After upper respiratory infections, low back pain (LBP) is the most common reason for seeing one’s primary care physician. Furthermore, the development into a chronic state is almost routinely encountered. The reason for this, especially in older patients, is the almost universal presence of osteoarthritis. Arthritis should be viewed as a systemic disease affecting the entire body but producing symptoms in a few areas. One of those areas is the low back. Due to the upright position and “wear and tear” of the multiple structures that comprise the back, the low back is the most frequent part of the body to produce pain. The most common pain generators for LBP in the low back are the facet joints. These line up vertically in the posterior lumbar spine to maintain a straight mid-line position in the low back and are oriented in the horizontal plane in the neck to allow for lateral movement. Pain on extending or twisting the lower spine, inability to stand or walk for anything but short periods, relief upon lying down or leaning forward are characteristic of lumbar facet disease but may also be seen with more serious, multifactorial conditions such as spinal stenosis. The diagnosis is made by clinical findings and confirmed by MRI or CT Scanning. Abnormalities within intervertebral discs can also be the cause of LBP and may need a discogram for its diagnosis. Physical therapy, medication management, transcutaneous stimulation (TENS) units and a wide host of interventional techniques are very effective in controlling LBP and referred leg pain (“sciatica”), prior to consideration of surgery.

Neck pain is also referred to as cervical pain. Due to the constant movement the neck does and its more rapid development of arthritis, neck pain is a common medical condition. The multiple structures that comprise the neck also can make the cause of the pain somewhat elusive to identify. Degenerative discs, facet joint arthritis, neck strain/sprain, whiplash, a herniated disc, or a pinched nerve are the most common reasons to have chronic neck pain. Each of these is treated in different approaches and often exists in combination. For example, a herniated disc may cause referred pain down the shoulder and arm but once treated the patient may still complain of neck pain, possibly due to arthritis in the facet joints. While the herniated disc may be treated with anti-inflammatories, physical therapy and possibly epidural steroid injections, neck pain due to facet arthritis may benefit from anti-inflammatories, transcutaneous electrical nerve stimulation (TENS) units and possibly facet injections with nerve radiofrequency ablation (“burning”) for longer-term relief. All of these are common short procedures (10-20 minutes) generally done in the office on an outpatient basis.

Hip pain is commonplace in our society as the population progressively ages and arthritic changes take hold. Calcifications and thinning of the joint cartilage are both involved in the aging hip. Pain emanating from the hip is most commonly felt over that joint, however, since the hip joint is large and involves multiple structures, it may be felt in the buttocks or even the groin. Muscle strains and sprains are frequently seen as the body compensates for the limitation of motion and avoids painful positioning and movements. A multitude of medications and interventions exist that can provide significant relief. Falls are the most common reason that elderly patients break a hip. The fracture is due to a combination of two effects of aging, osteoporosis (thinning of bones) and a loss of balance. These two risk factors precipitate many falls. Avoiding the fall by maintaining active and alert will be the most effective methods to prevent fractures. Hip replacement surgery has progressed enormously and offers dramatic improvement in the patient with advanced hip disease, unresponsive to other, more conservative approaches.

The knee is a weight bearing joint with a complex web of bones, ligaments and tendons, which allow for a multitude of movements by all the attached and connected muscles. To cushion the effect of the body weight, the bones rotate on cartilaginous padding (meniscus), which weaken over time and can tear with thinning and aggressive movements, such as might occur with sports and osteoarthritic changes. The knee joint is the most frequently involved joint in rheumatologic immune related diseases and due to its constant use and complex and weight bearing nature, is a common source of pain. In fact, the knee joint benefits more from weight loss than any other joint in the body. Cortisone injections have great potential to improve the arthritic joint but must be used with care. Physical therapy, cartilage stimulation injections and medications may help controlling the pain and limitation of movement.

Pain in arms or legs can be due to specific issues with the involved extremity or may be a function of spine disease at a corresponding level, most commonly a disc herniation in the neck or low back. In the upper extremity, shoulder problems may cause pain radiating into the upper arm and carpal tunnel syndrome is a common occurrence producing significant hand pain. The diagnosis is initially a clinical one, based on symptoms and examination and can be confirmed by electromyographic testing (EMG). This is especially helpful to eliminate spinal causes for the hand pain. Radiating pain into the shoulder, arm and extending into the hand is frequently associated with neck disc herniations. The suspicion is raised by symptoms and a physical examination and confirmed by MRI of the neck. Treatment options include medical management, physical therapy, epidural steroid injections and, if necessary, surgical correction. Similarly, hip and sacroliliac problems may cause pain radiating into the front/side and posterior thigh, respectively. Pain extending further down the leg and into the foot is commonly associated with low back disc herniations. Treatment options are similar to those performed for neck problems. As these are frequently age-related changes, a combination of changes, mainly arthritic in nature, are commonly found.

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