Back Problems

Back Pain

Four out of five of us get back pain at some time. Most back pain is caused by a simple sprain or strain and improves in a short time with simple self-help treatments.

However, sometimes back pain becomes persistent (chronic) or has a more complex cause. Either way, there is a great deal you can do to help yourself, our treatments however are available to help with the more complex problems.

If you have low back pain, you may have tension, soreness or stiffness in your lower back area. This pain is often referred to as ‘non-specific’ back pain .

Back pain may be called either ‘acute’ or ‘chronic’ depending on how long your symptoms last. You may have:

• acute back pain – lasting less than six weeks
• sub-acute back pain – lasting six weeks to three months
• chronic back lasting more than 3 months

 

How does back pain occur?

Back pain can be caused by injury or bad postural habits. Back pain is something that many people experience at some stage during their life. It brings with it stress and interruption to our work and social life.

Fortunately, serious or permanent damage is relatively uncommon. Your spine is an extremely strong structure made up of small bones (vertebrae) which are connected by discs and ligaments which make it strong, flexible and shock absorbent. It is reinforced by strong supportive muscles. All these structures have numerous nerve endings. If they are under stress or injured they will let you know.

Most back injuries do not cause any lasting damage. The pain experienced is your body telling you to do something about it.

 

Treatment of acute back pain

Tablets – Many people are reluctant to take tablets for fear of becoming dependent upon them, but simple pain killers such as aspirin or paracetamol, taken for short periods, are often very helpful.

Another group of pain killers known as non-steroidal anti-inflammatory drugs, are particularly effective in dealing with spinal and muscular pains. Some of these are available over the counter at pharmacies, but others require a prescription from a doctor.

You should be careful when using this type of pain killer if you suffer from indigestion or asthma.

Rest – In the past, prolonged periods of rest were prescribed for acute spinal pain. Research has shown us to limit this approach, because it is now appreciated that prolonged rest leads to stiffening of the facet joints (small joints in your spine) and wasting of the muscles which support the spine.

Short periods of bed rest, are rare only in extreme cases. The use of external supports (corsets or collars) for long periods is undesirable.

Initially the patient should always adopt the most comfortable position. Movements that cause unbearable pain should be avoided, while movements that are uncomfortable, have no effect or reduce the pain are encouraged.

As the acute pain subsides our physiotherapist can teach you progressive stretching, strengthening and core stability exercises to minimise the risk of a reoccurrence.

Our Physiotherapy team has been treating spinal pain for many years. Most people feel much more confident about managing their spinal pain if they first receive our expert advice.

 

Back Strain

Muscle sprains and strains can be a frequent source of back pain and the most common is a lower back muscle strain that causes pain in the lower back. Differentiating between a strain and a sprain can be difficult as both injuries show similar symptoms.

A sprain is the stretching or tearing of ligaments (the tissue that connects one bone to another) whereas a strain is a stretching or tearing of a muscle.

 

What causes back muscle sprains and strains?

Low back pain/muscle strain or ruptures can occur in the back just like they can anywhere else in the body. A muscle strain (or tear) in the back is usually caused by a sudden movement or trying to lift something that is too heavy.

The low back pain however is often a long time coming on as the muscles in the back gradually tighten up due to bad posture and overuse.

These muscles go into spasm and do not get enough blood through them resulting in weakness. When someone complains of low back pain when they bend down to pick up a piece of paper and tear a muscle in the back, it is not just the piece of paper that caused it but a gradual build up of tension over weeks and months.

Poor postural habits, weakness and reduced muscle activation, hormonal imbalance in the period cycle and pregnancy and cause symptoms consistent with this diagnosis.

 

What are the symptoms of back muscle sprains and strains?

People with a muscle sprain or strain frequently feel a tear or even a pop as the injury takes place but not always. The main symptom is pain that can appear either side of the back or in the upper buttocks and can get worse with muscle spasms as they occur. This type of pain does not go down into the legs.

