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Pain management

Pain in the cervical, thoracic, and lumbar spine is one of the most common sites of pain in the human body . Conservative and interventional methods are both used when treating pain. Conservative methods include medications or drugs to treat inflammation, heat or ice, and supervised physical therapy that includes muscle conditioning and exercises that can then be done at home. Muscle conditioning exercises help to tone muscles of the spine which in return provide stability and prevent injury. Interventional methods are mainly used on individuals experiencing chronic spine pain and are more invasive treatments like surgery. However, a low percentage of individuals choose this route

Exercise modifications

When dealing with pain in the spine it is important to refrain from activities that involve any type of impact or contact sports. It is also crucial to refrain from any type of weight training keeping in mind the importance of keeping the spine in neutral . Rest is imperative for any pain experienced in the spine however, resting should only occur for a few days because too much rest can weaken spinal muscles . As the healing process continues, individuals can gradually return to exercising but they should focus on aerobic conditioning and stretching . Gaining flexibility and strengthening abdominal muscles is one of the best ways to relieve spinal pain because flexibility and strength reduces the amount of tension placed on the spinal region inhibiting loss of range of motion .

Trigger Points

Lumbar Region

The quadratus lumborum, gluteus medius and maximus, illiopsoas, and rectus abdominus are all lumbar region trigger points . A technique called dry needling can be used to relieve trigger points in the lumbar region. Dry needling involves insertion and extraction of a needle without actual fluid injection and is known for breaking up fibrous pockets to then allow for increased blood flow and decreased sensitivity .

Trigger points in the cervical region include the upper and lower trapezius, sternal and clavicular divisions of the sternocleidomastoid, and the splenius muscles . One method to relieve these trigger points is to undergo trigger point injections where an anesthetic is injected into the trigger point area. The injection of an anesthetic helps to numb the pain felt in trigger point regions however, this is often times purely a temporary solution .

Thoracic Region

Trigger points for the thoracic region are located at the iliocostalis and quadratus lumborum (Perry, 2006). Spraying trigger point areas with vapocoolant spray can also help to inactivate trigger points which will lead to easier stretching .

Mobility

Mobility in each part of the spine differs, but as a whole the spine should always remain neutral . Back braces can be used to help stabilization however, they have also been known to cause [muscle weakness] . The cervical spine is the most mobile allowing for flexion and extension, but is also more susceptible to injury because movement in any range of the cervical region on a vertebral level isn’t simple. Scapular retraction could be difficult if shoulder muscles are weak thus affecting posture into kyphosis. Also, if hip muscles are weak there could be difficulty in performing actions that require squatting thus increasing shear forces on the spine and also decreasing mobility of the spine . Evidence has supported that therapeutic exercises such as deep breathing can specifically relieve lumbar spine pain because deep breathing helps muscle relaxation which in return decreases muscle tension and pain . Some stretches that will help manage pain are stretches that extend the spine for example a forward sitting stretch such as “child’s pose stretch” .