Important information to know about Back Pain & Sciatica
What Causes Back Pain?
Up to 80% of us in the UK will suffer with back pain at some times in our lives. In 85% of these cases, a clear pathology cannot be identified.
In most instances, when a pathology cannot clearly be identified, a diagnosis of "Mechanical Back Pain" is reached by exclusion. This type of pain happens for various reasons but is most often due to sub-optimal function of the bio-mechanics or the region which then cause abnormal tension and strain in the joints and surrounding tissues which in turn become inflamed and painful. It is not uncommon for this type of pain to settle down on it's own for a while and then occur again with increasing frequency over time. Frequent "niggles" between painful episode are also a frequent feature of Mechanical Pain.
Mechanical Back Pain - sometimes called "Non-specific Back Pain"- is what Osteopathy is best at treating. We first treat the area of pain to get your symptoms under control but unlike other specialists, we don't stop there!
We also carry out a full bio-mechanical assessment to identify area of dysfunction - which can be some distance away from the area of pain- and resolve those to allow your body to function at it's best and help avoid re-occurrence of the problem in the long term.
But we don't only treat mechanical pain. Often people with disc prolapses, arthritis, spondylosis, etc. will also have mechanical pain on top of the spinal problem. Whilst we can't change an underlying problem such as arthritis or spondylosis, removing the mechanical element of the pain presentation can make a world of difference on symptoms and quality of life.
In most instances, when a pathology cannot clearly be identified, a diagnosis of "Mechanical Back Pain" is reached by exclusion. This type of pain happens for various reasons but is most often due to sub-optimal function of the bio-mechanics or the region which then cause abnormal tension and strain in the joints and surrounding tissues which in turn become inflamed and painful. It is not uncommon for this type of pain to settle down on it's own for a while and then occur again with increasing frequency over time. Frequent "niggles" between painful episode are also a frequent feature of Mechanical Pain.
Mechanical Back Pain - sometimes called "Non-specific Back Pain"- is what Osteopathy is best at treating. We first treat the area of pain to get your symptoms under control but unlike other specialists, we don't stop there!
We also carry out a full bio-mechanical assessment to identify area of dysfunction - which can be some distance away from the area of pain- and resolve those to allow your body to function at it's best and help avoid re-occurrence of the problem in the long term.
But we don't only treat mechanical pain. Often people with disc prolapses, arthritis, spondylosis, etc. will also have mechanical pain on top of the spinal problem. Whilst we can't change an underlying problem such as arthritis or spondylosis, removing the mechanical element of the pain presentation can make a world of difference on symptoms and quality of life.
Indeed, the National Institute for Health and Clinical Excellence (NICE) recently published updated guidelines for the treatment of low back pain to include manipulative therapy such as that provided by osteopaths.
Put simpy, this means that enough clincal & scientific evidence has now been accumulated to show that manipulations (as provided by osteopaths) are effective and should be recommended by GPs for the treatment of low back pain.
The British Medical Association also states that GP can safely refer their patients to an osteopath.
Many structures in your back can be a source of pain. In turn, back pain can often cause symptoms in other areas such as the buttocks, groin, hips and legs (Commonly called sciatica).
Problems in the spine and neck can also cause symptoms such as dizziness, headaches, clicking jaw, pins and needles and many more.
Put simpy, this means that enough clincal & scientific evidence has now been accumulated to show that manipulations (as provided by osteopaths) are effective and should be recommended by GPs for the treatment of low back pain.
The British Medical Association also states that GP can safely refer their patients to an osteopath.
Many structures in your back can be a source of pain. In turn, back pain can often cause symptoms in other areas such as the buttocks, groin, hips and legs (Commonly called sciatica).
Problems in the spine and neck can also cause symptoms such as dizziness, headaches, clicking jaw, pins and needles and many more.
Can Back Pain be a Medical Emergency?
If your back pain or sciatica is accompanied by loss of bladder and/or bowel control you should seek urgent medical attention. These could be signs of Cauda Equina Syndrome: a rare but serious complication of low back pain which can leave permanent nerve damage if not treated promptly. Download the patient information leaflet on your right to find out more about Cauda Equina Syndrome.
Osteopaths are trained professionals who are skilled in diagnosing problems, including those which may require further investigation by other health care professionals.
