BackPainBackpain causes can be divided into several categories:
Lumbar Back Sprain/Strain "Pulled Muscle"
If there has been soft tissue damage to lumbar ligaments and muscles, this is diagnosed as a lumbar sprain/strain. This injury can be graded from one to three (I-III) depending on the grade of disruption of the fiber. The grade will determine the healing time. A lumbar sprain-strain often results from injuries such as Whiplash injury, sports injury in sports such as Tennis or Football. But the sprain can also be due to repetitive strain, postural strain or quick unguarded movements. A typical situation is quickly bending and twisting to pick something up. You can ease your pain by using ice or resting. Many patients benefit from non-steroidal anti-inflammatories (if well tolerated always ask your pharmacist and check the label for any contra-indications). At the Advanced Pain Relief Clinic in Milton Keynes, we can help you with chiropractic spinal joint manipulation or massage as well as acupuncture. This can be a very quick and effective way of easing your pain. We will prescribe back exercises as soon as this is appropriate. These physiotherapy and Pilates exercises will help you increase your activity as tolerated. One of the aims will be to increase your range of movement but we also look at strength and function. We see lumbar sprains very frequently and can help with a variety of treatments such as acupuncture, chiropractic or rehabiliation exercises.
Lumbar Facet Dysfunction/ Syndrome
Lumbar facet dysfunction or syndrome originates from the actual joint or the joint capsule and it is thought that up to 39% of lower back pain cases are as a result of this syndrome. The pain could be due to an injury of the relevant ligaments or it may be due to degenerative joint disease (DJD) and meniscal irritation. On examination patients are often bent away to the side and twisted. The character of the pain is mainly dull aching but it can also be sharp when moving in certain ways. There may be referred pain down the leg that resembles sciatic pain. Spinal manipulative therapy can make an amazing difference to this painful condition. It helps by freeing the entrapped cartilage (meniscoid). Many patients feel immediate muscle relaxation after having the chiropractic treatment. It is important to emphasise that chiropractors have a much deeper understanding of the spine and how to manipulate as the training goes a lot further than training of other physical therapists who learn their techniques in short post-graduate courses which are often weekend courses whereas most chiropractors have done a 4-5 year full time university education focusing on the lumbar spine and back. At the Advanced Pain Relief Clinic in Milton Keynes we have been providing chiropractic and acupuncture since 2001. Acupuncture has been proven to work on the spine and the Nervous System by inducing a number of modulating hormones.
Lumbar hypermobility or Instability
This pain is often due to spondylolisthesis, sprain/strain or repetitive motion or trauma and there are different types of instability. With this condition there are complaints of recurring lower backpain and possible sciatic pain. Pain is made worse by standing or maintaining the same posture such as sitting. There can be a relief of pain with manipulation but this is short-lived and the pain will recur a few days later with no apparent cause. There may be a “catching or locking” sensation. Bending forward may be painful and ther may be signs of nerve irritation. Core exercises, physiotherapy exercises such as Pilates exercises will increase the stability of the hypermobile segments and spinal manipulation to stiff segments will help. Acupuncture can provide pain relief and will allow the patient to start doing appropriate exercises.
Is the forward movement of one vertebra on the other (spondylos=vertebra, listhesis=slippage). Interestingly, 50% of patients are asymptomatic (they never develop any pain). Activities that require frequent flexion and extension such as gymnastics, cricket bowling or rowing may increase the incidence. Pain increases with bending backward. Very specific manipulation can improve the biomechanics of the spine and physiotherapy and core exercises will help with pain control. X-rays or MRI scan are indicated to see what grade the slippage is and if there has been any nerve root irritation.
Lumbar Disc Herniation
This pain is often described inaccurately as “slipped disc” or sciatic pain. With this pain the jelly like material in the disc will push out of the strong outer fibers (aka as annular tear) and this potentially causes a compressed spinal nerve (radiculopathy). The disc herniation is either central in the canal or lateral. This occurs most commonly between the ages of 20 and 40 years. 75% of herniations will resolve within 6 months due to re-absorption of the material. With this condition there is a very sudden onset of lower backpain and legpain beyond the knee. Pain is sharp, shooting and “electrical”. Pain is made worse by weightbearing such as standing, walking or sitting or coughing and straining on the toilet. Often there are decreased reflexes or there is decreased strength and pins and needles or numbness are felt. An MRI is the diagnostic tool of choice to highlight the disc herniation often this will show the nerve root being pinched or impinged. It is crucial to not miss Cauda Equina Syndrome: there are bowel and bladder symptoms such as urine retention, incontence, impotence or numbness or pins and needles in the saddle area and anal sphincter looseness. This is a medical emergency. Different types of treatments can provide some pain relief and it is estimated that 80% of patients will improve with conservative treatments. The National Institute of Excellence (NICE) has recommended Acupuncture, Chiropractic or Osteopathic spinal manipulation and a tailored exercise programme as being proven to be effective for backpain (please see https://www.nice.org.uk/guidance/NG59). This recommendation was based on existing evidence-based research that is available. The Bronfort report further recommended Chiropractic as a proven treatment. Both Acupuncture and Chiropractic have further been shown to be safe treatments with low incidences of side-effects and few contra-indications.