Low
Back Pain
Advice on Low
Back Pain In the UK a third of the
population are suffering with back pain and up
to 80% of the adult population will suffer
significant back pain at some time in their
life. Back pain may be referred to the hip,
groin, buttocks, the leg and foot as sciatica.
The main causes of most low back pain are
muscular weakness and postural strain due to
being overweight, sitting too much, lack of
exercise, unequal leg-length, trauma or
over-exercise. Sometimes it is the cushion
between the bones (intervertebral disc) which
bulges (herniates) and compresses spinal nerves.
Chiropractors
are specialised in diagnosis using
low-dose x-rays, a thorough spinal
examination using chiropractic and
orthopaedic tests of your joints, ligaments,
tendons and muscles and neurological tests
of your reflexes, muscular strength and
sensory changes.
We treat back pain and
sciatica using specific joint manipulation
or mobilisation, acupuncture as well as
massage, interferential, ultrasound,
exercise and nutritional advice.
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Acute or short-term low back pain
Most acute back pain is
mechanical in nature - the result of trauma
to the lower back or a degenerative disorder
such as osteoarthritis where joints have
gradually stiffened, become inflamed and
started to calcify through reduced mobility.
Pain from trauma may be
caused by a sports injury, work around the
house or garden, a sudden jolt such as a car
accident / whiplash or repetitive stress to
spinal bones and tissues.
Symptoms may range from
muscle aches to shooting or stabbing pain,
limited flexibility and joint range of
motion or an inability to stand straight.
Pain felt in one part
of the body may "radiate" or be referred
from an injury or disorder elsewhere in the
body. Some acute pain syndromes can become
more serious if left untreated.
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Chronic
back pain is pain that persists
for more than 3 months. It is important to
diagnose and treat spinal dysfunction sooner
rather than later to avoid further gradual
degeneration of spinal joints.
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The back is an intricate
structure of bones, muscles, and other
tissues that form the posterior part of the
body's trunk, from the neck to the pelvis.
The centerpiece is the spinal column, which
not only supports the upper body's weight
but houses and protects the spinal cord -
the delicate nervous system structure that
carries signals which control the body's
movements and convey its sensations.
The spinal column consists of over 30
vertebrae which contain round holes which,
when properly aligned with all the others,
create a channel that surrounds the spinal
cord. The spinal cord descends from the base
of the brain and extends in the adult to
just below the rib cage.
Small nerves ("roots") enter and emerge from
the spinal cord through spaces between the
vertebrae. Because the bones of the spinal
column continue growing long after the
spinal cord reaches its full length in early
childhood, the nerve roots to the lower back
and legs extend many inches down the spinal
column before exiting. This large bundle of
nerve roots is called the cauda equina, or
horse's tail.
The spaces between the vertebrae are
maintained by round, spongy pads of
cartilage called intervertebral discs that
allow flexibility in the lower back and act
like shock absorbers throughout the spinal
column to cushion the bones as the body
moves. Bands of tissue known as ligaments
and tendons hold the vertebrae in place and
attach the muscles to the spinal column.
There are seven cervical or neck vertebrae
(C1–C7), 12 thoracic or upper back vertebrae
(T1–T12), five lumbar vertebrae (L1–L5 and
the sacrum are bones fused together at the
base of the spine with the coccyx or
tailbones which have a variable number of
moveable joints.
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Causes of low back pain
As people age their bone strength,
muscle elasticity and tone tend to decrease.
The discs lose fluid and flexibility which
decreases their ability to cushion the
vertebrae.
Pain can occur when you
lift something too heavy or overstretch,
causing a joint locking or displacement (subluxation)
or a sprain, strain or spasm in one of the
muscles or ligaments in the back or a disc
may rupture or bulge outward.
This can put pressure
on one of the more than 50 nerves rooted to
the spinal cord that control body movements
and transmit signals from the body to the
brain. When these nerve roots become
compressed or irritated, back pain results.
Low back pain may reflect nerve or muscle
irritation, joint locking or bone lesions.
Most low back pain follows injury or trauma
to the back, but pain may have other factors
such as degenerative conditions such as
arthritis or disc disease, osteoporosis or
other bone diseases, viral infections,
irritation to joints and discs or congenital
abnormalities in the spine.
Obesity, smoking, weight gain during
pregnancy, stress, poor physical condition,
poor posture and poor sleeping position also
may contribute to low back pain.
