Acute or Chronic Back Pain?

Acute or short-term low back pain

Most acute back pain is mechanical in nature – the result of trauma to the lower back or a degenerative disorder such as osteoarthritis where joints have gradually stiffened, become inflamed and started to calcify through reduced mobility. Pain from trauma may be caused by a sports injury, lifting or work around the house or garden, a sudden jolt such as a car accident / whiplash or repetitive stress to spinal bones and tissues.

Symptoms may range from muscle aches to shooting or stabbing pain, limited flexibility and joint range of motion or an inability to stand straight. Pain felt in one part of the body may radiate or be referred from an injury or disorder elsewhere in the body. Some acute pain syndromes can become more serious if left untreated.

Chronic back pain

Chronic back pain is pain that persists for more than 3 months. It is important to diagnose and treat spinal dysfunction sooner rather than later to avoid further gradual degeneration of spinal joints.

Causes of Back Pain

As we age, our bone strength, muscle elasticity and tone tend to decrease. Discs lose fluid and flexibility which decreases their ability to cushion the vertebrae.

Pain can occur when you lift something too heavy or overstretch, causing a joint locking or displacement (subluxation) or a sprain, strain or spasm in one of the muscles or ligaments in the back or a disc may prolapse or bulge. This can put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body back to the brain. When these nerve roots become compressed or irritated, back pain results.

Low back pain may reflect nerve or muscle irritation, joint locking or bone lesions. Most low back pain follows injury or trauma to the back, but pain may have other factors such as degenerative conditions such as arthrosis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs or congenital abnormalities in the spine.

Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, poor posture and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when an injured back heals does not have the strength or flexibility of normal tissue. A build-up of scar tissue from repeated injuries eventually weakens the back and can lead to loss of normal flexibility and function and more serious injury can result.

Occasionally, low back pain may indicate a more serious medical problem. Pain accompanied by fever or loss of bowel or bladder control, pain when coughing and progressive weakness in the legs may indicate a severely compressed nerve or other serious condition. People with diabetes may have severe back pain or pain radiating down the leg related to neuropathy. People with these symptoms should contact their Chiropractor or GP immediately to reach a diagnosis and find the optimal help to prevent more permanent damage.

Conditions

Sacroiliac Joint Pain Syndrome

Sacro-iliac joint dysfunction is probably the commonest cause of back pain and is expertly treated by specialist manipulation with chiropractors and osteopaths at Sayer Back Pain Sacro-iliac Clinics in London.

The sacroiliac (SI) joints are located on either side of the spine just below the waist. Viewed from behind at the lowback you see two dimples. These joints between the two pelvic (iliac) bones, join to the sacrum and form the two sacroiliac or SI joints.

The sacroiliac joints are basically ‘L shaped’ and transmit the weight of the body from the low back to the hip joints. The joints are uniquely rough, pitted and undulating with strong complex ligaments, allowing a very limited but essential range of movement.

Even now in the 21st century many medical textbooks and orthopaedic specialists and rheumatologists know very little about sacroiliac joint problems and many deny that these joints move at all. Grey’s Anatomy now confirms that sacroiliac joints move, and recent research has helped us to understand how so many ”low-back” or ”hip pain” syndromes are primarily sacroiliac in origin and may only be expertly and successfully treated by chiropractic and osteopathic manipulation.

Women tend to suffer sacroiliac pain more than men due to looser pelvic structure and increased ligament laxity in pregnancy.

Joint capsule strains and damage to ligaments around the joint as well as joint subluxation – or mini dislocation – cause inflammation and pain with protective muscle spasm which is itself extremely painful.

Referred pain can radiate into the buttock, hip and groin involving piriformis, gluteal and psoas muscles as well as referral to the anterior or lateral thigh and knee.

Pain is potentially chronic over months or years with intermittent and repeated episodes of acute spasm and difficulty moving and walking until treated properly by a good manipulative specialist chiropractor or osteopath.

