Is Your Back Pain a Medical Emergency?

5 Signals You Need to Know

Approximately 80 percent of Americans will suffer from some form of back pain in their lifetime, according to a recent study in Neurology Today. About 50 percent of those will suffer one or more recurrences and 10 percent will at some point be candidates for surgical intervention. Far fewer are those who fall under the category of “medical emergency” in which failure to have surgery would result in permanent neurological impairment.

Thankfully, the majority of cases respond favorably to conservative care such as chiropractic manipulation, therapeutic rehabilitation and/or anti-inflammatory medication. Rarely does back pain become a medical emergency, however, there are cases where more aggressive treatment should not be avoided or delayed.

Although such patients make up a small portion of back pain cases, there are warning signs that indicate the presence of more complicated back pain. Listening to these 5 signals from your body can save you pain, time and distress if recognized and acted upon quickly.

Numbness and tingling are common symptoms which are classified as “paresthesias”. A paresthesia simply means abnormal sensation in a body part. In the case of back pain, paresthesias are associated with nerve compression or irritation and the pattern of the sensory change, usually along an arm or a leg, helps identify where the nerve is being affected. For this reason, thorough examinations can be just as accurate as MRIs in determining where the problem lies. Numbness and tingling are the least significant symptoms in terms of being medical emergencies and more often than not resolve with conservative care.

Weakness in an extremity can be difficult to identify because it can be subtle and slowly progressive such that it goes unnoticed until the symptom becomes severe. This symptom indicates that the motor or “movement” part of a nerve has been compromised. However, often there is weakness in a muscle which is masked by other muscles, called “accessory muscles”, that automatically pick up the slack. With thorough examination and strength testing of the muscles associated with each nerve root in the lower back, subtle weaknesses can be identified before more damage to a nerve occurs. In this way, the location of the problem can very accurately be identified, as is the case with symptoms of numbness and tingling.

Foot Drop is usually the end result of a herniated disc in the lower back compressing a nerve where it branches off from the spinal cord. This results in severe weakness of the muscles on the top of the foot so that the toes cannot be lifted upward. Onset can be sudden and drastic or slow and progressive with the patient having to lift the knee or “step up” on the side of weakness when walking. Presence of this symptom is not an automatic indicator for surgery, but detailed investigation is warranted.

Atrophy which is associated with back pain is the end result of prolonged loss of nerve supply to a muscle which causes weakness and loss of tone and bulk of the muscle or group of muscles (usually the calf or the thigh) that the nerve feeds. This is different from atrophy seen after wearing a cast or “disuse atrophy” that results from not using a muscle, in that it tends to be irreversible. It may be subtle and progress over time, often going unnoticed until symptoms of pain and dysfunction progress.

Loss of bowel and/or bladder function occurs when there is pressure on the nerves that control the opening and closing of the sphincter muscles of the bowel and bladder which allow for urination and defecation. This is referred to as Cauda Equina Syndrome and is a true medical emergency. Symptoms may vary and can present in a range from complete inability to hold urine, slight leakage, hesitancy or urgency to urinate, or it may result in total loss of the ability to urinate or defecate. In relation to back pain, this scenario can result from a large herniated disc pressing on the nerve roots, stenosis (narrowing of the space around the spinal cord or where the nerve travels to the bladder) or tumors/growths in the area. Medical care should be immediately sought if any of these symptoms appear to minimize permanent damage to these nerves.

Numbness/tingling, weakness, atrophy, foot drop and bowel/bladder dysfunction are a few of many symptoms that may indicate the need for more aggressive care. Any of these symptoms can occur alone or simultaneously, and they can be the result of medical conditions other than those related to back pain. Listen to your body’s signals and consult your doctor promptly for an accurate diagnosis.

The best way to maintain spinal health is to exercise, practice good posture and ergonomics, and to make spinal care part of your healthcare regimen.

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