Low back pain is one of the, if not, the most common reasons that clients come to seek our help at Back 2 Balance. Principle chiropractor and clinic owner Dr Rebecca Nicholas, gives you the 101 on low back pain.
There are many different types of low back pain, with different causes. The key to getting the right treatment is to establish which type of back pain you may be suffering from and to seek advice if it is not improving.
Your spine is made of 24 freely moveable solid blocks of bone known as vertebra, joined together by softer pads or discs which act as shock absorbers and maintain flexibility. Your back is reinforced by strong ligaments, surrounded by powerful muscles for support. It is, in fact, surprisingly difficult to actually severely damage your spine. Click here for more anatomy.
The majority of people with low back pain are suffering from what is known as ‘simple’ or ‘mechanical’ back pain. This means that the pain is not related to any serious underlying condition and there are no trapped or compressed nerves. We do not always know the exact tissues that are involved in simple back pain. Muscles, joints (called facet joints) and ligaments can all be involved. Simple back pain can be
caused by poor posture, prolonged sitting in an uncomfortable position, and even muscular tension due emotional or work-related stress.
As we get older, degeneration may contribute to back pain. The shock-absorbing pads or discs between the bones of the back can narrow with age and this can cause stiffness, pain and make it difficult to move.
Simple low back pain is relatively common. Research on the NHS website would indicate at least 1 in 10 will suffer from back pain. Less frequently, the nerves of the back can sometimes become irritated, compressed or trapped. Again, there can be many reasons why this happens, but slipped discs or degeneration can lead to pain spreading down the leg, which is commonly referred to as sciatica. This can be accompanied by pins and needles, tingling, numbness and weakness in all or part of the leg and foot.
Low back pain can be felt as a dull ache, throbbing, sharp stabbing, weak and collapsing feeling, numb and dead, tingling, crawling, toothache, spasm. As you can see, how people describe their low back pain when they come into the clinic is wide and varied.
People experience low back pain for all sorts of reasons. It might be the way they sit or stand, or because their work or lifestyle causes stress and strain on their back. Worry or stress can cause tension in the back muscles, or can delay recovery of existing back pain. Sometimes an old injury, or degeneration over time, might also cause problems.
Some common reasons clients cite for causing their low back pain:
- coughing and sneezing
- sleeping in funny awkward position
- wearing high heels
- going abroad (flight and sun lounger)
- sporting accident or at the gym (not always felt at the time!)
- bending lifting or twisting, often something that you have done in the past without a problem
- sleeping in a different mattress
- being laid up in bed poorly and not moving enough
- gradually started without knowing why
- sitting at a desk/computer too long
- poor posture
- using laptop/ipad/phone incorrectly
- repetitive movement patterns
- decorating and gardening
- putting on shoes, pants and socks in the morning
- bending down to pick up soap in the shower
- walking the dog- pulling on the lead
- falls and trips and slips
However, there is often no obvious reason why lower back pain develops.
Although it can be very painful, low back pain rarely has a serious underlying cause. Seeing a qualified health professional, such as a chiropractor or osteopath, who is experienced in diagnosing conditions of the back and spine, can help treat low back pain, and also identify if a referral or specialist investigations are needed.
Some of the more common diagnoses include, but not limited to:
- lumbar facet joint dysfunction- inc sprain/strain
- myofascial pain syndrome e.g. gluteal MFPS, quadratus lumborum MFPS
- sacroiliac joint dysfunction
- lumbar disc prolapse/bulge/herniation, commonly called ‘slipped disc’
- lumbar radiculopathy (spinal nerve irritation) commonly called sciatica
- degenerative joint disease/osteoarthritis
- degenerative disc disease
- spinal stenosis
- rheumatoid arthritis/ankylosing spondylitis
- spondylolytic spondylolithesis
Back pain can be very uncomfortable as the tissues and structures of the back are very susceptible to pain. Unfortunately, most GPs will give you painkillers/anti inflammatories and tell you to come back if it persists. They know that for most people, low back pain is not life threatening, and so will not do anything further.
Chiropractors here at Back 2 Balance understand, that, whilst it might not be serious, ongoing lower back pain can be disabling and miserable. In fact some people can not work or do normal daily activities of living.
It is estimated that back and neck pain affects the economy by £14bn a year! Almost 31 million days of work were lost in 2013 due to back, neck and muscle problems, according to the Office for National Statistics (ONS). The ONS’s Labour Force Survey, which polls hundreds of thousands of people in the UK, found that musculoskeletal (MSK) conditions, which include a large range of bone and joint complaints, accounted for more prolonged absences than any other ailment. Nearly a 1/4 of these were work related in cause. Minor illnesses such as the common cough or cold accounted for only 27 million lost days, but MSKs were more likely to recur, and develop into long-term conditions!
