Understanding Back Pain
Back pain is the most common musculoskeletal problem and is one of the main causes of seeking medical attention and work absences in the Western world.
So what’s going on?
Back pain can be caused by a multitude of factors but they usually fall into 3 main categories, injury and certain medical conditions or activities. The risk of back pain increases with age as our discs and vertebrae change. Women who have been through or are going through the menopause have a general increase in musculoskeletal issues, this is due to changes in hormones.
When do you need more urgent care for back pain?
There are red flags associated with back pain. This includes, bilateral weakness, loss of function or changes in sensation that is on both sides of your body. Loss of sensation in the saddle area, sexual dysfunction or loss of bladder or bowel control, especially faecal incontinence. Headaches, dizziness, altered vision, unremitting pain especially on a night, fever or feelings of deformity or heat around the area or previous history of cancer are also red flags. This is not a conclusive list but outlines some of the main issues that would need medical care urgently.
What causes back pain?
This isn’t an area that is fully understood. It can be caused by the vertebrae, the discs which sit between the vertebrae, soft tissue such as ligaments and muscles. Back pain can also be caused by the internal abdominal or pelvic organs and there are some other rare causes such as tumours or chest issues.
Osteoporosis increases the chance of lower back pain, again closely linked to the menopause this involves the bones losing density, although men and younger women can also have osteoporosis. A bone density scan can diagnose osteoporosis. Osteoporosis creates bony changes which leads to risk of fracture and compression on nerves.
The anatomy of the spine is complex and it is therefore, difficult to ascertain the exact cause of back pain. It’s a common misconception that diagnostic tools such as MRI scan can definitely pin point the cause of the pain. Of course this is not always so especially when surgery is indicated, this is rare and in most cases back pain can be managed conservatively.
Acute back pain can be caused by trauma, muscle pull or disc bulges or prolapses. It’s a common misconception that a disc can ‘slip’, the back is an extremely robust structure although back pain can make people feel otherwise. It is often reassurance that physiotherapists can offer that is one of the most effective tools to get people on their way to recovery.
It can be a simple muscle pull or spasm that causes really significant pain and become very disabling in the short term. Sometimes people struggling to sit down due to the acute nature of the pain. This can simply occur from twisting the wrong way for example, lifting shopping bags out of the car or bending down to pick something up especially if it’s heavy. This is not to say we should not do these activities simply an indication of the minor things that can cause back pain. It is really important to realise this does not cause ‘damage’ as such. Disc related back pain often (but not always) presents differently and can causes symptoms to radiate down the leg or arm in the case of cervical pain. Discs can bulge or protrude which can press on the nerves causing pain, pins and needles and/or numbness. Often the radiating symptoms feel worse than the back and the pain can be difficult to manage with pain medication. Your doctor may suggest amitriptyline in this case.
Some people have a curvature in their spine such as scoliosis which can cause pain and ongoing back problems. Most people who have a slight curve can live with it and often not have any symptoms. Some people can have very significant curves which require surgery but this is rare.
Direct trauma to the spine can also cause ongoing problems depending on the nature and severity of the trauma.
Posture and moving!
Staying in one position for a long period of time is not good for anybody. Our bodies are designed to move so sitting at a desk all day for example is detrimental to our musculoskeletal health. What we need to be doing is moving out of that posture. So set your alarm for each hour and get up and move doing some stretches, for more information about how to stretch please get in touch. Try to sit differently, i.e. don’t adopt a hunched over posture for hours on end.
There are a number of risk factors associated with back pain such as being obese and have a sedentary lifestyle, taking no exercise, smoking, certain occupations and illnesses, getting older, mental health problems and genetics. Pregnant ladies are also at risk of back pain.
How can physiotherapy help?
To start with it’s always helpful to try to control the pain, this can be done by using heat and ice, topical pain creams, analgesia you can get medications such as paracetamol and ibuprofen at a pharmacy. If you find this is not managing your pain you can ask your doctor for something more effective. Pain is something that tells our body not to move and it is important to move to start to alleviate the pain. The better the pain control the quicker you will start feeling better.
A short period of rest maybe required although it is important to keep moving, doing some gentle stretches prescribed by your physiotherapist can also help. Your physiotherapist can also provide appropriate hands-on therapies such as mobilising your joints and soft tissue. It’s important to know that it is not anatomically possible to realign or manipulate joints into different places. The clicks and pops you may hear is air pockets moving around in your synovial fluid. Although this may feel relieving and give you a feeling of ‘realignment’ this is not what has happened.
Exercise is important and there is an increasing amount of clinical evidence that this is the most effective way of managing back pain in the long run. It is important to find a type of exercise that you enjoy and take it regularly. Your physiotherapist will also prescribe you with some more specific rehabilitation exercises to help you move in the best way and strengthen specific muscles that maybe weak. Back pain can often lead us to adopt unhelpful postures such as leaning forwards or to the side.
Other factors that can help guard against back pain are healthy diet and maintaining a healthy weight, drinking alcohol in moderation and not smoking... yes all the boring stuff! But unfortunately, it’s true!
Want to know more?
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