In the first installment of our series “How Does My Neck Pain Relate to My Back Pain”, we discussed that when a problem develops in one area of the spine, then a problem will develop with the functioning of another level of the spine.
We also explained a problem with your neck can affect your back, and your ability to bend pain free, sit pain free, lift pain free, or any other “functional” back problems you may have.
And vice versa, problems with your back, can indeed affect the functioning of your neck.
Talking about this topic I believe is very important, because so many of my patients prior to coming to see me, as well as back or neck pain ridden individuals in general, continue to go on suffering, and never get any lasting relief, because they don’t realize that their problem is coming from a different part of the spine where the actual functional problem is.
I cited a lot of medical reference books and studies that support the idea of the entire spine acting as a singularly related functional unit. Dr. Kabot I mentioned cited that the most common cause of back pain and leg pain was because of herniated discs compressing the cervical spinal cord.
I part 1, I also implied the riskiness of overlooking the role the neck plays in contributing to your lower back suffering. That is, having any aggressive therapies, injections and surgeries aimed at the lower back, may not have any long lasting relief or quality of life improvements, simply because it was not a “back” problem to begin with.
In part 2, I would like to discuss how the neck and back are related anatomically or better yet, how a herniated disc in the neck compressing the cervical spine cord, can result in lower back and leg pain.
Well, Dr. Kabat, a specialist in physical medicine, explains that lower back and leg problems caused by herniations in the neck are a result of impingement upon the long tracts of the cervical spinal cord.
The leg problems that may occur from compression of the long tracts in the cervical spine are as follows: pain, decrease sensation, abnromal sensation, tingling, numb, and a buzzing or tingling sensation. As well, Dr. Kabot emphasizes that the main complaint may be pain to the lower back and leg, but any combination can occur like lower back and leg, low back alone, or leg pain alone. The leg pain can be one sided, both sided, and sometimes even alternate.
The interesting thing to note as mentioned by Dr. Kabot is the fact that the compression to the cervical spinal cord is from soft tissues (herniated disks) so the complaints, even if intense, are completely reversible by conservative treatment exclusively of the herniated disc, except when the rare occasional of spinal cord damage (myelopathy)
In an oversimplification representation of the spinal cord, when looking at the spinal cord from above (as shown in the yellow above) the cord is often described as a bulls eye. Well the outer rings of the bull eye target (spinal cord) are responsible for motor and sensory innvervation to the perineium, legs, and lower back. The inner rings of the bulls eye target image of the spinal cord are motor and sensory innervation to the upper extremities.
Central Canal Stenosis, a phenomenom whereby the central canal becomes narrowed, explains why neck herniation compression to the cord results in similar findings. Notice how with central canal stenosis, the normal canal size is wider then the side with stenosis. Central canal is basically a irrritation to the spinal cord from the outside to the center. similar to squeezing a sponge. With this image, the squeezing sensation occurs from the outside in.
Thus, central canal stenosis primarily affects the outer rings of the bull eye analogy of the spinal cord.
We said that it was the outer rings of the cord that have the nerve suppy to the perineum (torso), legs, and lower back. So when central canal stenosis develops, the squeezing of the spinal cord from the outside in, the primary affects will be to the perineum, legs, and lower back.
The most documented impairment when studying central canal stenois was with ”walking intolerance”.
A new study that is consistent with the leg and back problems associated with canal stenosis, and herniated disk compressing the spinal cord in the neck is the “Ten Second Step Test”.
Japanese researchers Dr. Yukawa and colleagues designed a test to measure the severity of cervical compression problems. They named the test the “Ten-second Step Test”. These authors measured the severity, prognosis, and outcomes of patients suffering from cervical compression myelopathy (problems with the cord itself). They did this counting the number of lower extremity steps they could perform in a ten second period of time.
In this study, the patients were told to take a step by lifting their thighs paralled to the floor in the same place without holding onto any object for balance. Then the number of steps in 10 sceonds were counted.
Aside from determining that this test was easy to perform, is sensitive to neurological impairment, and easily reproducible, it was also determined to be useful in assesing the severity of the cervical spine myelopathy.
Worsening of performance on the step test suggested increasing damage to the long tracts of the spinal cord. Again, cervical spine problems adversely affect the lower extremities.
Once again, patients with low back and/or leg pain may have a primary involvement of the cervical spine. When a patient has a back problem, not only should their lower back have an adequate evaluation, but the neck must be properly evaluated as well.
The cervical spine examination should include at a minimum, imaging for cervical canal stenosis, and performance of the “ten-second step test”.
If cervical spine is then determined to determined to be invovled as well, then treatment MUST of course be to the cervical spine.
In part 3, we will discuss the proper protocol for conservative management of the neck.
Till next time, watching your back and neck.
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