All About Back Pain

4 Cavendish Square, London

You Might Be Pleased To Know, You’re Not The Only One With Back Pain!

It is estimated that approximately 1 in 5 of us WON’T get back pain. This means that there is an 80% likelihood of you getting back pain at some point in your life. Back pain is a huge cause of disability nowadays, and costs individuals and companies alike 100’s of millions of £’s every year.

But don’t worry! We wrote this to help you & help relieve, prevent and reduce your back pain. Below are some of the topics we cover, so chose the parts that are most helpful for you!

 

What Can Trigger Back Pain

There are lots of different things that can trigger back pain but here are just a few and how to help fix them!

1. Bad Posture Causing Back Pain

Specifically, bad posture, puts stress on the body, slouching with a forward head posture is probably one of the biggest contributors to that really “insidious” back pain.  You’ll know it if you’ve had it, the type of back pain that comes on really slowly that you really can’t pinpoint when it started or what caused it.

Because most of you reading this will spend considerable amounts at a desk or sat down (don’t forget commuting counts too) you rack up a considerable mileage on your bottom! Sitting-down loads discs in the lower back by about 20% more than when standing. This is then made worse by a significant forward head carriage and rounding of your shoulders.

The spine is like a long stick, and as long as the top of the stick is over the bottom, all is well and as it should be. Unfortunately the further forward the top, relative to the bottom, the more pressure builds. So spending the time standing (which is supposed to be better for your back) turns into an activity that causes more problems.

Thus, over the course of a day, your poor back is trapped between a terrible seated posture and an awful standing one.  Over time this adds up and starts to lead to more ingrained lower back pain and eventually arthritic damage.

Fixing Posture
• Keep your shoulders retracted and chest opened out

• Keep Your head over your shoulders

• Take regular breaks from sitting at the desk to stretch out

• When sitting, keep your bottom in the back of the seat with your hips and knees at 90 degrees

• Adjust the height of the chair so your arms are by your side and elbows also at 90 degrees

• See our back exercises video on YouTube for strengthening techniques for your back muscles – Extra advice here

Lifting Badly Causing Back Pain

Poor lifting technique results in back pain sooner or later. It is normally because some element of disc damage has been done. This can be due to either one really heavy load to traumatize your back or a series of repetitive small loads. Repeated lifting done poorly can have a cumulative effect, adding up and resulting in damage and back pain.

Lifting badly basically means that you aren’t engaging your core muscles and bending your knees to lift something. Instead, your round your spine and twist from the hips, rather than moving your feet. In other words, “Lazy Lifting”. This bad approach to lifting compresses the discs in your lower back and can cause them to rupture or tear.

Twisting whilst lifting, dramatically increases the risk of damage to your lower back discs because of the anatomical arrangement of fibers of the disc.

How To Lift Well

• Don’t lift something that is too heavy for you – ask for help

• Bend your knees, keeping your back as straight and upright as possible

• Avoid twisting with the back during the lifting or lowering part

• Do not hold your breath or strain as you lift

• Engage your core muscles

Other Back Pain Triggers

The two triggers above are the main ones, and this is really a consequence of modern living and the stress it places on your body.  Quite often people whose parents & grandparents lived in a time of real “heavy duty” manual labor don’t always see an 8-hour shift behind a desk as being a problem.  It Is.

Here are some more triggers, perhaps lesser known:

  • Periods/menstruation
  • Trauma (fall/car accident or similar)
  • New Medication (side effects from)

The next few are much less common and will be accompanied by things like fever, possible nausea, and other abnormal symptoms, sometimes.

