Back Pain

What is it?

Many of us will have experienced back pain to some degree at some point in our lives. It’s a broad and complex topic and not something I will hope to explain in depth in this blog. However, I would like to touch on a few important points and perhaps provide some food for thought. In order to understand the multifactorial nature of back pain it helps to classify it into some broad categories:

  • A Pathoanatomical source of pain with associated adaptive motor responses – in other words, there is clear evidence of tissue damage eg disc prolapse and the body has subsequently taken measures to protect itself against further injury eg muscle spasm. 
  • Psychosocial factors drive pain centrally with maladaptive motor responses – this is when other aspects of the individuals life are simultaneously affected leading to stress, depression, illness etc and this has a sensitising effect on the nervous system predisposing to pain and leading to postures and behaviours which further provoke the sensitive area. 
  • Movement and/or control impairments as the primary issue with associated maladaptive behaviour that causes further irritation of back pain eg sitting in a very flexed or extended posture causing loading and irritation of certain spinal joints

 

Pathoanatomical sources of pain:

  • Disc
  • Facet joint
  • Muscle
  • Nerve
  • Ligament
  • Bone

It is important to note that radiological findings often do NOT correlate with signs and symptoms and that 2 very similar MRI scans can show very different levels of symptoms!!

 

When to seek help:

  • Whether you are suffering from acute intense back pain or a longstanding dull ache you should attend a health care professional for a diagnosis, treatment and guidance on how best to manage it particularly if:
    • It affects yours ADLs (activities of daily living)
    • Limits your ability to work or exercise
    • Requires you to take analgesia
  • If you have associated symptoms such as:
    • Referral of pain to your limbs (especially bilateral)
    • Weakness or loss of sensation in you limbs
    • A change in bladder or bowel function
    • Difficulty walking
    • General malaise

You should urgently see a health care professional for further investigation!!

 

Rehabilitation

As mentioned above, often times the root cause of back pain is a movement or control impairment which causes strain on the spine itself. While treating the symptoms may provide short-term relief it will be difficult to achieve 100% recovery and there will always be a tendency for recurrence if the movement/control impairments are not addressed. Also research suggests what when you have been experiencing back pain, there may be associated inhibition of key muscles that provide stability for your spine. A consultation with your physiotherapist will highlight your posture type, movement patterns and areas of weakness. They will guide you through a progressive rehabilitation programme to improve body awareness, stability and control of your spinal movement. Ultimately this is the key to long-term recovery!