Shaking from back pain

Shaking from back pain DEFAULT

Herniated Disc

If the ruptured disc is not pressing on a nerve there may be no symptoms at all, or there may be some minimal pain. If the disc is pressing on a nerve, symptoms may include pain in the  back or neck, leg or arm pain, weakness, numbness or tingling.

Symptoms of a lumbar (lower back) herniated disc include:

  • Intermittent or continuous back pain (this may be made worse by movement, coughing, sneezing, or standing for long periods of time
  • Spasm of the back muscles
  • Pain that starts near the back or buttock and radiates down the leg to the calf or into the foot (this is from “sciatica,” meaning pressure on the large sciatic nerve in the lower back, buttocks, and legs
  • Muscle weakness in the legs
  • Numbness in the leg or foot
  • Decreased reflexes at the knee or ankle

Symptoms of a cervical (neck) herniated disc:

  • Pain between the shoulder blades that can be dull or sharp
  • Pain that radiates down the arms to the hands
  • Muscle spasms
  • Numbness , tingling, or weakness in the arms, hands, or fingers
  • Muscle atrophy

The symptoms of a slipped disc vary from person to person, depending on the size and location of the herniation, how overweight or fit a person is, and other factors.

Sometimes a herniated disc can lead to another condition called spinal cord compression. This happens when pressure is placed on the spinal cord. There may be edema (swelling) of the cord, as well. Symptoms may come on either suddenly or gradually and may include:

  • Difficulty walking
  • Balance problems
  • Falling
  • Dropping things
  • Difficulty with fine-motor skills such as buttoning, handwriting, or picking up small objects
  • Arm or leg weakness, cramping
  • Changes in bladder or bowel function

Minimally invasive surgery can reduce the swelling and stop the progression of symptoms of spinal cord compression (see Diagnosing and Treating a Herniated Disc).

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Reviewed by: Eric Elowitz, MD
Last reviewed/last updated: September


A tremor is an involuntary, rhythmic, shaking movement of part of the body, such as the hands, head, vocal cords, trunk, or legs. Tremors occur when muscles repeatedly contract and relax.

  • Abnormal (pathologic), caused by a disorder or drug

Tremors are usually classified based on when they occur:

  • Resting tremor: Occurring mainly at rest

  • Action tremor: Occurring when a body part is moved voluntarily

  • Intention tremor: Triggered by movement toward a target (for example, reaching for a glass)

  • Kinetic tremor: Appearing at the end of a movement toward a target or during any voluntary movement, such as moving the wrists up and down or closing and opening the eyes

  • Postural tremor: Triggered by holding a limb outstretched in one position

Tremors can also be classified by what causes them, as follows:

  • Physiologic (the normal tremors that everyone has to some degree)

  • Essential (a common hereditary disorder that rarely causes any other symptoms)

  • Cerebellar (caused by damage to part of the brain called the cerebellum)

  • Secondary (caused by a disorder or drug)

  • Psychogenic (caused by psychologic factors)

Other important characteristics of tremors are

  • How fast the shaking is (frequency): Slow to fast

  • How wide the movement is (amplitude): Fine to coarse

  • How often the tremor occurs: Intermittent to constant

  • How rapidly it appears: Sudden to gradual

Physiologic tremor is the normal tremor that everyone has to some degree. For example, most people's hands, when held outstretched, usually tremble slightly. Such slight, rapid tremor reflects the precise moment-by-moment control of muscles by nerves. In most people, the tremor is barely noticeable. However, a normal tremor may become more noticeable under certain conditions and may worry people. For example, the tremor may be more noticeable when people

  • Stop drinking alcohol or taking a sedative (such as a benzodiazepine) or an opioid

  • Take certain drugs, including theophylline and albuterol (which are used to treat asthma Drugs for Preventing and Treating Asthma Drugs allow most people with asthma to lead relatively normal lives. Most of the drugs used to treat an asthma attack can be used (often in lower doses) to prevent attacks. (See also Asthma read more Drugs for Preventing and Treating Asthma and chronic obstructive pulmonary disease Treatment Chronic obstructive pulmonary disease is persistent narrowing (blocking, or obstruction) of the airways occurring with emphysema, chronic obstructive bronchitis, or both disorders. Cigarette read more Treatment, or COPD), corticosteroids, or recreational drugs (such as cocaine Cocaine Cocaine is an addictive stimulant drug made from leaves of the coca plant. Cocaine is a strong stimulant that increases alertness, causes euphoria, and makes people feel powerful. High doses read more or amphetamines Amphetamines Amphetamines are stimulant drugs that are used to treat certain medical conditions, but are also subject to abuse. Amphetamines increase alertness, enhance physical performance, and produce read more )

Essential tremor usually begins during early adulthood but can begin at any age. The tremor slowly becomes more noticeable as people age. Thus, it is sometimes incorrectly called senile tremor. The tremor usually involves the arms and hands and sometimes affects the head. When it affects the head, people may look as if they are nodding yes or shaking their head no. These tremors are usually worsened by holding a limb outstretched (against gravity) or by moving a limb.

