Understanding Back Pain

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?

Get in touch on 07725 304709, or email twistphysio@gmail.com

Twist Physiotherapy is now the club physiotherapist for Elemental Fitness and Kickboxing

Logo Rebecca Gregson

Who am I?

My name is Rebecca and I’m delighted to be working with Elemental Fitness and Elemental Kickboxing to offer a 1st class, bespoke physiotherapy service. I run Twist Physiotherapy which is based at Evolve Medical a CQC registered clinic near Owlcotes, Pudsey. I have worked in the NHS in a wide range of settings and in the private and charity sectors. I have worked with elite footballs and rugby players post orthopaedic surgery. I have run my own musculoskeletal clinic since 2017. I work with bootcamps, gyms, PTs, sports clubs and running clubs to treat sports and non-sports injuries. Getting my clients back to exercise and meet their own rehabilitation goals is my absolute passion. I treat a wide range of ages, ability and fitness levels, so it’s not all about sports injuries but pathologies such as, long-standing back pain or arthritis.

What is Physiotherapy?

Physiotherapy is aimed at restoring movement and function when injury, illness or disability cause problems, it also helps with injury prevention, reducing the risk of further injury or illness. Physiotherapy takes a whole person approach. This means that you are treated as an individual taking into account your physical, emotional and social situation. In my experience this is the most effective way of using physiotherapy. Physiotherapy is a partnership between you and your therapist and involves enabling you to manage your own condition. Conditions such as back pain, neck pain, shoulder pain, lower limb pain and sporting injuries can be treated. Physiotherapy also encompasses other areas such respiratory, neurological or cardiac conditions.

Physiotherapy is a degree qualified profession governed by the Health and Care Professions Council. The majority of physiotherapists work in the NHS, but there is an increasing number of us working independently to offer private care.

How can physiotherapy help you as personal training client?

As somebody that trains regularly or somebody that has started out you may notice that you pick up some niggles or injuries along the way. Sometimes these resolve themselves quickly, sometimes they linger for weeks or even months. You may find that the symptoms worsen and you have to adapt your exercise or technique or even stop certain activities. This can be frustrating and make you feel like you are losing motivation to hit your goals.

Injuries can occur as a trauma such as, a hamstring tear during a specific movement such as a fall or they can occur as an overload injury this can be the result of over training such as, going straight for a 10k run when you haven’t run before. Or it can be a repetive injury you can even get this in the office, for example if you do a repetive activity such typing all day. It can also occur as a sporting injury such as constantly overloading with an underlying injury or biomechanical issue.

Let’s take an example, think about your shoulder. There’s lots of things that can wrong here! But let’s think about the rotator cuff muscles, these are the intrinsic muscles i.e. deep not the ones you see on the outside such as the deltoid muscle. The rotator cuff keeps the head of the humerus in the glenoid fossa i.e. the socket. There are 4 in total that give the shoulder stability and certain movements. The shoulder joint is very shallow to allow for the wide range of movement we have. This means there’s lots of structures within the joint ligaments, tendons etc. If for example we have any inflammation this can reduce the joint space and cause ‘impingement’ in turn this causes pain, reduced range of movement and strength.

Rotator Cuff

Initially we’ll start to struggle at the gym lifting weights, bench pressing and sometimes weight bearing i.e. press ups or planks and at home we’ll start to get pain on dressing and reaching into cupboards. It’s super important that shoulders are dealt with quickly as they are in danger of becoming very painful and restricted. The first course of action is physiotherapy, this involves assessing your posture, movement and strength. Posture is super important when exercising and in everyday life so if you slouch forward, you are automatically putting your shoulder at a disadvantage. Your shoulder needs to sit neatly on your rib cage and be able to rotate to enable the shoulder move. Then we have muscle imbalances the rotator cuff, sometimes we’ve over trained the big muscles you can see but neglected the rotator cuff. Pain means we don’t want to move even though it is often the very thing we need to do to recover. This is where physiotherapy comes in, we can help you understand the ways to move, strengthen the weak muscles and mobilise any stiffness and educating you that it’s OK to move! This is done through a combination of bespoke exercise plans, hands on treatments, electrotherapy and other treatment techniques such as taping. All helping you on the road to recovery and back to what you love doing.

