pain that is untreated can lead to anxiety, depression, and loss of appetite; sleep disturbance; and other conditions. Spine problems should not go untreated. Advances in medications, physical therapy techniques, minimally invasive surgery, and more, can diminish pain and greatly improve function.
For more information about The Spine Center, a collaboration of Newton-Wellesley Hospital and Massachusetts General Hospital, or an appointment, call CareFinder at 1-866-NWH-DOCS, or find us online at www.nwh.org/spine.
This material is intended to provide general educational information and to help users arrange more easily for health care services. This site is not an attempt to practice medicine or provide specific medical advice and should not be used to make a diagnosis or to replace or overrule a qualified health care provider's judgment. Nor should users rely upon this information if they need emergency medical treatment. We strongly encourage users to consult with a qualified health care professional for answers to personal questions.
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