Resting tremor occurs when muscles are at rest. An arm or a leg shakes even when a person is completely relaxed. The tremor becomes less noticeable or disappears when the person moves the affected muscles. Resting tremors are often slow and coarse.

These tremors develop when nerve cells in the part of the brain called the basal ganglia are disturbed. The basal ganglia help initiate and smooth out intended (voluntary) muscle movements. Such disturbances usually result from

However, resting tremors can also result from use of drugs that can affect this part of the brain, such as antipsychotic drugs and some drugs used to relieve nausea.

Resting tremors may be socially embarrassing, but because they go away when people try to do something (such as drinking a glass of water), they typically do not interfere with daily activities.

This tremor occurs during a purposeful movement, as when reaching for an object with the hand. People may miss the object because of the tremor. Intention tremors worsen as people get closer to the targeted object. These tremors are relatively slow and wide (coarse).

Intention tremors result from damage to the cerebellum, the part of the brain responsible for balance and coordination. Thus, cerebellar tremor and intention tremor may be used as synonyms.

Common causes of intention tremor include

Other disorders and drugs can also cause the cerebellum to malfunction, resulting in an intention tremor. They include

This type of tremor is most obvious when a limb is held in a position that requires resisting the pull of gravity, as when people hold their arms outstretched.

The most common postural tremors are

  • Physiologic (normal) tremor

Complex tremor is a tremor that has features of more than one type of tremor.

Common causes of complex tremors are

Many disorders can cause tremor.

Most commonly, tremors are

Sometimes there is more than one cause of the tremors. For example, a person may have essential tremor and Parkinson disease.

The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.

The following symptoms are cause for concern:

  • Tremors that start abruptly

  • Tremors in people who are under 50 years old and have no relatives who have had essential tremors

  • Other neurologic symptoms, such as a change in mental status, muscle weakness, changes in the way a person walks, and difficulty speaking

  • A rapid heart rate and agitation

People with warning signs should see a doctor immediately.

People without warning signs should see a doctor as soon as possible.

If people are under 50 years old and do not have a family history of essential tremors, they should see a doctor soon. Being evaluated by a doctor is important to make sure that the cause is not another disorder or a drug.

Doctors ask about the tremor:

  • Whether the tremor began gradually or suddenly

  • Which body parts are affected

  • What triggers it (such as movement, rest, or standing)

  • What relieves or worsens it (such as alcohol, caffeine, stress, or anxiety)

If the tremor began suddenly, doctors ask about events that may have triggered it (such as a recent injury or use of a new drug).

Doctors review the person's past medical history, looking for conditions associated with tremor Some Causes and Features of Tremor A tremor is an involuntary, rhythmic, shaking movement of part of the body, such as the hands, head, vocal cords, trunk, or legs. Tremors occur when muscles repeatedly contract and relax. (See read more . They ask about tremors in close relatives. They review the drugs taken and ask about use of caffeine, alcohol, and recreational drugs (particularly whether the person recently stopped using such drugs).

  • When the affected body parts are at rest and when they are fully supported (for example, hands in the person's lap)

  • While the person maintains certain positions (such as holding the arms outstretched)

  • While the person is walking or doing tasks with the affected body part

The quality of the person's voice may be observed when holding a long note.

Doctors can usually identify the type of tremor based on its characteristics and results of the medical history and physical examination—for example,

  • Tremors that develop gradually: Usually physiologic or essential tremor

  • A postural tremor that starts suddenly: Possibly psychologic factors, a poison, a disorder (such as hyperthyroidism), stopping use of alcohol or another drug (such as a sedative), or use of a drug known to cause tremor


Brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT) is done if

  • The person has other neurologic symptoms that suggest a brain disorder, such as a stroke, a tumor, or multiple sclerosis.

  • The tremor started suddenly or progresses rapidly.

