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What can I do about my low back pain?

International guidelines for the treatment of back pain make the following recommendations (which we agree with):

  1. Consult a health professional trained in the management of low back pain
  2. Try to keep active and act as usual
  3. Use simple analgesics (like paracetamol or ibuprofen) following the instructions on the packet and on the advice of your pharmacist
  4. Consider a course of spinal manipulative therapy by consulting a health professional trained and experienced in this treatment approach
  5. Avoid bed rest

Who can provide treatment for people with low back pain?

It is advisable to consult a practitioner with specific training in the evaluation and treatment of low back pain. In Australia, osteopaths, physiotherapists, chiropractors and medical doctors are legally allowed to perform spinal manipulation; however medical doctors do not undergo training in spinal manipulation procedures as part of their basic training.  Look for a practitioner with specific training in low back pain and who stays up-to-date.  Also look for a practitioner who has a lot of experience in treating low back pain.

What to avoid?

It is a good idea to check out the credentials of your practitioner, and word-of-mouth referrals are also a great way for people to receive feedback about a certain practitioner.  Avoid unnecessary x-rays or treatment that is painful or prescribed too often.

Warning: symptoms you should see your health professional about

It’s rare that back pain is caused by a trauma, illness or disease – in fact, it’s only around 1-2%.  Even though it’s rare, it’s a good idea to be on the lookout for tell-tale signs that let us know you should consult your doctor.  Things like:

  1. pain in the area of the kidneys (at the back under your ribs)
  2. pain that you can’t relieve by changing positions
  3. numbness or tingling in the ‘saddle’ area (or perineum)
  4. weight loss that you can’t explain
  5. fevers, temperatures or chills
  6. changes to your bowel or bladder habits
  7. numbness or weakness in your legs, feet or toes

Summary

Back pain is usually caused by the joints and ligaments of the spine – but in many cases the exact cause is hard to figure out.  What’s important is to identify if you’re doing anything to aggravate the pain and then learn how to move without pain.  International guidelines also recommend a course of spinal manipulation.  An experienced health professional with specific training in this area can be very helpful in terms of providing treatment and helping you learn how to move differently.  Assessment and evaluation is also important in order to make sure you receive the correct treatment and to rule out rare causes of back pain that require specific medical treatment.

The osteopaths at Sydney Osteopathic Medicine have years of experience in the treatment of patients with lower back pain.  We provide an osteopathic approach to each patient that incorporates the best available scientific evidence regarding the diagnosis, treatment and management of this spinal pain condition.

Phone now for a consultation on (02) 9233 2788.

We are conveniently located in the Sydney CBD, near Wynyard Train Station.

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Disc Related Low Back Pain

Internal Disc Disruption (IDD) is minor damage to a disc, it is known as one of the most common causes of lower back pain. IDD accounts for around 40% to 50% of lower back pain. A number of factors can cause damage to the disc, ranging from the degenerative nature of this disc itself to poor postural habits developed over a long periods of time, and to injury and overload. Back pain and injury are caused by any number of factors that places excessive force on the spine.

Too much mechanical stress or dysfunction may occur due to repetitive strain on the spine leading to fatigue, one very large strain, or unexpected strain. Injury to the disc can be caused by poor technique and strain in physical activities or poor body mechanics. All of these can result from unexpected loading.

Discs are mainly avascular structures and the nucleus and inner 2/3 of the annulus have no nerves. The outer third of the disc does, however, contain tiny pain-carrying nerve fibres (nocioceptive C-fibres) that have the capacity to cause pain and disability when irritated. When a tear of the annulus spreads to the outer third of the disc, these nerve endings (known as sino-vertebral nerve endings) are exposed to material leaking out from the nucleus of the disc which will lead to pain due to chemical irritation of these pain-carrying fibres.

When the functional abilities of the annulus are compromised mechanical pain can occur. Annular collagen fibres are destroyed when the nuclear material invades the annulus. The disc’s normal ability to support the weight of the body is overwhelmed when mechanical forces spread across the remaining fibres which will result in strong compression and rotation forces being placed on the spine.

The excessive strain transmitted to the highly nerve sensitive outer third of the disc results in mechanical pain signals on normal movements. Tears can occur from the inner part of the disc outwards but also from the outer part in. There is also a relationship between a disc that has lost some of its water content and become increasingly brittle (part of the degenerative disc process) and disc tears.

In a degenerative disc, you can also get radial tears running circumferentially around the brittle annulus itself. This can lead to a weakening of the disc. These tears are known as concentric annular tears, or radial tears, and irritation of the nerve fibers within the annulus of the disc may occur.

