Back Pain Explained
The Facts
Back pain is a common condition in the UK and is the largest cause of work-related absence. 4 out of 5 of us get back pain at some time in our lifetime and the commonest age group is between 35 and 55 years. It can be very uncomfortable but most people recover spontaneously in 4-6 weeks. However the recurrence rate is high and can increase and become more of a problem year after year if preventative steps are not taken. It is difficult to accurately diagnose back pain as the spine is made up of many structures each of which can contribute to pain and frequently two similar types of pain can have very different diagnoses. For this reason back pain is often called ‘non specific’ back pain. It is essential to remember that the spine and indeed the whole body is made up of moving parts and you either ‘move it or lose it’ therefore rest is never a good idea except for short periods.
The Structure
The back is a complicated structure built around the bones of the spinal column. There are 24 vertebrae locking in to each with 7 in the cervical spine (neck), and 12 thoracic vertebrae which also attach to the ribs and 5 lumbar vertebrae which form the lower back. The skull balances on the neck and the pelvis articulates with the 5th lumbar vertebra. Interspinous discs and facet joints connect the vertebrae and are the moving parts and the discs also act as shock absorbers. Ligaments together with the spinal muscles give the back its strength. The deep muscles are smaller connecting one vertebra to the next and have the role of stabilising, and the superficial muscles are longer and stretch over several segments create movement.
The Nerves
The spinal nerve roots come off at each vertebral level and connect the brain to the rest of the body, through the spinal cord. Each nerve root will carry both sensory fibres which transmit both deep and light touch as well as pain; and motor fibres which connect with muscles to create movement.
Some of the more common causes of back pain.
Sprains
Overreaching or twisting can cause a sprain or strain of a ligament or muscle. The result can be muscle spasm which can last several days or even weeks and prolong what is really a simple problem. This may result in muscle weakness and the best remedy is gentle but frequent movement for short periods of time to reduce the spasm, maintain good blood supply and movement patterns. The loss of normal movement patterns can become a bad habit which is hard to remedy once it becomes established.
Bulging, herniated or prolapsed disc
The discs consist of thick bands of fibrous tissue surrounding a soft jelly like material called the nucleus pulposis. A good analogy is a thick car tyre with a soft centre. While acting as a shock absorber the ‘jelly’ shifts from side to side and a minor bulge should not cause a problem. However overloading the spine can cause the disc to herniate or prolapse putting pressure on the nerve roots.
Sciatica
Sciatica is pain travelling down the back of the leg to the foot and is caused by pressure on the 5th lumbar nerve root.
Spondylosis, wear and tear or degenerative joint disease.
In the normal aging process the discs in the spine become thinner and the spaces between the vertebrae become narrower. Spurs of bone, known as osteophytes, may form at the edges of the vertebrae and the facet joints. These can pinch the nerve roots and may cause pain. The important thing to remember with degenerative joints is that good posture and muscle support is vital to remain pain free.
Spinal stenosis
Occasionally back pain can be associated with pain in the legs which comes on with walking. This is called spinal stenosis. It is caused by narrowing of the spinal canal by osteophytes. This causes compression of the spinal cord or nerves. Typically, the pain is only felt after a few minutes’ walking and usually settles after a few minutes’ rest when the person can walk again for a while. This type of problem may need surgery to open up the spaces for the nerves.
Rarer causes of back pain
Osteoporosis which can cause micro-fracturing of bone; the joint inflammatory diseases such as rheumatoid arthritis; fractures; spondylolisthesis which is the slippage of one vertebra on another and can be either degenerative or genetic; infections and tumors are the more rare causes of back pain.
Investigations
In order to make a more accurate diagnosis an Xray, MRI scan or CT scan may be necessary.
Treatment
Physiotherapists recommend a proactive approach to back pain. In general prolonged rest is not helpful for back problems. Anti-inflammatory medication and pain killers may be prescribed by the GP and will help to reduce pain so that normal movement may be maintained. Maintaining strength in both deep and superficial back and abdominal muscles and keeping mobile is essential for both the short and long term recovery. Weight management and posture are important to reduce stresses on the spine. Pilates based exercises, a gym programme or just walking more frequently and using the stairs rather than a lift will be helpful in getting back to normal and maintaining good function. Physiotherapy treatments such as joint manipulation and mobilisation, soft tissue release and joint stabilization can expedite recovery.
Special Offer
ESPH works with Asquith clients to offer preferential rates to members. Please quote Asquith 2009 to receive a 25% discount on your first appointment if you book before February 28th 2009. For more details visit www.esph.co.uk or call directly on 020 7907 1900.
By ESPH
www.esphysicalhealth.com / www.esph.co.uk