  • Infection after surgery
  • Kidney problems (like stones) – normally slightly higher than the “lower back” and very much on the side of the back.
  • Pancreas problems (like pancreatitis) – typically around the level of your bra strap (ladies)
  • Prostate problems (like prostatitis) – typically lower back and may also have problems passing water (gentlemen)
  • Uterus/Gynaecological problems (like fibroids) – having seen some rather large fibroids in my time on X-Rays, these often go unnoticed for quite some time!
  • Psoriasis can be a trigger for joint pain in general and sometimes back pain

A Brief Word On Conditions That Cause Back Pain

First and foremost, there is only one way in which you “strain a muscle” that might be the “cause” of your back pain. And that is in the event that you maximally stress it through sheer loading and tear the muscle. This will always cause significant bruising that is visible. If you are ever diagnosed with a lower back muscle problem “it’s just a muscle spasm” that is a SYMPTOM and not the cause of your back pain. Making this distinction is vital. I’ve seen literally thousands of patients in the last couple of years most of whom have had back pain as a primary or secondary complaint.

A “muscle spasm” has NEVER been the cause of any of those patients pain. It is worth stressing the point as seeing patients being wrongly diagnosed as having muscular back pain for sometimes years is what leaves them with a problem of significantly greater magnitude. It is a personal frustration for me as it is the cause of such frustration and pain for patients before they see me and quite simply can be avoided. It is never a muscle, but muscles do react and “tighten up” or go “into spasm” if you have any of the following conditions – so pay attention.

Nevertheless, here are some of the more common conditions you may be diagnosed with…

1. Spondylosis & Degenerative Disc Disease

This condition affects the discs between the vertebra in your spine. It can affect any of the joints in the spine from the top of the spine in the neck, to the very last joint in your lower back. Spondylosis and Degenerative Disc Disease (DDD) most commonly affect the lower back, in particular, the L5/S1 Disc.

In my experience spondylosis can be present in association with other issues. For example, I’ve commonly found reductions in the normal curve of the lower back (lordosis) and forward head posture associated with this condition.

Essentially it is wear and tear, which your GP will probably tell you. However, research clearly shows that certain postural problems, such as a hyper lordosis, increased sacral base slope and forward head carriage all drastically increase the forces and pressure the L5/S1 disc is under. This is what cases ACCELERATED wear and tear which can be helped, and if factors are present within your spine that are speeding up the degeneration, a responsible practitioner should seek to address these with you, not dismiss you as being old or a lost cause.

2. Spinal Stenosis

Usually occurring in association with the above condition (spondylosis), Stenosis means narrowing of a hole. In this case, a hole that a nerve root or spinal cord runs through. This is more or less always caused by degenerative changes, however, other more severe causes of stenosis can be cancers and fractures. One of the problems of stenosis us that it will give you a greater risk of inflammation building up around your spine causing you pain. Inflammation and swelling take up space and put pressure (physical and chemical) on the surrounding tissues which lead to a painful feeling. If the hole that they are building up in is smaller, this “symptomatic” point is reached faster.

Stenosis will sometimes be treated in extreme cases by surgical intervention to open the hole and make it larger. However, treating patients to reduce the symptoms associated with stenosis can be quite often successful without the need for surgery or injections. The back pain caused by stenosis can vary from local back pain to sciatica-like symptoms that can travel part or all of the way down the leg. Muscle spasm will always play a part in this, as the muscles react to the inflammation as is their natural reflex. However, muscle spasm in conditions like this and stenosis, only serve to restrict movement, increase pressure and further accelerate the problem.

3. Spondylolisthesis

This Condition can cause back pain, but given my experience, it is a condition that although, serious, may sometimes go without real symptoms. Spondylolistheses are graded 1 to 4 depending on how bad the damage is. It most commonly occurs at the L5/S1 segment (again) and is where the L5 vertebra slips forward on the Sacrum. This can be caused by a trauma, fall or car accident, or can be a slow process that occurs over time. It’s worth noting, some people are born with a slight defect in this segment which increases their vulnerability to the problem.

Essentially this is a permanent condition but it can be stabilised and if your practitioner can understand why it has occurred and what factors are maintaining it as a problem, you’ll likely be able to get to a point of not having nearly as much day to day pain!  Typically, when symptoms are really quite bad, surgical fusion of the spine is done to make the issue permanent, but if the “causative” factors are still in play, you often find surgery to be much less successful.

