Back Pain Facts from a chiropractic & physiotherapy view
Low back pain at a glance
Low back pain is an extremely common condition, in fact it is suggested that 80% of adults will experience low back pain at some point in their lives. Low back pain is the most common cause of occupation-related disability and the most common condition to cause someone to have a day off work. Over the next three months it is likely that over ¼ of the adult population will experience low back pain.
Low back pain can affect us all with both men and women affected to a similar level. Low back pain can start with dull pain and increase to sharp pain that is deliberating in nature and requires urgent treatment. A range of activities can cause low back pain, such as poor lifting technique, prolonged sitting, prolonged inactivity and the natural ageing progress as our spines undergo normal wear and tear. People who don’t exercise much are more at risk of low back pain than those who do exercise frequently. However, people that work in occupations requiring large amounts of strenuous lifting and bending are also likely to be at risk of low back pain.
The good news is that low back pain is usually a self-limiting condition that Mother Nature takes care of. Meaning that even with no treatment (for example, chiropractic or physiotherapy), low back pain doesn’t last long. Most cases of low back pain are mechanical, meaning they are caused by an irritated musculoskeletal system (muscles, joints, supporting structures). When you read about low back pain you may see the following terms:
- Acute low back pain: this usually means its been there for less than 4 weeks
- Subacute low back pain: this means its been there for between 4 – 12 weeks
- Chronic low back pain: this means the low back pain is over 3 months old.
It is possible to have an acute attack of low back pain on top of an already chronic history of low back pain. These are called ‘flare ups’. The scary fact is that about 20% of people that experience an acute episode of low back pain will then go on to develop chronic low back pain with persistent low back pain for over 1 year. Surgery is not a magic bullet for most cases of low back pain with the data showing ongoing low back pain even after surgical intervention. Low back pain is one of the faster growing conditions or reasons someone will visit a medical practitioner and is in the top 6 for biggest burdensome condition in most western societies.
What is a low back made up of ?
The low back is called the lumbar spine and this is made up of 5 bones we call vertebrae. Between each of the vertebrae is a shock absorber made of cartilage called an intervertebral disc (disc). This is all held together with ligaments, muscles, tendons and joints. The spinal cord ends a little higher in the low back (around L2) but most of the low back vertebrae allow for the passage of the lumbar nerves (cauda equina) that will supply just about everything from the pelvis down to the toes.
What causes low back pain ?
Most of the time, low back pain is what we call mechanical low back pain and refers to our muscles, joints, ligaments, tendons or intervertebral discs. Any one of these structures may irritate the spinal cord or spinal nerves. Here is a short list of common causes of mechanical low back pain:
- Intervertebral disc pain
Our intervertebral discs are the cartilage cushions between our vertebrae. This cartilage can tear and become inflamed, resulting in chronic and persistent low back pain.
- Herniated discs
If the tears within a disc become large enough the soft central part of a disc can rupture through the outer layers of a disc, causing an inflammatory response and compression of nerves and the spinal cord. This will lead to low back pain in both the acute and chronic sense.
Sciatica is a condition (symptom) that produces pain from the back to the foot. This is what we call a radiculopathy as a result of an irritation one of the nerve roots that make up the sciatic nerve. This is caused from a herniated disc in the low back that compresses one of our spinal nerves. Patients describe pain, numbness and tingling.
Spondylosis is just a fancy way of saying ‘wear and tear in the back’. As our backs become degenerated they lose moisture or hydration in the disc and this leads to little tears that may turn into big tears that cause pain, disc herniation or rupture and place increase tension on other structures that leads to the formation of bone spurs.
Spondylolisthesis is a condition where the vertebrae slips out of place and may pinch and pull on the spinal cord and nerves.
Radiculopathy is a condition caused by compression or injury to a nerve root. This leads to inflammation called radiculitis.
- Spinal stenosis
As we age, the canals in the spinal cord that house the spinal cord and spinal nerves may shrink and become narrow. This can also happen as a result of bone spurs or a herniated disc. This can lead to serious neurological conditions.