Please download this information sheet and share the information with your friends & family in need:
Osteopaths are trained professionals who are skilled in diagnosing problems, including those which may require further investigation by other health care professionals.
Please download this information sheet and share the information with your friends & family in need:
| caudaequinasyndrome.pdf |
What is causing MY pain?
We'll do our best to diagnose your problem. We'll start with a comprehensive case history and examination because that's the most important part in reaching a diagnosis. We'll then explain what is causing your pain and what we're proposing to do to help it.
We'll answer as many questions as you have and explain things to you in plain English.
We don't lie. Sometimes a crystal ball would be handy, sometimes we can't tell a suspected diagnosis from another straight from the onset, often pain is the result of an accumulation of "little things", sometimes we come across a tricky presentation - we may not have the answer to everything, every time but one thing we do promise is to be honest with you EVERY SINGLE TIME.
We'll answer as many questions as you have and explain things to you in plain English.
We don't lie. Sometimes a crystal ball would be handy, sometimes we can't tell a suspected diagnosis from another straight from the onset, often pain is the result of an accumulation of "little things", sometimes we come across a tricky presentation - we may not have the answer to everything, every time but one thing we do promise is to be honest with you EVERY SINGLE TIME.
Do I need a Scan for my Back Pain?
This is something we find ourselves discussing with patients quite a lot!
Sometimes a scan is clinically indicated and in such cases we'll either write to your GP to ask them to consider referring you for a scan or we'll offer you a private referral either in Norwich or in London where you can now get a private MRI scan for less than £200.
One of the main question we ask ourselves in deciding if a scan is clinically indicated or not is this one:
- "Will the result of the scan change the intervention?"
i.e.: will it simply be information that is nice to have or will it affect the treatment received going forward?
Example: Some months ago, I saw a patient who I was certain had ruptured a ligament in his knee and I suspected the meniscus (cartillage) had also been damaged. I advised him that a scan was required and that treatment other than surgery was unlikely to help. Within a week he had the MRI results which confirmed the suspected damage to his knee. He was then able to go to his GP and get a referral directly to a consultant who performed reconstructive surgery some time later. Having a scan allowed him to fast tract the NHS process by several months and the information the scan provided changed the course of action.
If you think you may need a scan, book a consultation with us and we'll be more than happy to have an open & honest discussion with you about the pro & cons of a scan for your presentation and if appropriate, suggest the most appropriate imaging technique for you.
Sometimes a scan is clinically indicated and in such cases we'll either write to your GP to ask them to consider referring you for a scan or we'll offer you a private referral either in Norwich or in London where you can now get a private MRI scan for less than £200.
One of the main question we ask ourselves in deciding if a scan is clinically indicated or not is this one:
- "Will the result of the scan change the intervention?"
i.e.: will it simply be information that is nice to have or will it affect the treatment received going forward?
Example: Some months ago, I saw a patient who I was certain had ruptured a ligament in his knee and I suspected the meniscus (cartillage) had also been damaged. I advised him that a scan was required and that treatment other than surgery was unlikely to help. Within a week he had the MRI results which confirmed the suspected damage to his knee. He was then able to go to his GP and get a referral directly to a consultant who performed reconstructive surgery some time later. Having a scan allowed him to fast tract the NHS process by several months and the information the scan provided changed the course of action.
If you think you may need a scan, book a consultation with us and we'll be more than happy to have an open & honest discussion with you about the pro & cons of a scan for your presentation and if appropriate, suggest the most appropriate imaging technique for you.
Am I Alone?
No, definetly not! Here's a few key facts & figures on Back Pain...
- Back pain is very common; according to a survey published in 2000 almost half the adult population of the UK (49%) report low back pain lasting for at least 24 hours at some time in the year (1).
- Although in most cases back pain is nothing serious and disappears within a few weeks, the sheer number of people affected makes it a very costly condition imposing a considerable burden on the individual and society.
- Simple measures can be taken to reduce the chances of developing back pain and thereby reducing the impact of existing back pain
- In industrialised countries, up to 80% of the population will experience back pain at some stage in their life. During any one year, up to half of
the adult population (15%-49%) will have back pain (1,3)
- The number of people with back pain increases with advancing age, starting in school children and peaking in adults of 35 to 55 years of age.
Back pain is just as common in adolescents as in adults (3).
