Product Condition: FlamLeve

What causes back pain?

Acute and chronic backache are both caused by inflammation, a biological process that the body activates in order to heal injured tissues. Acute backache usually settles within a few weeks when the inflammatory process naturally abates. Chronic inflammation, however, results in continuous and unabating discomfort in the spine. Besides causing pain, chronic inflammation also progressively damages the spine if left to continue. In the latest Global Burden of Disease study (GDB 2013), lower back pain is ranked the single biggest cause for chronic disability in the world.

Where does the pain originate from?

The body experiences the perception of pain through specialised nerve cells called nociceptors. These are situated throughout the entire body and respond to potentially damaging stimuli by sending signals to the spinal cord and brain, usually causing the perception of pain. This process, called nociception, is biochemically triggered by certain molecules which are released or become activated during inflammation. The spine consists of several different tissue types which all contain nociceptors, as listed below:

• Vertebrae – segments of bone stacked upon each other, providing strength and structure.
• Intervertebral discs – circular pads of pliable soft issue situated between the vertebrae. These allow flexibility and shock absorption in the spine.
• Ligaments – fibrous bands which keep the vertebra in place.
• Nerves – fibres that run along the spinal column throughout the body and branches off in a segmental manner between each vertebra, passing information from the body to the brain.
• Muscles – vertical columns running down, and anchored to, the spine.
• Facet joints – small joints covered by cartilage that allow the vertebra to rotate upon each other.

Of importance is that each tissue type can be a source of pain, either individually or collectively. In a more chronic situation, pain often originates from several different disease processes, activating pain signals in several different tissue types at the same time.

What are the most common mechanisms that causes back pain?

• Muscle inflammation
  Painful muscle inflammation can be caused by several mechanisms including sprain, strain, poor posture, lifting heavy objects, or whiplash injury. Several different groups of muscles associated with the spine can be involved.

• Intervertebral disc prolapse or spondylosis
  Spondylosis is the medical term used to describe the combined effects of several degenerative processes that progressively start to affect the spine. It usually begins in one or more of the intervertebral discs situated between the vertebrae and then spreads to surrounding tissues such as ligaments, joints, and bones. Besides causing local pain, an inflamed intervertebral disc may progressively become weakened through continual enzymatic activity caused by inflammation. This corrosive activity makes the disc increasingly more prone to future damage and even collapse. A collapsed disc may cause direct pressure on the nerve roots as they exit the spinal cord between each vertebra, causing a referred pain syndrome during which pain radiates down the shoulder or arm. Tingling or pins and needles are also common symptoms, whilst in a more advanced state, weakness and loss of sensation may occur within the hands or arms.

• Osteoarthritis
  This is a common condition that mainly affects the integrity of the cartilage, especially as one becomes older. Osteoarthritis mostly affects the small facet joints between the vertebrae, as they are the only cartilage containing structures in the neck. Importantly, the presence of osteoarthritis in the neck is commonly associated with the presence of several other inflammatory conditions, such as spondylosis, where protein containing structures contained in the spine are simultaneously degraded. Since the neck is predominantly protein based, these cumulative effects can cause severe impairment and chronic disability over time.

• Other diseases
  Less common conditions may cause or contribute to back pain in certain circumstances. These include osteoporosis (reasonably common) as well as rheumatoid arthritis and certain forms of cancers (quite rare).

What are the risk factors for chronic back pain?

The following factors increase your risk:

• Age – lower back pain typically occurs as a first symptom between the ages of 30 and 40 and increases with age.
• Fitness level – back ache is more common among people who are physically unfit. Weak back and abdominal muscles offer poor support to the spine.
• Diet/weight – excess body fat increases mechanical stress on the back.
• Genetics – conditions such as ankylosing spondylitis, a rare form of arthritis that affects the spine, are genetically inheritable. Genetics may also contribute to poor bone structure, muscle development, and numerous other factors. These conditions are therefore often passed down among families.
• Occupational risk factors – having a physical job that requires heavy lifting, pushing, or pulling, particularly when this involves twisting or vibrating the spine, can lead to injury and back pain. An inactive job or a desk job, on the other hand, may also lead to or contribute to pain, especially if you have poor posture or sit all day in an uncomfortable chair.

How is back ache treated?

• Step 1 – alleviation of acute pain in order to improve your quality of life and help you remain as functional as possible.
• Step 2 –implementation of self-help strategies to help prevent recurrent or chronic bouts of back ache and help to protect your spine from the permanent structural damage that chronic inflammation often causes.

