Back pain is a common problem that affects most people at some point in their life.
It usually feels like an ache, tension or stiffness in your back.
The pain can be triggered by bad posture while sitting or standing, bending awkwardly, or lifting incorrectly. Back pain normally resides within 12 weeks however it is likely to reoccur as the damaged structures have not been treated.
For instance: if you have a bad sitting posture and have caused injury to the point of pain, the body will heal this injury after 6 weeks but you have made no modifications so will experience a relapse.
Back pain is most common in the lower back in the “lumbar region” because this is the part that experiences the most weight bearing loads.
The spine consists of 24 vertebrae with discs between them. In the spinal canal run the spinal cord and a set of two spinal nerves exits at each vertebra innervating various organs and tissues. Between each vertebra there are two joints (facet joints), there are ligaments for passive support and several layers of muscles for active support. This makes it a strong but also flexible structure allowing us mobility and at the same time gives good protection for the spinal cord and nerves. Our spinal cord (nervous system) is the only organ in the body that is completely surrounded by bone. This makes sense because without our nervous system we loose all bodily functions so we need to look after our spines and have them checked just like we do for our teeth at the dentist.
Main Common Causes of Back Pain
Facet joint syndrome / Facet joint sprain
The facet joints are located between each vertebra with a supporting system of ligaments and muscles. Pain from these joints can be a result of a ligament sprain, repetitive micro-trauma or ‘wear and tear’. This is probably the most common back injury and can occur at any age. Because these joints are highly innervated with lots of sensitive nerve endings it can be very painful indeed.
Sacroiliac joint syndrome / Sacroiliac joint sprain
Normally described as “hip pain” by patients in the lower lateral portion of the back, these joints can be a large contributor for back pain. Normally because people cross their legs, sleep on their side with their pelvis rotated, sit at work in a rotated position to the side. It is also very common issue with pregnant ladies due to the movement of the pelvis in preparation for birth which causes a lot of strain to these joints. Sports people i.e right footed players can get right sacroiliac joint dysfunction and imbalances.
The Sacroiliac Joints are large strong joints located either side of the spine and join the pelvis to the spine via the sacrum. These joints transfer load between the upper to lower body. Dysfunction usually involves the sacroiliac ligaments and associated muscles as well. It is seen as by many Chiropractors as the foundation and is pivotal to a lot of dysfunction in both lower limb pain such as knee problems and also upper spinal posture (alignment).
For instance if your pelvis is rotated your buttock muscles tighten on one side externally rotating your hip joint putting strain on the knee and then ankle etc. Our bodies are complex kinematic chains that need to work in harmony together.
Disc herniation / Slipped disc / Disc protrusion
The ‘discs’ are the cartilage or spongy space located between each vertebra in the spine. They are strong and flexible allowing for movement of the spine. They also act as a shock absorber and transmit loads up and down the spine. When a disc is injured, a gel-like substance from inside the disc can bulge out causing inflammation or compression of the nerves that exit the spine. This results in the associated leg symptoms. Also when arthritis has set in and there is no cartilage left the bone on bone causes a lot of irritation and pain. Chiropractors are trained to check for early disc signs and what is called “internal discal derangement” where you will start to get discogenic pain from damaging your spine. If not treated and habits are not changed then you are at risk of causing a full disc prolapse which can have up to 6 months to recover and are very painful and harder to treat.
This is a condition that involves a muscle called the piriformis. It is located deep in the buttock and can compress the sciatic nerve, giving similar symptoms as a disc herniation.
More serious Pathology
Central stenosis / Spinal stenosis
Pain is caused by compression of the spinal cord (myelopathy). This can be caused by bony outgrowths (osteophytes) caused by ‘wear and tear’, congenital variations, and scar tissue post-surgery. Walking and standing aggravate pain, causing ‘claudication’ – leg pain. Usually only affects people over 50. With a sudden change in bowel and bladder habbits, weakness of bladder and bowel functions.
Serious Red Flag Signs for Back Pain
It is good to have any back pain properly assessed by a Chiropractor to rule out any of the more serious signs where a referral is necessary. You will normally be referred to your GP if you have 3 of these conditions:
• fever of 38ºC (100.4ºF) or above for more than 3 days
• unexplained weight loss
• constant, unremitting back pain for longer than 12 weeks that doesn’t ease after lying down
• pain in your chest or high up in your back
• pain down your legs and below the knees
• loss of bladder or bowel control
• inability to pass urine
• numbness around your genitals, buttocks or back passage
Sykes Verwey Centre Advice for Back Pain
Before coming to our practice if you are in pain follow some of the simple advice to decrease your discomfort so it is easier to examine you.
