At some point in our lives we can expect to have an episode of back pain.
Thankfully most of the time the back pain will disappear within a few days. For other people though the pain can last for weeks or even years, causing a significant burden on their lives.
Back pain is one of the top reasons for days off work and costs businesses in the UK millions of pounds each year!
As an osteopath in Finchley I see all types of back pain and low back pain with many different causes so I thought I would share my experience about it so you can understand what is going on with your back pain.
Low Back Pain
“Low back pain” doesn’t describe the cause of the pain, of which there are many!
Successful treatment of low back pain is dependent on the diagnosis, establishing the triggers and the predisposing factors, a good treatment plan and most importantly; the things you do on your own to get it better.
As well as the mechanical causes of low back pain there could also be more serious problems, or pathologies, causing the pain.
I’ll talk about these later.
As such it is important to be diagnosed by someone such as an Osteopath who has the medical knowledge to differentiate between musculoskeletal issues and those that need referral for further investigations.
Structural Causes of Low Back Pain
The majority of back pain causes that we see at Precision Wellbeing are very common and treatable (the extent of recovery depending on the severity of the problem however).
The spine is a complex structure with many intricate areas surrounded by nerves, muscles, ligaments, discs, and joints.
Usually the sudden onset of pain may just be “the final straw” to years of poor usage or body mechanics.
These more common issues tend to fall within the following categories.
Discs
Discs are the “pads” that sit in between each vertebra providing cushioning and allowing movement from segment to segment.
You may have heard the term “slipped disc”; a layman’s term to describe a disc bulge or disc prolapse. Disc problems are one of the most common problems us osteopaths see in practice.
Discs are made up of rings of fibrous tissue, collectively known as the Annulus Fibrosus, surrounding a soft toothpaste-like centre called the Nucleus Pulposus (NP).
Over many years of wear and tear the annulus fibrosus can become thinner and eventually the nucleus pulposus can start to bulge through. Initially this begins as a disc bulge but eventually can progress to a full disc prolapse.
Disc prolapses can press on nerve roots which causes pain and other neurological problems.
Lumbago
Sometimes you will hear the term “Lumbago” used to describe low back pain.
“Lumbago” and “Low Back Pain” both have the same meanings and are often used interchangeably. Both used to describe pain localised to the low back with no referral of pain.
The terms Lumbago and Low back pain are both non specific terms and are not diagnoses (they are not describing what is actually causing the pain).
Muscle Spasms
When a muscle spasms it is usually the body’s way of protecting an area from further damage.
The spine is surrounded by muscles, some quite large and others tiny, each with their own specific purpose; from maintaining posture to controlling movements.
Sometimes these muscles can be over stretched (suddenly or gradually) beyond their limit causing a reflex action to contract to prevent further injury.
When this happens the contraction is often too strong and results in spasm (a strong contraction that doesn’t release). This causes pain along with reduction of movement in that area.
Spasms will often release on their own but can take weeks to fully return to normal if left untreated. Sometimes, a spasm doesn’t release and that part of the muscle will become solid and fibrotic. It almost feels like a rope or a ball underneath the skin.
This causes the muscle tissue to produce more waste products which will cause more pain.
The pain then causes the muscle to remain tight which then leads into a vicious cycle of pain, spasm, pain, and will remain this way until an external stimulus such as deep tissue massage or osteopathic manipulation breaks that cycle.
Ligament Sprains
Ligaments are what join bone to bone and give joints their structural stability.
In the spine there are different sizes of ligaments ranging from the small ones that support the discs to the large nuchal ligament that runs down the back of the spine.
The ligaments in the spine and pelvis tend to be responsible for pain in more traumatic injuries such as falls or sudden impacts, or from gradual stresses such as constant poor posture. We call this ligamentous creep (a bit like if you keep an elastic band at full stretch for a long time).
The recovery time of ligaments can be much slower than muscles due to the ligaments being poorly supplied with blood.
Sciatica
Sciatica is a painful condition characterised by shooting pain down the back of the buttocks, thighs or leg.
There are two main causes of sciatica; Intervertebral Discs or the Piriformis Muscle.
If you have a disc prolapse, there is a chance it may press on a nerve root and send shooting pains down your leg. Some disc problems will resolve on their own while other more serious prolapses may end up needing some surgical intervention.
If the sciatic pain is due to the piriformis muscle then this has a good recovery rate. The piriformis muscle usually sits above the sciatic nerve in most people but in some people the sciatic nerve may run through the piriformis due to genetic variation. When the piriformis spasms and is responsible for causing sciatica it is usually in response to some over exertion movement.
Scoliosis
Scoliosis is the sideways curvature of the spine. Many patients have presented saying they have scoliosis, but when we have a look at their backs many of these patients are perfectly normal.
On the other hand some people have a scoliosis without even knowing.
Scoliosis can be extremely subtle, virtually undetectable, whereas others can be incredibly severe and limiting.
There are two types of scoliosis; Structural and Functional.
Functional scoliosis is the temporary sideways curvature of the spine.
Functional scoliosis is caused by changes in leg length, muscles surrounding the spine or pelvis, or inflammation such as an appendicitis. Any lateral curvatures will disappear when the cause is treated.
Structural scoliosis is a permanent sideways curvature of the spine due to bony changes in the vertebrae. A structural scoliosis can be corrected if caught early enough through exercises and lifestyle modifications. However if left for too long then surgery may be the only method of correction.
Scoliosis can cause pain in the muscles surrounding the spine, cause difficulties breathing or even headaches and digestive problems.
Other Possible Causes Of Back Pain
When we see you in your consultation, we will ask you a detailed set of questions.
The purpose of this is to rule out certain pathologies which are less likely, but still worth checking for.
The questions we ask will be dependent on your age and gender mainly.
For example;
Young females between 16 and 40 may have pregnancies that they are unaware of.
Females can also have pain as a result of their menstrual cycles, polycystic ovaries, fibroids, endometriosis and more.
Older males can have back pain as a result of a Prostate problem.
Older men and women can also have enlarged Abdominal Aortas (a large artery in the abdomen).
Obviously we can’t diagnose every issue but we quite often know when to refer to your GP for further investigation.
How Can Precision Wellbeing Help You?
Our osteopaths will thoroughly assess you, taking into consideration your lifestyle, causing factors, predisposing factors and maintaining factors to build up a picture of the exact problem.
Our aim will be to help you regain the normal pain free function of your spine using many specific hands on techniques and advise you what to do in between treatments, whether that is in the form of exercises, hot or cold packs or some other advice.
Treatment may include soft tissue massage, stretching or joint manipulation. Once you are at a reduced level of pain we often recommend home exercises or physical therapy with our personal trainers.
One thing you can be sure of is that we will do our best to get you better as soon as possible!
So why don’t you give us a call on 0203 356 7060 or