Most low back pain episodes are mild and rarely disabling, with only a small proportion of individuals seeking care. Among those presenting for care, there is variability in outcome according to patient characteristics. Most new episodes recover within a few weeks. However, recurrences are common and individuals with chronic, long-standing low back pain tend to show a more persistent course.
J.A Hayden, DC, PhD
Non-specific back pain
Back pain can have many, different causes including the intervertebral disc, spinal ligaments, stenosis, nerve entrapment to name a few.
In around 80% of back pain cases, it is the intervertebral disc that is causing the pain. Back pain physiotherapy can help patients get better quicker. Unfortunately, patients often hear the diagnosis of non-specific back pain; many clinicians use this term as it is simply easier this way. It does not require them to look for the exact cause of pain. Instead, clinicians prescribe universal exercises for patients to do at home.
You may come across so many different terms in relation to back pain and spinal problems. Oftentimes specialists use very complex, and unknown to patients, specialist vocabulary. This may be very confusing!
Some of the terms you may come across
Spondylosis – relates to degenerative changes in the spine and spinal structures including intervertebral discs, ligaments, vertebrae.
Spondylolysis – this is a stress fracture; very common in active kids and adolescents.
Spondylitis – ankylosing spondylitis is an inflammatory, rheumatological condition affecting the spine and other joints.
Spondylolisthesis – condition where one vertebra slips on the other, exercises and physiotherapy may be helpful to start off with but an operation may be required at some point.
Low Back Pain definition
Low back pain is the fifth most common reason for GP visits.
The European Guidelines for prevention of low back pain defines back pain as “pain and discomfort, localized below the costal margin (the ribs) and above the inferior gluteal folds (above the thighs), with or without leg pain”
Three types of back pain
Low back pain is usually categorized into 3 subtypes: acute, sub-acute, and chronic low back pain.
This subdivision is based on the duration of the back pain.
Acute low back pain is an episode of low back pain for less than 6 weeks, sub-acute low back pain between 6 and 12 weeks, and chronic low back pain for 12 weeks or more
What causes back pain
In most cases, manual handling or sports injury leads to back pain. This happens when the spine and tissues around the spine (like muscles, tendons, and ligaments) are not strong enough.
In other words, the back is not prepared to support us in whatever we want to do i.e. at the gym, in the garden, or when moving furniture. Sometimes we simply want to do more than our body and fitness allows. The resulting injury is a sign of that imbalance. Back Pain Therapy aims to reduce pain and help you recover quicker.
Back Pain and work
Is there a link between the work you do and back pain, you may ask? Can the type of work increase your risk of developing back pain? Of course! In 2019 the Health and Safety Executive completed a health and safety at work report for Great Britain. According to this report, 40% of all MSK disorders reported are related to the back. A link between work-related ergonomics and back pain is clear. The report addresses most likely causes of back pain: tiring body positions, keyboard work (desk sitting), repetitive actions, and poor manual handling.
Back Pain and weather
Cold weather may lead to back pain and increased sensitivity of spinal tissues. The cold will reduce blood supply to soft tissues such as muscles, ligaments, and tendons thereby restricting movement in spinal joints and putting a strain on your spine. It may also affect spinal nerve roots.
There is no scientific evidence, however, linking back pain to barometric pressure. We know though that some people can sense forthcoming weather changes (i.e a rain, or storm) in their backs. They start experiencing aches and dull, low-grade, pain that can’t be otherwise easily explained.
Two Scandinavian studies were conducted in recent years. One of them recruited almost 135000 construction workers! These studies do prove a link exists between cold weather and back pain. So keep warm once the summer is over!
Back Pain – what are common sources of pain?
There are many potential sources of back pain. Here I list the most common ones
- Slipped (prolapsed) disc (a disc of cartilage in the spine pressing on a nerve) – this can cause back pain and numbness, tingling, and weakness in other parts of the body
- Torn muscle or tendon – there are a number of muscles supporting your lower back. Some of them are responsible for spinal movements, others stabilize the spine and make sure it can function properly. Muscle or tendon tear may be causing pain and also be a source of inflammation.
