Back pain is a very common problem. Most people experience back pain at some point in their lives, sometimes as a result of an injury or in many cases with no obvious cause. Often the trigger or start point is an innocuous action like bending over, reaching out or coughing. Prior to this you may recall some unusual stiffness or the occasional twinge that you largely ignored. The gradual (insidious) onset of the problem is due to a number of integrated factors that come together at a point in time when you notice the pain. These factors include posture, how you use your body (e.g./ sedentary lifestyle, balance of exercise and recovery), stress and general health (sleep, diet, hydration, mood). Other considerations that we know about include gender, genetics, previous experience, the immune system and co-existing conditions.
We see many people with back pain and offer bespoke treatment programmes to deal with the symptoms (pain, stiffness commonly) but also looking at how your spine can be healthier in the longer-term. These strategies reduce the risk of recurrence by normalising movement, joint position sense and sensory feedback. Our advanced rehabilitation works at multiple levels, targeting the changes that occur in the tissues, the nervous system and other body systems as a result of your condition.
The tissues that are often involved in back pain include the joints of the spine and their ligaments, the intevertebral discs, muscles and tendons and the nerve tissue. Any structure with a nerve supply can send messages to the brain about an injury, inflammation or a change in the local environment that needs your attention. We know that in a number of cases we know that there can be different types of pain at any one time. You can experience the pain of tissue damage, like a sprained ankle or a stubbed toe (nociceptive pain), mixed with the pain of a nerve (neuropathic pain). Our assessment process identifies different pain mechanisms allowing for selection of the most appropriate treatment as well as providing explanations for the symptoms.
Back pain can be very severe and disabling, especially with accompanying muscle spasm that is painful in itself. It can be very difficult to move as pain is provoked by the simplest movement of the body or limbs. Often the back stiffens both when sitting still or maintaining a particular posture or position. Mornings can be difficult as the back can be tight and painful, usually easing with gradual increase in movements. The daily pattern can vary, sometimes the pain worsening as the day progresses or improving with gradual movement. Occasionally nights can also be disturbed, especially when changing position.
In many cases back pain improves over a few weeks with the right guidance and treatment. When you have been assessed it will be clearer as to the likely time period of the pain. Of course back pain can recur or persist. In the former cases this can be in part due to incomplete rehabilitation, for example not fully gaining control over movement or retraining muscle activation patterns. Persisting pain is common in both the back and other areas of the body. This is typically because the body continues to protect the back whether there is a need for this or not. Chronic pain is not necessarily useful as a warning sign as often there is no ‘damage’. It is rather a processing issue which means that the brain interprets the tissues as under threat. Perception of the back can change so that it feels out of place or larger (this can actually be drawn out as in the clever research paper by Lorimer Moseley). Of course there can be underlying tissue changes such as arthritis or disc degeneration that may be described as the source of the pain. For more details about pain see the page dedicated to this topic but in brief, pain is an experience produced by the brain in response to a perceived threat. This means that there can be changes in the tissues but if there is no perceived threat then you will not feel pain. This is illustrated by approximately 1/3 0f people who have disc changes as determined by scan, but have no symptoms.
As a brief insight, we offer treatment programmes to deal with the immediate symptoms and then look at ways of reducing the risk of recurring episodes in part by training the body to move normally and optimise the flow of information from the tissues so as to reduce the perceived threat. There are numerous facets to our treatments that are encompassed by the very modern bio-psychosocial model of care.