Acute pain management for back ache:

• Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long term, since as a class, these drugs pose a significant side-effect risk relating to cardio-vascular, gastro-intestinal and kidney disease. (Ask your doctor or pharmacist for advice).
• Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
• Hot or cold packs – applying a heat pack to your neck can help to ease pain. You can use a microwavable heat pad or a hot-water bottle. Heat dilates the blood vessels which improves blood supply to the blood takes to the back and helps to reduce muscle spasms. Heat also alters the sensation of pain. (Some find cold packs offering better relief – for example, a bag of frozen peas).
• Rehabilitation therapies – physiotherapy, biokinetics, or chiropractic therapy may prove helpful. A good massage may also assist. Therapy may reduce inflammation, correct posture, muscle tension, or other contributors to neck pain.

Preventative self-help strategies:

By preserving the integrity and mobility of your back you are in turn protecting it from the consequences of chronic inflammatory damage over time. Judging from the number of people in the world who become permanently disabled from a chronic backache, these easy to implement but important strategies will likely prove one of the most worthwhile investments in your overall health.

• Stretch your back
  Stretching is a form of physical exercise during which a contracted, tight, or painfully stiff ligament or muscle group is deliberately lengthened in order to improve its elasticity and achieve a more relaxed tone. When done properly, this results in a more comfortable feeling of increased muscle control, flexibility, and range of motion. Regular stretching is an excellent way to alleviate muscle inflammation and pain.
• Strengthen your back muscles with exercise
  Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and reduce the risk of recurrence. Modern research has demonstrated that many of the benefits of exercise are mediated through the role that muscle tissue play as an endocrine (hormone producing) organ. Contracting muscles release multiple substances known as myokines which promote the growth of new tissue and facilitate tissue repair. Myokines also have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases. These anti-inflammatory effects will assist you locally with inflammation in your spine, as well as systemically in the rest of your body. Regular exercise can help reduce your risk of developing a herniated disc by slowing down their age-related deterioration as a result of chronic inflammation. It can also help keep your supporting back muscles strong and supple. Always stretch properly in order to warm up and cool down properly before and after any workout or sports activity.
• Use supplements that naturally reduce inflammation
  Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin™ is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation, and are also the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin.
• Manage stress better
  Any form and stress can increase the tension in the muscles of your spine and should therefore be managed.
• Sleeping posture
  Your mattress should be firm enough to support your body and the weight of your shoulders and buttocks, keeping your spine straight. If your mattress is too soft, place a firm board under the mattress. Support your head with a pillow, but make sure that your neck is not forced up at a steep angle. Ideally the pillow should fill in the natural hollow between the neck and shoulders, and a soft or moulded pillow may be useful.
• Weight-control
  Excess weight contributes to back pain as it increases the mechanical stress on the spine, hips and knees, Controlling weight may therefore prove helpful/beneficial. Although weight-loss can be very difficult to achieve, there are certain strategies that you can follow that will significantly increase your chance of success.

Read more about RheumaLin

What is osteoarthritis?

Osteoarthritis is the most common form of arthritis. Unlike other forms of arthritic diseases that may affect other parts of the body, osteoarthritis is primarily a disease of the joints.

What is joint cartilage?

Joint cartilage is the layer of robust slippery tissue that covers the ends of bones where they connect within a joint. Its purpose is to reduce the friction between apposing bone surfaces in order to allow bones to glide over each other during movement. During osteoarthritis the outer layer of cartilage becomes progressively weakened, starts to crumble and slowly breaks away. This eventually exposes the underlying bone and causes bone-to-bone friction during joint movement. Not surprisingly, bone rubbing on bone causes severe pain and reduces joint flexibility.

What causes osteoarthritis?

In the past, osteoarthritis was thought to be a natural consequence of the “wear and tear” process that results from ageing and frequent usage. Although partially true, new research by various investigators has since demonstrated that this is a somewhat simplistic outlook, and that the corrosive biochemical effects that inflammation has on cartilage plays a far bigger role than friction alone. This explains the reason why many marathon runners often have surprisingly low levels of osteoarthritis of their knees and hips at a later stage of their lives, especially when compared to some of their more sedentary peers. In addition, radiological evidence demonstrating the slow but steady destruction of the entire joint proves that osteoarthritis involves far more than just cartilage degradation.

Why does inflammation damage cartilage?

As part of the natural immune response, inflammation triggers the activation and release of several different enzyme systems that splice or cleave the bonds that join protein molecules together. Since cartilage is predominantly made from protein, these enzymes progressively corrode, and in the process, soften the cartilage. As a result, it becomes less resistant to impact and more prone to fragmentation. Of importance is that these enzymatic processes do not selectively degrade joint cartilage alone, but damage all other regional protein-based tissues, including ligaments, capsules, synovial membranes and adjacent bone.

