Common Causes of Back Pain
Pain arising from the intervertebral disc:
Pain is often located across the lower back. It appears as a deep dull aching pain. The onset of pain can begin after a sudden movement such as bending or lifting up a heavy object. The pain is often worse in the mornings or after long periods of sitting.
The role of the disc in the spine is to act as a shock absorber, distributing forces evenly through the spine as well as to allow for movement and flexibility of the spine. The central part of the disc is called the nucleus pulposus and is made of a gel like substance. The outer part of the disc is called the annulus fibrosis and consists of a more fibrous material. As a process of ageing or due to excessive forces placed on the spine small tears can develop in the outer annulus fibrosis. The gel like nucleus pulposis begins to seep into these tears stimulating nerve receptors and causing the sensation of pain. In more severe cases the disc can rupture and herniate causing compression along a nerve. This is commonly known as sciatica and is often experienced as pain, pins and needles or weakness travelling down a specific line in the leg.
Deep aching pain which may be running down on one or both sides of the back. Pain worse after prolonged periods of rest.
Caused by excessive strain placed on the back such as from lifting a heavy object or a sudden twisting motion.
General Back Care Precautions
- Try to maintain a good posture when sitting or standing. Good posture is regarded a maintaining the normal curvatures of the spine. In doing so the spine is in what is called the neutral position and has the least amount of forces placed on it. When the spine is out if its neutral position for eg. when sitting slouched with head poking forwards our muscles have to work harder to keep the body upright. There is also greater tension placed upon the ligaments. The result can lead to overload of the muscles, fatigue and the development of trigger points and spasm.
- Avoid prolonged postures in one position. It is very important to change position regularly especially for people with desks jobs and working at computers. One should perform gentle circulatory exercises every half an hour to increase circulation to muscles and prevent fatigue. This can be done by gently rolling the shoulders, moving the head from side to side and extending the arms and back. Alternatively just a short walk or standing to stretch also helps.
- Ensure appropriate set up of the workstation.
- Take care when lifting heavy objects. When lifting a heavy object, maintain a straight back. Bend at the hips and knees. Hold the object as close to you as possible. Avoid twisting your spine while holding the object. Rather turn your entire body.
- Regular exercise. Regular cardiovascular exercise and flexibility training helps to ensure good circulation to the joints and muscles. This helps the body to adapt to the different stresses placed on it.
- Strengthening of core muscles
The core muscles are muscles situated deep in the back which help provide stability to the spine. When we move, the core muscles work to keep the spine in a more neutral position thus eliminating excessive loading on the spine. Exercises such as yoga and pilates work well to strengthen these muscles.
- Heat / ice
- Moderate rest- avoid strenuous activity. It is advisable to continue gentle walking and activities of daily living. Prolonged bed rest is avoided.
- Gentle stretching exercises
- Activation of core muscles
- Surgery – in severe cases, if pain is lasting more than 6 weeks or if pain is associated with neurological symptoms such as numbness or weakness
Upon the initial consultation an evaluation will be done to determine the cause of the pain and determine a treatment plan.
Possible contributing factors from a person’s social life are discussed to help create awareness about changes that can be made to promote better back care.
Modalities that may be used during the treatment include:
- Myofascial release techniques
- Joint mobilisation
- Neural mobilisation techniques
- Electrotherapy such as interferential therapy or ultrasound
- Exercise prescription