LOWER BACK PAIN from a lower back strain.
The most common back problem.
This is the area where many people will have their first experience of back pain. It often starts whilst lifting something or during strenuous exercise BUT can just as likely start by getting out of the shower, leaning over a desk to pick up a pen etc etc. Symptoms are generally
1/a deep dull ache to one ( or both sides ) of the lower back.
2/ a sharp stabbing pain on bending, turning in bed, WHILST STANDING UP FROM SITTING etc.
3/ some mild to strong sciatic pain ( pins and needles, ache, shooting pain ).
Frequently ( with rest and anti-inflammatories ) the problem resolves. In fact studies have shown that 62% of lower back strains self resolve within 6 weeks. This statistic explains why GPs are keen just to give some pain killers and tell people to come back if needed. They know that over half of their patients will get better anyway!
These problems are generally due to joint strains between the vertebrae ( and/or the sacrum – the joints are called facet joints ) PLUS a significant amount of localised inflammation that is irritating a nearby nerve.
IS IT A DISC PROBLEM?
Everybody has heard about a “slipped disc”. This is a poor description of what could be a “bulging disc” or at worst a “prolapsed disc”. A true disc problem is more likely when
1/ a vigorous movement or an awkward lift ( involving bending and twisting ) started the pain.
2/ Sitting is frequently very painful either immediately or within minutes.
3/ The sufferer cannot stand up straight and is often very twisted to one side.
4/ Sciatic pain can be unbearable.
Pain is caused in these situations by direct pressure from the disc onto a nerve OR in the worst situations where the contents of the disc – a tooth pasty substance – causes an intense pain reaction with the contents of the spinal canal.
ONLY ABOUT 10-20% OF LOW BACK STRAINS ARE DUE TO A DISC
Osteopathy can help the most common lower back problem very effectively. Firstly, it helps the patient immediately if they can be reassured that it is very probably NOT a disc problem. Then a mixture of joint mobilisation, movement ABOVE the affected area, plus some acupuncture ( if the patient is willing to try ), tissue/muscle stretching, use of a good dosage level of anti-inflammatories PLUS postural awareness means that the person should be 50-60% better after 2 treatments.
Back strains with no disc involvement can still sometimes be EXTREMELY painful. A proper examination is necessary to find out what is happening.
This is when someone has pain and/or pins and needles and/or numbness going down from the back ( or buttocks ) down the legs.
If the sensations are more around the groin and the front of the thighs, the problem is being caused in the middle to higher part of the lumbar spine. If it is going down the back off the legs, affecting the calf muscles and even the feet and toes then the problem is from the lowest two joints in the back.
Sciatica can range from a vague annoyance e.g a numb spot on a calf muscle to be awful pain down the whole leg. It can be intermittent OR constant. There are 4-5 main scenarios.
IF the cause is a prolapsed disc or severe disc bulge then the problem can be long term 3 months to 1-2 years. Osteopathy and acupuncture can help reduce the pain levels and can frequently speed up the healing process. Severe cases necessitate surgery.
If the sciatica is caused by joint strains and or localised inflammation, the situation can be resolved within 1-2 months.
Treatment of lower back pain and sciatica
Firstly a case history and an examination would take place. This can take anything from 10-20 minutes depending on how much information is given.
The treatment itself involves a mixture of massage, mobilisation and manipulation. Massage is to loosen and warm the tissues. Mobilisation is usually done to the areas ( joints, ligaments tendons and muscles ) above and/or below the troubled area. Manipulation is when a joint is stretched ( carefully ) in a short, sharp movement so that a crack may be heard. These techniques are to allow the troubled area to heal more quickly.
Frequently, if the patient is ok with needles, some medical acupuncture will be done also. Usually 2-4 needles for approx. 5 minutes. I have found that this can often speed up recovery times and, just as importantly, can reduce pain levels by a matter of 10-40%.
Advice would be given on what movements to avoid, how to rest more comfortably and usually to take anti-inflammatories until pain levels are reduced.
Usually a second treatment would be advised in about a weeks time. If we are lucky and the patient returns 40-60% better, only a second treatment would be necessary. If the patient returns and is only 20-40% better often two more treatments would be necessary.
Recovery time relies a lot on how well the person can rest and NOT irritate the problem. The worst case scenario would be a mum with a 6 month old baby. Carrying car seats plus putting them in and out of cars can make their problem take quite a time to heal. Someone with a physical job involving lots of leaning forward OR someone who drives for many hours a day may need a similar longer period of recovery.
X-RAYS AND MRI SCANS
These are occasionally essential to be able to find out what is going on. These would only be recommended if there is not a good level/speed of recovery. The trouble is that, as everybody is aware of, the NHS is stretched to snapping point. An MRI scan can often be very hard to organise and even when possible, it may take up to 6 weeks. There is though an alternative –
There are centres around Birmingham notably Solihull, Redditch that give a first class private MRI service for about £230. This is not cheap BUT when you think of it, we regularly pay this amount for 2 car tyres or a car service or a new piece of furniture. I refer about 6-8 people a year to these establishments. It also has the benefit of making subsequent action in the NHS more rapid because ONCE there is proof that the lower back problem is from a bad disc problem and the patient IS NOT just a person with a mild back problem who moans a lot ( or just has a low pain threshold ) their GP has to send them to a specialist pretty quickly.
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