- Ligaments – Ligaments are there to stabilize the spine and ensure all vertebrae are kept in place. Spinal ligaments, for example, ligamentum flavium, can degenerate with age or after trauma. Under such circumstances, ligaments usually increase in thickness and may calcify or become infiltrated with fat
- Stenosis – foraminal stenosis is likely to cause pain, the narrowing of the intervertebral foramen will also lead to the local inflammation
- Sacroiliac joint – pain from sacroiliac joint is relatively common; 20-25% patients presenting with low back pain will have sacroiliac joint disfunction and sacroiliitis. More about the sacroiliac joint pain here.
Back Pain – other sources of pain
- Sciatica (irritation of the nerve that runs from the lower back to the feet) – this can cause pain, numbness, tingling, and weakness in the lower back, buttocks, legs and feet. Sciatica- like symptoms are often associated with problems outside the spine. Any problem with the sciatic nerve on its way down to the foot may be painful. Take for instance the Deep Gluteal Syndrome – almost 70% of cases are due to the piriformis muscle compressing on the sciatic nerve.
- Ankylosing spondylitis (swelling of the joints in the spine) – this causes pain and stiffness that’s usually worse in the morning and improves with movement
- Spondylolisthesis (a bone in the spine slipping out of position) – this can cause lower back pain and stiffness, as well as numbness and a tingling sensation
- Degenerative Disc Disease (DDD)
Disc degeneration may be completely asymptomatic, or the pain may be so intense that patients cannot continue with their daily activities. Age usually makes symptoms worse. The discomfort can range from mild to severe and debilitating. DDD can lead to osteoarthritis, with pain and stiffness in the back.
Myelopathy is in other words a compression of the spinal cord. It may occur in any part of the spine and the higher the compression the more serious consequences and symptoms. The most common form is cervical myelopathy, very rarely it occurs in the lumbar spine. The spinal cord, of course, is connecting the brain with muscles and carries vital messages that allow us to function normally. Its compression may lead to serious consequences.
Myelopathy, apart from the pain and discomfort, causes neurological symptoms (positive Hoffman sign, clonus sign, Babinskis, spasticity, hyperreflexia)
You may have problems with walking, coordination, balance, and strength. Your hand dexterity may be affected in cervical myelopathy and you may find it difficult to button up a shirt or hold a kettle.
What is causing myelopathy:
- Spinal degeneration – for example arthritis
- Ruptured discs
Oftentimes myelopathy does not progress quickly, and patients are neurologically stable for prolonged periods of time (even years). Sooner or later though myelopathy is getting worse and neurological functioning deteriorates.
Good news is that with prompt surgical intervention the condition can be improved, and patients can recover well. This is why diagnosing myelopathy is essential and MRI can help with that. No form of therapy will be helpful to this group of patients.
Also, patients with lower back pain who develop walking problems (especially ataxic type of gait) should be screened for cervical myelopathy and MRI of the neck should be done too. One needs to remember that stenotic changes in the lumbar spine co-exists with stenosis in cervical spine I roughly 20% of patients.
Back Pain and Intervertebral Discs
Spinal discs degenerate with time. The older we are the more likely we can experience a disc-related issue and back pain.
Pregnancy Back Pain
Back pain related to pregnancy is very common. It is that common that it would be surprising to see a woman with an advanced pregnancy not having any aches or pains in the low back.
The shift of the center of gravity, body weight gain and hormonal changes all lead to discomfort and pain in the low back. In addition to back pain, pregnant women are prone to developing pain in the pelvic girdle, groin, and symphysis pubis. At Physio-Soton, we help pregnant women with back pain issues. Call Southampton clinic with inquiries or to book an appointment
Chronic Back Pain
Chronic pain is defined as pain lasting for three months and more. Generally, the pain should go away within 3 months of its onset, but sometimes it lingers for much longer. Chronic back pain may be a result of an ongoing problem. For instance, patient may have an inflammatory process affecting the spinal tissues. The other cause might be to do with spinal nerves that sometimes get entrapped or compressed and give you pain that lasts for a long time. Pain may be a consequence of an old injury. It is not that uncommon to have a highly sensitized nervous system (it is called central sensitization) after an injury. It will be reminding you of the old injury, although the injury is no longer there. Pain is the protective mechanism that our bodies use in case of an injury. However, sometimes, that mechanism does not function properly, and we experience pain even though there is no need for that as the injury is gone.