Blood tests may be done to check for possible causes when the cause is unclear. Tests may include

  • Measurement of blood sugar

  • Tests to evaluate how well the thyroid and parathyroid glands, liver, and kidneys are functioning

For mild tremor, no treatment is needed. If tremors become bothersome, some simple measures can help:

  • Grasping objects firmly and holding them close to the body to avoid dropping them

  • Avoiding uncomfortable positions

  • Avoiding other circumstances that trigger the tremor (such as consumption of caffeine, lack of sleep, or fatigue)

  • Using assistive devices, as instructed by an occupational therapist

Assistive devices may include rocker knives, utensils with large handles, and, particularly if the tremor is severe, button hooks, Velcro fasteners (instead of buttons or shoe laces), zipper pulls, straws, and shoe horns.

Eliminating or minimizing the trigger may lessen the tremor. For example, avoiding caffeine, getting enough sleep, and minimizing stress may help.

If many daily activities (such as using utensils and drinking from a glass at mealtime) become difficult or if the person's work requires steady hands, drug therapy may help.

People with a physiologic tremor and anxiety may benefit from taking a low dose of a benzodiazepine (a sedative), such as lorazepam. However, these drugs should be taken only occasionally.

For some people, drinking alcohol in moderation may lessen the tremor, but doctors do not recommend this tactic as a treatment. Heavy drinking followed by suddenly stopping makes the tremor worse.

Antiseizure drugs (primidone, topiramate, or gabapentin) or propranolol may also be used if needed to control the tremor.

Benzodiazepines may be used to treat essential tremor if other drugs are ineffective.

Intention tremors are difficult to treat, but if the condition causing it can be corrected, the tremor may resolve.

If the condition cannot be corrected, a therapist may put wrist and ankle weights on the affected limb to reduce the tremor. Or people may be taught to brace the limb during activity. These measures sometimes help.

For this procedure, tiny electrodes are placed in the area of the brain involved in tremors—the basal ganglia (collections of nerve cells that help smooth out muscle movements). The electrodes send small amounts of electricity to the specific area of the basal ganglia responsible for the tremors and thus help relieve symptoms.

Deep brain stimulation is sometimes done when drugs cannot control a severe, disabling tremor. Sometimes essential tremors or tremors due to Parkinson disease or another disorder require such treatment. Such treatments are used only when drug therapy has been tried and has been not been effective. These treatments are available only at special centers.

Many older people think that developing a tremor is a part of normal aging and may not seek medical attention. Nonetheless, older people should talk to their doctor, who can ask them questions and do a physical examination to check for possible causes of tremor. Doctors may then recommend strategies or possibly drugs to lessen the tremor.

Tremor can significantly affect quality of life in older people, interfering with their ability to function, especially if they have other physical or mental impairments. Physical and occupational therapists can provide simple coping strategies A tremor is an involuntary, rhythmic, shaking movement of part of the body, such as the hands, head, vocal cords, trunk, or legs. Tremors occur when muscles repeatedly contract and relax. (See read more , and assistive devices may help older people maintain quality of life.

  • Tremors can be classified based on when they occur—whether at rest (resting tremor) or when moving (action tremor)—and action tremors can be classified as those occurring at the end of a movement toward a target or during any voluntary movement (kinetic tremor), when moving toward a target (intention tremor), or when holding a limb outstretched (postural tremor).

  • Most tremors are physiologic (normal) tremors, and some are essential tremor or are caused by other disorders.

  • Tremors that occur during rest are often caused by Parkinson disease.

  • Doctors can usually identify the cause based on the history and physical examination.

  • If a tremor begins suddenly or is accompanied by other neurologic symptoms, people should see a doctor right away.

  • If people are under 50, have a tremor, but do not have a family history of essential tremors, they should see a doctor soon.

  • The cause of the tremor is treated if possible, but otherwise, some simple strategies (such as avoiding circumstances that trigger tremors) and sometimes drugs can help control the tremors.

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When Back Pain May Be a Medical Emergency

The underlying causes for most occurrences of back pain are non-emergent, but the intense pain and related symptoms often elevate anxiety and prompt a visit to the emergency room (ER). While back pain is typically treated in a primary care setting or by a musculoskeletal specialist, physicians are often cautious and look for warning signs of neurologically impairing or life-threatening causes. These causes are rare, but if present, they are considered a medical emergency and warrant immediate treatment to preserve back and/or leg function.

Though rare, acute cauda equina syndrome is a serious medical emergency. It usually requires immediate medical attention. Watch Cauda Equina Syndrome Video

Back pain is considered the most common musculoskeletal cause for emergency room visits and typically involves individuals aged 18 to 65 years.1,2

This article provides a comprehensive guide to when back pain may indicate a medical emergency and the associated red-flag symptoms to watch out for.

