Back Pain Causes & Treatments
The back supports the head and the upper part of the body. It is a complex network of bones, muscles, ligaments and tendons. Back pain in adults is very common affecting up to 80% people in the UK, but fortunately, rarely serious, providing it is not ignored.
Our Orthopaedic Podiatrist, Chris Parish, has more than 2 decades of experience treating the causes of back pain, whether pain of the lower back or upper back. To Discuss your back condition in further detail or make an appointment to see Chris about pain in your upper or lower back, please contact us via phone, email or using our simple online form
Contents
- Mechanical Back Pain
- Treatment of Mechanical Back Pain
- Prolapsed Intervertebral Disc (‘Slipped Disc’)
- Treatment of a Prolapsed Intervertebral Disc (‘Slipped Disc’)
- Nerve Pain & Sciatica
- Treatment of Nerve Pain & Sciatica
- Ankylosing Spondylitis
- Treatment of Ankylosing Spondylitis
Causes of Back Pain
Mechanical Back Pain
Mechanical back pain, also called biomechanical back pain, is the most common cause of back pain. It occurs when the working parts of your back, the muscles, ligaments and small joints are not moving and working as they should be, causing pain, usually in the lower back area. This can be as a result of injury, poor posture or inactivity.
If left uncorrected, mechanical back pain can lead to further problems in later life such as arthritis.
Treatment of Mechanical Back Pain
Any type of persistent pain in your back should be investigated by a qualified professional.
X-rays and MRI scans can help to detect serious spinal injuries, but they are not usually needed for mechanical back pain. Mechanical back pain will have a biomechanical cause. In other words, something not working as it should be will be placing extra strain on your back, causing you pain.
An Orthopaedic Podiatrist will first want to establish where this strain is coming from in order to prevent back pain from recurring.
Losing excess weight, correct body posture and back strengthening exercises will also help to reduce the overall strain placed on the back.
Prolapsed Intervertebral Disc (‘Slipped Disc’)
A prolapsed or ‘slipped’ disc can cause severe lower back pain. The spine is made up of many bones, called vertebrae, and in between each vertebra there is a disc, a rubber-like tissue that enables the spine to bend and flex. A prolapsed disc hasn’t actually ‘slipped’ as its name would suggest, but rather part of the inner softer part of the disc bulges out through a weakness in the outer part of the disc. This is also referred to as a ‘herniated disc’. The bulging disc may press on or trap a surrounding nerve root, causing pain along the course of the nerve in addition to back pain. Depending on where the nerve is pinched will determine where you feel pain, but it can radiate down the back of the leg, affecting the knee and the foot.
The vertebrae in the lower back are numbered 1 to 5 and are referred to as Lumbar 1 (L1), Lumbar 2 (L2) and so on. S1 is the top of the sacrum. This is the proper name for the triangular-shaped structure of five-fused vertebrae at the base of the spine.
The bottom two discs, L4-L5 and L5-S1, are the most commonly damaged discs, and the sciatic nerve – the large nerve that branches out from the spinal cord and into each leg – is the most commonly affected, hence the term ‘sciatica’.
A prolapsed disc can also cause pins and needles, numbness or weakness in part of a buttock, leg or foot.
Who is most likely to suffer a prolapsed or slipped disc? While a job involving lots of lifting, lots of sitting, weight-bearing sports, obesity and age are certainly contributing factors; it seems that some people are naturally more likely than others to develop a weakness in the outer part of their discs, regardless of occupation or lifestyle.
Treatment of a Prolapsed Intervertebral Disc (‘Slipped Disc’)
An Orthopaedic Podiatrist will be able to diagnose a prolapsed disc from the symptoms you describe and by examining you. A prolapsed or slipped disc is the most common cause of sudden back pain with nerve root symptoms.
On the whole, symptoms tend to improve over a few weeks.
As far as possible, remain active but avoid anything that causes too much discomfort. In the past, advice has been to rest until the pain eases but it is now known that this was wrong. You are likely to recover more quickly and are less likely to develop persistent back pain if you keep active when you have back pain rather than resting.
Anti-inflammatory painkillers can help if pain is very bad. In some instances surgery may be necessary to remove the prolapsed part of the disc.
Nerve Pain & Sciatica
Nerve root pain is pain that occurs because a nerve coming from the spinal cord is pressed on or trapped by a prolapsed disc, or is irritated by the inflammation caused by the prolapsed disc.
