Back pain and lower back pain is thought to be the most common cause for lost work days in modern society. Most people will experience low back pain at one time or another in their lives and the effects can range from a sore stiff back for a few days to a life changing event that will cause long suffering and a drastic modification of work or social activities.
The back consists of 5 vertebral bones separated by a shock absorbing disc. The lowest vertebra termed L5 sits on the sacrum and pelvis. The vertebrae and discs absorb great shock and pressure whilst allowing the back to move into extreme positions and whilst also acting as a strong column for muscles to act both from and to. In short it is strong enough to endure enormous force whilst protecting the delicate nervous system and flexible enough to allow the 4 limbs and head to work off a strong base.
Muscles and ligaments add to the strength of the back and these are often the areas that first break down with back problems.
Non-specific back pain is probably the most common complaint. This is the injury that can come from lifting an object, from a repetitive action like weeding the garden or indeed can come from literally nowhere. Symptoms can range from a mild ache to severe and disabling pain and these symptoms can last from a few days to several weeks or months. The non-specific term implies that it is difficult to say with certainty what is injured, it may be a ligament or muscle and imaging such as x-ray or MRI will not show anything abnormal. Most of these back injuries will certainly get better with time, medication and a graded exercise program. Active treatment such as Physiotherapy, Chiro , RMT etc can speed up the recovery time and in time full return to activity should be attained.
However these retrospectively minor problems can be a warning of a bigger problem to come, a bit like a few tremors before the big earthquake.
A gradual erosion of the backs defenses ie the column alignment, the supporting strength (including the famous “core” muscles ) and a poor lifestyle can cause the joints to degenerate more rapidly and the inter-vertebral discs to push out of their position.
When a disc bulges it initially can cause mild back-ache, with time and repeated poor loading this bulge can impinge on an emerging nerve root, this is the basis for referred pain . Symptoms eventually can lead to raging pain in the leg, numbness, muscle weakness and a situation where it is very difficult to get into any comfortable position. A prolapsed disc cannot be “put back in” as the pressure is too great and the space too small (like trying to push jello back into a squashed doughnut). Generally time can allow the bulge to naturally recede as the inflammation reduces and this will give symptom relief, very occasionally surgery is required to remove the bulging bit.
So what can we do to try and avoid this happening?
- Keep a good posture at all times and try and keep the supportive muscles strong( look at yoga , pilates etc)
- Keep the weight down as extra pounds put more pressure on all the bodies systems.
- Sit well at work , get an ergonomic assessment or at least google how your computer and you should interact.
- Warm up and stretch for new or stressful activities. It is amazing how many people get back-ache after the first nice day in Spring when getting stuck into the weeding in the garden.
- Always be aware of the warning signs and stop an activity or change your position if your low back feels stressed.
- Finally, remember, if you get back-ache and it hasn’t improved after a few days rest, heat/ice and painkillers then seek help. A bit of advice and treatment in the early days can make a big difference and hopefully stop the rot from setting in.