Pain in your lower back.
Cramps shooting down your leg. That “pins and needles” feeling. When you have
these symptoms, you may assume you have a problem with your spine.
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“The problem with assuming is that we often see people who have medical issues that are mistaken as only a spine issue, when it could be a medical issue on its own — or a combination of the two,” says physical medicine/rehab specialist Tagreed Khalaf, MD.
For example, lumbar spinal
stenosis is a nerve problem and peripheral arterial disease is related to blood
flow, but the two have many symptoms in common. So do spinal stenosis and
diabetic neuropathy, or nerve damage in the legs and feet. And disk issues can
feel a lot like inflammatory arthritis.
back pain is likely spinal stenosis
Spinal stenosis is one of the
most common causes of spinal pain not related to injury. This narrowing of the
space around the spinal cord puts pressure on the nerves. If you have the
following symptoms, spinal stenosis may be to blame:
- Pain in the lower back.
- Cramping in the legs.
- A heavy feeling in the legs, which may lead to trouble walking.
- Increased pain going downhill.
- Symptoms that get worse with activity.
- Relief from the “grocery cart” position — bending forward like you’re leaning on a shopping cart.
However, Dr. Khalaf notes how
common “false positives” are. “Around 21% of asymptomatic people over age 60
will show signs of spinal stenosis on an MRI,” she says. “And sometimes spinal
stenosis and peripheral arterial disease co-exist. That’s why you need a
physical exam, and possibly other tests, to get a clear diagnosis.”
your back pain could be a more serious medical problem
There are a few ways to tell
the difference between spinal stenosis and something more serious:
- Pain that gets worse when going uphill is more common with peripheral arterial disease, a buildup of plaque in the blood vessels leading to the your limbs.
- Arterial disease patients don’t get relief from the “grocery cart” position.
- If your symptoms are worse at night but better with exercise, neuropathy may be to blame.
- In younger people, morning stiffness that lasts longer than 30 minutes and gets worse with stillness may be a sign of inflammatory arthritis, such as ankylosing spondylitis.
- Other unexplained symptoms such as weight loss and fatigue may be signs of a cancerous growth — very rare, but absolutely worth looking into.
“Serious issues such as
malignancies or abdominal aortic aneurysms rarely present with spine symptoms,”
Dr. Khalaf says, “but sometimes they do. They’re serious enough that ruling
them out is important.”
to find relief if the pain is spinal stenosis
If you do have spinal
stenosis, there are several treatments:
- Try physical therapy. Stretching and strengthening can help support your back, improve your balance and ease the pressure on your nerves.
- Ask your doctor about medications. Nonsteroidal anti-inflammatories and muscle relaxers may help. Some patients also find success with anti-seizure drugs such as Neurontin — also used for neuropathy.
- Consider steroid injections. Corticosteroids can reduce the inflammation and irritation that cause symptoms. They’re usually not a first resort because they can weaken bones and tissue over time.
- Know that surgery is an option. When more conservative treatments do not work, certain procedures can reduce symptoms.
to do if you expect something else
There’s only one major tip
here: See a doctor, whether it is your primary care physician or a
specialist. Each condition that mimics spinal problems comes with its own treatments,
but the first step is an accurate diagnosis. For example, a nerve test such as
electromyography (EMG) can help a doctor spot neuropathy, and a blood-flow test
such as the ankle-brachial index (ABI) can distinguish between spinal stenosis
and peripheral arterial disease.
“It’s so important to look at
all of your symptoms and history and do a thorough examination,” Dr. Khalaf
says. “It’s how we can tell the difference between a back issue and a medical