By Dr Kris Lewonowski
Chronic pain is any pain that lasts, on and off, for more than three months. Poor posture, sitting most of the time, sports injuries, aging – especially in women – and lifting heavy objects can cause mechanical and soft tissue injuries, leading to low-back and neck pain in people of all ages.
Herniated disc (sciatica if in the low back): The jelly-like center of a herniated disc can irritate the nerves as they exit the spine on their way to the extremities. Mechanical compression by the protruding disc can also create severe pain. An epidemic of neck pain is a result of spending more time on our smart phones and computers, while back pain is aggravated by excessive sitting and obesity.
Facet Joint Dysfunction: There are two facets at each vertebrae to facilitate the movement of the spine. The facet joints have cartridges that can be worn out, causing severe pain. The majority of these conditions can be treated without surgery.
Degenerative disc disease (DDD): When we age, the loss of hydration decreases the space between each vertebra, causing compression of the exiting nerves. Many cases can be treated with physical therapy and injections such as PRP and stem cells.
Spinal stenosis: The disc can also collapse, causing stenosis of the spinal canal and serious compression of the spinal cord in one or multiple levels. The only solution for advanced cases is decompression surgery.
Spondylolisthesis: One vertebra can slip over the following one, causing instability of the spine and can only be fixed with fusion of the affected vertebrae.
Physical therapy is the best place to start, provided it is under a doctor’s supervision and is individualized to your anatomy and specific injury. Injections using safe doses of steroids, or effective doses of PRP or stem cells, are growing in popularity, provided they are done by experienced practitioners under precise ultrasound guidance.
The only time you need to rush to surgery is when you have signs of severe spinal cord compression such as loss of bladder or defecation control, or rapid progression in weakness of your extremities.