Back pain will affect most people at some point in their lifetime. Government statistics report that 4 in every 10 adults will have suffered low back pain which lasted for more than a day in the last 12 month period.
Most episodes of low back pain will resolve themselves and will require no more treatment than some painkillers and a little time, however some episodes of back pain last significantly longer or are so painful that seeking professional help becomes a necessity.
What can we do for you?
There are many types of low back pain and our first priority will be to take a thorough history of your problem to help us establish the nature of the condition and the best way to help. After taking a detailed history, we will then make a physical examination of your spine, initially observing your posture and movements before using our hands to palpate the muscles, bones and other connective tissues in the area. We will be looking (and feeling) for areas of uneven movement, stiffness at a particular level of the spine, the way that your muscles work to support the spine and produce movement as well as any othe problems which may be relevant such as a hip or knee problem which may be causing awkward movement in the spine itself.
Once we have concluded our examination, we should be able to explain in a way that makes sense to you, the nature of your problem and what we can do to help you. Most often treatment is a partnership – there are things that we can do for you and things that you can do to help yourself. We may have identified a stiff joint in the spine which might need mobilising to improve its movement or you may have weakness in the muscles which support your back, for which we will give you a guided series of exercises to improve.
For most people a short course of treatment is enough to completely resolve the back problem. For some people whose condition is of a chronic nature (for instance arthritis in the spine) we will reach an agreed level of improvement where they can manage their problem themselves with appropriate exercises or modification of their lifestyle. This group of patients may come to see us intermittently for help if they have a flare-up of their condition or, a bit like going to the dentist, they will come in a couple of times a year for us to check on their progress or perhaps to modify their exercises as their condition changes.
Common Types of Low Back Pain
Disc related problems
The disc is a structure which sits between the bones of the spine and performs two jobs; it helps to cushion the impact of activities such as walking and it helps to limit the movement of the spine. In the lower back the disc is up to a centimetre thick and to do two jobs it contains two types of tissue – there is a soft central area which cushions impact and a tough outer coating which wraps around the central area and acts to control movement in the spine.
Degenerative disc disease
This “disease” can be considered the normal ageing process of the spine. Many people who are told this is the cause of their back pain are concerned – degenerative implies that the condition will worsen over time and if their pain is bad now, what will it be like in 20 years time? The good news is that the condition responds well to treatment and in fact for many people the pain associated with the disease gets better over time rather than worse.
In degenerative disc disease the disc itself narrows or loses height. As this happens, the disc loses its ability to cushion impact and the bones which sit either side of the disc come closer together. The X-Ray image below shows a typical narrowed section of the spine below a normal segment.
What can be done to help?
Avoiding impact activities – if the spine has lost some of its ability to cushion impact then it is a good idea to lessen the impact that the spine is subjected to. These activities include running on hard surfaces, water skiing, off-road cycling and motorcycling and high impact aerobics. Exercises that strengthen the muscles around the spine without causing impact are an important part of treatment and include Pilates, exercise classes in water (aqua aerobics) and walking.
Managing you body weight – if the bones in the spine are closer together than normal, to compres them as little as possible would seem a sensible idea. Keeping your body weight at an appropriate level helps greatly especially in men who tend to hold excess weight around their waist which puts further strain on the lower back.
Physiotherapy treatment particularly during a flare up can help by gently mobilising the affected area and relieving any painful muscle spasm which accompanies a flare of this condition. Your physiotherapist will also help devise a suitable programme of exercises for you to perform on a regular basis as well as giving guidance on activities to avoid and those to actively undertake.
This is a commonly used term which is not very descriptive at all and in fact gives rise to a lot of misconceptions about peoples back pain. A “slipped” disc has not slipped anywhere at all! What is being described is a change in the shape of the disc (bulging disc) or damage to the exterior of the disc which lets the soft central part protude (prolapsed disc). Both of these conditions cause pain because the bulging or prolapsing disc presses on the structures around it and irritates them. This gives pain locally in the back and may cause pain elsewhere in the body – referred pain.
The structure often compressed by the disc is called a nerve root – these nerve roots become the nerves which supply different parts of the body with perception of pain, sensation and movement. Pressing on the nerve root can cause pain, weakness and loss of sensation. The commonest example of this is sciatica, pain in the low back, buttock and back of the leg (the area of the body supplied by the sciatic nerve). The pain may vary in severity and the part of the leg it affects; some people with sciatica have no back pain at all but may have severe toothache like pain in the leg.
Most people with disc problems respond well to physiotherapy treatment and only a very small number of people require further medical treatment and fewer still ever require surgery. To give a rough indication of the numbers involved, the practice has been established for 17 years and around one third of our patients come in with low back pain. In 17 years we could count less than ten people we have seen who have required surgery to treat their back problems.