Common Kickboxing Injuries

Injuries to Professional and Amateur Kickboxing Contestants, A 15 year retrospective study, Reidar P Lystand PhD, Orthopaedic J Sports Med. 2015 Nov;3(11) Anatomic region and type of injury incurred

Anatomic Region Type of Injury
Head Dislocations
Shoulder Fractures
Elbow Hematoma
Forearm Joint sprain
Wrist and hand Laceration
Trunk Nerve injury
Chest Organ injury
Abdomen Tendon injury
Hip and groin
Thigh
Knee
Lower leg
Ankle
Foot

What to do to reduce the risk of injury

Make sure you warm up properly, this means getting your heart pumping as well as stretching out your limbs before training Make sure you are training at the correct level.

To reduce the chance of repetitive type injuries, mix your training regime up. A good balance of cardio, strengthening, stability and flexibility training gives you an all-round fitness that helps stave off those niggles.

Keeping a good fitness level in general will help you get more out of your training.

Introduce yourself to any new activity slowly!

What should I do if I get injured?

With a soft tissue injury, you want to be following the RICE protocol. Rest initially but not too long as we need to ‘load’ our tissues to start recovery, this is where physiotherapists come in! We can guide you through from acute injury to end rehab. Ice for the first 48-72 hours to reduce swelling, this will help you move your limb to get the blood flowing. Compression is great for a big swollen ankle, getting the swelling down enables you to get moving. I often advise tubi-grip of similar as long as swelling remains. Elevation, get those feet up to aid with circulation. If you’re worried at all especially if there is any deformity, there is excessive heat or tightness, you are struggling with pain management, you are struggling to weight bear or you are seeing no improvement you will need to seek medical attention.

Sometimes soft tissue injuries will sort themselves out quickly, this depends on the level of damage to the tissues. Sometimes they can take a really long time, some research suggests it can take up to 2 years to completely recover from some injuries. Structures such as the rotator cuff that I spoke about earlier have poor blood flow and therefore, take longer to recover. If you find your injury is not getting better it is always better to get professional advice and a rehabilitation plan.

If an injury is not rehabilitated properly it can lead to reinjury or become chronic in the sense that you lose range of movement and strength and have prolonged pain. A classic example is sprained ankles. Feet and ankles are really complex structures with many small bones, ligaments, tendons and nerves. Given the amount we ask from our ankles it amazing how such small ligaments are involved in keeping them stable. It means we have lot’s of input from the ankle/foot to our brains to make sure we can for example adapt to uneven surfaces or as in kickboxing do activities on a single leg. When we get injured those sensors that tell us where to place our foot get confused and we can struggle with our balance as well as the joint and/or soft tissue needing to heal. Feet themselves are notoriously weak, maybe because we wear footwear most of our lives, they have become lazy!

I nearly always give foot strengthening exercises for ankle and foot injuries and often lower limb issues in general. Here are some examples of exercises you can do to keep your feet strong and able for kickboxing.

Toe curls

Simply place a towel on the floor and scrunch it up with your toes.. it’s harder than it sounds! On a similar note try picking up a marble with your foot.. this one is great fun to get competitive with!

Arch shortening

Again, harder than it sounds, this is a strange one as we are a bit switched off from doing this movement you want to be placing your foot flat on the floor and start tell the front of your foot to slide back to shorten your foot arch.

Foot splaying

Simply spread your toes!

What to expect at your physiotherapy appointment?

Initially you will receive an assessment, this involves looking at your posture and how you move, range of movement and strength, physiotherapists also use ‘special tests’ to ascertain the source of your issue. As you are assessed I will explain what I am doing and why and will also explain what I think is happening we will then make a plan towards recovery. Treatment courses usually involve 3 to 6 sessions but this can vary. Your plan is bespoke to you this means that you will receive your own exercise plan via Physiotec, where you can see videos and explanations of the exercises that you have been given. You can also track your progress on the Physiotec App. Depending on your needs your treatment sessions may also involve mobilisations, soft tissue release and/or taping techniques. I often incorporate pilates based exercises in rehabilitation plans as I find this an extremely effective modality to get back to your sport or exercise preference. Either bring or wear shorts and a vest top for ladies. More information is available at www.twistphysiotherapy.co.uk

To book an appointment go to www.evolvemedical.co.uk and scroll to physiotherapy.