Conditions like spondylolisthesis are particularly vulnerable and sensitive to bio-mechanical changes, and it’s important that your practitioner fully understands what spinal issues you have that are contributing to the problem and making it worse. Although in my experience spondylolistheses are more difficult to treat, they are normally accompanied by some pretty significant abnormalities in the spine. When there is no trauma associated with the condition, it is usually very common to find such spinal alignment problems which can be influenced to help the patient significantly.

Other Conditions That Cause Back Pain

You might be thinking, “What about all the other conditions out there?” – Trapped nerves, arthritis, slipped discs, sciatica. And you’d be right to. However, Sciatica and trapped nerves are one in the same.  They both effectively are an irritation of a nerve that comes from the spine, causing pain along that nerve (to a varying degree), they are not really conditions though.  They are merely a description of a collection of symptoms, which will be caused by inflammation irritating the nerve. Inflammation doesn’t occur for no reason, it will be down to the following: degenerative change (including arthritis), a damaged muscle, tendon or ligament. Of course, there are many “pathological conditions” such as prostatitis in men and fibroids in women or infections in both, that can be responsible for back pain. However, thankfully those causes of back pain, are screened for in a comprehensive case history examination in practice, and should you be suffering from those sorts of conditions swift referral is appropriate.

Some Quick Self Help Tips For Your Back Pain!

  • Stretching the back muscles (knee hugs) gently will help alleviate some of the pain in the back (not good as a long term strategy)
  • Stretch hamstrings whilst lying on your back using a towel to pull the leg up (slowly)
  • Ice or heat can be used to ease the inflammation or muscle spasm
  • Natural anti-inflammatories such as turmeric can help if you are a long term sufferer, (note, this won’t help the condition but will help you manage the pain without the side effects of drugs)
  • See A Professional, If you’re in London (UK) contact the clinic for gentle, safe, and effective treatment.

Simple Ways To Prevent Back Pain In The Future!

Reduce Bodyweight

It has been proven time and time again that you are more at risk of back pain being overweight. And when you think that the main problems in the lower back are associated with too much compression causing degeneration, the weight loss part makes complete sense.

It’s definitely not the only thing but losing a few pounds will definitely help prevent back pain.

Avoid Repetitive Actions

Beware of repetitive actions you do on a daily basis, for example always having the copier on the right of your desk at work will lead you to continually twist right.

If you go through spells of being particularly busy with the copier, say 2 weeks leading up to a deadline, this can be a problem. Either move things so the task is not as repetitive, or remember not to be lazy and actually turn your whole body instead of twisting.

Supplementation

There are lots of supplements out there, too many to mention them all, but in short, supplements can be used in addition to a balanced diet.

This helps make sure your ligaments, joints, and bones are supported with all the necessary ingredients that sometimes are lacking in a modern diet. For example, a good joint support complex, Vitamin C, Calcium and Vitamin D are just some of the supplements you can use regularly to help guard against injury and premature degeneration.

Core Rehab Exercises

Strengthening your core muscles is particularly important for protecting your lower back. Dynamic core exercises that work the whole core – not just the “6-pack” is important. Remember you don’t have to be a body builder or really lean either. But patients that have good all round core stability do manage much better than those that don’t invest the time to help develop the “corset”.

Keep Flexible

Stretch regularly to keep your body supple and flexible and reduce the chances of injury.  Activities like yoga, without doing it to the extreme, can be very beneficial for keeping you supple and injury free!

If you are worried about yoga or that it might not be best for you, some gentle stretches can be done from home to increase your lower back & hip flexibility.

Correct Footwear & Orthotics

Footwear is probably one of the most overlooked contributors to back pain. You can probably imagine that high heels aren’t the best for your back. But lots of shoes do not provide the necessary support for your feet.  A good pair of orthotics are very inexpensive and can be inserted into many of the most stylish working shoes to great effect.

