Back pain: Causes and Management

In one of our previous post, we talked about back pain and what you could do about it. Because back pain is complex, we wanted to help you to learn the different causes, symptoms and all things related to lower back pain.

As we mentioned in a previous post (here), 70% to 90% of Australians have experienced back pain on and off in their life (1). Often lower back pain can
be defined as pain within the lumbar spine between the vertebrae of L1 and L5, however, your back is connected to your thorax, hips and pelvis. And therefore, all these areas can refer pain in the back or vice versa.

What is the most common cause of back pain?

Medically, your doctors may diagnose you with:

  • Disc degeneration: Represents a wide category of back pain resulting from or associated with the degeneration of intervertebral discs (2). It involves a process where the intervertebral discs lose height and hydration. When this occurs, the discs are unable to fulfil their primary functions of cushioning and providing mobility between the vertebrae. Although the exact cause is unknown, it is thought to be associated with the ageing process during which the intervertebral discs dehydrate, loose elasticity, and collapse. Despite its name, degenerative disc disease is not so much of a disease, but a natural occurrence that comes with ageing (3).
  • Facet irritation/sprain: Refers to a dysfunction at the level of the posterior facet joints of the spine. These joints, together with the disc, form the intervertebral joint. Changes at the level of the posterior facet joints can influence the disc and vice versa.
  • Herniated/Slipped disc: A herniated disc occurs when a portion of the nucleus pushes through a crack in the annulus. Symptoms may occur if the herniation compresses a nerve. A herniated disc refers to a problem with one of the rubbery cushions (discs) that sit between the individual bones (vertebrae) that stack to make your spine.
  • Spondilolithesis: Occurs when one of your vertebrae, the bones of your spine, slips out of place onto the vertebra below it. Fracture of the pars interarticularis occurs, allowing the injured vertebra to shift or slip forward on the vertebra directly below it.
  • Spondylosis: Is a weakness or stress fracture in one of the vertebrae, the small bones that make up the spinal column. This condition or weakness can occur in up to 5% of children as young as age 6 with no known injury. A stress fracture can occur in adolescents who participate in sports that involve repeated stress on the lower back, such as gymnastics, football, and weightlifting.
  • Sciatica: Is a term used to describe nerve pain in the leg that is caused by irritation and/or compression of the sciatic nerve. Sciatica originates in the lower back, radiates deep into the buttock, and travels down the leg.
  • Spinal stenosis: Is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck. Some people with spinal stenosis may not have symptoms.
  • Sacroiliac Joint (SIJ) syndrome: Refers to the pain arising from the SIJ joint structures. The sacroiliac joint is the joint that connects the hip bones to the sacrum. SIJ dysfunction generally refers to aberrant position or movement of SIJ structures that may or may not result in pain.

These pathologies are the ones we see most in our clinic. There are other pathologies that can trigger back pain such as Osteoporosis, Fibromyalgia, Endometriosis, Cancers, Kidney Stones or Spina Bifida. But these conditions would present themselves with other symptoms that will prompt you to see your GP almost straight away.

However, it is important not to be caught up by these scary words. Research has shown that 80% to 90% of patients with lower back pain have no pathological or anatomical cause for their pain (4-6). 

We know that pain can be really complex and we need to look at the entire person to have a clear picture of the problem. In other words, we need to have a holistic approach to your health.

There are few reasons why you can experience lower back pain:

#1: Injury to a muscle, a joint, a disc or nerve irritation

#2: Repetitive stress on the lower back tissues such as heavy lifting, standing, sitting or twisting for long hours at work

#3: Stress, worry, anxiety and depression

#4: Pregnancy

#5: Lack of physical activities and sedentary lifestyle

Often the symptoms can vary from tightness, stiffness, light numbness or tingling in the legs, burning, sharp, electrical or aching sensations depending on each person. And pain can be felt differently because we are all unique. Two people with the same disc herniation might not feel the same pain even though their scans are suggesting similar diagnosis. 

Where can pain be felt?

So pain can be either located:

  • Within the lumbar spine during movement or at rest
  • In the buttock area, radiating from the lower back down toward the leg
  • In both side of your spine and sometimes travelling from left to right or from right to left
  • Centrally within the spine

That’s the reason why having an assessment with a healthcare professional is almost always important

How do I know if my back pain is serious ?

Back pain can be scary and it can be really debilitating for many of us. But don’t forget as we mentioned above 80% to 90% of the cases of lower back pain are harmless. 

In other words, you won’t need surgery, any type of invasive treatments or have complications over time. With some help from a professional healthcare provider, you can most likely get better.

But here are a good list of symptoms that requires you to seek help from either your GP or straight to the ER.

