September 2011

Women's Back Pain. Yes. It's Different

Author: Edward Thomas

Pain in the neck and back area is the number one complaint among older Americans, and physicians now understand more clearly that pain affects men and women differently. According to studies by The Journal of American Geriatrics Society, women typically seek professional help more quickly about their pain but are less likely to let it control their lives, because they are better at finding resources and coping skills to deal with their pain. But that doesn’t belie the fact that the pain is there. According to most spine specialists, neck pain and pain in the tailbone area of the spine are both more likely to be present in women than in men.

K. Craig Boatright, M.D., a board certified spine surgeon with Reuben Spine Specialists and Hilton Head Hospital, says neck pain is a ubiquitous part of the human condition but, despite the fact that it is common, should never be taken lightly.

Recently Boatright saw a female patient in her 30s who was experiencing a “tingly sensation” running down her torso into her legs on occasions when she ducked her chin to her chest. “Whenever she bent her head forward, a portion of her vertebrae was tapping on her spinal column,” Boatright said, noting that the spine is ultra-sensitive to such contact. “The spine doesn’t like to be dinged.”

In Boatright’s experience, most forms of neck pain are best addressed with non-invasive treatments like physical therapy. But the foregoing conditions can often be successfully treated with surgery. “The really unfortunate patients are those who attempt to simply manage their pain without getting a proper diagnosis of the underlying problem,” he said. “If there is an impingement on the nerves or spinal column, it can cause irreversible damage over time, and the patient may never get lost functionality back.”

Boatright urges people who are experiencing neurologic symptoms, like tingling or numbness in their arms and legs, to see their primary care doctor or a spine specialist. People with weakness in their hands, an unexplained deterioration in their penmanship or balance issues should also be evaluated. “I had a patient tell me that his family accused him of ‘walking like a drunk guy’ because of his wobbly gait,” Boatright said. “In fact, he had spondylosis. The pressure on his nerves was causing him to lose his balance.”

Cervical spondylosis, or in layman’s terms “arthritis of the spine,” describes age-related wear and tear affecting the disks in your neck. As the spongy discs wear out, they become thinner, placing more stress on the facet joints that connect the vertebrae, causing inflammation.

Physical differences between men and women also seem to matter when it comes to the neck. The neck architecture differs between the two genders, which can pressure joints, muscles and bones in different ways. For example, a 12-year study by a major European insurance company revealed that women are more likely to sustain a whiplash neck injury than men are and are also less likely to recover well. This was determined to be due in part because women have less stability in their necks, because they have less cartilage in the back portions of the neck joints, which provide cushioning. A woman’s spinal canal in the neck area is also narrower than a man’s is which allows less room for error during injuries.

Genetic factors also appear to have significant influence on neck pain reported by women who come to physicians with neck related headaches. These headaches, sometimes referred to as tension headaches, are most likely caused by contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain. Studies also show that women report more dizziness, vertigo and motion sickness than men, which may also be related to the neck.

Whatever reasons there are for higher incidence of neck pain in women, spine specialists and physicians will universally point to proper posture—especially during work—to relieve pressure on the neck area. For example, looking down at a computer screen, which women often do when working on laptops, puts extra strain on neck and back muscles. Monitors should be at eye level with elbows and shoulders at 90 degrees.

Another female posture issue is the result of some women having the extra weight of large breasts that causes them to hunch over. Being fitted with the proper bra size and structure is a solution because it helps distribute the chest weight properly.

Women are also more prone to sacroiliac joint dysfunction than men are. The sacroiliac joints, located in the lower spine, formed by the connection of two bones, don’t allow for much movement. However, hormonal changes that occur during pregnancy relax the ligaments to facilitate childbirth. This also allows for more movement in the sacroiliac joints, which in turn, can increase stress on them. As with any weight-bearing joint, the sacroiliac joints are subject to arthritis, gout, psoriasis or any other ailment that affects other joints. Anything that causes a change in gait can also lead to sacroiliac joint dysfunction.

The typical patient with these symptoms is a woman in her 30s or 40s who has had children. It is thought that the relaxation of the sacroiliac ligaments necessary for childbirth does not fully reverse and that a subsequent minor trauma may partially dislocated the joint and cause the pain.

Accurately diagnosing this dysfunction can be difficult, however. Its symptoms can mimic those of other common conditions, such as disc herniation that causes pain along the sciatic nerve that radiates down the leg. Unless a physician specifically checks for sacroiliac dysfunction, the exam often turns out “normal,” and some patients may be told that nothing is wrong.

If diagnosed early, the majority of patients with sacroiliac dysfunction will improve with conservative treatment, which may include manipulation and physical therapy. For women who don’t respond to conservative measures, minimally invasive surgery would be the next step, which involves stabilizing the sacroiliac joint through fixation and fusion.

People who are experiencing problems with the neck or spine, especially if there are symptoms of tingling, should speak at length with their personal physician or receive a consultation with a spine specialist. While not everyone is a candidate for surgery, by consulting with a qualified physician, treatment options can be determined.

K. Craig Boatright, M.D., a board certified spine surgeon with Reuben Spine Specialists and Hilton Head Hospital.

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