Lower Back Pain

Lower back pain is really common and in most cases
is not caused by a serious problem. Most back pain will settle within a few weeks. There are many different reasons for why we have back pain but most lower back pain is related to our mechanics (how we move) and our daily lives as opposed to a structural or medical problem. We term this as mechanical or non-specific back pain.
Occasionally more serious medical conditions can lead to back pain. Julia at JWPhysiotherapy is experienced in the detection of more serious pathology and when further medical investigations are necessary.

Risk Factors for Lower Back Pain

Age - back pain typically occurs around the age of 30-50 and becomes more common with advancing age.
Fitness level – back pain is more common among those who are not physically active. Those who maintain a regular level of moderate exercise are less likely to suffer.
Pregnancy - due to pelvic changes and increased weight.
Weight gain.
Occupational risks - such as lots of heavy lifting, pulling, pushing but also jobs that are very inactive.
Mental health – stress, anxiety, depression are strongly linked with pain and the length of time pain can continue.

Some causes of Lower Back Pain

Sprains and strains.
Disc bulges, herniated discs, prolapsed discs with or without nerve irritation.
Degenerative changes in the discs or joints of the spine.
Skeletal irregularities such as a scoliosis (curve in the spine).
Infections - very rare.
Inflammatory disease.

Advice

Stay as active as possible - you may not feel like moving but this is the most important thing you can do when in pain. Long periods of rest generally makes pain worse and increases the length of the recovery.
Try gentle exercises to increase movement and strength.
Walking has be researched to be one of the best exercises for lower back pain.
Take pain medication as and when you require it, discuss how to do this with your GP or pharmacist.
Stay optimistic - people who manage to stay positive will tend to recover quicker.

Why a specific diagnosis is often hard to find

Although the above causes are mentioned, actually it is very common to find changes on MRI scanning in people without pain. As an example, the table here shows that between the ages of 40-50 years, 68% of people will have disc degeneration and 60% will have a disc bulge. These changes are seen in the absence of pain. In other words, changes to the spine can be very normal! Reassuringly, we also know that these changes, such as a disc bulge or a disc protrusion, are often not concerning and do not necessarily cause pain.
Hunting for a single, structural cause of pain is very hard to find and it rarely helps our treatment. By focusing too much on the structural changes in the spine, we can miss a lot and this can often lead a failure of treatment. It is much better to treat the person, and all that is contributing to the symptoms to get successful outcomes.

Back Pain Myths

The Chartered Society of Physiotherapy have developed a poster to dispell some common beliefs about back pain. Please click on the image to read more.

Medical Emergency Symptoms

Cauda Equina syndrome is a medical emergency. It happens when the nerves supplying the bladder/bowel and sexual organs are being compressed.

Warning signs are...

Loss of feeling/pins and needles between your inner thighs or genitals.
Numbness in and around your back passage or buttocks.
Altered feeling when using the toilet paper to wipe yourself.
Increasing difficulty when trying to urinate.
Increasing difficulty when trying to stop your flow of urine.
Loss of sensation when passing urine.
Recent leaking of urine.
Not knowing when your bladder is full or empty.
Inability to stop bowel movement or leaking.
Loss of sensation when you pass a bowel motion.
Change in ability to achieve an erection or ejaculate.
Loss of sensation in genitals during sexual intercourse.

Attend A&E if you have any of these symptoms.

(Warning symptoms developed by Dr Susan Greenhalgh, Chris Mercer and Laura Finucane).