Some times on waking up, the back is incredibly stiff, conversely it may feel rested and pain-free. Back Pain can ease or worsen throughout the day. It may be better or worse for activity. Your back may only hurt when standing or it may be pain-free when standing.
Different back tissues will be affected in each individual case. It is important to identify the affected tissues, so the correct treatment can be given.
The idea that Spinal Manipulation is a “Cure All” for back pain is incorrect, and on some occasions it can actually make the pain or condition worse.
The area that the back pain is experienced is not always where the problem lies. For example, low back pain may have its source in the thoracic area.
It is vital that all areas are examined when you have a sore back, and the affected and related back tissues identified, and correctly treated.
Once the likely factors behind the back pain are found, Osteopathic treatment may help ease the pain, then good advice on exercise, diet, seating, posture, beds and lifting can go a long way in helping prevent its recurrence.
In genuine Sciatica, there is a prolapsed disc in the lower back pressing on a nerve, the pain is excruciating. Frequently leg pain, numbness and weakness are present, the foot may drop when walking.
This is a serious condition and needs medical attention, correct diagnosis and prescribed medication for the sciatic pain.
That said, luckily the majority of the population who have “Sciatica” have a less severe condition. The source is usually found in the low back and/or the buttock.
People may move the wrong way, say when bending and lifting, and their back goes “out”. They may say they have “slipped a disc”.
Thankfully, the majority of people have done nothing of the sort. What they have done is to minimally displace a vertebra, over stretching small ligaments, which in turn causes the muscles in the low back to go into protective spasm and this can cause leg pain.
The deep muscles in the buttock can, in turn, can go into spasm, causing “Piriformis Syndrome”. The piriformis muscle lies across the sciatic nerve and if it goes into spasm it tightens over the sciatic nerve, compressing the nerve and causing sciatic like symptoms.
This condition normally responds very well to Osteopathic Treatment.
60% of the population will suffer from a sore back at some stage in their lives. It is a serious problem, and 350 million working days are lost every year in the UK because of back pain.
There is no single cause of Lower Back Pain. It may have started after an injury, or it may have started gradually, often being related to poor posture and a bad workstation arrangement.
In 75% cases of Low Back Pain, medical investigation shows no underlying cause of the sore back.
An Osteopath will usually find numerous painful muscles and stiff facet joints, which normally respond favourably to osteopathic treatment.
An Osteopath can usually help with the immediate debility of low back pain, and can give plenty of advice on exercise, diet, seating, beds, ergonomics and lifting.
In the long term, I encourage people to understand their lower back pain - which chairs, beds and exercises help, and become aware of which activities lead to back pain.
Exercise that involves movement combined with strengthening and stretching, such as Resistance/Weight Training, Pilates, Tai Chi & Yoga can be very beneficial for back pain.
When you are stressed it's not unusual to develop low back pain. Learning to relax lowers stress levels, although it can be difficult to learn to relax, the health benefits of relaxation are vast.
Mindfulness and Trauma Release Exercises are great tools that have been proven to work for relaxation.
The Joints between the Vertebra are called Facet Joints, and they can cause Back Pain when they misbehave.
There are a number of different ways that Facet Joints can cause Back Pain.
When you bend forward and twist to one side - say, when you are lifting a bag of messages from the floor - the mechanics of the spine can cause the Facet Joints go through an awkward change in movement/direction that can cause the Facet Joint to Subluxate (i.e. move further than it's supposed to) and this causes the joint capsule to over stretch - the result is instant - sudden back pain, muscle spasm and being unable to move.
The actual reason why this Facet Lock occurs is fairly complex, and the "Experts" still disagree on the mechanics, but it's a condition that usually responds wonderfully to Spinal Manipulation.
As we age, the Intervertebral Discs start to narrow. The Intervertebral Discs act as Bearings, they hold the vertebra apart. As the Discs narrow the Facet Joints come under greater load. This can cause some wear & tear of the cartilage that covers the facet joints, it's related to Degenerative Disc Disease. This condition is often painless, but can flare up periodically when the affected joints are subjected to unusual loads/stress. e.g. Mowing the lawn for the first time in the spring or changing a wheel after a puncture.