 

Buttock pain

Buttock pain is most commonly seen in athletes involved in kicking or sprinting sports. It can occur in isolation or it may be associated with low back or posterior thigh pain. Pain in this region may arise from a number of local structures or be referred from the lumbar spine or sacroiliac joint.

 

Referred lumber pain

Referred pain is often described as a deep, aching, diffuse pain, variable in site. Pain referred from the lumbar spine may be a result of abnormalities of the intervertebral disks and some of the small joints in the spine. Spondylolysis and Spondylolisthesis may also cause buttock pain.

 

Sacroiliac joint dysfunction

Sacroiliac joint dysfunction may also refer pain to the buttock. The sacroiliac joint is the articulation of the sacrum (at the base of the spine) with the pelvis.

Clinically the patient has deep buttock pain, difficulty in ascending and descending stairs and difficulty rolling over in bed. With this condition there is often a rotation of the sacroiliac joint with one side of the pelvis being higher than the other resulting in a possible difference in leg length. This is often associated with instability of the low back and pelvis. We often see golfers and athletes with this condition.

 

What are the symptoms?

Pain located either to the left or right of your lower back. The pain can range from an ache to a sharp pain which can restrict movement.

The pain may radiate out into your buttocks and low back and will often radiate to the front into the groin. Occasionally it is responsible for pain in the testicles among males.

Occasionally there may be referred pain into the lower limb which can be mistaken for sciatica
Classic symptoms are difficulty turning over in bed, struggling to put on shoes and socks and pain getting your legs in and out of the car.

Latest research has also linked hip stiffness and mal alignment to lower back pain and SIJ dysfunction.

 

Disc Prolapse / Siatica

What is a slipped disc?

The disc is made up of a number of components. If you can imagine cutting an onion in half you will find a number of rings. These are called the annulus fibrosis on a disc, the outer layer. For some reason the outer part of the disc near the back is weaker than the other parts. In the centre of the disc is called the nucleus. The disc acts in normal circumstances like a shock absorber on a car.

Occasionally the disc can “herniated” out or collapse or become worn through age. This can lead to the disc deforming (herniated) and therefore press on your nerve. Trauma can also create such a problem.

 

What are the symptoms of a prolapsed disc?

Back pain – The pain is often severe, and usually comes on suddenly. The pain is usually eased by lying down flat, and is often made worse if you move your back, cough, or sneeze.

Sciatica is: a well-localised leg pain which corresponds to the distribution of the sciatic nerve which normally radiates to the foot or toes. It is often associated with numbness and tingling in the foot and the outer side of the lower leg; the areas supplied by the sciatic nerve.

Nerve root pain (usually ‘sciatica’) – Nerve root pain is pain that occurs because a nerve coming from the spinal cord is pressed on (‘trapped’) by a prolapsed disc, or is irritated by the inflammation caused by the prolapsed disc.

Although the problem is in the back, you feel pain along the course of the nerve in addition to back pain. Therefore, you may feel pain down a leg to the calf or foot. Nerve root pain can range from mild to severe, but it is often worse than the back pain.

With a prolapsed disc, the sciatic nerve is the most commonly affected nerve. (The term ‘sciatica’ means nerve root pain of the sciatic nerve.) The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back. It travels deep inside the buttock and down the back of the leg.

 

Some people do not have symptoms

Research studies where routine back scans have been done on a large number of people have shown that some people have a prolapsed disc without any symptoms. It is thought that symptoms mainly occur if the prolapse causes pressure or irritation of a nerve. This does not happen in all cases.

Some prolapses may be small, or occur away from the nerves and cause minor, or no symptoms. It is now realised, however, that a minor tear of the disc can release chemicals causing inflammation of the sciatic nerve without actually touching it.