When an Emergency Room Visit Is Warranted for Back Pain

When dealing with severe back pain, making a judgment call about whether to seek help in a doctor’s office or visit the ER may be difficult.

The following list describes the symptoms and signs related to conditions that may have resulted in spinal cord, cauda equina, or internal organ damage, which are typically considered as a medical emergency.

Abdominal aortic aneurysm

Lower back pain that radiates to the front abdomen may occur together in a rare, serious medical condition called abdominal aortic aneurysm. Classic symptoms include:

  • A continuous, stabbing pain of severe intensity felt deep in the abdomen between the sternum in the center of the chest and the belly button.
  • Lower back pain, which may also spread to the groin, pelvis, and/or legs.
  • A pulsating mass in the abdomen, which may be felt through the skin and is sensitive to touch.
  • Sudden and rapid heartbeat, shallow breathing, clammy skin and cold sweats, general weakness, confusion, anxiety, and/or loss of consciousness, indicating shock.

Abdominal aneurysms are more prevalent among men aged 65 to 75 years who smoke cigarettes.3

See Abdominal Aortic Aneurysm Causes

Cauda equina syndrome

Damage to the cauda equina nerves can cause cauda equina syndrome, a condition that results in severe impairments in the lower back and leg(s). The hallmark symptoms of this condition include:

  • Difficulty or inability to control bowel movements with sensory loss and decreased sphincter tone in the anal region4,5
  • Difficulty in passing urine, a reduced urinary sensation, a loss of desire to pass urine, and/or a poor stream4,5
  • Numbness in the groin, buttocks, genitals, and/or inner thighs (saddle numbness)3
  • Sexual dysfunction5,6

Cauda equina syndrome may occur as a result of acute trauma or develop without an inciting event, due to the progression of an underlying condition. These conditions may include a lumbar herniated disc, lumbar spinal stenosis, or spinal tumor that affects the cauda equina nerves.

Read more about Causes of Cauda Equina Syndrome

Spinal tumor

Benign or metastatic spine tumors may cause back pain as the first symptom. Over time, they are typically accompanied by other distinguishing symptoms, such as:

  • Unrelenting pain despite rest and medication
  • Fever and chills
  • Night pain
  • Night sweats
  • Progressive or sudden motor weakness in the leg(s)
  • Unexplained weight loss

Tumors can originate in the spine or spread to the spine from other parts of the body, in which case they are more likely to lodge in the vertebrae because of the spine’s extensive network of blood vessels. The back and leg symptoms are typically dictated by the location of the tumor in the spine.

See Could My Back Pain Be Spine Cancer?

Spinal infection

Harmful microorganisms can travel to the spine from other parts of the body where infection exists. The resulting spinal infection, called vertebral osteomyelitis, can result in back pain. The symptoms of a spinal infection are variable and depend on the age of the patient, the severity of the infection, and the location in the spine. In addition to back pain, spinal infection symptoms may include some combination of the following:

  • Fever with chills
  • Pain that is worse at night
  • Swelling and possible warmth and redness around the infection site
  • Unexplained weight loss

A spinal infection may move into the spinal canal and cause an epidural abscess, which can place pressure on the neural elements, such as the spinal cord, cauda equina, and/or spinal nerve roots. Depending on the level of infection and/or the degree of severity, sciatica-like symptoms, such as numbness, weakness, or paralysis, may occur in the areas of the body below the affected site.

See Osteomyelitis Treatments

Acute trauma

Back pain that occurs immediately after acute trauma to the upper or lower back prompts urgent evaluation. Examples of acute trauma include sudden injuries from events like a slip, fall, playing active sports, or motor vehicle accident.

Moderate to severe back pain may develop as the only symptom or may occur in tandem with neurological symptoms, such as:

  • Leg pain and numbness
  • Inability to lift the foot (foot drop)
  • Complete loss of sensation in one or both legs indicating paralysis

Injuries from acute trauma to the back can result in a spinal fracture or severe spondylolisthesis, which can compress or injure the spinal cord and/or cauda equina at the level involved. If an underlying bone-weakening condition, such as osteoporosis, exists, even mild trauma may cause compression fractures in the spine.

Who May Be Prone to Back Pain from Medical Emergencies

While a serious medical condition can affect anyone, some individuals are more prone to these problems due to their underlying health conditions, physical characteristics, and lifestyle habits.

