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Back Problems – Cause and Treatment
I have many clients come to me with back pain, many of whom have had pain for some time and have seen other therapists and tried other treatments etc. with no or little improvement in their condition. In this article I want to give simple background information (researched and own experience) and briefly explain some problems that can help my clients understand and improve their back condition.
Back Pain is a widespread problem and affects many people in different ways. There are numerous potential sources and causes of back pain, meaning that the diagnosis of a specific issue as the cause of pain can present many difficulties. This is because symptoms arise from different issues but can feel very similar and is often difficult to differentiate without the use of diagnostic equipment, MRI scans etc., which are great for bone problems but can have limitations for muscular issues.
Back pain does not usually require immediate medical attention but in some cases it can be a sign of a serious medical problem. Although this is not frequently the case, it must always be considered. Most back pain problems are due to inflammation, which can last for a few days to a few months and sometimes longer dependent on the underlying condition.
The lumbar region (or lower back) where most pain is experienced is made up of five vertebrae (L1-L5). In between these vertebrae lie fibrocartilage discs (intervertebral discs) which act as cushions, preventing the vertebrae from rubbing together while at the same time protecting the spinal cord. Nerves stem from the spinal cord within the vertebrae.
Two conditions to which back pain is often attributed are lumbar disc herniation (slipped disc), and degenerative disc disease, in which the discs begin to diminish and shrink in size (mainly due to age, and we will all suffer this as we get older). This can result in vertebrae and facet joints (part of vertebrae at the back) rubbing against one another. However, the large majority of the general population with back pain do not have these conditions.
Facet joints often give problem neck pain following whiplash. Ligament and joint functionality also diminishes as one ages, and this can lead to vertebrae moving out of alignment called spondylolisthesis. There are many other potential sources of back pain: these include pelvic alignment, osteoarthritis, spinal stenosis, trauma, cancer, fractures, sciatica etc.
A common source of back pain derives from the multitude of skeletal muscles of the back. Potential causes of pain in muscle tissue include muscle strains (pulled muscles), muscle spasm, and muscle imbalances. The three main back muscle groups that cause problems are i. the quadratus lumborum (I find this muscle often tightens when I’ve been doing too much digging work in the garden); ii, the erector spinae group; and iii, psoas, (see diagram below). Back pain can also be caused by other muscles of the hips and thighs eg: tight hamstrings, glutes, adductors and quads. These are the main muscle groups but there are numerous smaller muscles that can cause problems and the piraformis needs to be checked if there’s a sciatica problem.
The treatment objectives for back pain are to achieve a reduction in pain and to restore the individual’s function. There are many treatments available (the list below is not exhaustive) and only the minority of back pain patients require surgery.
- Home heat therapy can be a useful start for some back conditions. Some patients find that moist heat works best e.g. a hot bath or whirlpool. Also cold therapy (e.g. ice or cold pack application) is advocated for inflammation.
- Use of medications, such as anti-inflammatory drugs or paracetamol etc may be sufficient. Injections with corticosteroids can help ease low back pain.
- Remedial massage therapy by a sports therapist can provide relief complemented by stretching and back exercises.
- Chiropractic work to ensure correct bone alignment.
- Acupuncture has been shown to be some benefit.
- Scenar Therapy is effective in relieving or reducing pain in many clients.
- Transcutaneous electrical nerve stimulation (TENS) can be used but results are inconsistent.
- Ultrasound is often used by therapists and the cost of these machines have reduced in recent years but many of my clients have said it has not been that beneficial for them.
- Posture training awareness and improvement in how we sit / stand, use the computer, drive etc. can be very effective in the long term.
- Unless specifically advised by a doctor bed rest is not recommended for more than 2 days as this often leads to stiffness and more pain. Physical activity within the limits of pain usually aids recovery.
- Home exercise. There are some excellent books around on back pain that provide simple rocking exercises to help ease back pain and help flexibility, aiding recovery.
- Surgery is usually the last resort in the treatment of back pain. It is normally recommended only if all other treatment options have failed. There are different types of surgical procedures eg: nerve decompression, fusion of vertebrae and deformity correction surgeries. A discetomy is performed when the intervertebral disc has herniated or torn. It involves removing either part or all of the protruding disc that is placing pressure on the nerve root. This is one of the most common types of back surgeries with a high success rate although nerve damage does take a long time to heal.
Back pain is such a common and varied condition which affects so many people. The reason why we have back pain can sometimes be obvious due to a certain accident or event but often the source can be hidden or complex. I have found while working with clients many normal activities have been the root cause of back problems eg: – poorly supporting bed frames and mattresses, sitting posture in chairs especially when using the PC or laptops, driving positions. As my mother says “you need to be your own doctor” and find what is triggering your problem and what remedial therapy works for you.
I have successfully helped many people with back pain and where this is due to muscular issues, sport massage therapy can be ideal. However I do not profess to know it all and will, and have, referred clients to other therapists where I have considered there are skeletal (bone) alignment issues beyond my expertise and training.
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