Secrets to Low Back Pain Prevention The Markland Clinic Cotswold Leisure Centre Tetbury Road, Cirencester GL7 1US Tel: 01285 654059 www.marklandclinic.com www.sportsperform.co.uk
There are many internet articles on low back pain. The reason this one is different is that it does not aim to sell you the latest lotion or potion or gadget. Instead it shows you how to prevent yourself experiencing low back pain in the first place. This booklet will explain how low back pain comes about, and explain the reasoning behind the strategies we explore at the end of the booklet. People s experience of back pain Low back pain affects nearly everyone at some stage of their active adult life and is one of the most common ailments. Maybe you have experienced one episode of low back pain or may be you are one of the many people who continue to have recurring problems. It may be that your attacks of back pain are getting more frequent, and the individual episodes may be getting more debilitating. Or maybe you have a chronic problem that is not responding to Physiotherapy, Chiropractic or medication prescribed by your doctor. Maybe you have even resorted to surgery, which has not corrected your problem. You may be reading this because all else has failed and you want to understand how you can help yourself. Many people find back pain a mystery. It often starts without warning and for no obvious reason. It interferes with simple, everyday tasks: sitting, getting in and out of the car, moving and sleeping well. When pain is acute we are often unable to think about the problem clearly and simply seek relief from the pain. Sometimes it disappears as quickly as it arrived and as soon as we have recovered, we forget about it until it reoccurs. With a little bit of knowledge and a few simple strategies, most people can learn to improve and manage their own symptoms. You just need to know what to do. If you take responsibility for managing your back pain and try to help yourself, the long term results are much more effective. I came to Physio after suffering sudden and unexplained back pain on the left side. I began a course of treatment and was advised on appropriate exercises. After 4 sessions there was a really significant and welcome improvement. Everything has been very well explained along the way and my money well spent to resolving this problem. Thank you. Lousie O
Where does back pain come from? Your spine The majority of back problems are mechanical. This means the pain is caused by a problem with the moving parts of the spine. Some movements or postures will aggravate your pain. Typically your pain will be worse when your spine is in a C shape, for example when you re bending forwards or sitting in a slumped position for long periods. Your spine is made up of a series of bones called vertebrae. They sit on top of one another like a row of cotton reels all strung together. At the back of each vertebrae is a bony arch. These arches line up, and the spinal cord runs through the holes in this string of arches. The spinal cord is well protected as it runs the full length of the spine from head to pelvis within the safety of the arches. The arches are connected together by a series of joints called facet joints. Most, although not all, back pain sufferers feel better when they are moving and changing position regularly, and worse when they stay still in one position for a period of time. Other people might have particular times of day with no pain, and some of course have constant pain, no matter what they do. Between each pair of vertebrae is a disc. This disc functions very much like a washer or shock absorber and separates the vertebrae. Each disc has a soft centre with a ligamentous surround. The discs are able to alter their shape, allowing the spine to move as one vertebra moves on top of another.
The vertebrae, discs and facet joints are supported by ligaments. Ligaments connect bone to bone and act like the guy ropes on a tent, providing support to the spine. And just like guy ropes, if they are subjected to too much strain they will fail. Overlying the ligaments are muscles. A movement is created when a muscle contracts. At each end of the muscle, it turns into a tendon, which is used to attach it to the bones. Nerves branch out from the spinal cord and leave the spine in the gaps between the arches. The nerves have many functions within the body and transmit messages to and from our brains. Amongst other things, they tell our muscles when to contract, and provide us with sensation. Your lower back In our lower back, the nerves leave our spine and combine on either side to form the sciatic nerves. The sciatic nerves supply our legs and, when irritated, cause pain in our legs, often referred to as sciatica. Our lower back connects our upper and lower body, protects our spinal cord and bears the compressive weight of our upper body. From an engineering perspective, it is our lower back which is subject to most mechanical stress and strain. It is therefore no coincidence that more back problems arise from the lower back than from anywhere else. A big thank you for all you help with my back, even sneezing holds no fear of pain now! Many thanks for your time and advice Michael W
Your Posture and Pain Our spines are S shaped, with a very important hollow in the small of our back, known as the lumbar lordosis. The lordosis is lost whenever the spine is curved in a C shape, such as when sitting slumped, lifting or bending forwards. Problems begin to occur in the lower back if the lordosis is lost for prolonged periods of time. When the lordosis is lost for a prolonged period of time, the ligaments which link the vertebrae together are overstretched and pain is produced. In just the same way it is uncomfortable if you bend your finger backwards and hold it. Now push your finger a bit further, and pain will be produced. You are overstretching your finger and the pain is telling you to stop doing it, as if you push it even further, the ligament will eventually tear. No damage results from short term strain, providing the pain warning is listened to. However, if the ligaments are torn, a pain will be produced which is more severe and will continue even when the finger is resting. The finger would heal in a few days; however, if every day it was pushed backwards repeatedly, the healing process would take longer. Back pain occurs in just the same way. If we repeatedly allow ourselves to slouch or adopt C shaped postures, the ligaments which cross the vertebrae will be strained, and will produce pain. More severe pain will be produced if the ligaments are overstrained. Unlike in the finger joints, the ligaments which support the spine and connect the vertebrae also form the retaining walls of the discs.