Causes of SI Joint Dysfunction:

Years of SITTING at office work causes chronic joint strain, muscular imbalance and stiffening of sacroiliac joints.

TRAUMA – FALLS off horses, bicycles, on ice, concrete, repetitive sports sprains of sacroiliac joints, car accidents.

Prolonged BENDING and LIFTING – Poor fitness and spinal stability (core muscle strength), lack of sporting or dance activity and movement.

TRAVELLING – carrying heavy suitcases, sitting on long flights, softer or harder beds and sofas in hotels, unaccustomed holiday activity.

PREGNANCY: Hormones released in the last three months increase laxity of pelvic ligaments in preparation for childbirth but leave the sacro-iliac and pubic symphysis joints prone to acute and extremely painful subluxation – PSD Pubic Symphysis Diastasis or Dysfunction - this is efficiently diagnosed and very effectively treated with specialist chiropractic 'pregnancy sacroiliac manipulation' plus intelligent advice by our chiropractors at Sayer Clinics.

LEG-LENGTH DIFFERENCE – especially following leg fractures in childhood, congenital leg-length discrepancy, unequal long bone growth in the lower limbs due to asymmetrical strains from dance or sports in childhood and problems of hip joint dysplasia, knees valgus angulation and pronated feet all add postural pressure to the sacroiliac joints, which become stiff, locked and painful and calcified. Obesity with sway-back is an added stress to spinal curvature or scoliosis resulting in increasing three-dimensional rotation and scoliosis torsion of the spine.

Signs and Symptoms of Sacroiliac Pain

Pain is usually deep, boring pain on one side but may affect both sacroiliac joints – pain radiates into buttocks.

Pain at the side of the upper thigh, groin or front of thigh. If acute there may be a twisted spine ‘antalgic’ pain-avoidance posture.

Pain is typically worse with standing, walking, climbing stairs, resting on one leg, getting in and out of a low chair, rolling over and turning over in bed.

Pain is also aggravated by bending, lifting and getting up after prolonged sitting or bending forward at a sink eg. to wash face.

Pain is relieved by lying down with knees flexed and a pillow between the knees.

There is arely neurological loss of strength, pins and needles or numbness. If there is inflammation and arthritis in the SI joint, you may feel stiffness and a burning sensation in the pelvis.

Diagnosis is based on case history, signs and symptoms of condition, clinical findings, orthopaedic and neurological tests and standing x-ray views which include the lumbar spine, hip joints, sacro-iliac and coccyx joints to rule out underlying inflammatory conditions such as sacroiliitis or Ankylosing spondylitis, major disc disease or narrowing, facet joint arthritis or significant hip joint degeneration. Only standing x-rays enable the diagnosis of leg-length discrepancy, compensatory scoliosis, disc or foraminal narrowing with vertebral twist or torsion. Special sacro-iliac joint divergent x-rays taken from a posterior to anterior direction show the sacroiliac joints much more clearly than standard hospital views.

The sacro-iliac joints will often show signs of calcification and arthrosis in patients with chronic sacroiliac dysfunction.

Pain is sometimes felt on the sacroiliac joint on the opposite side to the locked or calcifying joint. Treatment is extremely effective but only with expert and precise chiropractic or osteopathic manipulation of the sacroiliac joints with specific, exercises to be performed regularly throughout the day until normalisation of joint function and resolution of all symptoms. Heel - lifts are. Heel - lifts are often essential in permanently curing sacroiliac problems when associated with a leg-length difference.

The standard physiotherapy and orthopaedic approach which involves sacroiliac belts, lumbar extension exercises or steroid injections are not helpful and rarely successful. Use of drug therapy is not recommended or necessary provided proper joint manipulation is performed by a specialised chiropractor or osteopath.

Prognosis is excellent with the correct treatment at Sayer Sacroiliac Clinics London.

Bulging disc – protruding, prolapsed, herniated or ruptured disc.