Back Pain Physiotherapy – non-specific back pain
In the UK, clinicians very often give patients the diagnosis of non-specific back pain. Patients end up with a diagnosis after a 10-minute consultation. Is it a good thing? I do not think so! Watch my interview with Professor Stuart McGill below to find out what he thinks about it. I agree with him 100%. I do think every case of back pain has an underlying cause. The difficulty is that many clinicians including General Practitioners do not have specialist skills and knowledge to diagnose back pain. Well, they would not even have time to see patients for long enough to formulate a proper diagnosis based on clinical examination.
Back Pain – diagnosis takes time
Clinicians seldom have enough time to carry out proper diagnostic tests to find out really what is happening. During 10 minutes slots, GPs are required to see patients, examine them, prescribe treatment, and complete a set of medical notes! Patients are likely to receive Paracetamol and advised to rest for a week or two. That’s it! I am not surprised that patients then are so keen to have an MRI or any type of scan just to find out more about their problem and how can they help themselves. This is a difficult topic. Partly, because investigating back pain and the conduct of several diagnostic tests take time! Professor McGill spends 3 hours or more with each patient! You would not get it on the NHS! The other thing is that clinical research is not conclusive and we learn something new every day! Last but not least, the back is a complex part of our body; it does not make the process of making a diagnosis any easier.
Back Pain and serious conditions
Very rarely, back pain can be a sign of a serious problem such as:
- a broken bone in the spine especially as a result of a locomotive accident, fall or osteoporosis
- an infection
- cauda equina syndrome (where the nerves in the lower back become severely compressed)
- some types of cancer, such as multiple myeloma (a type of bone marrow cancer)
Back Pain Self-Help Tips
Back Pain Physiotherapy – can massage help me?
The answer is – It depends. Massage may help with certain conditions, muscle stiffness, tension, work-related back pain, and overuse injuries. It is great to loosen things up around the spine and for you to start feeling better. Moreover, it is also helpful in addressing any muscular imbalances and tensions. Many of my patients after massage feel great and no further therapeutic intervention is required. Massage, from my experience, will not do much, however, when it comes to so-called spinal mechanics and what is happening in the spine itself. Spinal joints oftentimes get jammed – this requires manual therapy on the spine itself. This can be achieved through spinal articulations or manipulations. Massage may take the edge of the pain, but will not help reduce or eliminate the pain long term. Find out more about massage from my article on the topic
Back Pain Physiotherapy – before your appointment
It is important you prepare yourself before consultation and therapy. I would ask you to:
- wear loose clothing
- avoid taking painkillers before your visit, if at all possible
- only eat a light meal
- Complete relevant COVID screening form online
- Complete and sign the Therapy Consent Form online
Back Pain Physiotherapy – appointment
During your appointment, I will carry out a series of tests and talk to you about your symptoms and your medical history. This will help me formulate the diagnosis and set the therapeutic program for you. We will also talk about your activities with the emphasis on those that trigger/may trigger your back pain. Eliminating triggers from your daily activities very often speeds up recovery and helps you enjoy pain-free life! In therapy, I use a wide range of modalities to include: manual therapy, therapeutic massage, myofascial alignment and release techniques, muscle energy techniques, neurodynamics (working on the nerves i.e. sciatic nerve) All my patients receive a home physiotherapy program that they need to follow at home. It is what they do outside the clinic that really counts most! If you live in Southampton and are in too much pain to come to me, call me to check if I can visit you at home.
Back Pain Therapy – after your appointment
You may feel sore, and achy after therapy but this is likely to settle within 72 hours after treatment. Patients who received manual therapy are more likely to have side effects following treatment for back pain
Back Pain – interview with the expert – Prof. Stuart McGill
Watch the video below to learn more about:
- Back pain from the biomechanical standpoint
- Why there is no such thing as non-specific back pain
- Different causes of back pain in sport
Back Pain Physiotherapy Clinic – how to find me
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