What are the risk factors for developing osteoarthritis?

Various factors including genetic, biochemical, and mechanical factors play a role in the development of osteoarthritis. These determine to a degree how resistant cartilage will be against inflammatory damages, and why inflammation often lingers within a joint. The following play a role:

• Getting older
• Being overweight (increases friction)
• Previous joint injury, fracture, or sprain (activates inflammation)
• Previous joint infection (activates inflammation)
• Joints that were not properly formed (increases risk of damage)
• A genetic defect in joint cartilage (may cause structural weakness)
• Extreme stresses on the joints – certain jobs and high-impact sports (increases friction)

What are the symptoms of osteoarthritis?

Osteoarthritis predominantly causes joint pain and stiffness. The following symptoms are common:

• Pain aggravated by movement
• Joint tenderness
• Stiffness, especially after having rested
• Joints appearing slightly larger or more ‘knobbly’ than usual, especially the fingers
• Grating sensation or crackling sound with movement
• Decreased range of movement
• Weakness and muscle wasting

Which joints does osteoarthritis affect?

Almost any joint can be affected by osteoarthritis, but the knees, hips, and small joints of the hands are the most common.

• Hands
  Osteoarthritis of the hands has a strong genetic basis. Women are more likely to develop osteoarthritis in the hands, especially if both your mother and grandmother were affected. Bony growths or nodules may develop on the finger joints. Nodules on the joints closest to the nails are called Heberden’s nodes whilst Bouchard’s nodes appear in the middle. This may cause the fingers to become gnarled and distorted. Additionally, the base of the thumb joint is commonly affected by osteoarthritis.
• Knees
  Symptoms include stiffness, swelling, and pain, which makes it hard to walk, climb stairs, and get out of chairs.
• Hips
  Symptoms include pain and stiffness of the hip joint itself, but pain can often be felt in the groin, inner thigh, or buttocks. Osteoarthritis of the hip may limit moving and bending, making daily activities such as dressing and putting on shoes a challenge.
• Spine
  Symptoms include stiffness and pain in the neck, mid-back, or lower back. In most cases, osteoarthritis is associated with other degenerative conditions such as intervertebral disc degeneration or spondylosis.

How does one diagnose osteoarthritis?

If clinically suspected, X-rays may confirm the diagnosis and exclude other forms of arthritis. The radiological findings on X-ray include cartilage loss, bone damage, and joint distortion. The development of bony outcrops or protrusions called spurs or osteophytes are common.

How is osteoarthritis treated?

• Step 1 – the alleviation of acute pain to improve your quality of life and help you to remain functional and productive.
• Step 2 – the implementation of preventative self-help strategies to control your level of pain, maintain mobility, and reduce chronic inflammation.

Acute pain management

• Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long term, since as a class, these drugs pose a significant side-effect risk relating to cardio-vascular, gastro-intestinal and kidney disease. (Ask your doctor or pharmacist for advice).
• Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
• Hot or cold packs – applying a heat pack to your neck can help to ease pain. You can use a microwavable heat pad or hot-water bottle. Heat alters the sensation of pain. Cold (for example a bag of frozen peas) may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area, and may reduce the sensation of pain through reducing nerve activity.
• Rehabilitation therapies – Physiotherapy, biokinetics, or chiropractic therapy may prove helpful.

Preventative self-help strategies:

• Exercise
  Research has shown that regular exercise provides numerous benefits for those suffering from osteoarthritis. Exercise can decrease pain, increase flexibility, strengthen the heart and improve blood flow, help maintain weight, promote general physical fitness and improve mood. Contracting muscles also release multiple substances, known as myokines, which promote the growth of new tissue and facilitate tissue repair. Myokines have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases.
• Use supplements that combat inflammation
  Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin® is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high-level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation, and are the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin.

• Weight-control
  Being overweight causes increased friction on your hips and knees. Although weight-loss can be very difficult to achieve, there are certain strategies that you can follow that will significantly increase your chance of success. Read more about weight-loss strategies.

• Surgery
  In some cases of advanced osteoarthritic disease, surgery may be required.

What is a slipped disc?

The spine consists of 24 individual bones called vertebrae that are stacked on top of each other. These give the spine strength and rigidity. To enable bending and flexibility, circular pads of pliable connective tissue are situated between each vertebra. These are therefore called intervertebral discs. Under certain circumstances, especially when a sudden downwards force is applied to the intervertebral disc (such as in the case of a whiplash injury or from lifting a heavy object), the internal structure gives way and the disc collapses. This occurrence is referred to as a “slipped disc”, although strictly speaking, no actual “slipping” has really taken place. The medical terms that are used to describe the same problem are “herniated disc” or “prolapsed disc”. Once collapsed, some section of the disc may bulge outwards, an occurrence that may cause certain neurological complications including pressure on spinal nerves and a referred pain syndrome.

