Back pain affects most people at some point in their life. Generally it is either muscular, skeletal or neurological and is not a serious medical condition. This is not suggesting that it is not painful or distressing, not requiring treatment or some kind of management but is more often than not, not a medical emergency.
Muscular refers to muscle tissue that may be in spasm, inflamed, stiff or fatigued, we can include tendons in this category as all muscles attach to bone via their tendon.
Skeletal refers to our joints including cartilage and ligaments . Joints may be stiff, inflamed or the cartilage may have excess wear and tear. Ligaments, which attach bone to bone, may become sprained.
Neurological refers to our nervous system and pain from nerve compression which may lead to numbness, tingling, sharp or shooting pain often in the limbs. The sciatic nerve for example can become compressed and cause sciatica.
Do see your GP or medical help urgently if your back pain is associated with any of the following:
- Constant deep ache not relieved by laying down and not aggravated by movement.
- Fever >38c
- Unexplained weight loss
- Swelling in the back
- Pain or tingling into your legs or feet
- Numbness around your genitals/buttocks
- Loss of bladder/bowel control
Why do I get muscle spasm?
Muscle spasm is an involuntary contraction of muscle fibres. This usually occurs when the muscle is fatigued due to over use, this can be during sport or just sitting with a poor posture all day at a desk. Finger muscles may spasm whilst writing for prolonged periods ie in an exam. Muscle spasm may also be caused by dehydration, loss of fluids during exercise without replacement can lead to fatigued muscles and eventually spasm. Scientists say that it only takes a 2% reduction in body weight due to fluid loss to have a 10-20% reduction in sport performance.
What actually is sciatica?
Many patients come in to me saying that they have been told they have sciatica. Sciatica is a symptom of a number of possible causes, the sciatic nerve is the longest and thickest peripheral nerve in the body, extending from our low back to our foot , in fact it can be as thick as your own thumb. Sciatic pain can be sharp, shooting pain and numbness from the low back through the buttock and down the back of the thigh to the calf and foot.
The main causes of sciatica are:
- A herniated disc pressing on a nerve root that compresses the sciatic nerve.
- Spinal stenosis: narrowing of the spinal canal usually due to ageing, as due to arthritis the joints become enlarged and choke the nerve.
- Piriformis syndrome, as the sciatic nerve run under or through the piriformis muscle in the buttock the nerve may become squeezed or compressed giving ‘sciatic like’ pain.
- Sacro-Illiac joint dysfunction. As the 5th lumbar nerve lies on top of this pelvic joint any inflammation caused by the joint dysfunction may cause ‘sciatic like’ pain. The sciatic nerve is made up of spinal nerves L4, L5 S1 and S2.
- Spondylolithesis is a forward slippage of one vertebrae on another due to a fracture which can pinch the nerve and cause sciatica.
- Other possible causes for sciatica can be in pregnancy due to constantly changing posture and although rare, a spinal tumour.
What are facet joints?
Facet or apohpyseal joints are the joints between each vertebrae, on either side, that control the movement of the spine. Like many joints of the body they are surrounded by a sac and have a very good nerve supply. Therefore any trauma to the joint or sac can be very painful and send the muscles in the surrounding area into a protective spasm.
Facet joint pain can be due to a sudden trauma involving a quick over- rotation of the lumbar spine, common in squash players, which causes acute inflammation and or a ‘locking’ sensation of the joint. Mostly facet joint problems are chronic and are due to ageing and arthritis in the joints. The joints become enlarged and grow spurs which cause pain on rotation and other movements of the lumbar spine.
When you visit an osteopath with back pain, they will first listen to you explain your symptoms and then ask some questions which will include onset of pain, what may make it better or worse and if you have any leg symptoms. They may ask some questions about your general and past health which you may think irrelevant, but this is to build a full picture of you as a whole person and to make sure that there is no under-lying medical problem (RED FLAGS). The osteopath will then observe your posture and feel how your back is moving and carry-out any relevant clinical tests. All this is to be able to form a diagnosis before treating or referring on to a specialist consultant or further investigations (MRI, X-Ray).