Many of my patients with a longer history of back pain have very poor foot mechanics. This is a problem made worse (and partly caused by) poor shoes. Orthotics can be a very easy fix for this, if you’d like more information about orthotics, do contact us!

Symptoms That You Should Watch Out For

In most cases, back pain does not require a visit to A&E however if you suffer low back pain as a consequence of trauma or you are getting any of the below symptoms, please do see a qualified medical practitioner immediately.

  • Fever or the chills
  • Any recent and unexplained loss of weight
  • Inability to control your bladder or bowel movements (cauda equina syndrome)
  • Severe abdominal pain associated with the back pain that is continuous (abdominal aortic aneurysm)

It is worth noting that the above are very uncommon, but should always be investigated.  On the whole, most cases of back pain are not a medical emergency and can respond well to treatment in a non-emergency setting.

Unfortunately, we have seen a handful of these cases and we are very good at identifying them, so as a patient you can rest assured, that if you are showing any “red flags” we will take the necessary swift steps to ensure you are directed to the appropriate place.

Relieve Back Pain Quickly!

• Apply Ice to the Low back to reduce excess inflammation

• Apply heat to the low back muscles to ease stiffness or muscle spasm

• Gentle stretching of the gluteal muscles and hamstrings.

In most cases booking in for a consultation and treatment is the fastest way to get relief from back pain. The longer the back pain lasts the more other areas of your body will have to struggle to compensate for the injury, which will lead to “collateral damage”. Treatment is easy and an appointment that will rarely take longer than 45 minutes to 60 minutes, will quite often avoid possible weeks of discomfort.

Tips to relieve back pain

You Have A History Of Back Pain…

Follow these tips on what you should do, and importantly, what you should avoid.

Desk Based Work Station

Ergonomics refers to your station at work. Most HR departments in larger corporations will know how costly bad ergonomics can be for the company. This means that your HR department will likely be happy to ensure you have a good working posture to protect your spine. This is particularly important if you have a history of back pain or other spine related problems. Check with your HR staff or ask for an Ergonomic assessment. In short, you should be sat up straight with a good supportive chair, the center of the screen should be lined up with your eyes and your knees, elbows, and hips at 90 degrees.

Core Strengthening Exercises

The abdominal muscles make up a strong and stable corset that support your lower back and protect it on a day to day basis. Doing exercises like side plank and unilateral exercises that involve core stabilization (ie. walking lunges). Other exercises like “woodchoppers” can be done in the gym using a cable machine to safely work the core.

Always try to fully exhale before the “contraction phase” of the exercise to get a maximal contraction through the entire abdominal muscular system.  Remember to work the back part of the core too with exercises like back extensions which can be seen here as part of our “back strengthening” rehab video.

Take Regular Breaks

Take regular breaks from sitting at the desk. Getting up and moving around frequently can do wonders for keeping the joints in not just your spine, but your whole body, lubricated well.  Keeping your joints lubricated helps keep them healthy.  You also avoid the remodeling and “creep” that occurs in ligaments.

When you hold ligaments stretched i.e. in a slouched position, for 15-20 minutes, remodeling and stretching of the ligaments occur, this is not good in 95% of cases. This permanent change can easily be avoided by taking breaks at work, such as standing to take phone calls.

Forward Bending

Avoid forward bending for the first 10 -15 minutes after waking up.  This includes having a shave or putting on your socks/tights. Bending forward is particularly bad for disc problems and compresses the front part of your spine. Although it will be a nice stretch, such activities like knee hugs or washing your face (whilst being bent over the sink) are best left for about 10-15 minutes.

Instead, walk around, and do other tasks like having breakfast or your morning tea/coffee.

