Hello and welcome back to the ThreeSpires Physiotherapy blog wheer we take a look at all things physiotherapy and health related. In our last few physiotherapy articles we have looked at conditions of the spine such as scoliosis and sciatica, so I thought it would be good to carry on looking at the spine and this time spend a couple of blog posts looking at the most common musculoskeletal complaint that our physiotherapists help with: back pain. Anyone who has had back pain (most of the UK population at some point) can tell you how extremely painful and limiting it really can be. Before we carry on and just to remind anyone who is not a regular reader of this physiotherapy blog: we are a home visit physiotherapy service based in Lichfield and offering services in Sutton Coldfield, Tamworth, Cannock, Rugeley and Walsall.

Back pain although seemingly simple in nature: "my back hurts and I want it fixed!" is actually extremely compex in terms of underlying structures and is a subject of continuing research into both the causes and best methods of treatment. Certainly my own experience as a physiotherapist is that assessing and treating back pain is extremely challenging due to the wide number of causes and how different each patient is. Athough the back is quite an extensive area, for the purposes of these articles we shall simply look at low back pain which is by far the most common area of the back that our physiotherapists help patients with.

Who Gets Back Pain?

Back pain is extremely common and research shows that almost everyone will have an episode of back pain at some stage in their lives and that approximately 50% of people will have one episode of acute back pain per year.  My own physiotherapy experience is that these figures although large probably underplay how often people have problems with their backs, for example many patients will have ongoing grumbles that they do nothing about for years and will have never attended a doctor or physio for before.

Why Is Back Pain A Problem?

Well apart from the personal discomfort and lack of mobility it is a huge problem for society. It is one of the leading causes of days off work and is a major cause of disability in the developed World. Back pain is pretty much the largest musculoskeletal cause for taking time off work. Time off work is basically lost productivity and increased costs for businesses and therefore back pain is clearly more than just an issue of personal difficulties

What Causes Back Pain?

So, it is fairly clearly a huge problem and you would think that medical science would have identified the precise cause and worked out how best to treat it by now! Well, unfortunately that is not the case and this is most likely due to a number of reasons, one of which being that not all back pain has the same cause and we all do very different things in our lives, some of these activities (or lack of activity to be precise) make us more prone to back pain.

The spine is a complex structure with many possible generators of pain including: the intervertebal discs, facet joints, nerve roots, the vertebrae themselves and the muscles and ligaments. Anyone of these structures can be a cause of back pain and depending on your age it may be all of them at the same time. One thing to bear in mind is that even if you get a scan that shows wear and tear in some of these structures there is no guarantee that this is the exact cause as it is possible that your back has looked like that for a very long time. However given these caveats it is worth having a look at some of the structures that might cause back pain:

1. The Intervertebral Discs: In between each of the vertebrae (bones) is a disc which provides cushioning. Sometimes this disc can get injured and can be responsible for back pain.

2. Facet Joints: either side of each of the vertebrae in teh low back is a facet joint which links the vertebrae with one another and provides stability. Sometimes these can become worn and cause back pain.

3. Ligaments: there are an array of ligaments situated around the joints of the back and if one of these is strained then this can cause back pain.

4. Muscles: sometimes it is simply a muscle that has been strained and is causing back pain.

5. Nerve Root: usually if the nerve root has been irritated then this will cause sciatica like symptoms but it may also be in conjunction with back pain.

Discussing the possibe causes of back pain is worthy of a whole blog post in itself! For more detailed information on the underlying causes have a look at our page on the causes of back pain here. So it is probably best to have a look at some of the treatment options.

Treatments for Back Pain:

There are an array of possible treatments for back pain and I have tried to list some below:

1. Physiotherapy: clearly I am biased but physiotherapy has a very good evidence basis to support its usage in treating and helping patients with back pain. It is used within an NHS setting and in private and usually involves a combination of manual therapy, exercises and advice.

2. Osteopathy/Chiropractic: many patients find either osteopathy or chiropractic helpul for relieving teh symptoms of back pain. It will usually involve "manipulation" (cracking) of your back.

3. Massage: many patients find that a simple massage can be extremely effective in relieving back pain.

4. Exercises: there is a large bulk of evidence that has formed showing that exercise is extremely effective in reducing chronic back pain.

5. Acupuncture: some patients may find acupuncture or trigger point needling effective at relieving the symptoms of back pain.

6. Yoga/Pilates: stretching and strengthening activities such as yoga and pilates can be very helpful for back pain.

7. Steroid Injections: for patients who have tried all conservative strategies and for whom physiotherapy is not working a steroid injection may be helpful for back pain.

8. Surgery: for some patients unfortunately surgery will be the only option after they have tried everything else.

 

As back pain is a complex phenomenon It might be helpful instead to look at how best to treat your back pain in the two main stages of back pain: acute and chronic and then how to reduce the likelihood of it coming back. 

Firstly it is important to understand two medical terms that patients commonly misunderstand: "acute" and "chronic". Most patients take "acute" to mean extremely painful (and in all likelihood the acute phase will be extremely painful!) whereas in fact "acute" relates to a period of time in medicine and physiotherapy. For example acute low back pain means that the patient has had it for less than 6 weeks (more likely it is very recent indeed) and chronic low back pain means it has been ongoing for over 3 months. This is an important distinction because the treatment and self-management for these two types of back pain is very different. To help understand how best to manage things in the next blog post we will look at how best to manage acute low back pain

Before finishing it is important to be aware that there are some symptoms associated with low back pain that are extremely serious and  that require immediate medical attention. If you experience pain in both legs, tingling, a change in sensation or numbness in the saddle area between your legs, an inability to urinate or loss of control of your bowels then it is important that you seek immediate medical help.  

For anyone reading: we are a home visit physiotherapy service, based in Lichfield but serving anywhere within a 20 minute drive including areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We offer a wide range of services including paediatric physiotherapy, post-operative rehabilitation, neurological physiotherapy and neck and back pain relief. If you need further information or would like to book an appointment we can be contacted on 0788 428 1623 or via enquiries@threespiresphysiotherapy.co.uk