What causes a slipped disc?

A slipped disc is largely caused by a medical condition called spondylosis. Key to this process is the corrosive effects of several highly caustic enzyme systems that are released and activated by inflammation.

What is spondylosis?

Spondylosis is a collective term used to describe the combined effects of several degenerative processes that progressively start to affect the spine. It usually begins in one or more of the circular pads of soft tissue between the vertebrae called intervertebral discs, and then spreads to surrounding tissues such as ligaments and bones.

What are the symptoms of spondylosis?

Although spondylosis may occur without causing many symptoms, it is mostly associated with some degree of pain and stiffness of the spine. Certain neurological complications may also occur. Cervical spondylosis involves the intervertebral discs of the neck, whilst occurrence in the lower back is referred to as lumbar spondylosis. Symptoms are dependent on the severity of the condition. Pain can either be local, causing regional pain, or referred, causing pain to travel down the arm or leg. Referred pain is caused by nerves that are either trapped or irritated in the spine. It is quite common for both local and referred pain to occur simultaneously.

What are the symptoms of cervical spondylosis?

Localised symptoms

• neck and shoulder pain
• headaches radiating up the neck to the back of the head (tension type headaches)
• stiffness and decreased mobility of the neck

Referred symptoms

• pins and needles in the arm, hands or fingers
• pain radiating down the arms towards the hands
• loss of feeling in parts of your hands

What are the symptoms of lumbar spondylosis?

Localised symptoms

• lower backache
• stiffness and decreased mobility of the back

Referred symptoms

• pins and needles in the legs, buttocks, feet, or toes
• pain radiating down the legs and buttocks towards the feet
• difficulty in maintaining your balance
• problems with bladder control (advanced cases)

How is spondylosis diagnosed?

Once suspected in a clinical context, the diagnosis of spondylosis is confirmed via an imaging procedure such as an X-ray, MRI, or CT scan. The most obvious feature visible on the radiological image is the collapse or disintegration of one or more intervertebral discs, as judged by loss of height when compared to normal discs. Later features are the distortion of the bony skeleton in the immediate vicinity of the collapsed disc, caused by inflammatory damage and the growth of bony projections or spurs along the collapsed disc’s margins. These are called osteophytes and resemble the tip of a parrot’s beak in appearance.

How does spondylosis develop?

Spondylosis is often triggered by a traumatic event such as an injury, especially when a sudden downwards force is applied to a normal or healthy intervertebral disc. Examples are whiplash injuries and strains caused by the lifting of heavy objects. However, the slow but progressive deterioration of intervertebral discs over time, caused by chronic inflammation, is also a major contributing factor. This is because chronic inflammation slowly degrades the basic structure of a disc and “softens” it, making the disc more vulnerable to injury. An inflamed disc also becomes increasingly less resilient to the daily micro-trauma that is caused by the usual stresses and strains of normal activity.

Which factors contribute to spondylosis?

Within a healthy spine, intervertebral discs are largely avascular and aneural, meaning that in their normal state they contain neither blood vessels nor nerves. New research has demonstrated that an early sign predicting the onset of the future disease is the microscopic appearance of blood vessels and nerve fibres that progressively start to tunnel through a healthy disc. New blood vessels provide access to several inflammatory factors present in blood plasma, which result in progressive damage to the disc.

Why does inflammation damage the intervertebral discs?

Intervertebral discs are predominantly made out of protein in the form of collagen fibres. These provide a robust, mesh-like structure that accommodates other protein-based molecules making up the rest of the disc (proteoglycans & aggrecans). This unique structural arrangement enables the spine to resist the extreme tensile forces required when lifting, bending and rotating the body.

Starting at the outer, more durable layer (annulus fibrosus), the progressive infiltration of blood vessels into the pliable inner core of the intervertebral disc (nucleus pulposus) provide access to inflammatory components present in the bloodstream. This activates an escalatory biochemical cascade that progressively degrades a healthy disc through powerful enzymatic action. Degradation is also accelerated by the activity of white blood cells which, under normal conditions, contain large quantities of severely caustic enzymes. These serve as the main offensive weapon used to eradicate and digest harmful microorganisms. Once these enzymes are released within the intervertebral disc, they rapidly degrade the protein-structures that the disc is made of.

Why does pain often gets worse?