This condition normally responds very well to Osteopathic Treatment.
Between the Vertebra there are the flat, plate like Discs. These Intra-vertebral Discs are what allow spinal movement to take place. If a Disc packs up - So do we!
The disc is formed of two parts, and outer elastic fibrocartilage and an inner deformable nucleus, basically you have a squidgy ball contained within a firm, elastic mesh. The squidgy ball moves/deforms in regard to movement and other loads.
When a Disc Bulges through the fibrocartilage - a Prolapsed Disc - the bulge will often press on a nerve. This can be disabling, and when serious may require Surgery.
With an uncomplicated Prolapsed Disc in the Lower Back it is worth trying a series of back extension exercises as soon as you possibly can. Doing these exercises will, hopefully, give the disc bulge enough space to be absorbed back into the disc. Recent research suggests this is the best approach.
These exercises can be quite uncomfortable to do, the back pain may become worse, but any pain radiating to leg, buttock or thigh should settle. This is because the pressure is being taken off the nerve - the serious part of the injury. The back pain is due to the inflammation around the damaged disc and the associated muscle spasm in the muscles that are splinting the spine.
At this Acute Stage it is NOT a wise idea to use Spinal Manipulation - as this may make the condition worse. In time, when the inflammation around the Disc and Facet Joints has settled, Spinal Manipulation can safely be used to aid recovery.
There are certain important criteria with Prolapsed Discs. A Disc Bulge will often cause Pain and Paraesthesia (Numbness or Pins and Needles). But in more serious cases the Pain may be intractable, there may be limb weakness, "electrical" sensations and possible loss of Bowel and/or Bladder Control - Cauda Equina Syndrome - loss of sensation in the area that would be in contact with a bicycle saddle if you were sitting on it - This is Serious and requires immediate Medical Attention - Go to Accident & Emergency as soon as you can.
The majority of "Slipped Discs' will settle down over three months. An Intervertebral Disk does not have a blood supply, it absorbs fluid from the vertebra above and below. This usually happens at night when there is less pressure on the disc, a person can be up to 3 cm taller at the start of the day. This may help explain why a disc injury takes such a long time to completely heal.
Astronauts in space, who are not subjected to the force of gravity, are also taller when they return to Earth because of fluid absorption into the disc.
Statistics show that the majority of disc prolapses occur between the ages of 30 and 50, the median age being 40. This is because the degenerative process is not so pronounced in younger people, and in older people the elasticity of the disk is decreased to such an extent that the disc cannot actually bulge. The older population has to contend with conditions such as arthritis and spinal stenosis.
Smoking is also an issue with this disease, a study showed that after two hours of exposure to cigarette smoke metabolism within the disc was decreased by 50%.
Cauda Equina Syndrome – This is a serious condition that requires medical intervention, it presents with numbness and pins & needles around the saddle area, that is the area that would be in contact with a bicycle saddle. There may also be pain and paraesthesia in the backside and legs. It can also cause incontinence. Cauda Equina Syndrome can occur to people of any age, and is usually the result of a serious disc prolapse.
Spinal Stenosis – spinal stenosis is generally seen in older people. There are certain reasons people are predisposed to spinal stenosis, the most common being a narrow spinal canal (trefoil shaped spinal canal). When a person develops osteoarthritis of the spine, the intervertebral discs will shrink in height, and this leads to a lack of space for the spinal cord, this in turn will compress the spinal cord and the nerve roots, leading to problems such as sciatica and neurogenic claudication (pain in legs with walking any distance).
Ankylosing Spondylitis is an autoimmune disease that affects men more than women. It's usually diagnosed in people in their twenties or thirties. Ankylosing Spondylitis is an autoimmune disease, which causes back stiffness and pain. It's treated with anti-inflammatories and painkillers. The condition is a progressive.
Spondylolithesis as a condition where the vertebral arch is not fused to the vertebral body. This means that the spine is unstable at this level and the spinal cord can be subjected to a shearing force. A spondylolithesis is graded from 1 through to 5, and people who have a higher grade of spondylolithesis often require an operation to stabilise it. A spondylolithesis can cause paraesthesia, pain and weakness in the gluteals and legs.