 

Treatment

Treatment begins after a through examination. 85-90% of the time a diagnosis can be made without the aid of scans, x-rays, or blood tests. The Physio Team-Works clinic has the expert skills available to provide you with a diagnosis and prognosis. If we can not make a definitive call on the condition then we have the facility to refer you on for scanning and an expert opinion. However most of the problems that present at the practice can be managed without this given the appropriate time.

Treatment in the acute phase consists of painkillers and should start with the appropriate exercises as soon as possible. As the acute episode settles, it is important to restore normal pain-free movement to the area with localised mobilisation, stretching and stabilisation exercises.

 

Lower Back Pain

What is lower back pain?

Lower back pain can be either an acute (sudden and short term) or chronic (long-term and often getting progressively worse) disabling condition that affects many people at some stage in their life. Lower back pain can also be described as a symptom of many other conditions.

 

What causes lower back pain?

It can be caused by an injury or a form of trauma, like a sports injury, a car accident or a fall, which although seemingly unlinked, can be the cause of many problems or abnormalities in the lower back that result in pain.

Poor posture can be another cause, as can emotional stress, obesity, age and poor body mechanics such as lifting without bending the knees.

Lower back pain can be the result of damage to the soft tissue like muscles, ligaments and tendons due to an accident of some sort. Other causes can be particular conditions such as osteoarthritis, rheumatoid arthritis, and degeneration of the discs between the vertebrae or cancer.

In summary, the possible causes of lower back pain can be categorised as mechanical, inflammatory, due to tumours, metabolic, referred pain from elsewhere, or can even be caused by depression.

 

Myofacial pain in the buttock

Myofascial pain or trigger points in the Gluteus medius and Piriformis muscles can cause pain in the buttock area. A trigger point is a tiny localised knot in the muscle. The muscles involved may also be shortened and tense.

 

Piriformis syndrome

The Piriformis muscle is a tiny muscle running from the base of your spine to the top of the thighbone that is deep inside the buttock and rotates the leg outwards. The sciatic nerve runs very close to this muscle and in some cases may even run through it.

 

What is piriformis syndrome?

Piriformis syndrome is when the piriformis muscle becomes tight and therefore inadvertently puts pressure on the sciatic nerve. The disorder therefore causes pain and tingling and numbness in the buttocks in the area in which the sciatic nerve exists.

 

What causes piriformis syndrome?

Piriformis Syndrome is most commonly caused by other muscles being tight or not working sufficiently and therefore putting more strain on the piriformis.

Muscle imbalances (meaning one muscle being more powerful than the other causing a tug of war effect) pull the hip joints and pelvis out of place and this changes this position alteration often tightens the piriformis muscle which in turn places pressure on the nerve.

 

What are the symptoms of piriformis syndrome?

Symptoms include pain in the buttocks that may radiate down the leg.

Physiotherapy Treatment for Piriformis Syndrome (following a detailed assessment):

• Heat and cold therapy
• Stretching exercises
• Exercises to strengthen the muscles to improve balance
• Sports massage

 

Scoliosis

Scoliosis is a sideways curvature of the spine, in which the spinal column can also twist, pulling the ribcage out of position.

It can affect a person’s appearance because when the spine bends to the side the vertebrae (the individual bones that make up the spine) become twisted and pull the ribs round with them, which sometimes forms a characteristic lump on the back and can cause the shoulder blade to stick out.

The spine can bend towards either side of the body at any place in the chest area (thoracic scoliosis), in the lower part of the back (lumbar), or above and below these areas (thoracolumbar). It can even bend twice, causing an S-shaped curve. When the curve is S-shaped (a double curvature) it is often not noticeable and the person can appear quite straight because the two curves counteract each other. If the curve is lower down in the spine, the ribs will not be affected but one hip might be higher than the other.

 

What causes scoliosis?

The causes of scoliosis are many, and although we well understand the consequences, the origins of this condition remain complex and obscure.