The progressive infiltration of a network of new nerve fibres creates a rich network of additional neural pathways both around and within the core of the intervertebral disc. These new neural pathways then result in the signalling of pain from previously unconnected regions. Additional neural pathways also increase the volume of signals thereby enhancing the total sensation of pain. The increased nerve signals from the spinal cord to the neighbouring back and neck muscles also triggers muscle tension and spasm, which significantly aggravates pain. A vicious cycle ensues. During this process, several other pain related syndromes are also likely to develop. Examples are hyperalgesia, or abnormally increased sensitivity to pain, and allodynia, during which minor stimuli such as touch and temperature, now trigger a significantly exaggerated pain response.

How is spondylosis treated?

Acute pain management

• Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long-term, since as a class, these drugs pose a significant side-effect risk relating to cardiovascular, gastrointestinal and kidney disease. (Ask your doctor or pharmacist for advice).
• Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
• Hot or cold packs – applying a heat pack to your neck can help to ease the pain. You can use a microwavable heat pad or a hot-water bottle. Heat dilates the blood vessels which improves blood supply to the back and helps to reduce muscle spasms. Heat also alters the sensation of pain. (Some find cold packs offering better relief – for example, a bag of frozen peas).
• Rehabilitation therapies – physiotherapy, biokinetics, or chiropractic therapy may prove helpful. A good massage may also assist. Therapy may reduce inflammation, correct posture, muscle tension, or other contributors to neck pain.

Preventative self-help strategies:

By preserving the integrity and mobility of your back you are in turn protecting it from the consequences of chronic inflammatory damage over time. Judging from the number of people in the world who become permanently disabled from a chronic backache, these easy to implement but important strategies will likely prove one of the most worthwhile investments in your overall health.

• Stretch your back
  Stretching is a form of physical exercise during which a contracted, tight, or painfully stiff ligament or muscle group is deliberately lengthened in order to improve its elasticity and achieve a more relaxed tone. When done properly, this results in a more comfortable feeling of increased muscle control, flexibility, and range of motion. Regular stretching is an excellent way to alleviate muscle inflammation and pain.
• Strengthen your back muscles with exercise
  Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and reduce the risk of recurrence. Modern research has demonstrated that many of the benefits of exercise are mediated through the role that muscle tissue play as an endocrine (hormone-producing) organ. Contracting muscles release multiple substances known as myokines which promote the growth of new tissue and facilitate tissue repair. Myokines also have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases. These anti-inflammatory effects will assist you locally with inflammation in your spine, as well as systemically in the rest of your body. Regular exercise can help reduce your risk of developing a herniated disc by slowing down their age-related deterioration as a result of chronic inflammation. It can also help keep your supporting back muscles strong and supple. Always stretch properly in order to warm-up and cool down properly before and after any workout or sports activity.
• Use supplements that naturally reduce inflammation
  Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin® is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high-level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation and are also the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin.

• Surgery
  In a small number of cases, surgery may be required to remove a section of a damaged prolapsed disc that is pressing on a nerve.

What is sciatica?

Sciatica is the medical term for any sort of pain that is caused by the irritation or compression of the sciatic nerve, a large nerve that runs from your lower back (lumber spine) past your pelvis down your leg towards your foot. The sciatic nerve is made up from five separate nerve roots, which leave the spinal column between each of the five vertebrae which form the lumber spine.

What are the symptoms of sciatica?

Sciatic pain may present as a dull, nagging pain which runs from your lumbar spine down the back, outside, or front of your leg. It is often compared to toothache. Sharp, stabbing pains may also be experienced, often triggered by movement. Symptoms usually only occur on one side of the body, but in certain cases pain occur on both sides of the body. Sciatica may not necessarily be associated with the presence of pain in the lower back. It may also present as weakness, pins and needles or numbness that may occur in various parts of the leg and foot.

What causes sciatica or sciatic pain?

Common causes (around 90%):

• Spondylosis / Intervertebral disc degeneration – In the majority of cases sciatic pain is due to the collapse of one or more of the rubbery pads of tough, elastic tissue situated between the vertebrae, called intervertebral discs. Under certain circumstances, especially when a sudden downwards force is suddenly applied to the intervertebral disc such as in the case of an injury or as a result of lifting a heavy object, the internal structure of the disc gives way and it ruptures or collapses. The medical terms used to describe this phenomenon are “herniated disc” or “prolapsed disc” and the general condition that leads to disc degeneration is called spondylosis. Once collapsed, some portion of the disk may bulge outwards and press on one of the five nerve roots that collectively form the sciatic nerve (See below).

Rare causes (around 10%):

• Spondylolisthesis – the forward displacement of a vertebra, especially the fifth lumbar vertebra, most commonly occurring after a fracture. (Backward displacement is referred to as retrolisthesis).
• Spinal stenosis – the abnormal narrowing (stenosis) of the spinal canal that may occur in any part of the spine.
• Piriformis syndrome – caused by the piriformis muscle, either as a result of inflammation or direct pressure on the sciatic nerve.
• Pelvic tumors – a rare cause.
• Pregnancy – direct compression by a baby’s head.