Over stretching can therefore affect the discs. This can result in the disc losing its shock absorbency, and with a weakened outer wall the disc can begin to bulge. If the disc bulges far enough, it will affect the sciatic nerve and cause leg pain or numbness, tingling or weakness. To help you think more about how the discs work, consider again the structure of the spine, a string of vertebrae like cotton reels. To allow flexibility, there is a disc between each pair of vertebrae. The disc is mobile and you can think of it moving a little like a bar of soap between your hands. As you bend forwards the disc moves backwards, just as when you close your fingers together a bar of soap would move towards your wrists. You can prevent the bar of soap moving any further backwards by squeezing your palms together, just like when you come upright after bending forwards. However if you bend forwards or slouch for a prolonged period of time the disc material can move so far backwards that it becomes painful and the ligaments strain. If the disc material displaces far enough it will be very painful. You may have symptoms in your legs and you maybe unable to stand up straight. It is possible to reverse this displacement; however, care must be taken to identify the right course of action. Before seeing Kate I had terrible lower back problems. Kate rightly diagnosed a disc problem and referred me to a surgeon. Following an MRI scan I have had several visits to Kate. My back is now better than it has been for a very long time. Thank you very much. Paul P
How to prevent back pain Unfortunately many back pain sufferers experience a lifetime of pain simply because they are not in possession of the knowledge to prevent or manage it. Please don t let that be you. Many of us spend much of our time with our spines in a rounded C shape with no lordosis. We rarely fully reverse this and stretch back as far as possible. We can therefore begin to lose our lordosis or ability to arch backwards. If this occurs over a long period, the spine can become quite flat and interestingly this is a feature commonly associated with longstanding low back pain. The effects of poor posture long term can be severe and result in pain, loss of elasticity and a stooped posture. To prevent low back pain the two single most important things you can do are: Move being a fidget will prevent you sustaining poor postures for a prolonged length of time. Look after your lordosis support the hollow in the small of your back and maintain the ability to arch backwards. Everyone s back pain is different, and so you need to have your back examined by a trained expert and to identify which specific movement directions are key to help you. There s no one size fits all exercise for a painful lower back, but keeping the two points above in mind at all times can help prevent and relieve the pain, and stop it coming back again.
How we can help you We can help you resolve your back pain. Call us now to arrange an appointment on 01285 654059. We can help you using diagnosis and physiotherapy, if you are experiencing: Lower back pain Leg pain, pins and needles or numbness A weak or stiff spine If you experience back pain with or without sciatica please consult us - we will help you understand the cause of your pain and how to resolve it. There will be specific movements or series of movements, which we can identify to help you resolve your symptoms. Recurrent back pain is common: it is essential that you understand your pain, how to prevent it reoccurring and how to manage it at the first sign of it reoccurring. As an Orthopaedic Spinal Surgeon I have had lots of discussion with Kate about different modalities of treatment. I have found Kate to be systematic in her approach and knowledgable. Kate certainly has excellent experience and qualifications. She also has great clinical experience and properly assesses her patients. She clearly has a great ability in making a correct diagnosis too. Mr Ata Kasis, Othropaedic Spinal Surgeon Other ebooks available at www.marklandclinic.com include: