Back pain, what is it?Treating back pain has always been considered to be an enigma, probably partly because the general understanding for how the back is constructed and how it works is poor. The recommendations from a recent national report to investigate the increasing problem of back pain and how it was treated were that back pain sufferers should have treatment, not bed rest and pain killers. Chiropractic was one of the preferred treatments. The success of any treatment depends on the mutual cooperation of patient and practitioner and this is particularly true in the treatment of back pain. A good starting point is to have a better understanding of the causes. This information sheet will start by clarifying some common misconceptions. I think I have a slipped disc! Fortunately, discs do not slip out. They are firmly attached to the vertebrae above and below. The disc consists of layers of strong ligaments surrounding the centre or nucleus, which is a gel-like material. The nucleus can rupture and press onto nerves if the ligaments have been damaged. This is called a disc herniation. The signs and symptoms are very characteristic and a qualified chiropractor can determine this by a physical examination. A disc herniation will improve with treatment but is a relatively serious injury compared to, say, a sprain, and therefore tends to take longer to improve. Some people who do not improve with treatment may require surgery to remove part of the herniated disc. Disc herniation is more common in people who have had repeated back injuries, which is a good reason to deal with the problem before it gets to that stage.
My back is out!
Again, fortunately, vertebrae do not slip out, nor are they pushed back by manipulation, but dislocations do happen. Christopher Reeve (Superman), had a so-called fracture dislocation and was paralysed in a wheelchair. This is a serious injury, often resulting in damage to the spinal cord. So when you think your vertebra is out of place, it probably isn’t.
I have a trapped nerve!
A nerve can get compressed suddenly by a herniated disc or gradually by entrapment by bony spurs developing from wear and tear of the spine. Nerves do not just simply get trapped and un-trapped. If the nerve is compressed or injured the chiropractor can quite easily determine this by performing an examination. Nerve injuries are normally associated with a feeling of ‘pins and needles’, numbness and radiating pain in one side, but you can have limb pain without the nerve being trapped. This is called referred pain.
I have back pain, I need rest!
Rest or activity? Rest is important in the early stages of an injury but not inactivity! Bed rest has been shown to prolong and worsen the recovery if used for more than three days. ‘Active rest’ including simple walking is the best way forward. Later in the treatment other exercises specifically chosen for your condition can be started.
I need a hot water bottle!
Ice packs should be used if you have any inflammation in your back, caused by tissue injury, damage to the bone, ligaments or muscle. Use of heat on inflamed tissue may increase the pain and prolong the healing.
Exercise is important to prevent recurrent and chronic pain. Important muscles to build up, in order to support the spine, include the deeper back muscles, which provide two thirds of the spine’s support; and the stomach muscles. The more superficial muscles are not targeted in spinal rehabilitation exercise as they produce movement rather than stability.
Heavy lifting and back pain
It is commonly believed that heavy lifting is the cause of back pain, but most people actually hurt themselves when performing relatively simple tasks that they have repeated hundreds of times, e.g. sneezing or coughing, turning in bed or getting out of the car. When we are about to lift something heavy we tense our muscles in readiness, which helps to protect our backs. When we turn to speak to somebody we do not, which is why we are more likely to hurt ourselves during such activities.
The way we sit, stand, lie or move can have a big impact on the health or our spine. Good posture cannot cure a bad back, but it can help to prevent problems. Generally, static postures, such as sitting, are more detrimental than mobile ones. Our bodies are built for movement, not sitting in front of the TV or computer. Recently, attention has been given to the way we perform our daily tasks, so called movement patterns. The chiropractor can tell if you have a muscle imbalance which is affecting your spine by observing how you perform certain movements. The chiropractor can then give you specific exercises to teach you how to move so as to improve the support and protection your muscles give to your back.
Pain and healing
Being pain free does not necessarily mean there is no problem with the back. Often, in the initial stages, patients are not in any pain. Pain only develops if there is an injury, which is more likely to happen if there is a weakness. Back pain often becomes a recurrent problem from neglect. In the beginning the pain often goes within a week or so. However, each time an injury occurs again, it takes longer to get over it, until eventually it does not go away. That is the time when most people seek treatment. At this stage, a lot more effort and work is needed to restore normal function. Gradually the pain subsides, but the restoration of normal function may take as long as 6-12 weeks.
Many people have been told they have ‘arthritis’ and nothing can be done for their backs. Osteoarthritis is ‘wear and tear’ and is considered normal after a certain age. That does not mean that nothing can be done to help get rid of the pain and dysfunction. Wear and tear is normally a sign of long standing dysfunction or previous injuries. The majority of patients over the age of forty have some sign of osteoarthritis. There are, of course, other types of arthritis, so called inflammatory arthritis like rheumatoid arthritis and gout, but they are fortunately rare by comparison.