The sciatic nerve, the large nerve that branches from the spinal cord in the lower back and travels deep inside the buttock and down the back of each leg, is the most commonly affected nerve, giving rise to the term ‘sciatica’.
Sciatica is a form of pain called ‘radiculopathy’. This means that it often follows the path of a single spinal nerve root such as the Lumbar 5 (L5) or Sacral 1 (S1).
The vertebrae in the lower back are numbered 1 to 5 and are referred to as Lumbar 1 (L1), Lumbar 2 (L2) and so on. Sacral 1 (S1) is the top of the sacrum. This is the proper name for the triangular-shaped structure of five-fused vertebrae at the base of the spine.
The bottom two discs, L4-L5 and L5-S1, are most likely to cause sciatic nerve pain.
As can be seen in the diagram opposite, where you feel pain will much depend on where the nerve is pinched (L4, L5, S1), but it can radiate down the back of the leg and affect the buttock, knee and foot.
Symptoms can also include numbness, ‘pins and needles’ and in severe cases, weakness affecting the ankle or toes.
In some individuals sciatica is caused by a condition called ‘piriformis muscle syndrome’. The piriformis muscle is a small muscle deep within the buttock that rotates the leg outwards. If this muscle is particularly tight it can go into spasm and pinch the sciatic nerve.
Sciatica is very common in those who suffer low back pain and is often triggered by a minor movement such as bending down to pick something up. It is also common during pregnancy due to the added weight and bending stress placed on the spine, which can worsen a bulging or prolapsed disc.
Treatment of Nerve Pain & Sciatica
Non-invasive treatments for nerve pain and sciatica include exercise, physical therapy, stretching, anti-inflammatory painkillers and rest.
When sciatica is due to the muscle spasm of piriformis syndrome, specific stretching exercises can help, but it is important you seek a proper diagnosis first from a qualified professional, as these same exercises could worsen sciatica if caused by a herniated disc.
An Orthopaedic Podiatrist will be able to advise on correct treatment, rehabilitation and prevention.
Ankylosing Spondylitis
Ankylosing spondylitis is a form of arthritis or chronic inflammation that mainly affects the spine and the sacroiliac joints located on either side of the sacrum (the triangular-shaped structure at the base of the spine). The term ‘spondylitis’ means ‘inflammation of the spine’ and ‘ankylosing’ means ‘to fuse together’.
If you have ankylosing spondylitis, the bones in your spine become inflamed at the part where they attach to the tendons, and also at the joints between the bones.
Your body then tries to mend the damage by producing new bone. As new bone grows, it can eventually cause them to fuse together, causing inflammation and stiffness.
Although the lower back is typically the main site of inflammation, ankylosing spondylitis can also affect other joints in the body, such as the knees, hips and shoulder, and organs such as the eyes, heart and lungs.
More men than women are affected (up to three times more) and symptoms usually begin between the ages of 15 and 35.
The cause is not known but it does appear to be hereditary.
The main symptom is lower back pain and stiffness that is made worse for rest. You may also have pain over your buttocks and down one side or down the back of the thighs. The pain tends to be worse first thing in the morning, easing as the day goes on.
Treatment of Ankylosing Spondylitis
A diagnosis of ankylosing spondylitis is usually made following X-rays and an MRI scan.
Until recently, X-rays were the only way to confirm and monitor the progression of the disease, but an MRI scan can give a more detailed view of the sacroiliac joints and confirm diagnosis at an earlier stage.
Symptoms can come and go and vary greatly from one person to another.
The main aims of treatment are to maintain mobility and flexibility of the spine, to limit the extent of any deformity and to ease pain and stiffness.
It is vital you seek the guidance of a medically qualified professional.
An Orthopaedic Podiatrist will help you to develop a regular exercise routine so as to maintain a full range of spinal movement and help prevent your spine from stiffening up. Ideally these exercises should be done daily even if you are relatively symptom-free.
Anti-inflammatory medication can help to reduce inflammation and ease pain.
Our Orthopaedic Podiatrist, Chris Parish, has more than 2 decades of experience treating back pain causes, whether pain of the lower back or upper back. To Discuss your back condition in further detail or make an appointment to see Chris about upper or lower back pain, please contact us via phone, email or using our simple online form