  • Sudden weakness or complete numbness of your legs
  • Loss of bladder function (going the toilet is an issue, you cannot control your bladder/bowel movements)
  • Erectile dysfunction for men
  • Loss of sensation in the perineum for women
  • Unexplainable weight loss
  • Severe stomach pain
  • High fever
  • Loss of motor function within the lower limb (You cannot walk at all)

These symptoms are rare but serious, so don’t ignore them.

How long will it last ?

This is the hard part. Because everyone is different, everyone will have a different prognosis depending on their individual situation. Most of the acute (new injury/short term) episodes of lower back pain tend to get better after 6-8 weeks. However, if you have persistent lower back pain then, the problem might take more time to resolve.

Pain is triggered by complex biological, psychological and social mechanisms and sometimes, it is not because you have a disc degeneration or herniation that you will necessarily have pain. Many people who have been diagnosed with a condition mentioned above can live well without pain (7-8).

 

Mismanagement of an acute episode of back pain can become chronic.

We often think that resting, taking medications and using a heat pack are the ‘go to’ strategies for pain relief. However, often it can actually be due to deconditioning of the nervous and musculoskeletal systems. In other words, it means that the less you are using your body, the less you are using your nerves, muscles, ligaments and tendons. 

And we know now that resting is not the solution for back pain because the less we move, the less we use our back muscles and tissues – And the less we use them, the more sensitive the area will be. Therefore you will more likely to experience pain every time you move.

What can I do to improve my back pain?

We wrote an article last year about what you can do (read here). The good news is that you can get better and most cases of lower back pain are harmless and they can be effectively managed by conservative approaches (9-10). Also if your pain is acute (so you have just injured your back), the goal is to stay mobile as much as you can and there are a lot of things you can do to help.

Taking pain killers can be an option but always check with your doctor or pharmacist first before going down that path. Or using heat pack can also be great to take the edge off, but ultimately your body loves movement. As I tend to say in the clinic:

“ If you don’t use it, you lose it”

So make sure that you move a little bit everyday.

Here are some ideas of movements you could do to keep yourself mobile. 

If you have chronic lower back pain, you need a completely different approach to your problem and you need to learn more about pain and how/what you can do to get better. You can always check our chronic pain management program (here) or our articles to explain how chronic pain works. But in a nutshell, when pain has been persistent for longer than 6 months, your body tissues (muscles, ligaments, tendons, bone, connective tissue) have been sensitise to pain. It may feel that your back is in constant agony as soon as you move or massage it. An important factor in your health journey is to learn how to retrain your pain system to behave differently. And this almost always has to be done with a healthcare professional.

Each person will present with different symptoms with their back pain and the best way to really overcome it is to seek professional advice to learn the causes of your injury, get a diagnosis and a management plan for the long term.

We see a lot of people with back pain in our clinic and Osteopaths work holistically with people to treat their whole body through hands on therapies (massage, dry needling, cupping, spinal manipulation, muscle energy techniques & more) and pain management plans to support you in the process.

The blog was written by Dr (Osteopath)Teano Nguyen-Verdenet  from Mana Health Clinic. Teano has a Bachelor (Clinical Science) and a Master degree in Osteopathic Medicine. Recently, Teano has been awarded a scholarship with the University of South Australia and is working with Pain Revolution to become a Certified Local Pain Educator for the South West. He is due to finish in 2022.

Disclaimer: this blog does not replace medical advice. Everyone will be impacted differently by their pain and you almost always need to get a medical assessment with a healthcare professional to understand the unique factors related to your unique condition.

References:

  1. Casiano, V. E., & De., N. K. (2019). Back Pain. In. Treasure Island (FL): StatPearls Publishing. 
  2. Goel, A.P., Wang, E.J. and Bicket, M.C., 2020. Degenerative Disc Disease. In Spine Pain Care (pp. 181-188). Springer, Cham.
  3. Medical News Today. All about degenerative disc disease. Available from: https://www.medicalnewstoday.com/articles/266630#diagnosis (Accessed 19 May 2020)
  4. Della Mora, L. S., Perruccio, A. V., Badley, E. M., & Rampersaud, Y. R. (2016). Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation. BMJ open, 6(12), e013060. https://doi.org/10.1136/bmjopen-2016-013060
  5. Saragiotto, B. T., et al. (2016). “Motor control exercise for chronic non-specific low-back pain.” Cochrane Database Syst Rev(1): Cd012004.
  6. Maher, C., et al. (2017). “Non-specific low back pain.” Lancet 389(10070): 736-747.
  7. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G.

 

 

 

 

 

 

 

 

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