Additionally, scar tissue created when an
injured back heals itself does not have the
strength or flexibility of normal tissue. A
build-up of scar tissue from repeated
injuries eventually weakens the back and can
lead to loss of normal flexibility and
function and more serious injury can result.
Occasionally, low back pain may
indicate a more serious medical problem.
Pain accompanied by fever or loss of bowel
or bladder control, pain when coughing and
progressive weakness in the legs may
indicate a severely compressed nerve or
other serious condition. People with
diabetes may have severe back pain or pain
radiating down the leg related to
neuropathy. People with these symptoms
should contact their Chiropractor or GP
immediately to reach a diagnosis and find
the optimal help to prevent more permanent
damage.
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Conditions that may cause low back pain
and require treatment :
Bulging disc
- protruding, prolapsed, herniated or
ruptured disc.
The intervertebral
discs are under constant pressure and may
degenerate and weaken, cartilage can bulge
compressing a nerve root, causing pain,
weakness, numbness and loss of reflexes..
A rare and serious
complication of a ruptured disc is cauda
equina syndrome, which occurs when disc
material is pushed into the spinal canal and
compresses the bundle of lumbar and sacral
nerve roots. Permanent neurological damage
may result if this syndrome is left
untreated.
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Sciatica
is a condition in which a herniated or
ruptured disc presses on the sciatic nerve,
the large nerve that extends down from the
lower back to its exit point in the pelvis
and carries nerve fibres to the leg.
Sciatic nerve
compression causes shock-like or burning low
back pain combined with pain through the
buttocks and down one leg to below the knee,
occasionally reaching the foot. In the most
extreme cases, when the nerve is pinched
between the disc and an adjacent bone, the
symptoms involve not pain but numbness and
some loss of motor control in the leg due to
interruption of nerve signalling.
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Disc wear and tear can
lead to a narrowing of the spinal canal
especially if the spine has become twisted
or curved laterally - scoliosis. A person
with spinal degeneration may experience
stiffness in the back on waking and leg
pain (sciatica) during walking or while
standing for a long time.
Specific and careful
chiropractic spinal mobilisation and
postural changes to reduce curvatures are
often very effective at reducing or
abolishing symptoms.
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Osteoporosis
is a metabolic bone disease marked by
progressive decrease in bone density and
strength. Fracture of brittle, porous bones
in the spine and hips results when the body
fails to produce new bone and/or absorbs too
much existing bone. Women are four times
more likely than men to develop
osteoporosis.
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Skeletal irregularities
produce strain on the vertebrae and muscles,
tendons, ligaments and tissues supporting
the spinal column. These irregularities
include scoliosis, a
lateral curve or series of curves of the
spine to the side; kyphosis,
in which the normal curve of the upper back
is severely rounded; lordosis,
an abnormally accentuated forward sway in
the lower back or neck.
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Fibromyalgia
is a chronic disorder characterized by
widespread musculoskeletal pain, fatigue,
and multiple "tender points," particularly
in the neck, spine, shoulders, and hips.
Additional symptoms may include sleep
disturbances, morning stiffness, bowel
sensitivity and anxiety.
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Spondylosis
refers to chronic back pain and stiffness
and Spondylitis to
inflammation of the spinal joints. Other
painful inflammations in the lower back
include osteomyelitis (infection in the
bones of the spine) and sacroiliitis
(inflammation in the sacroiliac joints).
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Dr Beard will take a
thorough medical history
and perform a physical examination
to identify any conditions or family history
that may be associated with the pain.
We thoroughly examine the
spine and conduct specific neurological and
orthopaedic tests to diagnose the cause of
pain and enable us to provide effective
treatment and intelligent advice.
Blood tests and x-ray
or MRI imaging may be necessary to diagnose
other sources of the pain.
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Spinal X-rays
help diagnose the cause and location of back
pain and look for broken bones or an injured
or malpositioned vertebra and shows the bony
structure and any vertebral misalignment.
X-rays are not necessary in most cases and
are only taken in accordance with very
strict guidelines. They are taken
privately at the Cumberland Centre by NHS
radiographers.
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Magnetic resonance imaging (MRI)
is used to evaluate the spine for bone
degeneration or injury or disease in tissues
and nerves, muscles, ligaments, and blood
vessels. The scans are be taken privately at
Derriford Hospital. They can normally
be done and the results back within 2 weeks.
