At some point in our lives we can expect to have an episode of back pain. Thankfully most of the time the back pain will disappear within a few days. For other people though the pain can last for weeks or even years, causing a significant burden on their lives. It is one of the top reasons for days off work and costs businesses millions each year!
As osteopaths in Finchley we see all types of back pain and low back pain with many different causes so we thought we would tell you a bit about it so you can understand what is going on with your back pain.
“Low back pain” doesn’t describe the cause of the pain, of which there are many! Successful treatment of low back pain is dependent on the diagnosis and establishing the triggers and the predisposing factors behind it; things such as bad lifting technique at the gym or at home, poor posture at work, repetitive awkward movements or even the mattress you sleep on.
As well as the mechanical causes of low back pain there are also unfortunately more serious causes or pathologies which could be causing the problems.
As such it is important to be diagnosed by someone such as an Osteopath who has the medical knowledge to differentiate between musculoskeletal issues and those that need referral for further investigations.
Structural Causes of Low Back Pain
The majority of back pain causes that we see at Ashley James Health are very common and treatable (the extent of recovery depending on the severity of the problem however). The spine is a complex structure with many intricate areas surrounded by nerves, muscles, ligaments, discs, and joints. Usually the sudden onset of pain may just be “the final straw” to years of poor usage or body mechanics. These more common issues tend to fall within the following categories.
Sometimes you will hear the term “Lumbago” used to describe low back pain. They both have the same meanings and are often used interchangeably and are both used to describe pain localised to the low back with no referral of pain. The terms Lumbago and Low back pain are both non specific terms and are not diagnoses (they are not describing what is actually causing the pain). Both lumbago and low back pain are terms that people come in to see us with and then after a thorough examination you should be given the practitioner’s “working diagnosis” where they explain whether the cause of the pain is from a ligament, disc, muscle or any other possible cause.
When a muscle spasms it is usually the body’s way of protecting an area from further damage. The spine is surrounded by muscles, some quite large and others tiny, each with their own specific purpose; from maintaining posture to controlling movements. Sometimes these muscles can be over stretched (suddenly or gradually) beyond their limit causing a reflex action to contract to prevent further injury. When this happens the contraction is often too strong and results in spasm (a strong contraction that doesn’t release). This causes pain along with reduction of movement in that area.
Spasms will often release on their own but can take weeks to fully return to normal if left untreated. Sometimes, a spasm doesn’t release and that part of the muscle will become solid and fibrotic (it almost feels like a rope or a ball underneath the skin).
Muscle is like a sponge in water (the water being blood); in its normal relaxed state the muscle can freely absorb blood which helps to keep the muscle healthy and fully functional. However when the muscle spasms it is like squeezing the sponge in the water- no water will be able to pass in. This causes the muscle tissue to produce more waste products which will cause more pain. The pain then causes the muscle to remain tight which then leads into a vicious cycle of pain, spasm, pain, and will remain this way until an external stimulus such as deep tissue massage breaks that cycle.
Ligaments are what join bone to bone and give joints their structural stability. In the spine there are different sizes of ligaments ranging from the small ones that support the discs to the large nuchal ligament that runs down the back of the spine. The ligaments in the spine and pelvis tend to be responsible for pain in more traumatic injuries such as falls or sudden impacts, or from gradual stresses such as constant poor posture. We call this ligamentous creep (a bit like if you keep an elastic band at full stretch for a long time).
Due to ligaments being poorly supplied with blood, the recovery time can be much slower than muscles which means the expected recovery time is considerably slower than with muscles.
Discs are the “pads” that sit in between each vertebra providing cushioning and allowing movement from segment to segment.
Discs are made up of rings of fibrous tissue, collectively known as the Annulus Fibrosus, surrounding a soft toothpaste-like centre called the Nucleus Pulposus (NP). Over many years of wear and tear the annulus fibrosus can become thinner and eventually the nucleus pulposus can start to bulge through. Initially this begins as a disc bulge but eventually can progress to a full disc prolapse.
Disc prolapses can press in nerve roots which causes pain and other neurological problems.
To find out more about disc related issues have a look at our page on Disc Problems.
There are two main causes of sciatica; Intervertebral Discs or the Piriformis Muscle. If you have a disc prolapse, there is a chance it may press on a nerve root and send shooting pains down your leg. Some disc problems will resolve on their own while other more serious prolapses may end up needing some surgical intervention.
If the sciatic pain is due to the piriformis muscle then this has a good recovery rate. The piriformis muscle usually sits above the sciatic nerve in most people but in some people the sciatic nerve may run through the piriformis due to genetic variation. When the piriformis spasms and is responsible for causing sciatica it is usually in response to some over exertion movement.
Scoliosis is the sideways curvature of the spine. Many patients have presented saying they have scoliosis, but when we have a look at their backs many of these patients are perfectly normal and on the other hand some people have a scoliosis without even knowing.
There are two types of scoliosis; Functional and Structural.
Functional scoliosis is the temporary sideways curvature of the spine caused by changes in leg length, muscles surrounding the spine or pelvis or inflammation such as an appendicitis. Any lateral curvatures will disappear when the cause is treated.
Structural scoliosis is a permanent sideways curvature of the spine due to bony changes in the vertebrae. A structural scoliosis can be corrected if caught early enough through exercises and lifestyle modifications but if left for too long then surgery may be the only way of correction.
Scoliosis can cause pain in the muscles surrounding the spine, cause difficulties breathing or even headaches and digestive problems.
How can we at Ashley James Health help you?
Our osteopath will thoroughly assess you, taking into consideration your lifestyle, causing factors, predisposing factors and maintaining factors to build up a picture of the exact problem. Our aim will be to help you regain the normal pain free function of your spine using many specific hands on techniques and advise you what to do in between treatments, whether that is in the form of exercises, hot or cold packs or some other advice.
One thing you can be sure of is that we will do everything we can to get you better as soon as we can! So why don’t you give us a call on 0208 445 1020 or
About The Author
Ashley Ridout has treated people of all ages, physical abilities and professions including professional athletes, so he knows the importance of getting you back to normal as quickly as possible.
Ashley has history of being a personal trainer in one of London’s top Mixed Martial Arts gyms so he can not only treat injuries but he can also help you with your rehab or prevention of injuries too.
Having been involved with various competitive sports himself, Ashley has also been on the receiving end of many injuries so knows the importance of good treatments and sound advice.