How is spondylosis diagnosed?

Once suspected in a clinical context, the diagnosis of spondylosis is confirmed via an imaging procedure such as an X-ray, MRI, or CT scan. The most obvious feature visible on the radiological image is the collapse or disintegration of one or more intervertebral discs, as judged by loss of height when compared to normal discs. Later features are the distortion of the bony skeleton in the immediate vicinity of the collapsed disc, caused by inflammatory damage and the growth of bony projections or spurs along the collapsed disc’s margins. These are called osteophytes and resemble the tip of a parrot’s beak in appearance.

How does spondylosis develop?

Spondylosis is often triggered by a traumatic event such as an injury, especially when a sudden downwards force is applied to a normal or healthy intervertebral disc. Examples are whiplash injuries and strains caused by the lifting of heavy objects. However, the slow but progressive deterioration of intervertebral discs over time, caused by chronic inflammation, is also major contributing factor. This is because chronic inflammation slowly degrades the basic structure of a disc and “softens” it, making the disc more vulnerable to injury. An inflamed disc also becomes increasingly less resilient to the daily micro-trauma that is caused by the usual stresses and strains of normal activity.

Which factors contribute to spondylosis?

Within a healthy spine, intervertebral discs are largely avascular and aneural, meaning that in their normal state they contain neither blood vessels nor nerves. New research has demonstrated that an early sign predicting the onset of future disease is the microscopic appearance of blood vessels and nerve fibres that progressively start to tunnel through a healthy disc. New blood vessels provide access to several inflammatory factors present in blood plasma, which result in progressive damage to the disc.

Why does inflammation damage the intervertebral discs?

Intervertebral discs are predominantly made out of protein in the form of collagen fibres. These provide a robust, mesh-like structure that accommodates other protein-based molecules making up the rest of the disc (proteoglycans & aggrecans). This unique structural arrangement enables the spine to resist the extreme tensile forces required when lifting, bending and rotating the body.

Starting at the outer, more durable layer (annulus fibrosus), the progressive infiltration of blood vessels into the pliable inner core of the intervertebral disk (nucleus pulposus) provide access to inflammatory components present in the blood stream. This activates an escalatory biochemical cascade that progressively degrades a healthy disk through powerful enzymatic action. Degradation is also accelerated by the activity of white blood cells which, under normal conditions, contain large quantities of severely caustic enzymes. These serve as the main offensive weapon used to eradicate and digest harmful microorganisms. Once these enzymes are released within the intervertebral disk, they rapidly degrade the protein-structures that the disc is made of.

Why does pain often gets worse?

The progressive infiltration of a network of new nerve fibres creates a rich network of additional neural pathways both around and within the core of the intervertebral disc. These new neural pathways then result in the signalling of pain from previously unconnected regions. Additional neural pathways also increase the volume of signals thereby enhancing the total sensation of pain. The increased nerve signals from the spinal cord to the neighbouring back and neck muscles also triggers muscle tension and spasm, which significantly aggravates pain. A vicious cycle ensues. During this process several other pain related syndromes are also likely to develop. Examples are hyperalgesia, or abnormally increased sensitivity to pain, and allodynia, during which minor stimuli such as touch and temperature, now trigger a significantly exaggerated pain response.

How is spondylosis treated?

Acute pain management

• Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long term, since as a class, these drugs pose a significant side-effect risk relating to cardio-vascular, gastro-intestinal and kidney disease. (Ask your doctor or pharmacist for advice).
• Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
• Hot or cold packs – applying a heat pack to your neck can help to ease pain. You can use a microwavable heat pad or a hot-water bottle. Heat dilates the blood vessels which improves blood supply to the back and helps to reduce muscle spasms. Heat also alters the sensation of pain. (Some find cold packs offering better relief – for example, a bag of frozen peas).
• Rehabilitation therapies – physiotherapy, biokinetics, or chiropractic therapy may prove helpful. A good massage may also assist. Therapy may reduce inflammation, correct posture, muscle tension, or other contributors to neck pain.

Preventative self-help strategies:

By preserving the integrity and mobility of your back you are in turn protecting it from the consequences of chronic inflammatory damage over time. Judging from the number of people in the world who become permanently disabled from chronic back ache, these easy to implement but important strategies will likely prove one of the most worthwhile investments in your overall health.