The symptoms of back pain due to disc disruption are of chronic duration and typically worse with any loading of the disc or activities that increase the intradiscal pressure. Activities such as bending, lifting, sitting and, sometimes changes in posture are all results of this. he pain is actually due to damage to the rings of the outer part (annulus) of the disc itself and not due to compression of the nerve. The resulting changes to the nuclear material and internal radial fissures lead to a pain that does not usually radiate into either leg past the knee and there are not usually classic neurological findings.

In other words, there is generally no weakness or sensory loss, no loss of deep tendon reflexes or root tension signs.

Conservative low back pain treatment and time will bring relief for most people who suffer back pain from IDD. Patience is an important factor here as IDD can take up to 18 to 24 months to heal. The other important factor is to reclaim mobility as early in the healing process as possible, without exacerbating the pain. This is where the Sydney CBD osteopaths at Sydney Osteopathic Medicine can help. Osteopathic treatment may include traction and mobilisation treatments and spinal stabilization training exercises.

The early stages of the healing process can be aided by anti-inflammatory and analgesic medications.

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Low Back Pain

Back pain can be complicated – not only because pain can be hard to work out – but also because there are so many different opinions about back pain.

And when you’re faced with a situation like this, you need to first start with the facts.

Where do people feel ‘low back pain’?

In their back, right?  Yes, but let’s get more specific.  When we talk about Low Back Pain, we’re talking about pain that is located below your ribs, but above your buttocks.  And we’re also talking about pain that is in the centre of your back or in the muscles to the left of right of your spine.  The reason we’re fussy about this is that if pain is felt further out to the left or right, it’s called ‘loin’ pain and might be due to something else like your kidney’s or ribs.  Take a moment to notice where you feel your pain?

What about pain in my leg?

It’s true that pain in your low back can spread down into your buttocks, thighs and even your lower leg. This is called ‘referred pain’ and can make things a little more complicated to sort out unless the practitioner knows what they’re doing.  The ‘funny’ thing about referred pain in the leg, is that even though you perceive pain in the leg, there aren’t any pain signals coming from the leg.  Why does this happen?  Well, we don’t really know why and scientists are only just beginning to understand ‘how’ it happens.  What we do know, however, is that when danger signals arise from your back and your brain tries to understand exactly where the signals are coming from, the final ‘pain experience’ can become blurred and you feel referred pain.

Does it get any more complicated?

Well, yes.  If you’re feeling referred pain in the leg, and then you touch the skin or push into the muscles of the leg, then you might find that they feel tender.  This is called ‘referred tenderness’ and it can make you think that there IS something wrong with your leg, when what’s really happening is:

  1. The danger signals are coming from your back
  2. Your brain tries to estimate where the pain is coming from and you may feel pain in your back AND your leg
  3. If you feel  some referred pain in your leg, then when you press the leg muscles the brain may interpret this as danger and the muscles will feel tender

And then, of course, you’re allowed to have a problem with both your back AND your leg at the same time.

You see, even with back pain and referred leg pain, it can get complicated.

How to tell if I have sciatica?

A lot of people think that pain in the leg is ‘sciatica’, which is an inflammatory problem of the sciatic nerve (the largest nerve in the body).  The fact is, however, that sciatica is very rare and only occurs in about 1% of people with back pain.  You see, sciatica is not ‘back pain’ but ‘nerve pain’ and it feels very different.  Instead of having back pain that spreads like an ache into the buttock or leg, sciatica is a sharp, shooting, electric shock that is felt mostly in the leg – not the back.  And the pain ‘shoots’ – it doesn’t just hang around as an ache.

So, if the pain you feel is mostly in the leg, it shoots down with a sharp electric feeling, and you have any tingling in the leg – then you are likely to have sciatica. It’s also important to note if you have any numbness or weakness (like not being able to lift your foot or bend your toe), or if you’re finding it difficult to go the toilet.  Any changes like this indicate a problem with your nerves and it’s important to be assessed as soon as possible.  On the other hand, if you have a backache that spreads down into the buttock or leg, and it doesn’t shoot and it doesn’t feel like an electric shock – then you probably don’t have sciatica.

Either way, you can see that it’s important to be thoroughly assessed by a qualified health professional.

Where is the pain sensation coming from?

There are quite a few structures in the spine and back that can produce painful sensations if they are irritated or damaged.  But just because there’s lot’s of them, doesn’t mean that they typically produce the pain you experience as low back pain. There have been many scientific studies looking at this question and the best information we have is that the pain is likely to be coming from the ligaments (or discs) that hold the vertebrae together or the little joints at the back of the spine. The muscles of the back might hurt – but muscles heal quickly and don’t usually produce ongoing, chronic low back pain – even though they may be very tender to touch.