- Facet joint pain
Facet joints are the steering wheels of the spinal cord that allow for movements. Sometimes they are loaded too much chronically or acutely and this leads to a number of problems, such as pain.
- Sprains and strains
Irritating ligaments and muscles can cause sprains and strains. For example, when we roll an ankle. In the low back, it usually occurs after lifting or twisting. We get muscle spasms and joint pain that is usually acute and will resolve with time. Chiropractic and physiotherapy help with this type of back pain.
Could low back pain be serious ?
In a majority of low back pain cases there is not a serious pathology or condition that requires urgent medical care. However, some serious underlying conditions may cause low back pain, which include:
- Abdominal aortic aneurysms
- Kidney stones
- Neurological compromise (cauda equina syndrome)
What are the risk factors ?
There are many risk factors for low back pain, such as:
Age: Back pain usually starts around 30-50 years old and becomes more common with age.
Sedentary lifestyle: Movements and active exercise is the best way to reduce the risk of back pain.
Pregnancy: Changes in pregnancy can be a risk factor for back pain.
Occupational risks: Prolonged sitting and laborious occupations.
Psychological factors: Back pain isn’t just about the muscles and joints in your spine, factors such as depression can contribute to back pain.
Genetic factors: Medical problems that run in the family can contribute to back pain, along with certain types of conditions, such as arthritis.
Smoking and alcohol: Abuse of smoking and alcohol increase the risk of back pain.
Many more: Back pain is complex, sometimes it’s mechanical (muscles and joints) and sometimes it’s not. At Sydney Spine & Sports Centre (S3C), our chiropractors and physiotherapists find the cause of your neck and back pain to provide you with sensible strategies to self manage your back pain.
What are the treatments for back pain at Sydney Spine & Sports Centre (S3C) ?
Chiropractic for back pain: Chiropractic is the profession that concentrates on diagnosis and treatment of spine, joint and muscle pain. It’s not just about cracking joints, like some people believe. A majority of what chiropractors do involves no cracking at all. Typical chiropractic treatments for back and neck pain would include: manipulation, McKenzie Method, joint treatments, muscle treatments, rehabilitation exercises and advice.
Sports Chiropractic for back pain: Sports chiropractors have specialised training in sports treatments and have a greater understanding of sports injuries and rehabilitation. This specialisation in chiropractic is one of the most exciting and rapidly expanding fields. Athlete’s and sports players should see a sports chiropractic if experiencing back pain when playing sport or during training or activity.
Physiotherapy for back pain: Physiotherapy is a profession concerned with the diagnosis and treatment of muscles, joints, tendons, ligaments and cartilage. Rehabilitation and active treatments are a large focus of physiotherapists and this is reflected at the Sydney Spine & Sports Centre (S3C) chiropractic and physiotherapy clinics in Balmain and Dee Why.
Nutrition for back pain: Our chiropractors and physiotherapists at Sydney Spine & Sports Centre (S3C) are also clinical nutritionists, with a particular interest in sports nutrition and injury nutrition. We give you advice on nutritional strategies that will help you overcome injury and aid in the healing process.
Strength and conditioning for back pain: Strength, conditioning and rehabilitation is a clinical focus for our Sydney Spine & Sports Centre (S3C) chiropractors and physiotherapists in Balmain and Dee Why. It is this service that makes us different. We work closely with personal trainers and coaches to make sure you are doing the right things to fix your pain.
What to do next ?
If you are experiencing back pain the most important thing is to get a clear diagnosis and then an evidence based treatment. This means that your treatment is supported by research and proven to actually work. There are more treatments for back pain then can be listed. However, many of them simple don’t work. Our Balmain and Dee Why chiropractors and physiotherapists at Sydney Spine & Sports Centre (S3C) give you a clear diagnosis of what is causing your back pain and then offer sensible strategies and treatments to fix it. Unfortunately, with back pain there is generally no recipe – strengthening exercises work for some, adjustments work for others (cracking), and simple education and reassurance works for certain types of back pain as well. The key is that you find someone that will give you a specific and tailored treatment plan that empowers you to fix back pain and self manage any recurrence in the future.