Bad Abdominal Exercises

Although core exercises are good for most if you have a history of specifically disc related probelms, be very cautious with certain core exercises. Straight leg raises and some of the more advanced rotational exercises like the ones in stage 3 of the abdominal strengthening video should be avoided.

Although more advanced exercises like that can be very powerful you MUST maintain good technique at all times and only progress to stage 3 exercises when you are confident that your lower back injury is healed (typically 6 weeks or so – depending on the exact tissue injured).

Avoid Heavy Lifting

Lifting abnormally heavy loads, the sort that occurs when moving house, for example, should be avoided. Although the pain in your back may have eased relatively quickly, this normally occurs before the injury is fully healed. So be mindful of lifting heavy loads if you do have recurrent low back pain. Better safe than sorry.

On an equal note, a large number of men in particular normally admit that it was something very light – like a sock, that was lifted to trigger the most recent episode of back pain. Quite often you won’t engage your body as effectively when lifting a nominal weight and this normally affects the gentlemen more than the ladies. Be careful, it’s not much more effort to lift properly.

Slipped & Bulging Discs Are Often Ignored & Treated Poorly!

One of the big mistakes we see in patients previous treatments is the failure to understand spinal structure and mechanics properly. However, most of the time this is just an honest mistake. Normal treatments for slipped discs include

Rest, physiotherapy exercises, injections, & surgery.

Fortunately, patients are starting to move towards the likes of osteopaths and chiropractors nowadays for an earlier intervention. However, treating merely the symptoms of the problem and not fully addressing underlying abnormalities in the structure of your spine will not get the best results possible.

I find, that when patients (or their practitioners) don’t have an understanding of the patients spinal structure and the implications this has, they get reoccurring episodes. Firstly the discs heal very slowly, 6-8 weeks or so to repair (although pain could go before the injury is fully healed). Secondly, if there are spinal alignment issues that put more pressure on the spinal disc on a daily basis, the complete healing may never occur, leading to vulnerabilities. Thirdly, If rehabilitation exercises & stretches are not specific enough or tailored to your own UNIQUE spinal misalignments, you will struggle to stave off relapse or new injured discs.

The approach we take at The Mayfair Clinic is to firstly to diagnose the problem, treating the injured discs and surrounding musculo-ligamentous tissues. Patients will then be offered (where clinically relevant) X-Ray imaging to further the clinical understanding of your case. From here, treatment will be combined with home-based strategies, including but not limited to:

Strengthening exercises, stretches, lifestyle modification, orthotics, dietary plans.

So with the right approach, you can really help a slipped disc and prevent re-occurrence. Just because there isn’t pain, doesn’t mean the problem isn’t there, and if you ignore the problem, the pain will come back in most cases sooner or later.

X-Rays Or MRI?

I do find that a lot of patients nowadays seem to be much more interested in getting an MRI done than a set of X-Ray films. You may have thought the same, and it is true, you cannot see the discs on an X-Ray, and the MRI has incredible views of the soft tissues and inflammation. Unfortunately, MRI’s will very rarely show any information that wasn’t already suspected. It is almost used to confirm a diagnostic test. Most of the case if have colleagues that will have referred for an MRI suspecting a slipped disc (for example). A treatment plan to help the patient with this problem will be formed, and the patient referred. Then the practitioner gets the report back and yes, it is a slipped disc, and the treatment plan is changed in no way what-so-ever.

Cervical Spine X-Ray vs MRI

Comparing this to an upright weight bearing X-Ray, I have very rarely referred for an X-Ray and not learned some extra useful information to further customize the treatment plan to the patient, and that stat is across thousands of patients (many of whom have had MRI’s prior to seeing me). This is partly because MRI’s are lying down 99.9% of the time and this does not show the true stresses that an upright existence places on your spine. Taking the previous example of the slipped disc that we spoke of earlier on MRI, there are numerous occasions where additional information has been gained from X-Rays to see why the patients have been struggling so they can benefit from an extra specific prescription of targeted rehab work.

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