• Stretch your back
  Stretching is a form of physical exercise during which a contracted, tight, or painfully stiff ligament or muscle group is deliberately lengthened in order to improve its elasticity and achieve a more relaxed tone. When done properly, this results in a more comfortable feeling of increased muscle control, flexibility, and range of motion. Regular stretching is an excellent way to alleviate muscle inflammation and pain.
• Strengthen your back muscles with exercise
  Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and reduce the risk of recurrence. Modern research has demonstrated that many of the benefits of exercise are mediated through the role that muscle tissue play as an endocrine (hormone producing) organ. Contracting muscles release multiple substances known as myokines which promote the growth of new tissue and facilitate tissue repair. Myokines also have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases. These anti-inflammatory effects will assist you locally with inflammation in your spine, as well as systemically in the rest of your body. Regular exercise can help reduce your risk of developing a herniated disc by slowing down their age-related deterioration as a result of chronic inflammation. It can also help keep your supporting back muscles strong and supple. Always stretch properly in order to warm up and cool down properly before and after any workout or sports activity.
• Use supplements that naturally reduce inflammation
  Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation, and are also the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin.

• Surgery
  In a small number of cases, surgery may be required to remove a section of a damaged prolapsed disc that is pressing on a nerve.

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a form of inflammatory arthritis caused by an autoimmune disorder. This means that your immune system mistakenly recognises some tissue or organ as foreign or potentially threatening, and inadvertently attacks it. During RA, this tissue is the synovium, a fibrous membrane that coats the inside of your joint cavities. As a consequence, severe inflammation is initiated. This results in significant corrosive damage to the interior of a joint through the release of several highly caustic protein-dissolving enzymes. Besides damaging the synovium, these enzymes also progressively degrade all other adjacent joint components, such as cartilage, tendons, ligaments and bone. In a more advanced stage, progressive tissue destruction can cause a joint to lose its shape and alignment, and become visibly distorted.

What causes rheumatoid arthritis?

Although the underlying mechanism involves the body’s immune system attacking the joints, the exact trigger is still not clearly understood and is generally believed to involve a combination of genetic and environmental factors:

• Family history – if a direct member of your family has had rheumatoid arthritis, you are at an increased risk. While your genes don’t directly cause rheumatoid arthritis, they can make you more prone to environmental factors such as infection, which may activate your immune system.
• Smoking – cigarette smoke is the most significant non-genetic risk factor. Rheumatoid arthritis is three times more common in smokers than non-smokers, particularly among men.
• Infections – certain viruses and bacteria are suspected to increase the risk. Epidemiological studies have confirmed a potential association between rheumatoid arthritis and two viral infections, namely Epstein-Barr virus (EBV) and Human Herpes Virus 6 (HHV-6).
• Gender – women are more likely to develop rheumatoid arthritis. The disease may improve during pregnancy and flare up afterwards, while breastfeeding may aggravate the disease. Additionally, a person’s likelihood of developing RA may be increased slightly by hormonal contraceptive use. These observations suggest that certain female hormones, or possibly deficiencies or changes in the response to hormones, promote the development of rheumatoid arthritis in a genetically susceptible woman who has been exposed to an environmental trigger.
• Age – although rheumatoid arthritis can occur at any age, it is more common after the age of 40.

What are the symptoms of rheumatoid arthritis?

Rheumatoid arthritis typically manifests with signs of inflammation in the joint. Specifically, the affected joint becomes swollen, warm, painful and stiff. A prominent feature which distinguishes RA from osteoarthritis is increased morning stiffness upon waking, which typically lasts for up to an hour. The small joints of the hands, feet and cervical spine, are most commonly affected, but larger joints like the shoulders, elbows, hips, knees, and ankles can also be involved. Gentle movements may relieve symptoms in early stages of the disease. The following symptoms are common:

• Swollen, tender, warm, and stiff joints.
• More than one joint involved at the same time (polyarthritis).
• Both large- and small-joints (fingers) involved at the same time.
• Symmetrical pattern, namely similar joints on both sides of the body are simultaneously involved.
• Inflammation in the fingers mostly affects the finger-joints closest to the hand (Osteoarthritis affects the opposite joints).
• Morning stiffness which lasts more than 30 minutes.
• General symptoms such as fatigue, low grade fever, malaise, loss of appetite and loss of weight.
• Deformity of joints and fingers in more advanced cases.

What are the common complications of rheumatoid arthritis?