The intervertebral discs are under constant pressure and may degenerate and weaken, cartilage can bulge compressing a nerve root, causing pain, weakness, numbness and loss of reflexes. A rare and serious complication of a ruptured disc is cauda equina syndrome, which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage and loss of bladder control may result if this syndrome is left untreated.

True ‘Sciatica’ is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve bundle that extends down from the lower back to its exit point in the pelvis and carries nerve fibres to the leg. Sciatic nerve compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control in the leg with ' foot-drop' due to interruption of nerve signalling.

Spinal degeneration – Osteoarthritis and Spinal Stenosis.

Disc wear and tear can lead to a narrowing of the spinal canal especially if the spine has become twisted or curved laterally – scoliosis. A person with spinal degeneration may experience stiffness in the back on waking and leg pain (sciatica) during walking or while standing for a long time. Specific and careful chiropractic spinal mobilisation and postural changes aim to reduce curvatures and improve symptoms.

Osteopenia / Osteoporosis

Osteopenia / Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength. Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone and/or absorbs too much existing bone. Women are four times more likely than men to develop osteoporosis.

We are often the first to diagnose osteopenia (low bone density) which may be seen on our digital computed x-rays. We then refer to the patient’s GP for a bone density DXAscan and treatment to improve bone density. Vitamin D3 deficiency is finally being recognised through research as crucial to our general health and specifically to our bone health.

Scoliosis, Kyphosis and Lordosis

Skeletal irregularities and postural imbalances produce strain on the vertebrae and muscles, tendons, ligaments and tissues supporting the spinal column. These irregularities include Scoliosis, a lateral curve or series of curves of the spine to the side; Kyphosis, in which the normal curve of the upper back is rounded; Lordosis, an abnormally accentuated forward sway in the lower back or neck. A detailed scoliosis assessment (which may include computed digital xrays ) and expert spinal manipulation and specific exercises can help to mobilise curvatures and minimise spinal pain and stiffness.

Fibromyalgia

Fibromyalgia is a poorly understood chronic disorder characterised by widespread musculoskeletal pain, fatigue, and multiple “tender points,” particularly in the neck, spine, shoulders, and pelvis. Additional symptoms may include sleep disturbances, morning stiffness, bowel sensitivity and anxiety. Massage therapy and Japanese acupuncture can be helpful.

Spondylosis

Spondylosis refers to chronic back pain and stiffness and Spondylitis to inflammation of the spinal joints. Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints).

Treatment

Back Pain Diagnosis at Sayer Clinics

Our Chiropractors and Osteopaths take a thorough medical history and perform a physical examination to identify any conditions or family history that may be associated with the pain.

We thoroughly examine the spine and conduct neurological and orthopaedic tests to diagnose the cause of pain and enable us to provide effective treatment and intelligent advice. Blood tests and digital x-ray, MRI or CT imaging may be necessary to diagnose the source of the pain. We make specific referrals to medical specialists when indicated.

Spinal x-rays taken standing help diagnose the cause and location of back pain and look for broken bones or an injured vertebra and show bony structure and any disc narrowing , osteoarthritis , joint degeneration or vertebral misalignment.

Magnetic resonance imaging (MRI). We can, without delay, refer patients for private MRI of the spine or joints to help diagnosis of disc prolapse or disease in nerves, muscles, ligaments or blood vessels.

Chiropractic and Osteopathy treatment at Sayer Clinics

Sayer Clinics aims to remobilise displaced or locked vertebrae, reducing inflammation, restoring proper function and strength to the back and preventing recurrence of the injury through postural rehabilitation.

Back pain may be referred to the hip, groin, buttocks, the leg and even into the foot as ‘sciatic’ pain.

The main causes of low back pain are muscular weakness and postural strain due to being overweight, sitting too much, lack of exercise, unequal leg-length, trauma or over-exercise. Sometimes the cushion between the bones (intervertebral disc) bulges (herniates) and compresses nearby nerves.

