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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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