- Back pain is very common; according to a survey published in 2000 almost half the adult population of the UK (49%) report low back pain lasting for at least 24 hours at some time in the year (1).
- Although in most cases back pain is nothing serious and disappears within a few weeks, the sheer number of people affected makes it a very costly condition imposing a considerable burden on the individual and society.
- Simple measures can be taken to reduce the chances of developing back pain and thereby reducing the impact of existing back pain
- In industrialised countries, up to 80% of the population will experience back pain at some stage in their life. During any one year, up to half of
the adult population (15%-49%) will have back pain (1,3)
- The number of people with back pain increases with advancing age, starting in school children and peaking in adults of 35 to 55 years of age.
Back pain is just as common in adolescents as in adults (3).
What Can I Do to Help Myself?
As we get older (over 25 years!) the body starts to loose some of the elasticity that allows it to cope and adapt to the stress and strains it is put under. This is especially true for the intervertebral discs: those cartilagenous cushions that act as shock absorbers between the vertebrae of the spine. The discs require regular movement and sufficient sleep (time spent lying down) to increase local circulation and nutrition to the tissues and promote maximal health.
What else contributes to Back Pain?
I am sure these wont come as a surprise to most of you but here we go:
- Having a previous history of back pain (3)
- Smoking (3)
- Obesity (3)
- Physical factors such as heavy physical work, frequent bending, twisting, lifting, pulling and pushing, repetitive work, static posture
and vibrations (5)
- Psychosocial factors such as stress, anxiety, depression, job satisfaction, mental stress (3,6)
In fact, there are indications that our stressfull modern lives may have a much bigger impact on lower back pain than heavy physical work...
- Having a previous history of back pain (3)
- Smoking (3)
- Obesity (3)
- Physical factors such as heavy physical work, frequent bending, twisting, lifting, pulling and pushing, repetitive work, static posture
and vibrations (5)
- Psychosocial factors such as stress, anxiety, depression, job satisfaction, mental stress (3,6)
In fact, there are indications that our stressfull modern lives may have a much bigger impact on lower back pain than heavy physical work...
Top tips for back care
1. Take part in some regular exercise & do regular stretching
2. Take frequent breaks between repetitive tasks and vary the rhythm
3. Adopt a correct sitting position when doing computer work and change position often. See how to set up your workstation page.
4. Pace yourself when the work is heavy or physical. If you are lifting (shopping & children included), make sure you are doing so safely.
5. Adjust car seats correctly, and follow the safe driving tips.
6. Watch children’s posture – don’t let them carry bags on one shoulder
7. Make sure your bed & mattress is right for you and isn't getting too old and be mindful of your sleeping posture
8. Seek osteopathic advice earlier rather than later
Sources: British Osteopathic Association, http://www.osteopathy.org/
Cited in Backcare (http://www.backcare.org.uk):
1. Palmer KT, Walsh K, et al. Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years BMJ 2000;320:1577-1578
3. Burton AK, Balague F, et al. European guidelines for prevention in low back pain. Eur Spine J 2006:15(suppl 2):S136- S168
4. Nachemson AL, Waddell G, Norlund AI. Epidemiology of neck and low back pain. In: Nachemson AL & Jonsson E (eds). Neck and back
pain:The scientific evidence of causes, diagnosis and treatment. Philadelphia: Lippencott Williams & Wilkins, 2000
5. Andersson GBJ. The epidemiology of spinal disorders. In: Frymoyer JW (eds) The adult spine: Principles and practice.
6. Philadelphia: Liipincott-Raven, 1997.
Cited in Backcare (http://www.backcare.org.uk):
1. Palmer KT, Walsh K, et al. Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years BMJ 2000;320:1577-1578
3. Burton AK, Balague F, et al. European guidelines for prevention in low back pain. Eur Spine J 2006:15(suppl 2):S136- S168
4. Nachemson AL, Waddell G, Norlund AI. Epidemiology of neck and low back pain. In: Nachemson AL & Jonsson E (eds). Neck and back
pain:The scientific evidence of causes, diagnosis and treatment. Philadelphia: Lippencott Williams & Wilkins, 2000
5. Andersson GBJ. The epidemiology of spinal disorders. In: Frymoyer JW (eds) The adult spine: Principles and practice.
6. Philadelphia: Liipincott-Raven, 1997.
