What is Low Back Pain?
Here at the Spitalfields Osteopathy our Osteopaths and Physiotherapists explain how low back pain is the most prevalent of all musculoskeletal conditions and affects nearly everyone some time during their lifetime and also how it puts the NHS is in excess of £1000 million per year.
Most low back pain is triggered by a combination of overuse, injury and inflammation to the structures associated with the spine. Common causes of low back pain may be:
• Injury or overuse to muscles, tendons, ligaments, facet joints and joint capsules of the spine.
• Injury or irritation to the nerves that pass through the spine and pelvis.
• The aging and degeneration of spine and discs.
• Local compression or ischemia (reduced blood flow) of the nerves that exist the spine or the spinal cord itself (spinal stenosis)
• Disc conditions such as budging discs or herniated disc that can then irritate or compress nerve roots (sciatica).
• Degenerative disc disease, due to reduced nutrition and hydration to the disc, resulting in increased axial compression.
• Misalignment or slipping of the vertebra of the spine (Spondylolisthesis).
• Chemical irritation of nerves due to associated swelling and inflammatory mediators.
• Abnormal on unbalanced spinal postures (scoliosis).
• Alterations to the central nervous system, which alter the processing and perception of pain.
Less common conditions may include:
• Ankylosing Spondylitis – A form of autoimmune rheumatic disorder causing inflammation and rigidity of the joints of the spine and pelvis, from calcification.
• Compression Fractures – more common in postmenopausal women with osteoporosis or dramatic trauma.
• Infections – Bacteria and viruses via the bloodstream. This could be from an infection elsewhere in the body, surgery, intravenous drugs or open wounds. Infection may involve osteomyelitis (bone) or meningitis.
• Benign tumours – Growths can occur on the bones, connective tissues, nerves or spinal cord itself.
• Scheuermann’s Kyphosis – spine segmental developmental defective. This disorder mainly presents during teenage years and can result in wedge-shaped vertebra, leading to a slight rounding of the back.
• Cauda Equina Syndrome – an emergency condition where the nerves at the very bottom of the spinal cord become compressed from a central disc prolapse. Problems with bowel and bladder function (usually unable to pass urine), numbness in the 'saddle' area (around the anus), and weakness in one or both legs. This syndrome needs urgent treatment.
The vast majority of these conditions are caused from compensatory issues where one problem tends to add on to another. An example may be a mild disc herniation leading to local inflammation, muscle spasms, change in posture and gait, compression of a single nerve and chemical irritation of nerves nearby.
Discogenic Back Pain:
Mechanical stimulation of the outer section of the disc can cause central back pain, not leg pain. In addition, changes in the intervertebral disc can contribute to other conditions that subsequently result in muscular or neurological pain.
Repetitive torsional forces have been shown to cause microtrauma to the disc, particularly when the torsion is coupled with bending forward. Subsequently, a pain response from the outer disc may be provoked with exposure of pain nerve endings which will give a complain of backache. Disc prolapse can also occur gradually when discs are subjected to repetitive compression and flexion loading
Acute and Chronic Low Back Pain:
Our Osteopaths here at Spitalfields Osteopathy are spinal specialists who have many years of experience as musculoskeletal Osteopaths, aiding and treating the elements of acute and chronic low back pain. He explains how most back pain is referred to as non-specific mechanical low back pain in which the symptoms by definition cannot be linked to a particular pathology.
• Radicular (or nerve root pain) may occur with low back pain. Sciatica is a lay term for pain travelling into the buttock, thigh, calf or heel.
• Acute pain (less than 6 weeks), sub-acute (6-12 weeks) and chronic (more than 12 weeks) has been used in research. Acute pain commonly brought on by acute trauma, or in some cases it can be brought on from a build-up of low grade mechanical. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results.
• Chronic low back pain can often be due to low level irritation of the structures surrounding the spine, example being, joints, ligaments and muscles. More often than not chronic back pain becomes predisposed by local aging and degeneration with the discs that leads to the on-going consequences of increased spinal axial compression, leading to a reduced range of movement, local low level irritation from functional structures, reduced blood flow into the deconditioned locations and local muscular ischemic pain from increased overuse and chronic shortening.
Available Treatment for Low Back Pain at Spitalfields Osteopathy
Spitalfields Osteopathy musculoskeletal spinal Osteopaths and Physiotherapists have been treating a wide range of injuries, aches and pains for many years and have helped many patients who have suffered with acute and chronic spinal and joint pains. High amounts of benefit have been proved significant from our expertise and out outpatient treatments. Treatment includes:
Manual therapy such as spinal mobilization that play a major role in the treatment of low back pain, this along with lumbopelvic pain. Mobilization is a series of rhythmical or non-rhythmical movements of the joints applied by the clinician intended to create increased range of movement of a particular joint. These techniques are used by our clinicians to address reduced range of motion and to reduce pain. It is this restricted range that leads to mechanical stress and therefore pain. Manual treatment mechanically mobilizes the areas to relieve the stress on the painful structure while protecting the over mobile structures. Subsequently, this then allows your own healing mechanisms to take place and restore tissue health. Manual Therapy and Vertebral Axial Decompression Therapy may also be used to treat for disc herniation, this aiming at reducing disc protrusion, muscle relaxation, and patient mobilization. Spinal traction has been heavily explored as a therapeutic option in musculoskeletal medicine.
Clinical Exercise Therapy is aimed at rehabilitation and prevention of low back and pelvic pain. Our Clinicians have significant backgrounds in the clinical area of Exercise Medicine, which focuses on optimizing the balance between movement and stability. Exercise interventions are commonly used to improve control of the spine and pelvis. Changes in this system can occur with low back and pelvic pain and strategies to train optimum control of the spine must be re-established. The spine is controlled by dynamic function, which is a combination of stability and movement. The spine is inherently unstable and relies heavily on muscular support to maintain this stability. Dynamic function is maintained by co-contraction of muscles, which is a synchronised firing of muscles that act on the lumbar spine. Flexibility is necessary for healthy functioning of the spine, and it is critical for enabling movement, shock absorption, breathing, and balance control. Lumbopelvic pain is associated with a vast array of changes in the activity of the trunk muscles. Many of these changes are likely to affect the movement and stability of the spine.
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