Ice (the use of cold compresses) can help reduce pain and inflammation and allow greater mobility. As soon as possible following trauma, you should apply a cold pack or a cold compress (such as a bag of ice or bag of frozen vegetables wrapped in a towel) to the tender spot several times a day for up to 20 minutes.

Bed rest for more than a day or so following onset of low back pain may prolong symptoms and can lead to secondary problems such as decreased muscle tone. You should resume activities as soon as possible. At night or during rest, you should lie on one side, with a pillow between your knees or lie on your back and put a pillow under your knees).

Exercise at the right point in your recovery, is the best way to speed recovery from low back pain and help strengthen core back and abdominal muscles. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Our chiropractors, osteopaths and physical therapists provide a list of gentle exercises which help keep muscles and joints moving and speed the recovery process. A routine of back-healthy activities may include stretching exercises, swimming, walking or movement therapy to improve coordination and develop proper posture and muscle balance. Pilates Yoga and Tai Chi are excellent means to gently stretch and strengthen muscles and ease pain.

Medications are often used to treat acute and chronic low back pain. NSAIDs -Non-steroidal anti-inflammatory drugs eg ibuprofen are unsafe during pregnancy and can cause side effects including drowsiness or stomach irritation with prolonged use. Opioids such as codeine, oxycodone, hydrocodone and morphine, if medically prescribed to manage severe, acute and chronic back pain produce side effects of drowsiness, decreased reaction time, impaired judgment and potential for addiction. Avoid steroid injections which temporarily lessen pain but prevents pain feedback, inhibits tissue healing and may cause permanent tissue weakness and damage.

Spinal manipulation is a safe “hands-on” approach in which professionally registered chiropractors and osteopaths use specific spinal manipulation and a series of exercises to mobilise spinal structures, restore back mobility and function and gradually rehabilitate posture.

Japanese and medical acupuncture involves the insertion of very fine needles at precise points throughout the body to trigger the release of naturally occurring opioid molecules and stimulate the brain to stimulate healing.

Massage and physical therapy (Laser, Ultrasound and Electrotherapy) are therapeutic for muscle, tendon and ligament damage or injury.

Sayer Clinics Back Pain Advice

Following any period of prolonged inactivity, gradually start regular low-impact exercise. Walking, swimming or cycling 30 minutes a day will increase muscle strength and flexibility. Pilates Yoga and Tai Chi can also help stretch and strengthen muscles and improve posture. Ask your chiropractor for a list of low-impact exercises designed to strengthen lower back and abdominal muscles.

Don’t slouch when standing or sitting. When standing, keep your weight balanced on your feet without most of your weight on your heels. Your back supports weight best when spinal curvatures are reduced.

Sit in a chair slightly tilted forwards with your knees below your hips and your feet under the chair. Keep your chest up and don’t poke your head forward. Your computer screen should be positioned so the middle of the screen is level with your eyes. Change sitting positions often and spend most of every hour on your feet or walking around the office to make phone calls or use your computer with your wireless keyboard raised on a shelf or box - gently stretch to relieve tension. Wear comfortable, low-heeled shoes.

Sleep on your side or back to reduce excessive twisting in your spine. Ideally sleep on a fairly firm mattress with a soft 'sleeper' surface layer.

Don’t try to lift objects too heavy for you. Lift with your knees bent, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist your spine when lifting.

Maintain proper nutrition and diet to reduce and prevent excessive weight which puts a chronic strain on lower back discs and muscles. A good diet without processed food and with sufficient daily intake of calcium, phosphorus and vitamin D3 helps to promote new bone growth.

If you smoke, stop. Smoking reduces blood flow to the spine and worsens spinal disc degeneration.

There has been limited large-scale, clinical research into the physical treatment of sciatica and limited evidence of the efficacy or otherwise of manual and acupuncture treatment for this condition. See The Bronfort Report. We either achieve good results for our patients or refer for MRI and neurosurgery when necessary.