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Chiropractic treatment involves
realigning and mobilising displaced or
locked vertebrae, reducing inflammation,
restoring proper function and strength to
the back, and preventing recurrence of the
injury through postural rehabilitation.
Back pain
may travel to or be referred to the hip,
groin, buttocks, the leg and even into the
foot, otherwise known as sciatica . The main
causes for low back pain are muscular
weakness and postural strain due to being
overweight, sitting too much, lack of
exercise, unequal leg-length, trauma and
over-exercise. Sometimes it is the cushion
between the bones (intervertebral disc)
which bulges (herniates) and presses on the
nearby nerves.
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Ice
(the use of cold compresses) can help reduce
pain and inflammation and allow greater
mobility. As soon as possible following
trauma, you should apply a cold pack or a
cold compress (such as a bag of ice or bag
of frozen vegetables wrapped in a towel) to
the tender spot several times a day for up
to 20 minutes.
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Bed rest
following onset of low back pain worsens
symptoms and prolongs pain and often leads
to secondary complications such as
depression, decreased muscle tone, and blood
clots in the legs. You should resume
activities as soon as possible. At night or
during rest, you should lie on one side,
with a pillow between your knees or lie on
your back and put a pillow under your
knees).
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Exercise
at the right point in your recovery, is the
best way to speed recovery from low back
pain and help strengthen back and abdominal
muscles. Maintaining and building muscle
strength is particularly important for
persons with skeletal irregularities.
Chiropractors and physical therapists
provide a list of gentle exercises which
help keep muscles moving and speed the
recovery process. A routine of back-healthy
activities may include stretching exercises,
swimming, walking, and movement therapy to
improve coordination and develop proper
posture and muscle balance. Pilates and Yoga
are excellent means to gently stretch and
strengthen muscles and ease pain.
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Medications
are often used to treat acute and chronic
low back pain. Most medicines, even those
sold over the counter such as nonsteroidal
anti-inflammatory drugs (aspirin, naproxen,
and ibuprofen), are unsafe during pregnancy,
may conflict with other medications, may
cause side effects including drowsiness,
stomach ulcers or may lead to liver damage
and heart disease in the long-term.
Opioids such as codeine, oxycodone,
hydrocodone, and morphine are often
prescribed to manage severe acute and
chronic back pain but are not advisable.
Side effects can include drowsiness,
decreased reaction time, impaired judgment,
and potential for addiction.
Chiropractors and many
other specialists are certain that chronic
use of these drugs is detrimental to back
pain patients, adding to depression and
increasing pain.
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Spinal
manipulation is an effective,
safe "hands-on" approach in which
professionally registered specialist
chiropractors and osteopaths use specific
spinal manipulation and a series of
exercises to adjust spinal structures,
restore back mobility and function and
gradually rehabilitate posture.
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Acupuncture
involves the insertion of very fine needles
at precise points throughout the body to
trigger the release of naturally occurring
painkilling molecules and stimulate the
brain to optimise healing.
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Massage and physical therapy (
Laser, Ultrasound and Electrotherapy) are
effective for muscle, tendon and ligament
damage or injury.
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Back 2 Fitness
advice for a healthier back.
Following any period of prolonged
inactivity, gradually start regular
low-impact exercise. Walking, swimming or
cycling 30 minutes a day will increase
muscle strength and flexibility. Pilates can
also help stretch and strengthen muscles and
improve posture. Ask your chiropractor for a
list of low-impact exercises designed to
strengthen lower back and abdominal muscles.
Don't slouch when standing or sitting. When
standing, keep your weight balanced on your
feet without most of your weight on your
heels. Your back supports weight best when
spinal curvatures are reduced.
Sit in a chair with good lumbar support and
proper position and height for the task.
Keep your chest up and don't poke your head
forward. Change sitting positions often and
periodically walk around the office or
gently stretch to relieve tension. Wear
comfortable, low-heeled shoes.
Sleep on your side to reduce any curve in
your spine. Always sleep on a firm surface.
Don't try to lift objects too heavy for you.
Lift with your knees, pull in your stomach
muscles, and keep your head down and in line
with your straight back. Keep the object
close to your body. Do not twist when
lifting.
Maintain proper nutrition and diet to reduce
and prevent excessive weight which puts a
chronic strain on lower back muscles. A good
diet without processed food and with
sufficient daily intake of calcium,
phosphorus, and vitamin D helps to promote
new bone growth.
If you smoke, stop. Smoking reduces blood
flow to the lower spine and causes the
spinal discs to degenerate.
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