The honest answer to this question is that for quite a lot of back pain, we don’t know exactly where the pain is coming from.  Now, that might seem like a ridiculous statement – surely by now we should know where the pain is coming from – and so many people claim to know where the pain is coming from – right?  Well, there’s lot’s of so-called ‘theories’, but if we stick to the facts, for the most part, we just don’t know.

What causes this back pain?

Here’s an intellectual challenge.  When it comes to the ligaments (or discs) in the back, we know that the common ‘disc bulge’ doesn’t cause pain!  That’s right.  Many, many people have disc bulges, but they don’t have any pain.  So, there has to be something else going on to cause the pain.

To many people, this just doesn’t make sense.  After all, the doctors and the radiologists always report disc bulges ‘as if’ they are the cause of low back pain.  Well, again, if we stick to the facts, and not to opinions or out-of-date information, you’ll find that disc bulges are not painful by themselves.  And of course, the problem with this is that if you’ve had a CT scan or an MRI that shows a ‘disc bulge’ then it’s very tempting to blame the ‘disc bulge’ for the pain.

And then there’s the problem of the x-ray.  You see, x-rays do not take pictures of the ligaments or discs – yet we have many patients who’ve been told they’ve got a ‘disc bulge’ as the cause of their pain even though they’ve only had an x-ray!  The practitioner who told them this must have been imagining things …

And when it comes to the little joints of the spine – this is a research mine-field – with experts across the world in heated debates about whether these joints hurt and what causes them to hurt.  But there is one thing we know, and this is contrary to what most people think: wear and tear of these joints isn’t painful!

But how can that be?  Isn’t that what all the advertising in the media is about?  Isn’t that what the information on the tablet bottles at the chemist and supermarket say? If an x-ray shows that these joints are ‘degenerated’ or ‘arthritic’ surely this means that they are causing pain?

Well – no.  Lot’s and lot’s of people have all sorts of ‘degenerative’ changes on their x-ray but don’t have any back pain.  So, just as with ‘disc bulges’ there must be something else going on.

What about alignment and bones going ‘out of place’?

It’s true that when someone is in pain, their spine may take on an abnormal position – being bent to one side, or being held too straight.  But here’s the thing – again if we stick to the facts – no studies have found that spinal mis-alignment ’causes’ back pain.  So, the back doesn’t ‘go out’ and cause pain, it’s more that when your feel pain in your spine the ‘back’ goes out.  And very often, when the pain goes, the back also returns to normal alignment.

There are some important treatments that help to restore normal alignment to the back if it is an abnormal position due to pain.

The way we use our backs can cause pain

There’s one other thing that can cause our backs to hurt – and that is the way in which we use them.  And this is perhaps one of the most important things to focus on.  If you are using your back in a way that makes it hurt – and you can learn to change the way you use your back so that it doesn’t hurt – then you have just found a very useful solution for your back pain.  And sometimes it can be quite a simple or subtle change that makes all the difference.  And that’s because whether your back is injured or not, learning how to move in a non-painful way is a great idea.

If my back hurts, does it mean that I am injured?

This is the last mind-bender in this short article.  Just because your back hurts, doesn’t mean that you have injured or damaged it.  Pain is an early warning system.  It is supposed to warn you before you injure yourself.  It’s the same as if you were to gently bend your finger back until it hurt – even though you’re feeling pain, you haven’t injured your finger joint.  And all you have to do to stop the pain is to stop bending your finger.  This alone is proof that you can have pain without damage.

Taking this one step further, even if you did injure your finger joint by bending it backwards, it makes sense to stop bending it backwards in order to stop irritating it and allow it time to heal.  You see, the way you use your finger – or your back – is very important in terms of reducing pain and recovering from injury.

So, in summary,

  1. most back pain is not due to serious illness, disease or nerve injury
  2. the ligaments (discs) and joints of the spine are the most likely source of the pain, but it’s hard to work out exactly which part the pain is coming from
  3. pain in the back can be referred into the buttock and legs, although this pain is not sciatica (which is sharp and shooting and worse in the leg)
  4. spinal misalignment can occur with back pain, but is more likely to be caused by the pain rather than it causing the pain
  5. degeneration and arthritis are often blamed for back pain, but lot’s of people have these things and never have back pain
  6. likewise, just because your back hurts, doesn’t mean that you have damaged it
  7. because it’s hard to work out where the pain is coming from and what’s causing it, we can also try to understand if you are using your back in a way that is contributing to the pain – and if we do you can often learn to change and experience a reduction in pain

OK – so what can I do about my back pain?

 

For more information, call our clinic for an appointment or fill out our contact form to receive an email response from one of our practitioners.  Our Osteopathic clinic is located in the Sydney CBD.

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