What is Back Pain?
Back pain is one of the most common medical problems experienced by most people at some time in their life. It can be acute, usually lasting from a few days to a few weeks, or chronic, lasting for more than three months.
It is really important that we discourage people from being afraid of back pain as it is well understood that, in a lot of people, the emotional and psychological experience of back pain can be a primary factor in prolonging the symptoms and preventing people from returning to happy, healthy, active lives.
Characteristics of Back Pain
Back pain can occur as a dull constant pain or a sudden sharp pain. It may be confined to one area or radiate to other areas such as the arm and hand, upper or lower back, and leg or foot.
Other than pain, some people may experience weakness, numbness or tingling in your arms or legs caused by irritation of the nerves or the spinal cord.
Risk Factors for Back Pain
Back pain is a complex problem and although some sports or certain jobs are often associated with back pain, the cause of back pain can be wide and varied, including trauma, too much activity and not enough activity.
Causes of Back Pain
The common causes of back pain in athletes include:
- Intervertebral disc injuries: the discs that sit between the spinal bones can become inflamed, and sometimes can herniate, or bulge. Some people refer to this as a “slipped disc” but in reality it is almost never the case that the disc actually moves out of position. It is perhaps easier to think of this as either irritated, or not irritated. Statistically, the majority of adults over the age of 35 will have some element of naturally occurring degeneration in their lower lumbar discs which is quite commonly not painful. In sport, lifting injuries are often associated with acute injury of the disc.
- Musculoligamentous joint strain: a strain of the joints involves over stretching the ligaments and capsule that surround the joint between two bonus surfaces. This is very common injury and in most people this pain will improve in a matter of weeks without ongoing problems.
- Spondylitis: is an inflammatory condition of the spinal bones. This can occur for a number of reasons with management typically involving strengthening and mobility exercises to reduce pain and keep people functioning.
- Spondylolysis: is an overloading of the bony segments in the spine, causing a stress response or stress fracture in part of the vertebrae. These typically improve with a period of reduced activity followed by a period of strengthening and a supervised, graduated return to activity.
- Spondylolisthesis: is a condition of the spine that occurs when one vertebra is displaced or has slipped forward over the other below it.
- Other causes include inflammatory conditions such as rheumatoid arthritis, Ankylosing Spondylitis, growth-related problems such as scoliosis and Scheuermann's kyphosis.
Diagnosis of Back Pain
Your physiotherapist will diagnose back pain by reviewing your history and symptoms and examining your spine. A complete examination includes the examination of the signs of unusual curves of the spine, rib hump, tilted pelvis and tilting of the shoulders, and a test of your sensations. Other diagnostic tests may be needed, and if appropriate your physiotherapist will assist with onward referral for these.
Treatment for Back Pain
The treatment for back pain is usually non-surgical and includes:
- Exercises to strengthen your trunk and back muscles.
- Manual therapy such as joint mobilisations, manipulation, and massage to promote movement and reduce pain
- Anti-inflammatory medications or NSAIDs can provide relief from the pain and may be recommended by your GP or pharmacist
- Acupuncture can provide very good pain relief for some people
- Cold packs or heat packs, or both, may help alleviate much of the discomfort and feeling of stiffness
- Some rest initially may help in the first few days, but more than a few days of immobility can be associated with longer recovery times and delayed return of function.
These measures help to relieve your back pain and in the vast majority of cases people will improve in a period of 4-12 weeks. In certain circumstances, some people do not improve and a referral to a Consultant is required for further intervention such as spinal injections, and very occasionally, surgery. If this is the case, our physiotherapist will be able to advise you and facilitate onward referral.