As the leading cause of work-related absence in the UK, back pain is having a major impact on us on both a personal and societal level. It can cause a great deal of pain and discomfort but is rarely serious, mostly manifesting as aching or pain in regions of the back and sometimes pain into the buttocks or the back of the legs (usually this is sciatica). Interestingly, of all the many people who present to the clinic with back pain, it is most commonly adults between 35 and 55 years old.
There are many structures in the back which can be problematic and cause pain. Pain, tingling, numbness and muscle spasm and weakness in the back can be linked to the vertebral joints at the back of each vertebrae, the vertebral spongy discs acting as shock-absorbers between each vertebrae, the ribs which attach to the spine, the ligaments that connect bone to bone throughout the back or the nerves which exit from the spinal cord through narrow gaps between the vertebrae and can be compressed (the spinal cord itself can also be squeezed). Back pain can also be related to problems with the organs in the abdomen or thorax (rib cage) where dysfunction of organs such as the stomach can cause pain, in this case, in the mid back. This is known as referred pain (see referred pain article). In the case that it is referred pain, it is important that the underlying problem is dealt with as otherwise the back pain will not go away.
Risk factors for back pain
Back pain can develop back pain, however these factors may result in a greater risk of back pain:
- Age - back pain is more common as you get older, starting around 30 or 40, usually due to wear and tear on the spine.
- Gender - females suffer with back pain more than men
- Lack of exercise - weak, unused muscles might lead to back pain
- Excess weight - carrying too much weight puts extra stress on the joints of your back
- Sedentary lifestyle
- Anxiety, depression or mental illness
- Genetic predisposition
- A mentally or physically stressful job - any job that requires repetitive bending and lifting or long hours standing without a break or sitting unsupported in a chair leads to a higher incidence of back pain
The main causes of back pain
The majority of back pain is related to everyday small strains and sprains (either acute or chronic) involving the muscles, ligaments or tendons of the back which usually resolve with some over the counter medication such as pain killers or anti-inflammatories and keeping gently mobile. Otherwise, the pain can be related musculo-skeletal structural problems such as:
- Intervertebral disc problems - which may result in back pain and affect the nerves supplying the legs and cause sciatica (a shooting pain into the buttock and down the back of the leg). This most often presents in people below 60 years old.
- Arthritis - which is wear and tear or degeneration of the spine. Again, this can result in back pain and can be secondary to arthritis in the hip. This most of often presents in people over 50 years old
- Osteoporosis - a condition of the bones of the body which causes them to be porous and brittle which can increase the likelihood of fractures.
Often patients refer to one event causing the pain, for example ‘I was just brushing my teeth and my back went’, but this is most often the trigger which tipped the back over the edge and made it symptomatic. In most cases, poor posture or the factors above like lack of exercise and stretching or a number of physical or stressful events in the patient’s life either recently or over the course of their lifetime, compromise the back. It then just takes that final trigger to result in back pain. Unless these causational factors are addressed, the back pain often returns - each time more frequently and with more intensity.
Osteopaths are trained to identify what structures have been affected and the likely cause of the back pain you are experiencing and treat accordingly to relieve your symptoms. Treatment includes manual therapy techniques such as soft tissue massage and mobilisation of the joints and also exercise and other advice which you can do at home. Cranial Osteopathy and dry needling (modern acupuncture) is also administered as appropriate. In some cases, it is necessary to refer patients to their GPs for further investigation.