This list outlines the groups of people most prone to back pain from medical emergencies:

  • The young and the elderly. The age of the individual is an important initial consideration when diagnosing back pain. Those less than 18 years or more than 50 years of age are typically at a higher likelihood of serious conditions as the cause for the back pain and typically need immediate care when symptoms occur.
    • Tumors and infection occur with higher frequency in both these age groups.1
    • Younger individuals are at increased risk of spondylolysis and spondylolisthesis.1 If these conditions are severe, they can affect the neural elements of the spine, causing pain and disability.
    • Elderly individuals are more susceptible to abdominal aortic aneurysm.3
    • Older individuals may sustain fractures, including pathologic fractures, even with minor trauma.1
  • The immunocompromised. Reduced immunity or a weakened immune system can make individuals susceptible to specific spinal conditions. Examples of the various causes of reduced immunity and the resultant back pain conditions that are likely to occur are outlined below1:
    • A history of intravenous drug abuse, and/or recent bacterial infection, such as pneumonia or urinary tract infection, may pose an increased risk for spinal infection.
    • Chronic steroid use and/or a history of cancer are linked to an increased risk for a spinal fracture, even from minor trauma.
    • Cancer in another part of the body, especially in the breast, lung, or prostate, can metastasize in the spine, which is the third most common site for metastatic tumors.

As a general rule, any concerning symptom or sign needs to be evaluated by a medical professional. A trained medical professional can adequately evaluate the vital signs, prescribe the necessary diagnostic tests, identify potential neurologic defects, and uncover any red flags. Physicians can also provide timely treatment to prevent the progression of the condition, avoiding permanent damage to the tissues.

See When to Seek Medical Care for Low Back Pain


  • 1.Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. ;28(4) doi: /j.emc
  • 2.Pakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. ;(2) doi: /AJR
  • 3.Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, Accessed January 15,
  • 4.Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier;
  • 5.Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. ;64()– doi/bjgp14X
  • 6.Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; doi/b
Low Back Pain Part 1: Anatomy of Muscle, Facet Joint, \u0026 Sacroiliac Joint Injuries

Different Symptoms of Back Issues

back issues

Back pain is one of the most common reasons why people see a doctor or even miss work or school. Back pain does not discriminate – it affects people of all ages and both genders.

A hurting back can be the result of lifting heavy objects or simply improper posture. In some cases, it may also result from a fall that may have been considered inconsequential.

Our back supports the upper body, the spinal column, and our everyday mobility. The bones and discs in the spinal column also protect the spinal cord, which hosts the body’s nerve center. This is responsible for transmitting messages from the various parts of the body to the brain.

Common Signs of Back Issues

Back pain may indicate a more serious underlying health issue. The following symptoms should be addressed by a medical professional:

Stinging or Burning Pain

Back pain may be due to improper posture or a stressful day at work. But if the pain is a burning or stinging pain, or if it extends from one spot on your back and down one of your legs, it may be a symptom of a dislocated or herniated disc.

Also, if you had a hard fall or if you accidentally hit or struck your back against something, a visit to the doctor is a must. It is better to get quickly evaluated and treated than for an injury to get worse and potentially become debilitating.

Numbness and Weakness

A sudden feeling of numbness in the back, including in the arm or down the legs, may be due to nerve damage or inflammation in the spine. Unusual weakness in the arms often indicates a problem in the nerve roots of the spinal cord.

Problems with the Bladder or Bowels

Some common, but also frequently disregarded, symptoms of back issues include the following:

  • Difficulty urinating or passing stools
  • Blood in the urine
  • Numbness of the genital area

If you experience any of these symptoms along with numbness in one or both legs, it should be treated as an emergency. A problem with the spinal cord nerve roots is irreversible if left untreated, so immediate treatment is the key to thwarting any further damage.

Fever and Chills with Back Pain

Back issues are often accompanied by fever or chills. Fever may signal an infection, which requires treatment as quickly as possible.

No matter how mild lower back pain may be, if it is coupled with chills or a feverish feeling, it deserves medical attention before it becomes worse. This pain may also be accompanied by unexpected and abrupt weight loss.

Back Doctors in New Jersey

If you live in the Dover area in New Jersey, visit the professionals at Orthopedic Associates of West Jersey. Our well-trained physicians and surgeons are happy to provide you with the best remedy to relieve your back pain and other symptoms.

Call us today at () , or schedule an appointment online. We look forward to helping you enjoy a more pain-free lifestyle once again.

Filed Under: Back PainTagged With: back pain, lower back pain, orthopedic associates, orthopedic associates of west jersey, orthopedic doctor


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