Although rheumatoid arthritis predominantly affects the synovium and therefore causes joint disease, the inflammatory process activated by the immune system may have a detrimental effect on other organs. Examples are:

• Skin – the appearance of subcutaneous lumps called rheumatoid nodules. These range from a few millimetres to a few centimetres in size and are usually found over bony prominences, such as the elbow, the heel, the knuckles, or other areas of skin exposed to repeated mechanical stress.
• Lungs – fibrosis or scaring of the lungs may occur, either as a direct result of the disease or as consequence of treatment (methotrexate and leflunomide).
• Kidneys – chronic damage from inflammation. Treatment with penicillamine and gold salts may also lead to renal disease.
• Heart and blood vessels – individuals with rheumatoid arthritis are more prone to hardening of the arteries (atherosclerosis). Risk of heart attack (myocardial infarction) and stroke is therefore markedly increased.
• Eyes – inflammation of the sclera (episcleritis) and dry eye syndrome.
• Blood – anaemia caused by a variety of mechanisms.
• Neurological – peripheral neuropathy and carpal tunnel syndrome.
• Bones – osteoporosis, both local (around inflamed joints) and systemic. This is caused by immobility, inflammation (as a result of certain inflammatory signalling molecules called cytokines), as well as corticosteroid therapy.

How is rheumatoid arthritis treated?

The goals of treatment are:

• To relieve pain
• To reduce inflammation
• To slow or stop joint damage
• To improve a person’s sense of well-being and ability to function

Current treatment approaches are:

• Medication
• Lifestyle strategies
• Surgery
• Routine monitoring and ongoing care

Medication:

• Disease-modifying anti-rheumatic drugs (DMARDs) – these are the primary treatment for RA and have been found to improve symptoms, decrease joint damage, and improve overall DMARDs should ideally be started early in the disease since they result in disease remission in approximately half of patients. They comprise a diverse collection of different drugs grouped according to their pharmaceutical function. Common DMARDs include methotrexate, hydroxychloroquine, leflunomide, and sulfasalazine. Other DMARDs, called biologic response modifiers, may be used in people with more serious disease. These are genetically engineered medications that reduce inflammation and structural damage to the joints by interrupting the cascade of events that cause inflammation. Examples are abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab, and tofacitinib. (Ask your rheumatologist for advice).
• Anti-inflammatory drugs (NSAID’s) – these include the COX-2 inhibitors and reduce both pain and stiffness in those with RA. Generally, no effect on people’s long term disease course is observed and are therefore no longer first line agents. NSAIDs should be used with caution in those with increased risk of gastrointestinal, cardiovascular, or kidney disease. (Ask your doctor or pharmacist for advice).
• Steroids – glucocorticoids can be used over the short term for acute flare-ups, especially when waiting for slow-onset drugs to take effect. Injections of glucocorticoids into individual joints are also effective. While long-term use reduces joint damage, it also results in osteoporosis and an increased susceptibility to infections. (Ask your doctor for advice).
• Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).

Lifestyle strategies:

• Exercise – regular exercise is recommended as both safe and useful to maintain muscle strength and overall physical function. However, individuals with rheumatoid arthritis need to balance rest and exercise, with more rest during stages when the disease is active and more exercise when it is not. Rest reduces active joint inflammation, pain, and fatigue. Resting time varies from person to person, but shorter rest breaks are generally more helpful than long times spent in bed. Exercise is important for maintaining healthy and strong muscles, preserving joint mobility, maintaining flexibility, improving sleep better, reducing pain, maintaining a positive attitude, and managing weight. Exercise programs should take into account the person’s physical abilities, limitations, and changing needs. Contracting muscles also release substances called myokines, which promote the growth of new tissue and facilitate tissue repair. Myokines have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various other inflammatory diseases such as cardiovascular disease.
• Use supplements that combat inflammation – various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making the approach attractive when compared to other pharmaceuticals. RheumaLin™ is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised, and combat inflammation via different biochemical mechanisms compared to existing anti-inflammatory drugs. Read more about RheumaLin.
• Hot or cold packs – applying a heat pack to inflamed joints can help to ease pain. You can use a microwavable heat pad or hot-water bottle. Heat alters the sensation of pain. Cold (for example a bag of frozen peas) may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area, and may reduce the sensation of pain through reducing nerve activity.
• Rehabilitation therapies – physiotherapy, biokinetics, or occupational therapy will prove helpful.
• Joint care – supporting an inflamed joint and allowing it to rest often reduces pain and swelling. Splints are useful for wrists, hands, ankles, and feet. Other ways to reduce stress on joints include self-help devices such as zipper pullers and long-handled shoe horns. Devices to assist with getting on and off chairs, toilet seats, and beds may also be required.
• Stress reduction – besides physical hardship, individuals with rheumatoid arthritis face several emotional challenges as well. Distress, anger, and frustration stem from the disease itself, aggravated by chronic pain and physical limitations. These increase levels of stress which also increase the amount of pain that one experiences. There are a number of successful techniques for coping with stress.