Clinic number 0113 257 6701 Mob. 07725 304709 Email twistphysio@gmail.com FB and IG @twistphysiotherapy

Twist Physiotherapy at Evolve Medical, Priesthorpe Ave, Pudsey, LS28 7TG

The menopause and musculoskeletal pain

The Menopause and Physiotherapy The menopause is becoming more of a hot topic with the recent airing of Davina McCall’s documentary for Channel 4. The NHS is also recognising the significant effects on women’s health by introducing measures for employees. The Welsh TUC found that 8 out of 10 women had noticeable symptoms during the menopause whilst 45% found their symptoms troublesome. Most women found the work environment made their symptoms worse. Which is strange when you think that millions of women in fact the majority of women struggle with the menopause one way or another, after all it is natural process of the woman’s body around the ages of 45-55. Main symptoms of menopause are hot flushes, night sweats, vaginal dryness, joint and muscle pain, fatigue, depression and anxiety. All those fun things. The menopause is often talked about in a physiotherapy clinic due to the physiological effects that it has on the body and the fact that women in their 40s onward form a large proportion of people seeking physiotherapy. A woman’s experience of the menopause is massively variable there are around 30 symptoms of the menopause including physical and psychological symptoms and can also have social implications. From a physical health point of view injury risk increases from perimenopausal stage onwards. This can mean an increase in risk from anything from sports injury to repetitive strain conditions. Tendons, ligament and oestrogen levels are important to consider although not fully understood, we do know there is some effect of changing oestrogen levels on connective tissue. It is thought that decreased oestrogen levels impact on the ability of the body to strengthen and repair tissues. It is also worth bearing in mind that the normal aging process effects the ability of type 1 collagen (which comprises around 95% of tendons) to repair. This is also relevant in considering other musculoskeletal issues during aging and the reduced ability of the body to repair itself, think grey hair on the inside. It is also thought although not much researched that oestrogen enables connective tissues to tolerate and adapt to load, think about recovering from an injury. Generally speaking In physiotherapy with teach you during the rehabilitation process to exercise and gradually increase repetitions and resistance. This is because we need to ‘load’ in order to recover from injury be it sports or otherwise. Are we now thinking that reduced oestrogen means longer rehabilitation and more risk of injury? This is what I would say I see in clinic. While an over simplification we can conclude that reduced oestrogen levels play havoc with our musculoskeletal health. It’s also worth mentioning bone health, I often send my ladies off to get a bone density scan.. why? It’s that pesky oestrogen again basically reduced oestrogen makes women lose bone mass. This means after about 50 years old women are at risk from osteopenia (the stage before osteoporosis) and osteoporosis. Risk factors such as ethnicity, eating disorders such as anorexia or low BMI, low bone mass prior to menopause, lactose intolerance which can make it difficult to absorb enough calcium and the usual suspects drinking too much alcohol, smoking, taking no exercise. Why does bone density matter and why do we need to know about? Why do send my ladies to GPs to pretty please ask for a bone density (DEXA) scan. Well it’s good to know because we have to be aware that breaking a bone is more likely, a broken hip is no fun. There are treatments that can be used such as medications that can be prescribed to slow the rate of bone density loss and adjustments to lifestyle such as making sure you get enough Calcium and Vit D and that you are taking enough exercise. There’s so much more to say but what does this mean for your physiotherapy experience? As a woman in her 40s I find it easy to empathise with all of my patients of course. I also feel often when I meet a lady perimenopausal onwards she has not been listened too. Often injury is treated in isolation so for example a back pain, tennis elbow or a rotator cuff issue. The expectation seems to be that given the normal amount of healing time and a generic exercise protocol that it will just go away, that alongside the over reliance of the medical model of pain medication, doesn’t always make for a positive recovery. I do know this group of patients is not alone in this experience. We are no doubt an epidemic of treating many disorders like this due to the enormous pressure on the NHS during the covid-19 pandemic. Given my experience of meeting menopausal patients this is a common experience. Don’t get me wrong pain management is a massively important part of musculoskeletal injury management but it’s a long way from the full story. I get frustrated on behalf of my patients who have not been listened too. And certainly with me the first step of the physiotherapy journey is to really listen to what is happening with that person. It’s not just about assessing the physical attributes of why there is pain and dysfunction but to that person’s lifestyle, social situation, medical history, personal experience and social situation. There is no point in giving a busy career woman who travels 5 times a week or a mother with 3 children a 30 minute exercise programme to do 5 X a week which involves using exercise equipment. But there maybe warrant in giving that to somebody that usually runs or goes to the gym but is unable to due to injury. It fills their frustration at not being able to exercise. It’s about engagement and buy in to the recovery process, not one size fits all. This is what you should be expecting this from your physiotherapist. You can book an appointment with Rebecca Gregson BSc(HONS), MCSP at www.twistphysiotherapy.com Her clinic is based at Evolve Medical Pudsey, Leeds