Main types of scoliosis:

• Congenital: This refers to a condition that is present at birth, such as a malformed vertebra.
• Degenerative: Sometimes called neurodegenerative, this refers to a disease or condition that results in progressive deterioration and is usually age-related– it continues to get ‘worse’ over time.
• Idiopathic: This means that the cause is unknown. Idiopathic scoliosis means that the curve has formed for an unknown reason.

What are the Symptoms of Scoliosis?

• Asymmetric alignment in the body such as uneven hip and shoulder levels
• One prominent shoulder blade
• Dissimilar size or location of breasts in females
• Often there is a muscle masses that causes a “hump” on one side of the body.

The pain caused by the irregular shaping of the spine and the resulting muscular compensation can vary from being mild to acute, and often affects the area directly surrounding the spine itself. Often there is stiffness in the back and neck.

Physiotherapy treatment:

• Manipulation and mobilisations
• Postural advice and adaptations
• Onward specialist opinion if scoliosis is progressive.

 

Surgery

Cobb angle: This is the name of the measurement of scoliosis that is obtained from an X-ray. It refers to the severity of the curvature and is measured in degrees. A measurement under 10 degrees is regarded as normal, between 10 degrees and 30 degrees is classed as mild, and anything over 60 degrees is severe.

Success of surgery depends a lot on what happens in the postoperative stages. It is important to maximise the surgery by doing exercises that help to stabilise, mobilise and protect the area. Your consultant may also recommend you have some sort of pre-operative intervention; we are ideally suited to do this.

Physio Team-Works will be able to guide you through these stages of rehabilitation. We can assist in monitoring your progress, setting your goals, and providing appropriate treatment to maximise your recovery potential.

We can also inform you of how you can help your own recovery, and what should be avoided. You will be provided a specific rehabilitation program, and we aim to back to your full levels of activity and/or sport as quickly as possible.

 

How Can We Help?

Physio Team-Works will carry out a full assessment to determine the cause and develop an individually tailored rehabilitation programme. We have the facility to provide written graphical programs that can be modified throughout your treatment and management.

We offer comprehensive treatment of acute and chronic conditions using both a hands-on approach and core-stability retraining. We will offer advice to enable you to manage your back in the long term and therefore reduce the risk of recurrence of pain and time off work. The better you are informed the more likely you will recover and be able to prevent re- occurrence of your injury.

Exercise is very effective in facilitating recovery. Any form of continuing pain will mean that you stop moving. This leads to your muscles wasting and this will make your back weaker and more easily tired. So you need to restore the strength and flexibility in your back. The body needs strong back muscles to work as a shock absorber for jolts and knocks which is part of daily life.

Our and job is to help you:

• regain flexibility
• build up muscle strength and stamina
• improve your general fitness.

Even when your back is sore you can make a start without putting too much stress on your back. Also, remember that your back may feel sore after the first few days of exercise – this is normal so don’t let it put you off (it may help to take some painkillers before exercising on these days).

 

The exercises fall into three main groups:

• Stretching exercises
• Strength, stamina and stabilising exercises
• Exercise for general fitness

 

To bring your condition under control we incorporate some of the following skills at our disposal:

• Massage
• Manipulation
• Acupuncture
• Electrotherapy
• Team Approach

We are fortunate enough at the Physio Team-Works clinic to have access to many leading surgeons and doctors in the regions should we consider further investigations suitable medical professionals regarding your treatment and diagnosis E.g. GP’s, orthopaedic/ rheumatology consultants.

We also has excellent post operative rehabilitation skills that can help lead you out of the problems you are faced with in work, sport or social activity.

 

Contact us

Physio Team-Works will be able to guide you through these stages of rehabilitation. We can assist in monitoring your progress, setting your goals, and providing appropriate treatment to maximise your recovery potential.

We can also inform you of how you can help your own recovery, and what should be avoided. You will be provided a specific rehabilitation programme, and we aim to back to your full levels of activity and/or sport as quickly as possible.

Call 07486 692119 or complete our quick online form to arrange an appointment.