Back pain can be felt in one or both sides of the back, sometimes between the shoulder blades or from waist level and into the buttocks and down the front or back of the legs. It can be a sharp or dull pain, and can spread into the lower legs and sometimes as far as the feet.
If the pain does not go after a few days, or starts to get worse, it is worth seeking professional advice.
Early treatment will help you get better faster.
About half of people who have an episode of back pain will have another episode within a couple of years. But that still doesn’t mean that it is necessarily serious. Between episodes most people return to normal activities within two or three weeks, with few remaining symptoms. It’s estimated up to 8 in every 10 people in the UK are affected by back pain at some point in their lives, so working on preventing it is of some importance.
Back pain can be very painful due to inflammation and muscle spasm, and you may need to take it easy for a while. But resting for more than a day or two does not usually help, and may actually do more harm than good. It is best to try to keep moving and seek the help of a trained professional, such as a chiropractor, if you are finding it difficult to cope, or to speed up recovery.
- use alternate hot/cold application
- keep moving
- careful of bending, lifting, twisting
- bend the knees if coughing or sneezing
- do daily stretches e.g knee swings, side and back bends (see our YouTube channel)
- sleep on your back or sides but not on your front- blog on sleep position
- strengthen it up with core exercises- start with abd bracing (see our YouTube channel)
- get manual therapy treatment e.g. see a chiropractor, osteopath or massage therapist – call us 01273 206868
Your back is designed for movement. The sooner you get back to normal activity, the sooner your back will feel better. The people who cope best are those who stay active and get on with their life despite the pain.
If your back pain does not improve, it is important to seek help. Early treatment will get you better faster.
Chiropractors specialise in assessing, diagnosing and managing conditions of the spine. They are highly trained in finding the cause of pain in the spine. In the UK they undergo a minimum of four years’ full-time training. Importantly, chiropractors are regulated by law and must work within strict professional and ethical boundaries.
Before starting treatment, a chiropractor will do a full assessment. This will involve taking details about your condition, current health and medical history, and performing a physical examination. Sometimes it may be necessary to refer you for other tests, such as X-rays, MRI scans or blood tests. Your Back 2 Balance chiropractors can take in house X-rays and refer you privately for MRI scans in the local vacinity. It is important for your chiropractor to gather as much information about your back pain as possible so that the most precise diagnosis can be made.
Your chiropractor will then explain what is wrong, what can be done and what you can expect from chiropractic treatment.
Chiropractors are best known for manual treatments such as spinal manipulation, where they use their hands to free stiff or restricted joints, or mobilisation, which is the gradual moving of joints.
But they may also use other recommended treatments such as certain types of acupuncture, electrotherapy, stretching exercises and rehabilitation, all of which form part of a chiropractor’s package of care. Feel free to check out our YouTube channel that has many different stretches, strengthening exercises and self help tips and advice. Your chiropractor here will also offer lifestyle advice to help recovery and to prevent repeated episodes of back pain.
We often get asked what the difference between a chiropractor, osteopath and physiotherapist. Many clients find a therapist that suits them and that they trust. This would be what we would recommend. Physiotherapists are great at exercise programmes and getting you fitter and stronger and rehabilitated. They usually have a 3 year degree programme and limited manipulation skills. A chiropractor and osteopath both have experienced manual adjusting/manipulation techniques which have developed over a min 4 year degree.
Chiropractors have often also trained in radiology and radiography so that they can take and read x-rays. Chiropractors and Osteopaths are equally trained in exercise protocols and rehabilitation, although prefer to give these for home use, and do the hands on treatment in the clinic.
Increasingly worrying, physiotherapists, massage therapists and GPs have started to do manual manipulation courses over a weekend or two. On the surface this would appear to be great news as more and more clinicians are realising the benefit from manual manipulation (adjustments), however, we would recommend people to be careful. Adjustments are safe and very effective in fully trained and qualified hands. Give your spine to a therapist who has had years of training and experience- adjusting is a skill and art best left to those who do it frequently.
Other treatments can include mind based therapies such as CBT, mediation, yoga and pilates, acupuncture, and massage.
Medical treatments can include facet joint or epidural injections (often steroid based), micro discectomy, laminectomy and other decompression surgery, radiofrequency denervation, and occasionally spinal fusion. However, a lot of clients consulting with us really don’t want to go down this route, as there is still no guarentee that it will work, and has much higher risks attached.
Many people who suffer long-term back pain benefit from regular, supportive chiropractic care to reduce the risk of recurrent episodes. We have even launched our wellbeing community to give clients the best price and added benefits befitting those who commit to regular care at the clinic. Ask the front desk or your Back 2 Balance clinician about our wellbeing community if you want more information.