-*Do not avoid painkillers before coming to see us. It is a common misconception amongst many patients to not take pain killers before your consultation and examination. In actual fact it is harder to do the tests if you are in pain and it will limit the extent to which we can examine you. So if you are in a lot of pain please do take the medication your doctor has advised before presenting to the clinic. The more pain you are in the tenser you will be. So it is important particularly days 1-3 to keep up with what has been recommended.
-We encourage all our patients to remain as active as possible and continue with your daily activities. Research suggests that being inactive for long periods is bad for your back. Moderate activity, such as walking or doing everyday tasks, will help your recovery.
-Use hot or cold compression packs which may also help reduce the pain. You can buy compression packs from your local pharmacy or the clinic which will reduce inflammation and promote healing so you can be examined.
-Keep a positive attitude towards your recovery, research has shown that people who remain positive tend to recover quicker than those who get depressed.
-Try to receive treatment within the first 3 months of back pain so you can make a full recovery. Research suggests that chronic pain suffers those who have had a problem for over 3 months have a psycho-social component to their pain.
For example: if you have had an injury that you did not receive treatment for which went on for over 3 months. The nociceptive pain receptors have been sending signals back to the brain that there is an injury present in the lumbar spine. The muscles respond by spasming to protect the area to stop you moving the joints. After 3 months, 6 months, 1 year, 5 years +… this feedback mechanism has been constantly firing and telling your brain you are in pain and have a back injury. So even after the original injury may have long healed the pain fibres have been altered so are constantly firing off causing true “chronic pain”. This is something called “central sensitisation” and is the reason why those people who have had pain for many many years have complex pain syndromes which are harder to treat and often get referred to “pain clinics” on the NHS. I see a lot of these types of patients who are chronic pain suffers who have been through the NHS system and respond very favourably to treatment (please see our testimonials sections). However, they have not yet tried “manual therapy” such as Chiropractic manipulation. Please look up the NICE guidelines for chronic back pain and you will find manipulation and massage on the national guidelines for back pain 8 sessions over 12 weeks. So it is worth trying this conservative treatment first prior to surgery etc which carries associated risks.
Treatments at Sykes Verwey Centre
The principal treatment is joint adjustments or manipulation in which a precise movement is applied by the Chiropractor to a joint in the spine which can be associated with a “click” or “pop”. These spinal adjustments can be applied manually using our hands or using a percussion tool such as an “activator”.
We are trained in many different techniques, which enables us to select a safe treatment method that is suitable for all ages and types of patients.
The adjustment is highly affective in restoring movement, increasing healing time and getting you out of pain as quickly as possible.
Other treatment used by the Chiropractors includes:
• rehabilitative exercises,
• patient education and lifestyle modification,
• diet and nutrition,
• the use of physical modalities
• soft tissue techniques and massage
• the use of orthotics and heel lifts
• and the use of electrical modalities
• Use of acupuncture
• Kinesio sports taping
• Instrument assisted soft tissue release
Apart from high levels of general diagnostic skills, we are trained how to take and analyse X-rays, when necessary for use in establishing a diagnosis. The clinic no longer has x ray services and can refer to your GP if deemed necessary before starting treatment.
Although Chiropractors are considered spinal specialists Freddie Powell has a lot of experience treating sports injuries and extremity problems like knees, ankles, feet, wrists, and shoulders. All our treatments our natural hands therapy which is evidence based, safe, offered in a professional comfortable practice. It is always best to try conservative treatment first before taking lots of painkillers to mask your pain and opting for high risk surgery.
Prevention for Back Pain
It is all well and good having treatment and getting pain free, but why not stop it from happening in the first place so you don’t have to visit a Chiropractor in the first place.
We put a lot of emphasis and encourage our patients educating them on how to sit, stand, lie and lift correctly to maintain good level of health for your back. It is fair to say that people generally forget about their spines and keeping a healthy back until they experience a great deal of pain.
Try to avoid placing too much pressure on your back when lifting and ensure your back is strong and supple. Regular exercise, such as walking and swimming, is an excellent way of preventing back pain. Activities such as yoga or pilates can improve your flexibility and strengthen your back muscles.