Back Pain – Causes and Treatments

General back pain is a common clinical condition across the world and is a frequently cited reason for absence from work and interruption to daily activity. Symptoms of back pain can vary in intensity ranging from mild to excruciatingly painful and can be either acute or chronic. Acute pain is short-term, whereas chronic pain is the term used to describe symptoms that last for longer than 3 months.

Back pain may be experienced in any of its 3 regions, the cervical spine, the thoracic back, and the lumbar/sacral region. Lower back pain, in the lumbar or sacral region, is the most common location for back pain.

The back is a complex structure made up of bones and muscle supported by a network of ligaments, tendons, cartilage and intervertebral discs. These are fed by blood vessels and nerve roots exiting from the spinal cord. The back supports and stabilises the weight of the upper body including the head, which is surprisingly heavy, weighing on average between 5 to 6kg. It also has the important function of housing the spinal cord, part of the central nervous system, that extends from the brain. The spinal cord lies in between a protective column of bones; the vertebrae, and these interact and connect with each other via the facet joints, providing the body with movement and flexibility.

Causes of Back Pain

Pain around the back can severely interrupt day-to-day life. In many cases back pain will resolve itself with homecare, however, sometimes it can be more persistent and require treatment, usually in the form of pain relief medication, physiotherapy and if appropriate as a last resort, surgery.

Back pain is generally categorised into either mechanical pain or referred pain. Mechanical pain is the most common type of back pain and occurs when muscles and other soft tissue structures along the spinal column become excessively strained and irritated. This is often due to bad habits such as poor posture, poor ergonomics, incorrect lifting, incorrect exercise techniques or other injuries. Mechanical pain is usually experienced locally, around the area of aggravated soft tissue in the spine itself. Referred pain, however, is where pain radiates to other parts of the body away from the actual source of the injury and it is usually associated with damage to the nerves. Sciatica is a classic example, where irritation of the sciatic nerve, occurring in the lower back, can cause pain to radiate to other parts of the body such as the buttocks and down through the leg. Compression or irritation of the nerves is often a result of changes to the surrounding tissues.

Posture and Ergonomics

Poor posture is responsible for a surprisingly large number of ailments including back pain. Slouching, or hunching of the shoulders are bad habits that many of us adopt whilst growing up and never learn to correct. Poor postural habits can be worsened by a sedentary lifestyle; occupations that involve long periods of sitting, such as desk work, jobs that involve a lot of driving, lack of exercise or general movement and so forth, may all provoke back pain-related issues. Awkward sleeping positions and an unsuitable mattress can also cause or further exacerbate existing symptoms.

Sports Related Activity

Exercise and sports can also be responsible for back pain. Repetitive strain, poor training technique during exercise, weightlifting etc. can lead to a number of soft tissue problems caused by overloading and irritating muscles, tendons and ligaments. Overuse disorders can occur in several areas of the body including the back, causing painful symptoms.

Other factors which increase the likelihood of developing back pain include, smoking, being overweight, pregnancy, and stress/depression.

Medical Conditions

There are various medical conditions associated with back pain including:

Disc Related Issues

A herniated or degenerate disc is a common cause of back pain. The intervertebral discs are positioned along the spine to absorb shocks and jolts experienced during movement and to prevent the vertebrae from coming into contact with one another. A herniated disc can cause the inner gel-like substance of the disc to seep out and encroach on nearby structures, including nerve roots exiting the spinal cord. This can cause very painful symptoms and severe back ache. Degenerative disc disease can also cause severe back pain, in this case, the disc becomes dehydrated, losing height and elasticity, allowing the vertebrae to come into contact with one another. The bone-on-bone friction can cause pain and inflammation and lead to secondary conditions such as the formation of osteophytes (bone spurs).

Spinal Arthritis

This primarily affects the joints of the spinal column. Degeneration of the joints causes the cartilage to wear down, resulting in friction and painful movement.

Whiplash

This neck injury is commonly cited in road traffic accidents, where a vehicle suddenly stops and the weight of the head is thrown forward, overstretching the neck muscles and potentially damaging its ligaments.

Spinal Stenosis

Spinal stenosis refers to the narrowing of the space around the spinal cord in the spine column, causing compression to the spine and a range of painful symptoms. It is usually due to a combination of degenerative disc disease, arthritis and hypertrophy of the facet joints and due to thickening of the ligament. These cause a narrowing of the spinal canal and can cause nerve or cord impingement.

Spondylosis

A generalised term encompassing a wide range of conditions which are typically a result of degenerative changes to the spine.

Red Flags

Sometimes back pain may be a sign of a more serious underlying condition such as a bone fracture, infection, tumour, or cauda equina syndrome (a rare condition that occurs when the cauda equina, the nerves exiting at the bottom of the spinal cord, become suddenly compressed). Red flags to be aware of include back pain accompanied by unexplained fever, weight loss, loss of sensation around the saddle area (saddle anaesthesia), or changes to bowel or bladder movement.

Diagnosis

In order to discover exactly what the cause of the back pain is, an investigation of the symptoms and into the general lifestyle of the patient including their occupation and routine etc. is necessary. Further diagnostic tests such as MRI scans, X-Rays, blood tests, and SPECT CT Scans may be required if the suspected cause of the pain, is possibly due to another medical condition.

Treatment

Medication such as analgesics and anti-inflammatories can provide pain relief, and heat packs may offer comfort during the acute phase. Stronger medication may be described by a GP or pain management consultant.

Physiotherapy

Physiotherapy is highly beneficial in the treatment of back pain and is usually recommended as an integral part of any back pain-related treatment program. A physiotherapist can help to establish a diagnosis, request further medical intervention if required, and devise an individualised treatment plan, collaborating with other health professionals when needed.

Physiotherapy offers a holistic approach to treatment, taking into consideration the patient’s circumstances including their lifestyle, occupation, habits, and routine. It offers a tailored treatment program with specific stretches, exercises, and hands-on manipulation if required, suitable for that individual.

If activity is the cause of the back pain, then a physiotherapist can offer invaluable help and advice on correct technique, helping to retrain posture, strengthen the core muscles of the body and provide stretches and exercises for specific purposes. They can also help patients to address any bad habits in terms of lifestyle and postural issues if necessary.

Surgery

In some severe cases, surgery may be required if all other forms of treatment have proven to be ineffective.

How We Can Help

ProPhysiotherapy offers professional physiotherapy services to treat a wide range of back pain-related ailments.

Taking steps to stay healthy by exercising, maintaining good posture, eating healthily, and taking regular breaks if sitting for prolonged periods, can help to reduce the risk of back pain. For help and advice on the treatment or prevention of back pain or for any other information on our services, get in touch today.